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Ç̲ÑÒ / CONTENT

ÒÅÎÐÅÒÈ×ÍÀ ² ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ THEORETICAL AND EXPERIMENTAL ÌÅÄÈÖÈÍÀ MEDICINE

Êðèëþê Â.Î., Ãàð³ÿí Ñ.Â. Âïëèâ Kryliuk V.O., Garian S.V. Influence is- ³øå쳿-ðåïåðôó糿 íà ìîðôîëîã³÷í³ çì³íè chemia-reperfusion on the morphological âåëèêèõ ñóãëîá³â íèæí³õ ê³íö³âîê çà óìîâ changes large joints of the lower extremities ïîºäíàíî¿ àáäîì³íî-ñêåëåòíî¿ òðàâìè 4 under combined abdomino-skeletal injury

Ñîðîê³íà Î.Ã., Ïîïîâ Ì.Ì., Ëÿäîâà Ò.²., Sorokina O.G., Popov M.M., Liadova T.I., Îãí³âåíêî Î.Â., Ñàââî Î.Ì. Îñîáëèâîñò³ Ognivenko O.V., Savvo O.M. Features ïåðåá³ãó õðîí³÷íî¿ Åïøòåéíà–Áàðð â³ðóñíî¿ of the course of chronic Epstein–Barr viral ³íôåêö³¿ 9 infection

ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß PSYCHIATRY, NARCOLOGY ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß AND MEDICAL PSYCHOLOGY

Ãåðàñèìóê Â.À., Àã³øåâà Í.Ê. Ðîëü Gerasimuk V.A., Agisheva N.K. The role ³ ì³ñöå ñòðåñ-äîëàþ÷î¿ ïîâåä³íêè and place of stress-coping behavior â ôîðìóâàíí³ ïñèõîëîã³÷íî¿ äåçàäàïòàö³¿ in the formation of psychological maladap- ó äðóæèí, ÷îëîâ³êè ÿêèõ ñòðàæäàþòü tation in wives of patients with paranoid íà øèçîôðåí³þ 14 schizophrenia

Êîñåíêî Ê.À. Ñòðóêòóðíî-ôåíîìåíî- Kosenko K.A. Structural-phenomenological ëîã³÷íà õàðàêòåðèñòèêà àãðåñèâíîñò³ characteristics of aggressiveness and hostile ³ âîðîæèõ ðåàêö³é ó êîìàíäíîãî ñêëàäó reactions in the command warehouse of the òîðãîâåëüíîãî ³ ïàñàæèðñüêîãî commercial and passenger navy ìîðñüêîãî ôëîò³â 25 Êðèâèöüêèé Â.Î. Ñòàí ïñèõîåìîö³éíî¿ Kryvytskyi V. The state of the psycho-emotio- ñôåðè ó õâîðèõ íà õðîí³÷íèé ïðîñòàòèò nal sphere in patients with chronic prostatitis ç ð³çíèì ñòàíîì ïîäðóæíüî¿ çàäîâîëåíîñò³ 33 with different status of marriage satisfaction

Êðèâîí³ñ Ò.Ã. Àíàë³ç îñîáèñò³ñíî-ïîâå- Krivonis T.G. Personal and behavioral ä³íêîâèõ ïðîô³ë³â ó îíêîëîã³÷íèõ ïàö³ºí- profiles in cancer patients, depending ò³â çàëåæíî â³ä ¿õ êë³í³÷íèõ, ñ³ìåéíèõ on their clinical, family and gender features òà ãåíäåðíèõ îñîáëèâîñòåé 41 Ìàðóòà Í.Î., Øåâ÷åíêî–Á³òåíñü- Maruta N.O., Shevchenko–Bitensky K.V. êèé Ê.Â. Ïðîãðàìà ïñèõîñîö³àëüíî¿ Program of psychosocial rehabilitation ðåàá³ë³òàö³¿ ïàö³ºíò³â ç ãàëþöèíàòîðíî- of patients with hallucinatory-paranoid ïàðàíî¿äíèìè ðîçëàäàìè ïðè äåìåíö³ÿõ disorders in dementias of different genesis ð³çíîãî ãåíåçó ³ ñòà䳿 ðîçâèòêó ³ îö³íêà and stage of development and evaluation ¿¿ åôåêòèâíîñò³ 47 of its effectiveness

Ìèñóëà Þ.². Ñó÷àñí³ ï³äõîäè äî ë³êóâàííÿ Mysula Yu.I. Modern approaches to the õâîðèõ ç ïåðâèííèì åï³çîäîì á³ïîëÿð- treatment of patients with a primary episode íîãî àôåêòèâíîãî ðîçëàäó 55 of bipolar affective disorder

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 3

²ÍÔÅÊÖ²ÉͲ ÕÂÎÐÎÁÈ INFECTIOUS DISEASES

Áóê³é Ñ.Ì. Ãóìîðàëüíà ³ìóííà Bukiy S.M. Humoral immune response â³äïîâ³äü ä³òåé, õâîðèõ íà øèãåëüîç of children with shigellosis and infected òà ³íô³êîâàíèõ öèòîìåãàëîâ³ðóñîì 62 with cytomegalovirus

ÍÅÂÐÎËÎÃ²ß NEUROLOGY

Âàðåøíþê Î.Â., Â'þí Â.Â. Ïðîãíîñòè÷í³ Vareshniuk O.V., Vyun V.V. Prognostic êðèòå𳿠ðîçâèòêó ïîðóøåíü ìîòîðíèõ criteria for development of impaired motor ôóíêö³é ó íåäîíîøåíèõ íåìîâëÿò function in preterm infants with perinatal ç ïåðèíàòàëüíèì ã³ïîêñè÷íî-³øåì³÷íèì hypoxic-ischemic lesions of the central óðàæåííÿì öåíòðàëüíî¿ íåðâîâî¿ ñèñòåìè 67 nervous system

×åðíåíêî Ì.ª. Äî ïèòàííÿ ïðî íåîá- Chernenko M.E. To the question of the õ³äí³ñòü ðîçðîáêè êîìïëåêñíèõ ðåàá³ë³- need for the development of integrated òàö³éíèõ çàõîä³â ó ïàö³ºíò³â ç íåéðî- rehabilitation measures in patients with äåãåíåðàö³ºþ 72 neurodegeneration

Õ²ÐÓÐÃ²ß SURGERY

Ïóëÿºâà ².Ñ., Ïðàñîë Â.Î. Ðèçèêè ïîâ- Pulyaeva ².S., Prasol V.O. The riscs òîðíèõ ³íñóëüò³â ³ ðåïåðôóç³éíîãî of repeated strokes and reperfusion ñèíäðîìó ó õâîðèõ ç êðèòè÷íèì ñòåíîçîì syndrome in patients with severe stenosis ñîííèõ àðòåð³é 78 of carotid arteries

×åðêàøåíèíîâ Å.Ã., Êàëìûêîâà À.Ñ. Cherkasheninov E.G., Kalmykova A.S. The Ðåçóëüòàòû ïðèìåíåíèÿ ìàëîèíâàçèâíûõ results of the application of low-invasive ìåòîäîâ ëå÷åíèÿ âàðèêîçíîé áîëåçíè 83 methods for treatment of varicose disease

ÑÒÎÌÀÒÎËÎÃ²ß STOMATOLOGY

Àñòàïåíêî Î.Î., Êîñòþê Ò.Ì., Astapenko O., Kostiuk T., Lytovchenko N., Ëèòîâ÷åíêî Í.Ì., Òÿæêîðîá Ò.Â. Äîñâ³ä Tyazhkorob T. The application of construc- âèêîðèñòàííÿ ðåçîðáòèâíèõ ìàòåð³àë³â tions made from biodegradable material ó ðåêîíñòðóêòèâíî-â³äíîâí³é õ³ðóð㳿 with bioactive action in reconstructive 88 surgery of maxillofacial area

Òåðåõîâ Ñ.Ñ., Õðîë Í.Ñ. Ñèñòåìà öèôðî- Terekhov S.S., Khrol N.S. Digital volume âîãî îá'ºìíîãî ñêàíóâàííÿ äëÿ ï³äâèùåííÿ scanning system for improving the quality ÿêîñò³ ðåòðàêö³¿ ÿñåííîãî êðàþ 96 of garden retraction

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 4 ÒÅÎÐÅÒÈ×ÍÀ ² ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ÌÅÄÈÖÈÍÀ

ТЕОРЕТИЧНА І ЕКСПЕРИМЕНТАЛЬНА МЕДИЦИНА https://doi.org/10.35339/ekm.2019.85.04.01 ÓÄÊ 616.3/.71-001-005.1-06:616.137-005.4-007.271-06:611-018.4

Â.Î. Êðèëþê1, Ñ.Â. Ãàð³ÿí2 1ÄÇ «Óêðà¿íñüêèé íàóêîâî-ïðàêòè÷íèé öåíòð åêñòðåíî¿ ìåäè÷íî¿ äîïîìîãè òà ìåäèöèíè êàòàñòðîô ÌÎÇ Óêðà¿íè», ì. Êè¿â 2ÊÇ ÒÎÐ «Òåðíîï³ëüñüêà óí³âåðñèòåòñüêà ë³êàðíÿ»

ÂÏËÈ ²ØÅ̲¯-ÐÅÏÅÐÔÓDz¯ ÍÀ ÌÎÐÔÎËÎò×Ͳ Ç̲ÍÈ ÂÅËÈÊÈÕ ÑÓÃËÎÁ²Â ÍÈÆÍ²Õ Ê²ÍÖ²ÂÎÊ ÇÀ ÓÌΠÏΪÄÍÀÍί ÀÁÄÎ̲ÍÎ-ÑÊÅËÅÒÍί ÒÐÀÂÌÈ Âèâ÷åíî îñîáëèâîñò³ ìîðôîëîã³÷íèõ ïîðóøåíü òêàíèí âåëèêèõ ñóãëîá³â íèæí³õ ê³íö³âîê â óìîâàõ ìîäåëüîâàíèõ òðàâì ó ï³çí³ òåðì³íè. Åêñïåðèìåíò ïðîâîäèëè íà 40 ñòàòåâî- çð³ëèõ á³ëèõ ùóðàõ-ñàìöÿõ ë³í³¿ Wistar, ìàñîþ 190–220 ã, ÿê³ çíàõîäèëèñü íà ñòàíäàðò- íîìó ðàö³îí³ â³âàð³þ. ϳääîñë³äíèì òâàðèíàì ìîäåëþâàëè çàêðèòó òðàâìó îðãàí³â ÷å- ðåâíî¿ ïîðîæíèíè, ñêåëåòíó òðàâìó, ìàñèâíó çîâí³øíþ êðîâîâòðàòó òà ³øåì³þ-ðåïåð- ôóç³þ íèæí³õ ê³íö³âîê. Äîñë³äæåííÿ ïðîâîäèëè íà 21-øó äîáó ï³ñëÿ ìîäåëþâàííÿ òðàâì. Óñ³ åêñïåðèìåíòè ç íàíåñåííÿ òðàâì âèêîíóâàëè â óìîâàõ ò³îïåíòàë-íàòð³ºâîãî çíå÷ó- ëåííÿ (40 ìã·êã-1 ìàñè). Âñòàíîâèëè, ùî ïîºäíàíà àáäîì³íî-ñêåëåòíà òðàâìà ó ïîºäíàíí³ ç ³øå쳺þ-ðåïåðôó糺þ íèæí³õ ê³íö³âîê â ï³çí³õ ïåð³îäàõ ï³ñëÿ òðàâìàòè÷íîãî ïåð³îäó ìîæå âèêëèêàòè ðåàêòèâí³ çì³íè ó âåëèêèõ ñóãëîáàõ íèæí³õ ê³íö³âîê. Êëþ÷îâ³ ñëîâà: ïîºäíàíà òðàâìà, ³øåì³ÿ-ðåïåðôóç³ÿ, åêñïåðèìåíò, êîë³ííèé ñóãëîá, êóëüøîâèé ñóãëîá. Âñòóï ñòåìíî¿ çàïàëüíî¿ ðåàêö³¿ íà ðîçâèòîê ï³ñëÿ- Ïîºäíàíà òðàâìà çàëèøàºòüñÿ îñíîâíîþ òðàâìàòè÷íîãî îñòåîàðòðèòó [5, 6]. Îäíàê ö³ ïðè÷èíîþ ëåòàëüíèõ íàñë³äê³â òà òðàâìàòèçìó äîñë³äæåííÿ â îñíîâíîìó ñòîñóþòüñÿ ëîêàëü- ñåðåä îñ³á ïðàöåçäàòíîãî â³êó. Ïðîãíîçóºòü- íèõ òðàâì. ñÿ, ùî ê³ëüê³ñòü òðàâìîâàíèõ îñ³á áóäå çðîñ- Îñíîâîþ óðàæåííÿ ñóãëîá³â âíàñë³äîê òàòè ïðîòÿãîì íàñòóïíèõ 20 ðîê³â [1]. òðàâìàòè÷íèõ ïîøêîäæåíü º çì³íè â õðÿùîâ³é Ïðîâåäåí³ êë³í³÷í³ òà åêñïåðèìåíòàëüí³ òêàíèí³. Ïàòîô³ç³îëîã³ÿ ïðîöåñó ïîëÿãຠó äå- äîñë³äæåííÿ ïîêàçàëè, ùî ïîºäíàíà òðàâìà ãåíåðàö³¿ òà çàãèáåë³ êë³òèí õðÿùà, ðîçâèâàºòü- ïîâ'ÿçàíà ç³ çíà÷íî á³ëüøèì ÷àñîì çàãîºííÿ ñÿ äåïîë³ìåðèçàö³ÿ îñíîâíî¿ ðå÷îâèíè ÿêà âè- ïåðåëîì³â òà á³ëüøîþ ÷àñòîòîþ ðîçâèòêó ðîáëÿºòüñÿ õîíäðîöèòàìè, çíèæóºòüñÿ ê³ëü- óñêëàäíåíü ó ïîð³âíÿíí³ ç ³çîëüîâàíèìè ïåðå- ê³ñòü ãë³êîçàì³íãë³êàí³â, ùî ïðèçâîäèòü äî ïðî- ëîìàìè. Êð³ì òîãî, âèçíà÷åíî, ùî ëîêàëüíà ãðåñèâíî¿ äåãåíåðàö³¿ õðÿùà. Ñïîñòåð³ãàºòü- òà ñèñòåìíà çàïàëüíà ðåàêö³ÿ çíà÷íî âïëèâຠñÿ ðîçðîñòàííÿ ê³ñòêîâî¿ òêàíèíè òà óòâîðåí- íà ïðîöåñè â³äíîâëåííÿ çàãîºííÿ ïåðåëîì³â íÿ îñòåîô³ò³â.  ïàòîëîã³÷íèé ïðîöåñ âòÿãó- [2–4]. þòüñÿ ñèíîâ³àëüíà îáîëîíêà, ô³áðîçíà êàïñó- Îäíèì ³ç íàéá³ëüø ðîçïîâñþäæåíèõ óñê- ëà òà íàâêîëîñóãëîáîâ³ ì'ÿçè. Çã³äíî ç³ ñòàòè- ëàäíåíü ³ ïðè÷èíîþ ³íâàë³äíîñò³, ÷àñòîòà ÿêî¿ ñòè÷íèìè äàíèìè çà ÷àñòîòîþ óðàæåííÿ ïåð- ïîñò³éíî çðîñòàº, º îñòåîàðòðîç. Òðàâìà, çîê- øå ì³ñöå ïîñ³äຠêóëüøîâèé ñóãëîá, äðóãå – ðåìà ñóãëîá³â, º âàæëèâèì ôàêòîðîì ðèçèêó êîë³ííèé, òðåòº – ïëå÷îâèé [7, 8]. ïîñòòðàâìàòè÷íîãî îñòåîàðòðèòó. Íàðàç³ íàó- Ìåòà ðîáîòè – äîñë³äèòè îñîáëèâîñò³ êîâöÿìè ÷³òêî äîâåäåíî íåãàòèâíèé âïëèâ ñè- ìîðôîëîã³÷íèõ ïîðóøåíü òêàíèí âåëèêèõ ñóã-

© Â.Î. Êðèëþê, Ñ.Â. Ãàð³ÿí, 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÒÅÎÐÅÒÈ×ÍÀ ² ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ÌÅÄÈÖÈÍÀ 5

ëîá³â íèæí³õ ê³íö³âîê â óìîâàõ ìîäåëüîâàíèõ «SWAT®» ( âèðîáíèöòâî ÑØÀ). Ïîïåðåäíüî òðàâì â ï³çí³ òåðì³íè. ïåðåä íàêëàäàííÿì ç îðèã³íàëüíîãî ïîëîòíà Ìàòåð³àë ³ ìåòîäè êðîâîñïèííîãî äæãóòà âèð³çàëè øìàòîê øè- Ðîáî÷îþ ã³ïîòåçîþ åêñïåðèìåíòàëüíîãî ðèíîþ 1,5 ñì òà äîâæèíîþ 10 ñì. Äîñòàòíº äîñë³äæåííÿ º ïðèïóùåííÿ, ùî âèêîðèñòàííÿ ðîçòÿãíåííÿ äæãóòà, äëÿ ïîâíîãî ïåðåòèñêàí- êðîâîñïèííîãî äæãóòà òà ïîäàëüøà ðåïåðôó- íÿ ñóäèí íèæíüî¿ ëàïè òâàðèí, êîíòðîëþâàëè ç³ÿ ³øåì³çîâàíèõ òêàíèí ïðèçâîäèòü äî çíà÷- çà äîïîìîãîþ ñïåö³àëüíèõ ³íäèêàòîð³â, ùî íèõ ñèñòåìíèõ çì³í ³ç ïîäàëüøèì ïîðóøåí- íàíåñåí³ âèðîáíèêîì íà éîãî ïîâåðõíþ. íÿì ôóíêö³îíóâàííÿ âåëèêèõ ñóãëîá³â ó ï³çíüî- Òâàðèí âèâîäèëè ç åêñïåðèìåíòó íà 3, 7, ìó ï³ñëÿòðàâìàòè÷íîìó ïåð³îä³ ïðè ïîºäíàí³é 14 òà 21-øó äîáó ï³ñëÿ ìîäåëþâàííÿ òðàâì. àáäîì³íî-ñêåëåòí³é òðàâì³ íà ôîí³ ã³ïîâîëå- ϳä ò³îïåíòàë-íàòð³ºâèì çíå÷óëåííÿì ïðîâî- ì³÷íîãî øîêó. äèëè çàá³é óñ³õ ùóð³â â³äïîâ³äíî¿ ãðóïè ìåòî- Åêñïåðèìåíòàëüíå äîñë³äæåííÿ âèêîíàíî äîì òîòàëüíîãî êðîâîïóñêàííÿ ç ñåðöÿ. óñòî- íà 40 ñòàòåâîçð³ëèõ á³ëèõ ùóðàõ-ñàìöÿõ ë³í³¿ ëîã³÷í³ çì³íè â òêàíèíàõ êóëüøîâîãî òà êîë³í- Wistar, ìàñîþ 190–220 ã, ÿê³ çíàõîäèëèñü íà íîãî ñóãëîá³â âèâ÷àëè íà 21-øó äîáó ï³ñëÿ- ñòàíäàðòíîìó ðàö³îí³ â³âàð³þ. Óñ³ åêñïåðèìåí- òðàâìàòè÷íîãî ïåð³îäó. Äëÿ ã³ñòîëîã³÷íèõ äî- òè ³ç íàíåñåííÿ òðàâì âèêîíóâàëè â óìîâàõ ò³î- ñë³äæåíü çàáèðàëè òêàíèíí³ çðàçêè êóëüøîâîãî ïåíòàë-íàòð³ºâîãî çíå÷óëåííÿ (40 ìã·êã-1 ìàñè). òà êîë³ííîãî ñóãëîá³â. Çð³çè òîâùèíîþ 5–6 ìêì, Çàêðèòèé ïåðåëîì ñòåãíîâî¿ ê³ñòêè ìîäåëþâàëè çàáàðâëåí³ ãåìàòîêñèë³íîì ³ åîçèíîì, äîñë³- øëÿõîì çàâäàííÿ îäíîêðàòíîãî äîçîâàíîãî äæóâàëè òà äîêóìåíòóâàëè çà äîïîìîãîþ óäàðó ñïåö³àëüíî ðîçðîáëåíèì ïðèñòðîºì ïî ì³êðîñêîïà ËÎÌÎ Áèîëàì È. ñòåãíó, ÿêèé âèêëèêàâ çàêðèòèé ïåðåëîì (ïëî- Çàçíà÷åí³ ïîêàçíèêè äîñë³äæóâàëè â Öåí- ùèíà óäàðíîãî ïðèñòðîþ ñòàíîâèëà 0,5 ñì2, òðàëüí³é íàóêîâ³é ëàáîðàòî𳿠Òåðíîï³ëüñüêî- ñèëà óäàðó á³ëüøå í³æ 120 êã/ñì2). Çàêðèòà ãî äåðæàâíîãî ìåäè÷íîãî óí³âåðñèòåòó ³ìåí³ òðàâìà îðãàí³â ÷åðåâíî¿ ïîðîæíèíè ìîäåëþ- ².ß. Ãîðáà÷åâñüêîãî. âàëàñü øëÿõîì çàâäàííÿ äâîõ äîçîâàíèõ óäàð³â Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ â îáëàñòü ÷åðåâíî¿ ïîðîæíèíè ñïåö³àëüíî ðîç- ̳êðîñêîï³÷í³ äîñë³äæåííÿ êóëüøîâîãî ðîáëåíèì ïðèñòðîºì. Çàâäÿêè äîçîâàíîìó óäà- ñóãëîáà òâàðèí ïðè åêñïåðèìåíòàëüí³é òðàâì³ ðó â îáëàñòü ÷åðåâíî¿ ïîðîæíèíè ìîäåëþºòü- ïîêàçàëè, ùî ó ïîâåðõíåâ³é ã³àë³íîâ³é õðÿùîâ³é ñÿ çàêðèòà òðàâìà îðãàí³â ÷åðåâíî¿ ïîðîæíè- ïëàñòèíö³ íàÿâí³ ä³ëÿíêè ç ïîðóøåííÿì óïî- íè. Ñèëà óäàðó ïðèñòðîþ ðîçðàõîâàíà òàêèì ðÿäêîâàíîãî ðîçòàøóâàííÿ õîíäðîöèò³â. Ó ÷èíîì, ùîá âèêëèêàòè çàêðèòó òðàâìó îðãàí³â ÷àñòèí³ õîíäðîöèò³â ïåðøîãî ³ äðóãîãî ïî- ÷åðåâíî¿ ïîðîæíèíè áåç ìàñèâíî¿ êðîâîâòðàòè ðÿäê³â çì³íåí³ ÿäðà, íàÿâíèé ¿õ ï³êíîç. ³äì³÷à- (ïëîùèíà óäàðíîãî ïðèñòðîþ ñòàíîâèëà 2,5 ñì2, þòüñÿ ä³ëÿíêè õðÿùà äå â³äñóòí³ êë³òèíè, à íà ñèëà óäàðó íå á³ëüøå í³æ 60 êã/ñì2). Çà òàêèõ ¿õ ì³ñö³ ðîçòàøîâàí³ ïîì³ðíî áàçîô³ëüí³ ä³ëÿíêè ïàðàìåòð³â âèíèêàëè âíóòð³øíüîîðãàíí³ ãåìà- ì³æêë³òèííî¿ ðå÷îâèíè (ðèñ. 1). òîìè ç óøêîäæåííÿì ïàðåíõ³ìè òà äð³áíèõ âíóòð³øíüîîðãàííèõ êðîâîíîñíèõ ñóäèí, òàêîæ âèíèêàëè çàáî¿ òà íåâåëèê³ ðàä³àëüí³ ðîçðèâè ïàðåíõ³ìàòîçíèõ îðãàí³â. Ìàñèâíó çîâí³øíþ êðîâîâòðàòó ìîäåëþ- âàëè øëÿõîì âèêîíàííÿ äîñòàòíüîãî îïåðà- ö³éíîãî äîñòóïó äî ñòåãíîâèõ ñóäèí íà ïðîòè- ëåæíîìó â³ä ïåðåëîìó ñòåãíîâî¿ ê³ñòêè áîö³, ïîò³ì ï³ä ñóäèííèé ïó÷îê çàâîäèëè ë³ãàòóðó òà ðîçñ³êàëè ñóäèíè. ϳñëÿ öüîãî çä³éñíþâàëè çàá³ð 20–22 % öèðêóëþþ÷î¿ êðîâ³, óïðîäîâæ 1 õâ (ãîñòðà êðîâîâòðàòà). Êðîâ çàáèðàëè øëÿ- õîì ïðîñî÷óâàííÿ òà çâàæóâàííÿ âàòíîãî ñïîí- æà. Îäðàçó ï³ñëÿ â³äáîðó äîñòàòíüî¿ ê³ëüêîñò³ êðîâ³ êðîâîòå÷ó ïðèïèíÿëè øëÿõîì çàâ'ÿçóâàí- Ðèñ. 1. óñòîëîã³÷í³ çì³íè â êóëüøîâîìó íÿ ë³ãàòóð. ñóãëîá³ ùóðà ïðè åêñïåðèìåíòàëüí³é òðàâì³. Ó ÿêîñò³ êðîâîñïèííèõ äæãóò³â âèêîðèñ- Ñóãëîáîâèé õðÿù (1), îñòåîíè ê³ñòêè (2), òîâóâàëè ìîäèô³êàö³þ øèðîêîãî åëàñòè÷íîãî Ãàâåðñîâèé êàíàë (3). Çàáàðâëåííÿ êðîâîñïèííîãî äæãóòà òîðãîâåëüíî¿ ìàðêè ãåìàòîêñèë³íîì òà åîçèíîì,  400

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 6 ÒÅÎÐÅÒÈ×ÍÀ ² ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ÌÅÄÈÖÈÍÀ

Ó ê³ñòêîâ³é òêàíèí³ îêðåì³ îñòåîíè âèãëÿ- äàþòü äåôîðìîâàíèìè, à ¿õ Ãàâåðñîâ³ êàíàëè ìàþòü íåâåëèêó ïëîùó. Ó ãóá÷àñò³é ÷àñòèí³ ê³ñòêè ê³ñòêîâ³ áàëêè âèãëÿäàþòü âèòîí÷åíèìè, ì³æ íèìè ðîçòàøî- âàí³ øèðîê³ ïîðîæíèíè ç ÷åðâîíèì ê³ñòêîâèì ìîçêîì. Âîëîêíèñòèé øàð ñóãëîáîâî¿ êàïñó- ëè ì³ñöÿìè íàáðÿêëèé ³ íå ù³ëüíî ïðèëÿãຠäî îê³ñòÿ â ä³ëÿíö³ ä³àô³çó (ðèñ. 2).

Ðèñ. 3. óñòîëîã³÷í³ çì³íè â êóëüøîâîìó ñóãëîá³ òâàðèíè ïðè åêñïåðèìåíòàëüí³é òðàâì³. Êîìïàêòíà ÷àñòèíà ê³ñòêè (1), îñòåîí (2), âñòàâí³ ïëàñòèíêè (3). Çàáàðâëåííÿ ãåìàòîêñèë³íîì òà åîçèíîì,  200

Ðèñ. 2. óñòîëîã³÷í³ çì³íè â êóëüøîâîìó ñóãëîá³ òâàðèíè ïðè åêñïåðèìåíòàëüí³é òðàâì³. Áàëêè ãóá÷àñòî¿ ÷àñòèíè ê³ñòêè (1), ïîðîæíèíè ç ÷åðâîíèì ê³ñòêîâèì ìîçêîì (2), çì³íåíà ìåòàåï³ô³çàðíà ïëàñòèíêà (3). Çàáàðâëåííÿ ãåìàòîêñèë³íîì òà åîçèíîì,  100 Çà âåëèêîãî çá³ëüøåííÿ ñâ³òëîîïòè÷íîãî ì³êðîñêîïà ñïîñòåð³ãàþòüñÿ çíà÷íî çì³íåí³ ä³ëÿíêè ã³àë³íîâîãî õðÿùà ìåòàåï³ô³çàðíî¿ ïëà- ñòèíêè ñóãëîáà. Âòðà÷àºòüñÿ óïîðÿäêîâàíå Ðèñ. 4. óñòîëîã³÷í³ çì³íè â êîë³ííîìó ñóãëîá³ ðîçòàøóâàííÿ õîíäðîöèò³â ó âèãëÿä³ ñòîâï÷èê³â, òâàðèíè ïðè åêñïåðèìåíòàëüí³é òðàâì³. ÷àñòèíà äåñòðóêòèâíî çì³íåíèõ êë³òèí óòâî- Ïîâåðõíåâèé ñóãëîáîâèé õðÿù (1), ðþþòü ñêóï÷åííÿ, ìàþòü ï³êíîòè÷í³ ÿäðà òà ê³ñòêîâà òêàíèíà ñóãëîáà (2). Çàáàðâëåííÿ ï³äâèùåíó áàçîô³ë³þ öèòîïëàçìè. ̳æêë³òèí- ãåìàòîêñèë³íîì òà åîçèíîì,  100 íà ðå÷îâèíà ó òàêèõ ä³ëÿíêàõ ñòຠíåîäíîð³ä- õðÿùà ñóãëîáà ìàþòü çì³íè ¿õ îðãàí³çàö³¿. Ó íîþ çà çàáàðâëåííÿì. ïîâåðõíåâîìó ¿¿ øàð³ ìàëî õîíäðîáëàñò³â,  êîìïàêòí³é ÷àñòèí³ ê³ñòêè êóëüøîâîãî âíàñë³äîê ÷îãî â³í ãîìîãåíèé, áàçîô³ëüíèé. ñóãëîáà ñïîñòåð³ãàþòüñÿ çì³íåí³ îñòåîìè òà Òàêîæ º íåâåëèê³ áåçêë³òèíí³ çîíè ïî âñ³é òîâù³ âñòàâí³ ïëàñòèíêè, òèíêòîð³àëüí³ âëàñòèâîñò³ ïëàñòèíêè, äå õîíäðîöèòè ïîîäèíîê³ àáî çîâñ³ì îñòàíí³õ ïîðóøåí³, âîíè ñâ³òë³øå çàáàðâëåí³ â³äñóòí³ (ðèñ. 5). òà âòðà÷àþòü óïîðÿäêîâàí³ñòü ðîçòàøóâàííÿ Ó ñïîëó÷í³é òêàíèí³, ùî îòî÷óº ñóãëîá, ïëàñòèíîê, ìàþòü âèãëÿä áåçñòðóêòóðíèõ êîí- ñïîñòåð³ãàþòüñÿ êðîâîíàïîâíåí³ ñóäèíè, ñò³íêà ãëîìåðàò³â (ðèñ. 3). ÿêèõ ìຠïîãàíî âèðàæåí³ îáîëîíêè, â³äñóòíÿ ̳êðîñêîï³÷í³ äîñë³äæåííÿ êîë³ííîãî ñóã- åëàñòè÷íà ìåìáðàíà ì³æ âíóòð³øíüîþ òà ñå- ëîáà òâàðèíè ïðè åêñïåðèìåíòàëüí³é òðàâì³ ðåäíüîþ îáîëîíêàìè. Ó ïóõê³é ñïîëó÷í³é òêà- ïîêàçàëè, ùî ã³àë³íîâà õðÿùîâà ïëàñòèíêà íèí³ íàÿâí³ íåâåëèê³ ñêóï÷åííÿ ã³ñòîöèòàðíî- íåçíà÷íî çì³íåíà. Íàÿâí³ îêðåì³ ä³ëÿíêè ï³äâè- ãî ³íô³ëüòðàòó. ùåíî¿ áàçîô³ë³¿, â ÿêèõ õîíäðîöèòè ïîøêîäæåí³ Îòæå, àíàë³ç ìîðôîëîã³÷íèõ çì³í íà 21-øó ³ ¿õ óïîðÿäêîâàíå ðîçòàøóâàííÿ ïîðóøåíå. äîáó åêñïåðèìåíòàëüíî¿ òðàâìè âèÿâèâ íà- Ñóãëîáîâà ïîðîæíèíà ÷³òêî îáìåæåíà ñóãëî- ÿâí³ñòü ðåàêòèâíèõ çì³í ó êóëüøîâîìó òà êî- áîâîþ êàïñóëîþ (ðèñ. 4). ë³ííîìó ñóãëîáàõ , ÿê³ õàðàêòåðí³ äëÿ çàïàëü- óñòîëîã³÷íî âñòàíîâëåíî, ùî â ìåòàåï³ô³- íèõ ïðîöåñ³â âåëèêèõ ñóãëîá³â, à ñàìå: âèðà- çàðí³é ïëàñòèíö³ îêðåì³ ä³ëÿíêè ã³àë³íîâîãî æåí³ çì³íè ã³àë³íîâîãî õðÿùà ìåòàåï³ô³çàðíî¿

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÒÅÎÐÅÒÈ×ÍÀ ² ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ÌÅÄÈÖÈÍÀ 7

âñòàâíèõ ïëàñòèíîê êîìïàêòíî¿ ÷àñòèíè ê³ñòêè, ³ñòîòí³ ñóäèíí³ ðîçëàäè ó âèãëÿä³ àðòåð³é ç ïî- òîâùåíîþ ñò³íêîþ ³ çâóæåíèìè ïðîñâ³òàìè, â³äì³÷åíî íàáðÿê àäâåíòèö³éíî¿ îáîëîíêè ñóäèí. Âèñíîâêè 1. Ïðîâåäåí³ ã³ñòîëîã³÷í³ äîñë³äæåííÿ ïî- êàçàëè, ùî íà 21-øó äîáó ï³ñëÿ ìîäåëþâàííÿ òðàâìè â êóëüøîâîìó òà êîë³ííîìó ñóãëîáàõ íàÿâí³ ðåàêòèâí³ çì³íè, ÿê³ õàðàêòåðí³ äëÿ çà- ïàëüíèõ ïðîöåñ³â. 2. Âñòàíîâëåí³ çì³íè â ñóäèíàõ ïîðóøó- þòü òðîô³êó ê³ñòîê, ùî âèêëèêຠçì³íè ¿õ ñòðóêòóðíèõ êîìïîíåíò³â. Ó â³äïîâ³äü íà ìî- Ðèñ. 5. óñòîëîã³÷í³ çì³íè â êîë³ííîìó ñóãëîá³ äåëþâàííÿ òðàâìè ðåàãóº ïîâåðõíåâà ñóãëî- òâàðèíè ïðè åêñïåðèìåíòàëüí³é òðàâì³. áîâà õðÿùîâà ïëàñòèíêà. Ìåòàåï³ô³çàðíà ïëàñòèíêà (1), ãóá÷àñòà Ïåðñïåêòèâè ïîäàëüøèõ äîñë³äæåíü ê³ñòêîâà òêàíèíà (2). Çàáàðâëåííÿ Ó ïåðñïåêòèâ³ ïåðåäáà÷àºòüñÿ ðîçðîáèòè ãåìàòîêñèë³íîì òà åîçèíîì,  200 ïàòîãåíåòè÷íî îá´ðóíòîâàí³ çàñîáè êîðåêö³¿ ïëàñòèíêè ñóãëîá³â, íàáðÿê ñïîëó÷íî¿ òêàíè- ñèñòåìíèõ çì³í, ùî âèíèêàþòü ï³ä âïëèâîì íè, ïîðóøåííÿ óïîðÿäêîâàíîãî ðîçòàøóâàííÿ ðåïåðôó糿 ê³íö³âêè.

References 1. Oyeniyi B.T., Fox E.E., Scerbo Ì. et al. (2017).Trends in 1029 Trauma Deaths at a Level 1 Trauma Center. Injury, vol. 48 (1), pp. 5–12. 2. Karladani A., Granhed H., Karrholm J. et al. (2001). The influence of fracture etiology and type on fracture healing: a review of 104 consecutive tibial shaft fractures. Archives of Orthopaedic and Trauma Surgery, vol. 121 (6), pp. 325–328. 3. Park S.H., Silva M., Bahk W.J. et al. (2002). Effect of repeated irrigation and debridement on fracture healing in an animal model. Journal of Orthopaedic Research, vol. 20 (6), pp. 1197–1204. 4. Bunn R.J., Burke G., Conelly C. et al. (2005). Inflammation – a double edged sowrd in high-energy fractures. The Bone & Joint Journal, vol. 87 (3), pp. 265–266. 5. Abbey C. Thomas, Tricia Hubbard-Turner, Erik A. Wikstrom et al. (2017). Epidemiology of Posttraumatic Osteoarthritis. J Athl Train., vol. 52 (6), pp. 491–496. 6. Johnson V.L., Hunter D.J. (2014). The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol., vol. 28, pp. 5–15. 7. Bahaa Ali Kornah, Hesham Mohamed Safwat, Said K. Abdel-hameed et al. (2019). Managing of post-traumatic knee arthritis by total knee arthroplasty: case series of 15 patients and literature review. Journal of Orthopaedic Surgery and Research, vol. 14, pp. 1–9. 8. Van Tienderen R.J., Dunn J.C., Kusnezov N., Orr J.D. (2017). Osteochondral allograft transfer for treatment of osteochondral lesions of the talus: a systematic review. Arthroscopy, vol. 33 (1), pp. 217–222.

Â.Î. Êðûëþê, Ñ.Â. Ãàðèÿí ÂËÈßÍÈÅ ÈØÅÌÈÈ-ÐÅÏÅÐÔÓÇÈÈ ÍÀ ÌÎÐÔÎËÎÃÈ×ÅÑÊÈÅ ÈÇÌÅÍÅÍÈß ÁÎËÜØÈÕ ÑÓÑÒÀÂΠÍÈÆÍÈÕ ÊÎÍÅ×ÍÎÑÒÅÉ Â ÓÑËÎÂÈßÕ ÑÎ×ÅÒÀÍÍÎÉ ÀÁÄÎÌÈÍÎ-ÑÊÅËÅÒÍÎÉ ÒÐÀÂÌÛ Èçó÷àëè îñîáåííîñòè ìîðôîëîãè÷åñêèõ íàðóøåíèé òêàíåé áîëüøèõ ñóñòàâîâ íèæíèõ êîíå÷íîñ- òåé â óñëîâèÿõ ìîäåëèðîâàííûõ òðàâì â ïîçäíèå ñðîêè. Ýêñïåðèìåíò ïðîâîäèëè íà 40 ïîëîâîçðå- ëûõ áåëûõ êðûñàõ-ñàìöàõ ëèíèè Wistar, ìàññîé 190–220 ã, êîòîðûå íàõîäèëèñü íà ñòàíäàðòíîì ðàöèîíå âèâàðèÿ. Ïîäîïûòíûì æèâîòíûì ìîäåëèðîâàëè çàêðûòóþ òðàâìó îðãàíîâ áðþøíîé ïîëî- ñòè, ñêåëåòíóþ òðàâìó, ìàññèâíóþ âíåøíþþ êðîâîïîòåðþ è èøåìèþ-ðåïåðôóçèþ íèæíèõ êîíå÷- íîñòåé. Èññëåäîâàíèå ïðîâîäèëè ÷åðåç 21 ñóòêè ïîñëå ìîäåëèðîâàíèÿ òðàâì. Âñå ýêñïåðèìåíòû ïðè ìîäåëèðîâàíèè òðàâì âûïîëíÿëè â óñëîâèÿõ òèîïåíòàë-íàòðèåâîãî îáåçáîëèâàíèÿ (40 ìã êã-1 ìàññû). Çàêðûòûé ïåðåëîì áåäðåííîé êîñòè ìîäåëèðîâàëè ïóòåì íàíåñåíèÿ îäíîêðàòíîãî äîçèðî- âàííîãî óäàðà ñïåöèàëüíî ðàçðàáîòàííûì óñòðîéñòâîì ïî áåäðó. Óñòàíîâèëè, ÷òî ñî÷åòàííàÿ àáäî-

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 8 ÒÅÎÐÅÒÈ×ÍÀ ² ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ÌÅÄÈÖÈÍÀ

ìèíî-ñêåëåòíàÿ òðàâìà â ñî÷åòàíèè ñ èøåìèåé-ðåïåðôóçèåé íèæíèõ êîíå÷íîñòåé â ïîçäíèõ ñðîêàõ ïîñòòðàâìàòè÷åñêîãî ïåðèîäà ìîæåò âûçâàòü ðåàêòèâíûå èçìåíåíèÿ â êðóïíûõ ñóñòàâàõ íèæíèõ êîíå÷íîñòåé. Ýòî äàåò îñíîâàíèå ïîèñêà íîâûõ ïîäõîäîâ ê ìåòîäàì ëå÷åíèÿ ïðè òàêîé ïàòîëîãèè. Êëþ÷åâûå ñëîâà: ñî÷åòàííàÿ òðàâìà, èøåìèÿ-ðåïåðôóçèÿ, ýêñïåðèìåíò, êîëåííûé ñóñòàâ, áåäðåííûé ñóñòàâ.

V.O. Kryliuk, S.V. Garian INFLUENCE ISCHEMIA=REPERFUSION ON THE MORPHOLOGICAL CHANGES LARGE JOINTS OF THE LOWER EXTREMITIES UNDER COMBINED ABDOMINO-SKELETAL INJURY To study the effect of limb reperfusion in a model of combined abdominal-skeletal trauma and massive blood loss on histological changes of the knee joints. The experiment used 40 adult white male Wistar rats weighing 190–220 g, which were on a standard diet of vivarium. The experimental animals who modeled closed abdominal trauma, skeletal trauma, massive external blood loss, and ischemia-reperfusion of the lower extremities. The studies were performed 21 days after trauma modeling. All trauma experiments were performed under thiopental sodium (40 mg kg-1 mass). The closed femoral bone fracture was modeled by applying a single metered blow to a specially designed thigh device. Closed trauma to the abdominal organs was modeled by applying two metered blows to the abdominal cavity with a specially designed device. Massive external blood loss was modeled by blood flow from 20 to 22 % of circulating blood volume from the femoral vessels on the opposite side of the femur fracture. Lower limb ischemia- reperfusion was simulated by imposing hemostatic plaits on the proximal portions of the lower legs of the test animals for two hours. In the preparations of the tissues of the hip and knee joint tissue reactive changes characteristic of inflammatory processes was found: pronounced changes in the hyaline cartilage of the metepiphyseal plate of the joints, edema of the connective tissue, disruption of the ordered arrangement of the insert plates of the compact part of the bone, significant vascular disorders in the form of arteries, edema of the adventitious sheath of vessels was noted. Thus, it was determined that combined trauma combined with ischemia reperfusion of the lower extremities in the later periods after the traumatic period can cause reactive changes in the large joints of the lower extremities. Keywords: combined trauma, ischemia reperfusion, experiment, knee joint, hip joint.

Íàä³éøëà äî ðåäàêö³¿ 01.10.2019

Êîíòàêòíà ³íôîðìàö³ÿ Êðèëþê ³òàë³é Îìåëÿíîâè÷ – äîêòîð ìåäè÷íèõ íàóê, çàâ³äóâà÷ â³ää³ëó ï³äãîòîâêè ³íñòðóê- òîð³â ç íàäàííÿ åêñòðåíî¿ ìåäè÷íî¿ äîïîìîãè ÄÇ «Óêðà¿íñüêèé íàóêîâî-ïðàêòè÷íèé öåíòð åêñò- ðåíî¿ ìåäè÷íî¿ äîïîìîãè òà ìåäèöèíè êàòàñòðîô ÌÎÇ Óêðà¿íè». Àäðåñà: Óêðà¿íà, 02660, ì. Êè¿â, âóë. Áðàòèñëàâñüêà 3. Òåë.: +380672431643 E-mail: [email protected] ORCID: https://orcid.org/0000-0003-0210-1692

Ãàð³ÿí Ñåðã³é Âàñèëüîâè÷ – çàâ³äóâà÷ îðòîïåäî-òðàâìàòîëîã³÷íèì â³ää³ëåííÿì ÊÇ Òåðíî- ï³ëüñêî¿ îáëàñíî¿ ðàäè «Òåðíîï³ëüñüêà óí³âåðñèòåòñüêà ë³êàðíÿ». Àäðåñà: Óêðà¿íà, 46000, ì. Òåðíîï³ëü, âóë. Êë³í³÷íà 1. Òåë.: +380673522560 E-mail: [email protected] ORCID: https://orcid.org/0000-0002-5379-759X

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÒÅÎÐÅÒÈ×ÍÀ ² ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ÌÅÄÈÖÈÍÀ 9

https://doi.org/10.35339/ekm.2019.85.04.02 ÓÄÊ 616.98:578.825.13]-036

Î.Ã. Ñîðîê³íà, Ì.Ì. Ïîïîâ, Ò.². Ëÿäîâà, Î.Â. Îãí³âåíêî, Î.Ì. Ñàââî Õàðê³âñüêèé íàö³îíàëüíèé óí³âåðñèòåò ³ìåí³ Â. Í. Êàðàç³íà ÎÑÎÁËÈÂÎÑÒ² ÏÅÐÅÁ²ÃÓ ÕÐÎͲ×Íί ÅÏØÒÅÉÍÀ–ÁÀÐР²ÐÓÑÍί ²ÍÔÅÊÖ²¯ Âñòàíîâëåíî, ùî ó õâîðèõ íà õðîí³÷íó ÂÅÁ-³íôåêö³þ ñåðåä êë³í³÷íèõ ïðîÿâ³â íàé÷àñ- ò³øå â³äçíà÷àâñÿ õðîí³÷íèé òîíçèë³ò, ñèíäðîì õðîí³÷íî¿ âòîìè òà ïåðèôåðè÷íà ë³ìôàäå- íîïàò³ÿ. Ïðè ïðîâåäåíí³ ëàáîðàòîðíèõ äîñë³äæåíü âñòàíîâëåíî, ùî äëÿ õâîðèõ íà õðî- í³÷íó ÂÅÁ-³íôåêö³þ õàðàêòåðíå äîñòîâ³ðíå ï³äâèùåííÿ ØÎÅ, ï³äâèùåííÿ â³äíîñíîãî âì³ñòó ë³ìôîöèò³â òà ìîíîöèò³â, à òàêîæ çíèæåííÿ àáñîëþòíîãî òà â³äíîñíîãî âì³ñòó íåéòðîô³ë³â, ó ïîð³âíÿíí³ ç ïîêàçíèêàìè êîíòðîëüíî¿ ãðóïè ïàö³ºíò³â, ùî ñâ³ä÷èòü ïðî çñóâ ëåéêîöèòàðíî¿ ôîðìóëè êðîâ³, õàðàêòåðíèé äëÿ â³ðóñíî¿ åò³îëî㳿 çàõâîðþâàííÿ àñîö³éîâàíîãî ç ÂÅÁ. Êëþ÷îâ³ ñëîâà: õðîí³÷íà ÂÅÁ-³íôåêö³ÿ, ïåðåá³ã çàõâîðþâàííÿ, êë³í³êî-ëàáîðàòîðí³ ïîêàçíèêè, ³ìóííà ñèñòåìà. Âñòóï ï³ðàòîðíîãî â³ðóñíîãî çàõâîðþâàííÿ. Àëå ïðè Àêòóàëüíîþ ïðîáëåìîþ êë³í³÷íî¿ ³ìóíî- ïîïàäàíí³ âåëèêî¿ ê³ëüêîñò³ ³íôåêòó ³/àáî íàÿâ- ëî㳿 òà ³íôåêòîëî㳿 íà ñüîãîäí³ º â³ðóñí³ çà- íîñò³ ó äàíèé ïåð³îä çíà÷óùîãî îñëàáëåííÿ õâîðþâàííÿ ëþäèíè, ùî àñîö³þþòüñÿ ç çàòÿæ- ³ìóííî¿ ñèñòåìè ó ïàö³ºíòà ìîæå ðîçâèíóòèñü íèì ïåðåá³ãîì, äîâ³÷íîþ ïåðñèñòåíö³ºþ, õðî- êàðòèíà ³íôåêö³éíîãî ìîíîíóêëåîçó [4]. í³çàö³ºþ ïðîöåñó òà íåñïðèÿòëèâèìè íàñë³äêà- Ïåðâèííå ³íô³êóâàííÿ ÂÅÁ ïðèçâîäèòü äî ìè õâîðîáè. Ñåðåä ÷èñëåííèõ ôàêòîð³â, ÿê³ äîâ³÷íî¿ ïåðñèñòåíö³¿ çáóäíèêà ç ìîæëèâîþ áåçïîñåðåäíüî âïëèâàþòü íà ³ìóííó ñèñòåìó, ïåð³îäè÷íîþ ðåàêòèâàö³ºþ ï³ä 䳺þ ð³çíèõ ³ìó- îñîáëèâî¿ óâàãè çàñëóãîâóþòü ³íôåêö³¿ âèêëè- íîñóïðåñèâíèõ ÷èííèê³â, ùî çóìîâëþº âèíèê- êàí³ â³ðóñîì ãåðïåñó [1–3]. Îñòàíí³ìè ðîêà- íåííÿ õðîí³÷íèõ ôîðì çàõâîðþâàííÿ. ÂÅÁ ìè ñïîñòåð³ãàºòüñÿ çðîñòàííÿ ê³ëüêîñò³ õâî- ìîæå âèêëèêàòè õðîí³÷í³ ìàí³ôåñòí³ òà ñòåðò³ ðèõ, ÿê³ ñòðàæäàþòü â³ä õðîí³÷íèõ ðåöèäèâó- ôîðìè çàõâîðþâàííÿ, ùî ïåðåá³ãàþòü çà òè- þ÷èõ ãåðïåñâ³ðóñíèõ ³íôåêö³é, ùî ó áàãàòüîõ ïîì õðîí³÷íîãî ìîíîíóêëåîçó. Ñë³ä çàçíà÷è- âèïàäêàõ ñóïðîâîäæóþòüñÿ âèðàæåíèì ïîðó- òè, ùî BÅÁ â³ä³ãðຠêëþ÷îâó ðîëü ÿê â ³íôåê- øåííÿì çàãàëüíîãî ñàìîïî÷óòòÿ é ö³ëèì ðÿ- ö³éí³é, òàê ³ â íåâðîëîã³÷í³é, ³ìóíîëîã³÷í³é, ðåâ- äîì òåðàïåâòè÷íèõ ñêàðã [4, 5]. ìàòîëîã³÷í³é, îíêîëîã³÷í³é, ãåìàòîëîã³÷í³é òà ³ðóñ Åïøòåéíà–Áàðð (ÂÅÁ) íàëåæèòü äî ³ìóíîëîã³÷í³é ïàòîëî㳿 [4, 8]. ñ³ìåéñòâà Herpesviridae òà º îäí³ºþ ç íàéïîøè- Çà îñòàíí³ ðîêè çíà÷íî çðîñëà çàõâîðþ- ðåí³øèõ ³íôåêö³é ó ñâ³ò³. Çà äàíèìè á³ëüøîñò³ âàí³ñòü íà ÂÅÁ-³íôåêö³þ, ùî, ñêîð³øå çà âñå, äîñë³äíèê³â íà ñüîãîäí³ áëèçüêî 80–90 % íàñå- ïîâ'ÿçàíî íå ò³ëüêè ç åï³äåì³îëîã³÷íèì ï³äéî- ëåííÿ ³íô³êîâàíî ÂÅÁ [6, 7]. Ïåðâèííà ³íôåêö³ÿ ìîì, à é ç ïîêðàùåííÿì ìåòîä³â ä³àãíîñòèêè. ÷àñò³øå âèíèêຠâ äèòÿ÷îìó àáî ìîëîäîìó â³ö³. Îäíàê ïðî õðîí³÷íó ³íôåêö³þ, âèêëèêàíó ÂÅÁ, ϳñëÿ çàðàæåííÿ ÂÅÁ ðåïë³êàö³ÿ â³ðóñó â îð- òà ¿¿ ôîðìè ë³êàð³ çàãàëüíî¿ ïðàêòèêè îá³çíàí³ ãàí³çì³ ëþäèíè òà ôîðìóâàííÿ ³ìóííî¿ â³äïîâ³ä³ ÿâíî íåäîñòàòíüî [4]. ìîæóòü ïåðåá³ãàòè áåçñèìïòîìíî àáî ïðîÿâ- Òàêèì ÷èíîì, âèâ÷åííÿ õàðàêòåðó êë³í³êî- ëÿòèñÿ ó âèãëÿä³ íåçíà÷íèõ îçíàê ãîñòðîãî ðåñ- ëàáîðàòîðíèõ çì³í ó õâîðèõ íà õðîí³÷íó ÂÅÁ-

© Î.Ã. Ñîðîê³íà, Ì.Ì. Ïîïîâ, Ò.². Ëÿäîâà òà ³í., 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 10 ÒÅÎÐÅÒÈ×ÍÀ ² ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ÌÅÄÈÖÈÍÀ

³íôåêö³þ òà îñîáëèâîñòåé ïåðåá³ãó çàõâîðþ- õðîí³÷íî¿ âòîìè – 93 õâîðèõ (72,6 %). Ïåðè- âàííÿ º àêòóàëüíîþ ïðîáëåìîþ ñó÷àñíîñò³. ôåðè÷íà ë³ìôàäåíîïàò³ÿ çóñòð³÷àëàñü ó 91 õâî- Ìåòà äîñë³äæåííÿ – âèâ÷åííÿ îñîáëè- ðîãî (71,1 %) òà õàðàêòåðèçóâàëàñÿ ïåðåâàæ- âîñòåé ïåðåá³ãó õðîí³÷íî¿ ÂÅÁ-³íôåêö³¿. íî çá³ëüøåííÿì ïåðåäíüîøèéíèõ ³ çàäíüîøèé- Ìàòåð³àë ³ ìåòîäè íî¿ ë³ìôàòè÷íèõ âóçë³â. Ñèíäðîì òðèâàëîãî Íàìè áóëî âèêîíàíî êîìïëåêñíå êë³í³êî- ñóáôåáðèë³òåòó ðåºñòðóâàâñÿ ó 58 õâîðèõ ëàáîðàòîðíå îáñòåæåííÿ 128 õâîðèõ íà õðî- (45,3 %). Òàê³ ñèìïòîìè ÿê àðòðàëã³ÿ, ì³àëã³ÿ í³÷íó ÂÅÁ-³íôåêö³þ (ïåð³îä ðåàêòèâàö³¿) – áóëè çàô³êñîâàí³ ó 49 õâîðèõ (38,3 %). Ó 13 ïà- 68 æ³íîê (53,1 %) òà 60 ÷îëîâ³ê³â (46,9 %). ijà- ö³ºíò³â (10 %) áóëî ä³àãíîñòîâàíî ãåïàòî볺- ãíîç õðîí³÷íà ÂÅÁ-³íôåêö³ÿ áóâ âñòàíîâëåíèé íàëüíèé ñèíäðîì. íà ï³äñòàâ³ àíàìíåçó, ñêàðã, íàÿâíîñò³ ñïåöè- Ïðè àíàë³ç³ ÷àñòîòè ðåöèäèâ³â çàõâîðþâàí- ô³÷íèõ àíòèò³ë äî àíòèãåí³â ÂÅÁ òà âèÿâëåí- íÿ óïðîäîâæ ðîêó áóëè îòðèìàí³ íàñòóïí³ äàí³: íÿ ÄÍÊ â³ðóñó â êðîâ³. Âêëþ÷åííÿ ïàö³ºíò³â ó 65 îñ³á (50,8 %) ñïîñòåð³ãàëîñü – 2 ðåöèäè- äî ïðîãðàìè îáñòåæåííÿ ïðîâîäèëîñÿ çà íà- âè, ó 42 îñ³á (32,8 %) – 3 ðåöèäèâè, ó 21 îñîáè ñòóïíèìè êðèòåð³ÿìè: âñòàíîâëåíèé ä³àãíîç (16,4 %) – 4 òà á³ëüøå ðåöèäèâ³â. õðîí³÷íà ÂÅÁ-³íôåêö³¿; íàÿâí³ñòü êë³í³÷íèõ Äîñë³äæåííÿ êë³í³÷íîãî àíàë³çó êðîâ³ õâî- ïðîÿâ³â àêòèâàö³¿ õðîí³÷íî¿ ÂÅÁ-³íôåêö³¿; â³ê ðèõ íà õðîí³÷íó ÂÅÁ-³íôåêö³þ òà êîíòðîëüíî¿ õâîðèõ â³ä 18 äî 45 ðîê³â; äîáðîâ³ëüíà çãîäà ãðóïè ïîêàçàëî íàÿâí³ñòü äåÿêèõ â³äì³ííîñòåé. ïàö³ºíòà íà ó÷àñòü â äîñë³äæåíí³. Äî äîñë³- Òàê, ó õâîðèõ íà õðîí³÷íó ÂÅÁ-³íôåêö³þ áóëî äæåííÿ íå áóëè âêëþ÷åí³ ïàö³ºíòè, ïðè íàÿâ- âèÿâëåíî íàÿâí³ñòü äîñòîâ³ðíî ï³äâèùåíîãî íîñò³ îäíîãî ç íàñòóïíèõ êðèòåð³¿â: âðîäæåí³ ð³âíÿ ØÎÅ – (12,6±1,8) ìì/ã ïðîòè (4,5±1,1) àáî íàáóò³ ³ìóíîäåô³öèòè, âæèâàííÿ ³ìóíîìî- ìì/ã ó ãðóï³ êîíòðîëþ (ð<0,05). гâí³ åðèòðî- äåëþþ÷èõ, ñòåðî¿äíèõ çàñîá³â âïðîäîâæ îñ- öèò³â, ãåìîãëîá³íó òà òðîìáîöèò³â äîñòîâ³ðíî òàíí³õ 6 ì³ñÿö³â, íàÿâí³ñòü õðîí³÷íî¿ ñóïóòíüî¿ íå â³äð³çíÿëèñü â³ä ïîêàçíèê³â êîíòðîëüíî¿ ãðó- ïàòîëî㳿. Äî êîíòðîëüíî¿ ãðóïè óâ³éøëî 30 êë³- ïè òà ñòàíîâèëè (4,72±1,1) õ 1012/ë, (129±10,3) ã/ë í³÷íî çäîðîâèõ ëþäåé â³êîì â³ä 20 äî 35 ðîê³â òà (218±31,2)  109/ë ïðîòè (4,43±0,9)  1012/ë, áåç îçíàê ãîñòðî¿ àáî áóäü-ÿêî¿ õðîí³÷íî¿ ïà- (131±9,1) ã/ë òà (226±30,8)  109/ë ó ãðóï³ êîíò- òîëî㳿.  àíàìíåç³ æèòòÿ öèõ ïàö³ºíò³â áóëè ðîëþ â³äïîâ³äíî. Ó õâîðèõ íà õðîí³÷íó ÂÅÁ- â³äñóòí³ äàí³ ïðî ïåðåíåñåíèé ³íôåêö³éíèé ìî- ³íôåêö³þ ñïîñòåð³ãàëîñü çíèæåííÿ ð³âíÿ ëåé- íîíóêëåîç, ïðè äîñë³äæåíí³ êðîâ³ ÄÍÊ ÂÅÁ êîöèò³â (5,13±0,22)  109/ë ïðîòè (6,20±1,8)  íå áóëî âèÿâëåíî. 109/ë ó ãðóï³ êîíòðîëþ (ð>0,05), àëå ö³ çì³íè Ðîáîòà áóëà âèêîíàíà íà êàôåäð³ çàãàëüíî¿ íå âèõîäèëè çà ìåæè íîðìè, âñòàíîâëåíî¿ äëÿ òà êë³í³÷íî¿ ³ìóíîëî㳿 òà àëåðãîëî㳿 ìåäè÷íî- çäîðîâèõ îñ³á. ãî ôàêóëüòåòó Õàðê³âñüêîãî íàö³îíàëüíîãî óí³- Àíàë³ç ëåéêîöèòàðíî¿ ôîðìóëè äîçâîëèâ âåðñèòåòó ³ìåí³ Â.Í. Êàðàç³íà â ðàìêàõ íàóêî- âñòàíîâèòè íàÿâí³ñòü ó õâîðèõ íà õðîí³÷íó âî-äîñë³äíèöüêî¿ òåìè: «Âèâ÷åííÿ ðîë³ ³ìóííèõ, ÂÅÁ-³íôåêö³þ äîñòîâ³ðíîãî ï³äâèùåííÿ â³ä- àóòî³ìóííèõ òà ìåòàáîë³÷íèõ ïîðóøåíü ó ïà- íîñíîãî âì³ñòó ë³ìôîöèò³â – (42,50±2,0) % ïðî- òîãåíåç³ òà íàñë³äêè ³íôåêö³éíîãî ïðîöåñó, âèê- òè (33,70±2,68) % (ð<0,05) òà ìîíîöèò³â (11,15± ëèêàíîãî ãåðïåñâ³ðóñàìè», íîìåð äåðæàâíî¿ 0,9) % ïðîòè (3,0±0,6) % (ð<0,05), ùî áóëî ðåºñòðàö³¿ ¹ 0112U005911. Çàá³ð àíàë³ç³â òà ¿õ ï³äñòàâîþ äëÿ ï³äòâåðäæåííÿ íàÿâíîñò³ õðî- òåõí³÷íå âèêîíàííÿ çä³éñíþâàëîñÿ â êë³í³êî- í³÷íîãî ³íôåêö³éíîãî ïðîöåñó. Çàãàëîì ó 94,8 % ä³àãíîñòè÷í³é ëàáîðàòî𳿠Îáëàñíî¿ êë³í³÷íî¿ õâîðèõ íà õðîí³÷íó ÂÅÁ-³íôåêö³þ â³äçíà÷àâ- ³íôåêö³éíî¿ ë³êàðí³, ÷àñòèíà àíàë³ç³â âèêîíóâà- ñÿ ë³ìôîöèòîç òà ó 82,5 % – ìîíîöèòîç. ³äíîñ- ëàñÿ ó ëàáîðàòî𳿠«Â³ðîëà» òà «Àíàë³òèêà». íà ê³ëüê³ñòü íåéòðîô³ë³â ó õâîðèõ íà õðîí³÷íó Ñòàòèñòè÷íà îáðîáêà ðåçóëüòàò³â äîñë³äæåí- ÂÅÁ-³íôåêö³þ ñòàíîâèëà â ñåðåäíüîìó íÿ ïðîâîäèëàñÿ ç âèêîðèñòàííÿì ïàêåòó ñòà- (45,35±4,1) % ïðîòè (61,7±3,8) % ó êîíòðîëüí³é òèñòè÷íèõ ïðîãðàì STATISTICA 10.0. ãðóï³ (ð<0,05); â³äíîñíà ê³ëüê³ñòü åîçèíîô³ë³â Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ. òà áàçîô³ë³â çíàõîäèëàñü ó ìåæàõ íîðìè òà Çà ðåçóëüòàòàìè ïðîâåäåíîãî äîñë³äæåí- ñòàíîâèëà ó õâîðèõ íà õðîí³÷íó ÂÅÁ-³íôåê- íÿ áóëî âñòàíîâëåíî, ùî ïåðåá³ã ÕÂÅÁ-³íôåê- ö³þ â ñåðåäíüîìó (1,0±0,4) % òà (0,4±0,08) % ö³¿ õàðàêòåðèçóâàâñÿ ïîë³ìîðôí³ñòþ òà íåñïå- ïðîòè (1,0±0,4) % òà (0,6±0,07) % ó êîíòðîëüí³é öèô³÷í³ñòþ êë³í³÷íèõ ïðîÿâ³â, ÿê³ ìàëè ñò³éêèé ãðóï³ â³äïîâ³äíî òà íå â³äð³çíÿëàñü ñòàòèñòè÷- òà òðèâàëèé õàðàêòåð. íîþ äîñòîâ³ðí³ñòþ (ð>0,05). Íàé÷àñò³øå ó õâîðèõ â³äçíà÷àâñÿ õðîí³÷- Ïðè äîñë³äæåíí³ àáñîëþòíî¿ ê³ëüêîñò³ íèé òîíçèë³ò – 101 õâîðèé (78,9 %) òà ñèíäðîì ë³ìôîöèò³â òà ìîíîöèò³â ó õâîðèõ íà õðîí³÷íó

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÒÅÎÐÅÒÈ×ÍÀ ² ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ÌÅÄÈÖÈÍÀ 11

ÂÅÁ-³íôåêö³þ ñïîñòåð³ãàëàñü òåíäåíö³ÿ äî ¿õ Âèñíîâêè ï³äâèùåííÿ, ¿õ ð³âåíü â ñåðåäíüîìó áóâ (2,13± Òàêèì ÷èíîì, çà ðåçóëüòàòàìè ïðîâåäåíîãî 0,7)  109/ë òà (0,51±0,08)  109/ë ïðîòè (2,39± äîñë³äæåííÿ íàìè áóëî âñòàíîâëåíî, ùî ó õâî- 0,7)  109/ë òà (0,47±0,08)  109/ë ó êîíòðîëüí³é ðèõ íà õðîí³÷íó ÂÅÁ-³íôåêö³þ ñåðåä êë³í³÷íèõ ãðóï³ (ð>0,05). Àáñîëþòíà ê³ëüê³ñòü íåéò- ïðîÿâ³â íàé÷àñò³øå â³äçíà÷àâñÿ õðîí³÷íèé òîí- ðîô³ë³â ó õâîðèõ íà õðîí³÷íó ÂÅÁ-³íôåêö³þ çèë³ò (78,9 %), ñèíäðîì õðîí³÷íî¿ âòîìè (72,6 %) áóëà äîñòîâ³ðíî íèæ÷îþ, í³æ ó ãðóï³ êîíòðî- òà ïåðèôåðè÷íà ë³ìôàäåíîïàò³ÿ (71,1 %). ëþ òà ñòàíîâèëà 2,70  109/ë ïðîòè 4,21  109/ Àíàë³ç îòðèìàíèõ ðåçóëüòàò³â ëàáîðàòîð- ë (ð<0,05). Ïðè äîñë³äæåíí³ àáñîëþòíî¿ íèõ äîñë³äæåíü äîçâîëèâ âñòàíîâèòè ó õâî- ê³ëüêîñò³ åîçèíîô³ë³â òà áàçîô³ë³â ó õâîðèõ íà ðèõ íà ÕÂÅÁ äîñòîâ³ðíå ï³äâèùåííÿ ØÎÅ, õðîí³÷íó ÂÅÁ-³íôåêö³þ íå áóëî âèÿâëåíî ñòà- â³äíîñíîãî âì³ñòó ë³ìôîöèò³â òà ìîíîöèò³â, à òèñòè÷íî äîñòîâ³ðíèõ â³äì³ííîñòåé ó ïîð³âíÿíí³ òàêîæ çíèæåííÿ àáñîëþòíîãî òà â³äíîñíîãî ç ïîêàçíèêàìè êîíòðîëüíî¿ ãðóïè òà ¿õ ð³âåíü âì³ñòó íåéòðîô³ë³â ó ïîð³âíÿíí³ ç ïîêàçíèêà- ñêëàäàâ äëÿ åîçèíîô³ë³â – (0,13±0,04)  109/ë ìè êîíòðîëüíî¿ ãðóïè ïàö³ºíò³â, ùî ñâ³ä÷èòü ïðîòè (0,15±0,03)  109/ë (ð>0,05), äëÿ áàçî- ïðî çñóâ ëåéêîöèòàðíî¿ ôîðìóëè êðîâ³, õàðàê- ô³ë³â  (0,03±0,008)  109/ë ïðîòè (0,03±0,005) òåðíèé äëÿ â³ðóñíî¿ åò³îëî㳿 çàõâîðþâàííÿ  109/ë â³äïîâ³äíî (ð>0,05). àñî-ö³éîâàíîãî ç ÂÅÁ. ˳òåðàòóðà 1. Êðàñíèöêàÿ À. Ñ. Èììóíîëîãè÷åñêèå àñïåêòû õðîíè÷åñêîãî òîíçèëëèòà, àññîöèèðîâàííîãî ñ âèðóñ Ýïøòåéíà–Áàðð èíôåêöèåé / À. Ñ. Êðàñíèöêàÿ, Í. À. Áîðîâñêàÿ // Ôóíäàìåíòàëüíûå èñ- ñëåäîâàíèÿ. – 2012. – ¹ 4 (×. 2). – Ñ. 299–305. 2. Êðàìàðºâ Ñ. Î. Õðîí³÷í³ ôîðìè Åïøòåéíà–Áàðð â³ðóñíî¿ ³íôåêö³¿ ó ä³òåé: ñó÷àñí³ ï³äõîäè äî ä³àãíîñòèêè òà ë³êóâàííÿ / Ñ. Î. Êðàìàðºâ, Î. Â. Âèãîâñüêà // Ñîâðåìåííàÿ ïåäèàòðèÿ. – 2008. – ¹ 2 (19). – Ñ. 103–108. 3. Cytokine production peculiarities in different forms of Epstain–Barr virus infection / Ì. Popov, T. Lyadova, O. Volobuyeva [et al] // Georgian medical news. – 2017. – ¹ 2 (263). – C. 55–59. 4. Êë³í³÷í³ ôîðìè õðîí³÷íî¿ Åïøòåéíà–Áàðð â³ðóñíî¿ ³íôåêö³¿: ïèòàííÿ ñó÷àñíî¿ ä³àãíîñòèêè òà ë³êóâàííÿ / Î. Ê. Äóäà, Ð. Î. Êîëåñíèê, Ì. Â. Îêðóæíîâ, Â. Î. Áîéêî // Àêòóàëüíàÿ èíôåêòîëîãèÿ. – 2015. – ¹ 1 (6). – Ñ. 42–46. 5. Characterization and treatment of chronic active Epstein–Barr virus disease: a 28-year experience in the United States / I. Cohen Jeffrey, S. Jaffe Elaine, K. Dale Janet [et al.] // Blood. – 2011. – Vol. 117 (22). – P. 5835–5849. 6. Ñîðîê³íà Î. Ã. Äîñë³äæåííÿ ñòàíó êë³òèííîãî ³ìóí³òåòó ó õâîðèõ íà õðîí³÷íó ÂÅÁ-³íôåêö³þ / Î. Ã. Ñîðîê³íà // ²ìóíîëîã³ÿ òà àëåðãîëîã³ÿ: íàóêà ³ ïðàêòèêà. – 2018. – ¹ 3. – C. 65–70. 7. Ñîðîê³íà Î. Ã. Õàðàêòåðèñòèêà ïîêàçíèê³â ãóìîðàëüíîãî ³ìóí³òåòó ó õâîðèõ íà õðîí³÷íó ÂÅÁ- ³íôåêö³ºþ / Î. Ã. Ñîðîê³íà // Åêñïåðèìåíòàëüíà ³ êë³í³÷íà ìåäèöèíà. – 2018. – ¹ 2–3 (79–80). – C. 57–60. 8. Clinical and immunological criteria for adverse course of infectious mononucleosis in children / Ya. Kolesnik, Ò. Zharkova, Î. Rzhevskaya [et al] // Georgian medical news. – 2018. – ¹ 5 (278). – P. 132–138. References 1. Krasnickaya À.S., Borovskaya N.À. (2012). Immunologicheskie aspekti chronicheskogo tonzilita, associirovannogo s virus Epsteina–Barr infekciey [Immunological aspects of chronic tonsillitis associated with Epstein–Barr virus infection]. Fundametnalnie issledovaniya – Basic research, vol. 4 (part 2), pp. 299–305 [in Russian]. 2. Kramarev S.Î., Vigivskaya Î.V. (2008). Chronichni formi Epsteina–Barr virusniyi infekcii u ditey: suchasni pidhodi do diagnostiki ta likuvannya [Chronic forms of Epstein–Barr viral infections in children: modern way to diagnostics and treatment]. Sovremennaya pediatriya – Modern pediatrics, vol. 2 (19), pp. 103–108 [in Ukrainian]. 3. Popov Ì., Lyadova T., Volobuyeva O. et al. (2017). Cytokine production peculiarities in different forms of Epstain–Barr virus infection. Georgian medical news, ¹ 2 (263), pp. 55–59. 4. Duda Î.Ê., Kolesnik R.Î., Îkruzhnov Ì.V., Boyko V.Î. (2015). Clinichni formi chronichnoi Epsteina–Barr virusnoi infekcii: pitannya suchasnoi diagnistiki ta likuvannya [Clinical forms of chronic

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 12 ÒÅÎÐÅÒÈ×ÍÀ ² ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ÌÅÄÈÖÈÍÀ

Epstein–Barr virus infection: nutrition of the current diagnostics and treatment]. Aktualnaya infectologiya – Actual infectious diseases, ¹ 1 (6), pp. 42–46 [in Ukrainian]. 5. Cohen Jeffrey I., Jaffe Elaine S., Dale Janet K. et al. (2011). Characterization and treatment of chronic active Epstein–Barr virus disease: a 28-year experience in the United States. Blood, vol. 117 (22), pp. 5835–5849. 6. Sorokina O.G. (2018). Doslidzhennya stanu klitinnogo imunitetu u chvorih na chronichnu VEB- infekciyu [Prior to becoming a clerical immunity in ailing on chronic WEB-infection]. Imunologiya ta alergologiya: nauka ta praktika – Immunology and allergology: science and practice, ¹ 3, pp 65–70 [in Ukrainian]. 7. Sorokina O.G. (2018). Charakteristica pokaznikiv gumoralnogo imunitetu u chvorih na chronichnu VEB-infekciyu [Characteristics of indicators of humoral immunity in ailments on chronic WEB-infection]. Eksperimentalna i klinichna medicina – Experimental and clinical medicine, ¹ 2–3 (79–80), pp. 57–60 [in Ukrainian]. 8. Kolesnik Ya., Zharkova Ò., Rzhevskaya Î. et al. (2018). Clinical and immunological criteria for adverse course of infectious mononucleosis in children. Georgian medical news, ¹ 5 (278), pp. 132–138.

Î.Ã. Ñîðîêèíà, Í.Í. Ïîïîâ, Ò.È. Ëÿäîâà, Å.Â. Îãíèâåíêî, À.Í. Ñàââî ÎÑÎÁÅÍÍÎÑÒÈ ÒÅ×ÅÍÈß ÕÐÎÍÈ×ÅÑÊÎÉ ÝÏØÒÅÉÍÀ–ÁÀÐÐ ÂÈÐÓÑÍÎÉ ÈÍÔÅÊÖÈÈ Ïî ðåçóëüòàòàì ïðîâåäåííûõ èññëåäîâàíèé óñòàíîâëåíî, ÷òî ó áîëüíûõ õðîíè÷åñêîé ÂÝÁ-èí- ôåêöèåé ñðåäè êëèíè÷åñêèõ ïðîÿâëåíèé ÷àùå îòìå÷àëñÿ õðîíè÷åñêèé òîíçèëëèò, ñèíäðîì õðîíè- ÷åñêîé óñòàëîñòè è ïåðèôåðè÷åñêàÿ ëèìôàäåíîïàòèÿ. Ïðè ïðîâåäåíèè ëàáîðàòîðíûõ èññëåäîâàíèé óñòàíîâëåíî, ÷òî äëÿ áîëüíûõ õðîíè÷åñêîé ÂÝÁ-èíôåêöèåé õàðàêòåðíî äîñòîâåðíîå ïîâûøåíèå ÑÎÝ, ïîâûøåíèå îòíîñèòåëüíîãî ñîäåðæàíèÿ ëèìôîöèòîâ è ìîíîöèòîâ, à òàêæå ñíèæåíèå àáñî- ëþòíîãî è îòíîñèòåëüíîãî ñîäåðæàíèÿ íåéòðîôèëîâ ïî ñðàâíåíèþ ñ ïîêàçàòåëÿìè êîíòðîëüíîé ãðóï- ïû ïàöèåíòîâ, ÷òî ñâèäåòåëüñòâóåò î íàëè÷èå ñäâèãà ëåéêîöèòàðíîé ôîðìóëû êðîâè, õàðàêòåðíîãî äëÿ çàáîëåâàíèÿ âèðóñíîé ýòèîëîãèè àññîöèèðîâàííîãî ñ ÂÝÁ. Êëþ÷åâûå ñëîâà: õðîíè÷åñêàÿ ÂÝÁ-èíôåêöèÿ, òå÷åíèå çàáîëåâàíèÿ, êëèíèêî-ëàáîðàòîðíûå ïîêàçàòåëè, èììóííàÿ ñèñòåìà.

O.G. Sorokina, M.M. Popov, T.I. Liadova, O.V. Ognivenko, O.M. Savvo FEATURES OF THE COURSE OF CHRONIC EPSTEIN–BARR VIRAL INFECTION Today, about 85–95 % of the population is infected with EBV, therefore, the study of the nature of clinical and laboratory changes in patients with chronic EBV infection and the characteristics of the disease is an urgent problem of our time. According to the results of the study, it was found that in patients with chronic EBV infection, chronic tonsillitis, chronic fatigue syndrome and peripheral lymphadenopathy were more often observed among the clinical manifestations. In laboratory studies, it was found that patients with chronic EBV infection are characterized by a significant increase in ESR, an increase in the relative content of lymphocytes and monocytes, as well as a decrease in the absolute and relative content of neutrophils compared with the control group of patients, which indicates the presence of a shift in the leukocyte blood count, characteristic of the disease of viral etiology associated with EBV. Keywords: chronic EBV infection, course of the disease, clinical and laboratory parameters, immune system.

Íàä³éøëà äî ðåäàêö³¿ 23.10.2019

Êîíòàêòíà ³íôîðìàö³ÿ Ñîðîê³íà Îëüãà Ãåîð㳿âíà – êàíäèäàò ìåäè÷íèõ íàóê, äîöåíò êàôåäðè çàãàëüíî¿ òà êë³í³÷íî¿ ³ìóíîëî㳿 òà àëåðãîëî㳿 Õàðê³âñüêîãî íàö³îíàëüíîãî óí³âåðñèòåòó ³ìåí³ Â.Í. Êàðàç³íà. Àäðåñà: Óêðà¿íà, 61022, ì. Õàðê³â, ïë. Ñâîáîäè, 6. Òåë.: +380662634884 E-mail: [email protected] ORCID: http://orcid.org/0000-0001-6646-544X

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÒÅÎÐÅÒÈ×ÍÀ ² ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ÌÅÄÈÖÈÍÀ 13

Ïîïîâ Ìèêîëà Ìèêîëàéîâè÷ – äîêòîð ìåäè÷íèõ íàóê, ïðîôåñîð êàôåäðè êë³í³÷íî¿ ³ìóíî- ëî㳿 òà àëåðãîëî㳿 Õàðê³âñüêîãî íàö³îíàëüíîãî óí³âåðñèòåòó ³ìåí³ Â.Í. Êàðàç³íà. Àäðåñà: Óêðà¿íà, 61022, ì. Õàðê³â, ïë. Ñâîáîäè, 6. Òåë.: +380577075450 E-mail: [email protected] ORCID: http://orcid.org/0000-0002-5759-9654

Ëÿäîâà Òåòÿíà ²âàí³âíà – äîêòîð ìåäè÷íèõ íàóê, ïðîôåñîð, çàâ³äóâà÷êà êàôåäðè êë³í³÷íî¿ ³ìóíîëî㳿 òà àëåðãîëî㳿 Õàðê³âñüêîãî íàö³îíàëüíîãî óí³âåðñèòåòó ³ìåí³ Â.Í. Êàðàç³íà. Àäðåñà: Óêðà¿íà, 61022, ì. Õàðê³â, ïë. Ñâîáîäè, 6. Òåë.: +380577075450 E-mail: [email protected] ORCID: https://orcid.org/0000-0002-5892-2599

Îãí³âåíêî Îëåíà Âîëîäèìèð³âíà – êàíäèäàò ìåäè÷íèõ íàóê, äîöåíò êàôåäðè çàãàëüíî¿ òà êë³í³÷íî¿ ³ìóíîëî㳿 òà àëåðãîëî㳿 Õàðê³âñüêîãî íàö³îíàëüíîãî óí³âåðñèòåòó ³ìåí³ Â.Í. Êàðàç³íà. Àäðåñà: Óêðà¿íà, 61022, ì. Õàðê³â, ïë. Ñâîáîäè, 6. Òåë.: +380577075450 E-mail: [email protected] ORCID: https://orcid.org/0000-0003-3936-0305

Ñàââî Îëåêñ³é Ìèêîëàéîâè÷ – êàíäèäàò ìåäè÷íèõ íàóê, äîöåíò êàôåäðè çàãàëüíî¿ òà êë³í³÷íî¿ ³ìóíîëî㳿 òà àëåðãîëî㳿 Õàðê³âñüêîãî íàö³îíàëüíîãî óí³âåðñèòåòó ³ìåí³ Â.Í. Êàðàç³íà. Àäðåñà: Óêðà¿íà, 61022, ì. Õàðê³â, ïë. Ñâîáîäè, 6. Òåë.: +380577075450 E-mail: [email protected] ORCID: http://orcid.org/0000-0002-8584-3749

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 14 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

ПСИХІАТРІЯ, НАРКОЛОГІЯ ТА МЕДИЧНА ПСИХОЛОГІЯ https://doi.org/10.35339/ekm.2019.85.04.03 ÓÄÊ 616.45-001/.3-055.2: 616.895.8

Â.À. Ãåðàñèìóê1, Í.Ê. Àã³øåâà2 1³ííèöüêèé íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ì. Ì.². Ïèðîãîâà 2Õàðê³âñüêà ìåäè÷íà àêàäåì³ÿ ï³ñëÿäèïëîìíî¿ îñâ³òè ÐÎËÜ ² ̲ÑÖÅ ÑÒÐÅÑ-ÄÎËÀÞ×ί ÏÎÂÅIJÍÊÈ Â ÔÎÐÌÓÂÀÍͲ ÏÑÈÕÎËÎò×Íί ÄÅÇÀÄÀÏÒÀÖ²¯ Ó ÄÐÓÆÈÍ, ×ÎËβÊÈ ßÊÈÕ ÑÒÐÀÆÄÀÞÒÜ ÍÀ ØÈÇÎÔÐÅÍ²Þ Âèâ÷åíî ðîë³ òà ì³ñöÿ ñòðåñ-äîëàþ÷î¿ ïîâåä³íêè â ôîðìóâàíí³ ïñèõîëîã³÷íî¿ äåçàäàï- òàö³¿ ó äðóæèí, ÷îëîâ³êè ÿêèõ õâîð³þòü íà ïàðàíî¿äíó øèçîôðåí³þ (ÏØ). Íà áàç³ ÊÇ «Â³ííèöüêà îáëàñíà ïñèõîíåâðîëîã³÷íà ë³êàðíÿ ³ì. Î.². Þùåíêà» áóëî îáñòåæåíî 120 æ³íîê, ÷îëîâ³êè ÿêèõ õâîð³ëè íà ÏØ òà 50 æ³íîê, ÷îëîâ³êè ÿêèõ íå ìàëè ïñèõ³÷íèõ ³ ïîâåä³íêîâèõ ðîçëàä³â.  ðåçóëüòàò³ äîñë³äæåííÿ ï³äòâåðäæåíî ã³ïîòåçó ïðî íàÿâí³ñòü ó äðóæèí õâîðèõ íà ÏØ ÷îëîâ³ê³â îçíàê ïñèõ³÷íî¿, ñ³ìåéíî¿, ïñèõîñîö³àëüíî¿ òà îñîáè- ñò³ñíî-ïîâåä³íêîâî¿ äåçàäàïòàö³¿ ð³çíîãî íàïîâíåííÿ é âèðàæåíîñò³, êîíñòåëÿö³ÿ ÿêèõ ñêëàäຠêë³í³÷íó êàðòèíó ö³ë³ñíîãî ôåíîìåíó ïñèõîëîã³÷íî¿ äåçàäàïòàö³¿ æ³íîê, ùî ð³çíèòüñÿ çàëåæíî â³ä òðèâàëîñò³ õâîðîáè òà ìîæå áóòè ðåàë³çîâàíà ó äâîõ êë³í³êî- ïñèõîëîã³÷íèõ âàð³àíòàõ: ñóáäåçàäàïòèâíîìó ç÷åïëåíî-ñï³âçàëåæíîìó, ïðèòàìàííîìó äðóæèíàì ÷îëîâ³ê³â ç òðèâàë³ñòþ ïñèõ³÷íî¿ õâîðîáè äî 8 ðîê³â, òà äåçàäàïòèâíîìó ðî- ç’ºäíàíî-äèñòàíö³éíîìó, õàðàêòåðíîìó äëÿ äðóæèí ÷îëîâ³ê³â ç äàâí³ñòþ çàõâîðþâàííÿ â³ä 8 äî 15 ðîê³â.  õîä³ äîñë³äæåííÿ äîâåäåíî, ùî â ïðîöåñ³ ôîðìóâàííÿ òà äèíàì³ö³ ðîçâèòêó ³ ïðîãðåñóâàííÿ ïñèõîëîã³÷íî¿ äåçàäàïòàö³¿ ïðîâ³äíå ì³ñöå íàëåæèòü ñòðåñ- äîëàþ÷³é ïîâåä³íö³, ÿêà îäíîìîìåíòíî º ¿¿ äåñêðèïòîðîì ³ ïðåäèêòîðîì. Êëþ÷îâ³ ñëîâà: äðóæèíà ïñèõ³÷íîõâîðîãî, ïàðàíî¿äíà øèçîôðåí³ÿ, ïñèõîëîã³÷íà äåç- àäàïòàö³ÿ, ñòðåñ-äîëàþ÷à ïîâåä³íêà, êîï³íã-ñòðàòå㳿, êîï³íã-ðåñóðñè.

Âñòóï òèçàö³ÿ òà ³íøå, íåãàòèâíî ïîçíà÷àþòüñÿ íà Íàÿâí³ñòü ó ðîäèí³ õâîðîãî íà ïàðàíî¿äíó ïñèõîëîã³÷íîìó ñòàí³ óñ³õ ÷ëåí³â ì³êðîñîö³àëü- øèçîôðåí³þ (ÏØ) º íàäçâè÷àéíî ïîòóæíèì íîãî îòî÷åííÿ õâîðîãî [8, 9]. ñòðåñîâèì ôàêòîðîì, ÿêèé âïëèâຠíà ôóíê- Òðèâàëî ïðèñóòí³é ñòðåñ ïðèçâîäèòü äî ö³îíóâàííÿ óñ³õ ÷ëåí³â ñ³ìåéíî¿ ñèñòåìè [1]. ïîñòóïîâîãî âèñíàæåííÿ àäàïòàö³éíèõ ìå- Ðåçóëüòàòè ñó÷àñíèõ äîñë³äæåíü ñòâåðäæó- õàí³çì³â ³ ðåñóðñ³â îñîáèñòîñò³ ³, ÿê íàñë³äîê, þòü, ùî ðîäè÷³ õâîðèõ íà øèçîôðåí³þ ïîòåð- äî ïîðóøåííÿ ïñèõ³÷íî¿ àäàïòàö³¿, çðèâó ôóíê- ïàþòü â³ä åìîö³éíî¿ äåïðèâàö³¿ òà êîíôë³êò- ö³îíàëüíèõ ñèñòåì æèòòºä³ÿëüíîñò³ òà ðîçâèò- íîñò³, ôðóñòðàö³éíèõ ïåðåæèâàíü, íàñë³äêîì êó ïîðóøåíü ïñèõ³÷íî¿ òà ñîìàòè÷íî¿ ñôåð ÷îãî º àôåêòèâíà íåñò³éê³ñòü ç âèðàæåíèìè ð³çíîãî ñòóïåíÿ âèðàæåíîñò³ [10–12]. íåãàòèâíèìè åìîö³ÿìè ðîç÷àðóâàííÿ ³ ãí³âó [2– Ñòàíè ïñèõîëîã³÷íî¿ äåçàäàïòàö³¿ ó ðîäè÷³â 7]. Ñòðàõ, çáåíòåæåí³ñòü, íàäì³ðíå ïñèõîåìî- ïñèõ³÷íîõâîðèõ ïàö³ºíò³â îñòàíí³ äåñÿòü–ï’ÿò- ö³éíå íàâàíòàæåííÿ, ùî ôîðìóþòüñÿ ÿê ïà- íàäöÿòü ðîê³â ïðèâåðòàþòü óâàãó äîñë³äíèê³â. òîëîã³÷íà â³äïîâ³äü íà ïðîÿâè ïñèõ³÷íî¿ õâî- Òàê, íàóêîâöÿìè îïèñàí³ ïðîÿâè ïñèõ³÷íî¿ äåç- ðîáè ðîäè÷à, íèçüêà òîëåðàíòí³ñòü äî íåâè- àäàïòàö³¿ ó ðîäè÷³â õâîðèõ ç ïåðøèì åï³çîäîì çíà÷åíîñò³ ùîäî ïåðñïåêòèâ éîãî çàõâîðþâàí- ïñèõîçó [9], ñòâîðåí³ ïñèõîîñâ³òí³ êåð³âíèöòâà íÿ, â³äñóòí³ñòü ñîö³àëüíî¿ ï³äòðèìêè, ñòèãìà- äëÿ íèõ [4], âèâ÷åíà äèíàì³êà ðåñóðñó ñ³ì'¿,

© Â.À. Ãåðàñèìóê, Í.Ê. Àã³øåâà, 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 15

äå ïðîæèâຠõâîðèé íà ÏØ [5], äîñë³äæåí³ ðåïðåçåíòàòèâíèìè ç îñíîâíîþ ãðóïîþ îáñòå- îñîáëèâîñò³ ïñèõîëîã³÷íî¿ äåçàäàïòàö³¿ ó äðó- æóâàíèõ çà îñíîâíèìè ñîö³àëüíî-äåìîãðàô³- æèí òà ìàòåð³â ïàö³ºíò³â ³ç ð³çíîþ òðèâàë³ñòþ ÷íèìè õàðàêòåðèñòèêàìè òà ìàëè ÷îëîâ³ê³â çàõâîðþâàííÿ íà ÏØ [13], âèñâ³òëåíà ñïåöè- áåç êë³í³÷íî âèðàæåíèõ ðîçëàä³â ïñèõ³êè é ïî- ô³êà ïñèõîëîã³÷íîãî ðåàãóâàííÿ ÷îëîâ³ê³â, äðó- âåä³íêè. æèíè ÿêèõ õâîð³þòü íà ÏØ [14, 15]. Êîìïëåêñíå îáñòåæåííÿ âêëþ÷àëî çàñòî- Îäíàê, ïîçà óâàãîþ äîñë³äíèê³â çàëèøàº- ñóâàííÿ êë³í³êî-ïñèõîëîã³÷íîãî, ïñèõîä³àãíîñ- òüñÿ âàæëèâå ïèòàííÿ ùîäî ðîë³ ðåñóðñíîãî òè÷íîãî ³ ñòàòèñòè÷íîãî ìåòîä³â äîñë³äæåí- àðñåíàëó êîï³íã-ïîâåä³íêè â ïðîöåñ³ ôîðìóâàí- íÿ. Ïñèõîä³àãíîñòè÷íå äîñë³äæåííÿ ì³ñòèëî íÿ ïñèõîëîã³÷íî¿ äåçàäàïòàö³¿ ó ðîäè÷³â ïñèõ³- ê³ëüêà çì³ñòîâíî ð³çíèõ áëîê³â: ñòàí ïñèõîåìî- ÷íî õâîðèõ ïàö³ºíò³â. ̳æ òèì, çðîçóì³ëî, ùî ö³éíî¿ ñôåðè âèçíà÷àëè çà äîïîìîãîþ îïèòó- ñòðåñ-äîëàþ÷à êîï³íã-ïîâåä³íêà, ÿê àêòèâíà âàëüíèêà «Ð³âåíü íåâðîòèçàö³¿ ³ ïñèõîïàòèçàö³¿» ñòðàòåã³ÿ òà ³íäèâ³äóàëüíèé ñïîñ³á âçàºìî䳿 [17] òà êë³í³÷íèõ ðåéòèíãîâèõ øêàë òðèâîãè ñóá'ºêòà ç âàæêîþ æèòòºâîþ ñèòóàö³ºþ, º íàé- (HARS) ³ äåïðåñ³¿ (HDRS) Ì. Hamilton [18]; âàæëèâ³øîþ ôîðìîþ àäàïòàö³éíèõ ïðîöåñ³â ³ ð³âåíü ñòðåñîâîãî íàâàíòàæåííÿ òà ñòðåñ-ïðî- ðåàãóâàííÿ ³íäèâ³äà íà ñòðåñîâ³ ñèòóàö³¿, à òåêòèâíèõ ðåñóðñ³â îñîáèñòîñò³ – çà øêàëîþ â³äñóòí³ñòü ðåçóëüòàò³â ¿¿ ðåòåëüíîãî âèâ÷åí- ïñèõîñîö³àëüíîãî ñòðåñó Ë. гäåðà [19] ³ ìå- íÿ óíåìîæëèâëþº ñòâîðåííÿ ä³éñíî åôåêòèâ- òîäèêè âèçíà÷åííÿ ñòðåñîñò³éêîñò³ Ä. Õîëì- íèõ ïåðñîí³ô³êîâàíèõ ïñèõîêîðåêö³éíèõ ïðî- ñà–Ðàãå [20]; îñîáëèâîñò³ ôóíêö³îíóâàííÿ ãðàì, ñïðÿìîâàíèõ íà ïñèõîêîðåêö³þ ³ ïñèõî- ñ³ìåéíî¿ ñèñòåìè îö³íþâàëè çà ìåòîäèêîþ âè- ëîã³÷íó ï³äòðèìêó òàêîãî âàæëèâîãî ³ âåëèêî- çíà÷åííÿ ð³âíÿ ñ³ìåéíî¿ òðèâîãè «ÀÑÒ» Å. Åé- ãî êîíòèíãåíòó ñïîæèâà÷³â ìåäèêî-ïñèõîëîã³- äåì³ëëåðà, Â. Þñòèöê³ñà [21], ìåòîäèêîþ âè- ÷íî¿ äîïîìîãè, ÿê ðîäè÷³ õâîðèõ íà ÏØ. çíà÷åííÿ ñòàâëåííÿ ðîäè÷³â äî íàÿâíîñò³ ïñè- Ìåòà äîñë³äæåííÿ – âèâ÷èòè ðîëü ³ ì³ñöå õ³÷íîãî çàõâîðþâàííÿ ó ÷ëåíà ðîäèíè [22] òà ñòðåñ-äîëàþ÷î¿ ïîâåä³íêè â ôîðìóâàíí³ ïñè- øêàëîþ FACES-3, ñòâîðåíîþ Ä.Õ. Îëñîíîì, õîëîã³÷íî¿ äåçàäàïòàö³¿ ó äðóæèí, ÷îëîâ³êè Äæ. Ïîðòíåðîì, ². Ëàâ³ â 1985 ð. òà àäàïòîâà- ÿêèõ ñòðàæäàþòü íà ÏØ, çàëåæíî â³ä òðèâà- íîþ Ì. Ïåððå â 1986 ð., çàñòîñóâàííÿ ÿêî¿ äàëî ëîñò³ çàõâîðþâàííÿ, çàäëÿ âèçíà÷åííÿ ñïåöè- çìîãó îö³íèòè ð³âåíü ñ³ìåéíî¿ çãóðòîâàíîñò³ òà ô³÷íèõ ì³øåíåé çàõîä³â ìåäèêî-ïñèõîëîã³÷íî¿ ôëåêñèá³ëüíîñò³ ðîäèíè ÿê ñèñòåìè [23]; ð³- ï³äòðèìêè äëÿ äàíîãî êîíòèíãåíòó. âåíü ïñèõîñîö³àëüíîãî ôóíêö³îíóâàííÿ ä³àãíî- Ìàòåð³àë ³ ìåòîäè ñòóâàëè çà äîïîìîãîþ îïèòóâàëüíèêà ÂÎÎÇ Äëÿ äîñÿãíåííÿ ïîñòàâëåíî¿ ìåòè, ç äîòðè- «ßÆ-100» [24]; âèâ÷åííÿ îñîáëèâîñòåé êîï³íã- ìàííÿì ïðèíöèï³â á³îåòèêè ³ äåîíòîëî㳿, íà ïîâåä³íêè ïðîâîäèëè ç âèêîðèñòàííÿì îïèòó- áàç³ ÊÇ «Â³ííèöüêà îáëàñíà ïñèõîíåâðîëîã³÷- âàëüíèêà «Çàñîáè äîëàþ÷î¿ ïîâåä³íêè» À. Ëà- íà ë³êàðíÿ ³ì. Î.². Þùåíêà» áóëî îáñòåæåíî çàðóñà, Ñ. Ôîëêìàíà â àäàïòàö³¿ Ò. Êðþêîâî¿ 120 æ³íîê, â³êîì â³ä 22 äî 55 ðîê³â (ñåðåäí³é [25], ìåòîäèêà ä³àãíîñòèêè êîï³íã-ïîâåä³íêè â³ê – 38 ðîê³â), ÷îëîâ³êè ÿêèõ õâîð³ëè íà ÏØ. Å. Õåéìà [26] òà ìåòîäèêè À. Ìåãðàáÿíà ùîäî Êðèòåð³ÿìè âêëþ÷åííÿ áóëè íàÿâí³ñòü ó ÷î- âèçíà÷åííÿ ñòàíó êîìóí³êàòèâíèõ êîï³íã-ðå- ëîâ³êà ä³àãíîçó «Øèçîôðåí³ÿ, ïàðàíî¿äíà ôîð- ñóðñ³â îñîáèñòîñò³ [27]. Ñòàòèñòè÷íèé ìåòîä ìà» (F20.0 çã³äíî ç äîñë³äíèöüêî-ä³àãíîñòè÷- áóâ âèêîðèñòàíèé äëÿ îö³íêè ðîçá³æíîñòåé ì³æ íèìè êðèòåð³ÿìè ÌÊÕ-10), ïðîæèâàííÿ ç õâî- ãðóïàìè òà çàëåæíîñòåé ì³æ ôàêòîðàìè. ðèì â îäí³é îñåë³. Êðèòåð³ÿìè âèêëþ÷åííÿ áóëè Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ æ³íêè, ùî ìàëè ïñèõ³÷í³ àáî õðîí³÷í³ ³íâàë³äè-  ðåçóëüòàò³ äîñë³äæåííÿ áóëî ï³äòâåðä- çóþ÷³ ñîìàòè÷í³ çàõâîðþâàííÿ. Ó 65,8 % æ³íîê æåíî ïîïåðåäíþ ã³ïîòåçó ïðî íàÿâí³ñòü ó äðó- òðèâàë³ñòü õâîðîáè ÷îëîâ³êà áóëà â³ä îäíîãî æèí õâîðèõ íà ÏØ ÷îëîâ³ê³â îçíàê ïñèõ³÷íî¿, äî âîñüìè ðîê³â (âîíè ñêëàëè îñíîâíó ãðóïó ñ³ìåéíî¿, ïñèõîñîö³àëüíî¿ òà îñîáèñò³ñíî-ïî- äîñë³äæåííÿ 1, ÎÃ1), ó 34,2 % – â³ä âîñüìè âåä³íêîâî¿ äåçàäàïòàö³¿ ð³çíîãî íàïîâíåííÿ é äî ï'ÿòíàäöÿòè ðîê³â (âîíè ñêëàëè îñíîâíó ãðó- âèðàæåíîñò³, êîíñòåëÿö³ÿ ÿêèõ ñêëàäàëà êë³- ïó äîñë³äæåííÿ 2, ÎÃ2). Äàíèé ðîçïîä³ë çà òðè- í³÷íó êàðòèíó ö³ë³ñíîãî ôåíîìåíó ïñèõîëîã³÷- âàë³ñòþ õâîðîáè áóâ îáóìîâëåíèé îñîáëèâî- íî¿ äåçàäàïòàö³¿ æ³íîê, ùî ð³çíèëàñü çàëåæíî ñòÿìè ¿¿ ïåðåá³ãó, ùî, çà òâåðäæåííÿì ².ß. Ãó- â³ä òðèâàëîñò³ õâîðîáè (òàáë. 1). ðîâè÷à ç³ ñï³âàâòîðàìè [16], âïëèâàþòü íà ñòàí Òàê, ó á³ëüøîñò³ äðóæèí ÎÃ1 ð³âåíü íå- ñ³ìåéíîãî ãîìåîñòàçó.  ÿêîñò³ ïîð³âíÿëüíî¿ âðîòèçàö³¿ âèÿâèâñÿ ï³äâèùåíèì (39,2 %) àáî ãðóïè áóëî îáñòåæåíî 50 æ³íîê â³êîì â³ä 21 âèñîêèì (31,6 %), â òîé ÷àñ, ÿê ó ïèòîìî¿ âàãè äî 56 ðîê³â (ñåðåäí³é â³ê – 36 ðîê³â), ÿê³ áóëè æ³íîê ÎÃ2 – âèñîêèì (36,6 %) òà äóæå âèñî-

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 16 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

Òàáëèöÿ 1. Çì³ñòîâíà ³ ê³ëüê³ñíà õàðàêòåðèñòèêà îçíàê ïñèõîëîã³÷íî¿ äåçàäàïòàö³¿ ó äðóæèí õâîðèõ íà ÏØ ÷îëîâ³ê³â, çàëåæíî â³ä òðèâàëîñò³ çàõâîðþâàííÿ, %

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 17

êèì (34,1 %). Äåïðåñèâí³ ïðîÿâè íà ð³âí³ ìà- ë³êóâàííÿ ÷îëîâ³êà òà íàêîïè÷åííÿ, â ïåðøó ëîãî äåïðåñèâíîãî åï³çîäó áóëè õàðàêòåðí³ äëÿ ÷åðãó, åìîö³éíî¿ òà ïñèõîëîã³÷íî¿ âòîìè â³ä ïðî- 53,2 % îáñòåæåíèõ ÎÃ1, à ó 39,2 % çíà÷óù³ áëåì, ÿê³ âèíèêàëè ó çâ’ÿçêó ³ç çàõâîðþâàí- ïðîÿâè äåïðåñ³¿ áóëè â³äñóòí³. Ñåðåä æ³íîê íÿì ÷îëîâ³êà. Ðåçóëüòàòè àíàë³çó ð³âí³â ñ³ìåé- ÎÃ2, íàâïàêè, ïåðåâàæíà á³ëüø³ñòü ìàëè íî¿ çãóðòîâàíîñò³ é ñ³ìåéíî¿ ãíó÷êîñò³ òàêîæ êë³í³÷íî âèðàæåí³ ñèìïòîìè äåïðåñèâíîãî ïðîäåìîíñòðóâàëè íåãàòèâíó äèíàì³êó ôóíê- ðîçëàäó – 63,4 % íà ð³âí³ ìàëîãî äåïðåñèâíî- ö³îíóâàííÿ ñ³ìåéíî¿ ñèñòåìè îáñòåæåíèõ ãî åï³çîäó, 22,0 % – òÿæêîãî äåïðåñèâíîãî åï³- æ³íîê ç³ çá³ëüøåííÿì òðèâàëîñò³ çàõâîðþâàí- çîäó. Ïñèõî-ïàòîëîã³÷í³ ïðîÿâè òðèâîãè íà ð³âí³ íÿ ¿õ ÷îëîâ³ê³â. Òðåáà çàçíà÷èòè, ùî ñåðåä òðèâîæíîãî ñòàíó áóëè ïðèòàìàíí³ 51,9 % ðîäèí ç õâîðèì íà ÏØ ÷îëîâ³êîì ç 4 ìîæëè- æ³íîê ÎÃ1, à ó 41,8 % âîíè ìàëè ñóáêë³í³÷íèé âèõ ð³âí³â çãóðòîâàíîñò³ çóñòð³÷àëèñü ò³ëüêè ð³âåíü âèðàæåíîñò³.  òîé æå ÷àñ, ñåðåä äðó- äâà – äóæå íèçüêèé ðîç’ºäíàíèé àáî íàäì³ðíî æèí ÎÃ2 ïåðåâàæíà á³ëüø³ñòü (73,2 %) ïîòåð- âèñîêèé ç÷åïëåíèé. Ïðè öüîìó ñåðåä æ³íîê ïàëà â³ä íàÿâíîñò³ ñòàí³â ïàòîëîã³÷íî¿ òðèâî- ÎÃ1 á³ëüø³ñòü (67,1 %) çíàõîäèëèñü ó íàäì³ðíî ãè, à 14,6 % – â³ä ïîâíîö³ííîãî êë³í³÷íî îêðåñ- ç÷åïëåíèõ ñòîñóíêàõ, à ñåðåä ÎÃ2 – 92,7 % ëåíîãî òðèâîæíîãî ðîçëàäó. ʳëüê³ñòü îñ³á ç îáñòåæåíèõ, íàâïàêè, ìàëè äóæå íèçüêèé – âèñîêèì ð³âíåì ïñèõîñîö³àëüíîãî ñòðåñó áóëà ðîç’ºäíàíèé – ð³âåíü çãóðòîâàíîñò³. Öå ñâ³ä- á³ëüøîþ ñåðåä æ³íîê ÎÃ2 (75,6 % ïðîòè 55,7 % ÷èëî ïðî òå, ùî â ðîäèíàõ ÎÃ1 ó á³ëüøîñò³ ÎÃ1), à ïîì³ðíîãî – íàâïàêè, ÎÃ1 (34,2 % ïðî- âèïàäê³â ïàíóâàëè âèìîãè ó íàäì³ðí³é åìî- òè 24,4 % ÎÃ2); ñë³ä çàçíà÷èòè, ùî ñåðåä ÎÃ1 ö³éí³é áëèçüêîñò³ îäèí äî îäíîãî, ÷ëåíè öèõ ó 10,1 % äðóæèí ð³âåíü ïñèõîñîö³àëüíîãî ñòðå- ðîäèí íå ìàëè íàâèê³â ä³ÿòè îêðåìî îäèí â³ä ñó âèÿâèâñÿ íèçüêèì, à ñåðåä ÎÃ2 òàêèõ îñ³á îäíîãî, ¿õ ñòîñóíêè áóëè íèçüêî äèôåðåíö³éî- íå áóëî. Ñõîæà òåíäåíö³ÿ áóëà âèÿâëåíà ïðè âàíèìè, à ä³ÿëüí³ñòü ðîäèíè ìàëà æîðñòê³ âèâ÷åíí³ ñòðåñîñò³éêîñò³ îáñòåæåíèõ: íèçüêèé çîâí³øí³ ìåæ³ íà òë³ ñëàáêèõ âíóòð³øí³õ êîð- ¿¿ ð³âåíü áóâ ïðèòàìàííèé ïåðåâàæí³é á³ëü- äîí³â ì³æ ¿¿ ÷ëåíàìè òà áóëà ñôîêóñîâàíà íà øîñò³ æ³íîê ÎÃ2 (82,9 %) òà äîñòàòíüî âå- âèð³øåííÿ ñóòî âíóòð³øí³õ ïðîáëåì. Íà â³ä- ëèê³é, ïðîòå çíà÷óùå ìåíø³é ê³ëüêîñò³ äðóæèí ì³íó â³ä íèõ, â ÎÃ2 ÷ëåíè ðîäèí áóëè åìîö³é- ÎÃ1 (62,0 %), ó òîé ÷àñ, ÿê ìåæîâèì ð³âíåì íî äèñòàíö³éîâàíèìè, ìàëè íåóçãîäæåíó ïî- ñòðåñîñò³éêîñò³ õàðàêòåðèçóâàëàñü òðåòèíà âåä³íêó òà âåëèê³ òðóäíîù³ ïðè íàäàíí³ ï³ä- æ³íîê ÎÃ1 (30,4 %) ³ ìàéæå âäâ³÷³ ìåíøà ê³ëü- òðèìêè îäèí îäíîìó. Çà ïàðàìåòðîì ñ³ìåéíî¿ ê³ñòü æ³íîê ÎÃ2 (17,1 %). Òàêèì ÷èíîì, ìîæ- ôëåêñèá³ëüíîñò³ á³ëüøå ïîëîâèíè ðîäèí ÎÃ1 íà ñòâåðäæóâàòè ïðî íàÿâí³ñòü ó äðóæèí õâî- (58,2 %) ìàëè íàäì³ðíî âèñîêèé õàîòè÷íèé ¿¿ ðèõ íà ÏØ ÷îëîâ³ê³â îçíàê ïñèõ³÷íî¿ äåçàäàï- ð³âåíü, âíàñë³äîê ÷îãî â öèõ ðîäèíàõ áóâ â³ä- òàö³¿ ó âèãëÿä³ ï³äâèùåííÿ íåâðîòèçàö³¿, äåï- ñóòí³é ÷³òêèé ðîçïîä³ë ñ³ìåéíèõ ðîëåé, ïðèé- ðåñèâíèõ ³ òðèâîæíèõ ïðîÿâ³â, ÿê³ ïðîãðåñó- ìàëèñü ³ìïóëüñèâí³ ³ íåïðîäóìàí³ ð³øåííÿ, ùî þòü ç³ çá³ëüøåííÿì òðèâàëîñò³ çàõâîðþâàííÿ ïðèçâîäèëî äî íåïåðåäáà÷åíîñò³ ñ³ìåéíèõ ïðî- ÷îëîâ³êà. öåñ³â. Ñåðåä ðîäèí ÎÃ2 78,0 % ìàëè äóæå Ùå á³ëüø âèðàæåíà ïàòîëîã³÷íà äèíàì³- íèçüêèé ðèã³äíèé ð³âåíü ñ³ìåéíî¿ ãíó÷êîñò³, êà çàëåæíî â³ä òðèâàëîñò³ çàõâîðþâàííÿ ðî- âíàñë³äîê ÷îãî ö³ ðîäèíè íå ìàëè çìîãè àäåê- äè÷à íà ÏØ áóëà âèÿâëåíà ïðè àíàë³ç³ îçíàê âàòíî ðåàãóâàòè íà æèòòºâ³ çàäà÷³, ÿê³ ïîñòà- ñ³ìåéíî¿ äåçàäàïòàö³¿, âñòàíîâëåíèõ â îáñòå- âàëè ïåðåä íèìè. Ñë³ä ï³äêðåñëèòè, ùî ðîäè- æåíèõ æ³íîê. ßêùî ñåðåä ÎÃ1 âèñîêèé ð³âåíü íàì îáîõ ãðóï áóëè ïðèòàìàíí³ íàéá³ëüø íå- ñ³ìåéíî¿ òðèâîãè áóâ ïðèòàìàííèé 39,2 % îñ³á, ñïðèÿòëèâ³ ïîºäíàííÿ òèï³â çãóðòîâàíîñò³ ³ òî ñåðåä ÎÃ2 òàêèõ îñ³á âæå ñòàëî 82,9 %. ãíó÷êîñò³ – ç÷åïëåíèé ³ õàîòè÷íèé â ðîäèíàõ Çâåðòàëà íà ñåáå óâàãó çì³ñòîâíà òðàíñôîð- ÎÃ1 ³ ðîç’ºäíàíèé ðèã³äíèé – â ðîäèíàõ ÎÃ2. ìàö³ÿ ñêëàäîâèõ ñ³ìåéíî¿ òðèâîãè: ó äðóæèí Òðåáà çàçíà÷èòè, ùî çà îçíàêàìè ïñèõî- ÎÃ1 ïðåâàëþâàëè îçíàêè òðèâîãè (73,4 %) ³ ñîö³àëüíî¿ äåçàäàïòàö³¿ îáñòåæåí³ æ³íêè íå âèíè (68,4 %), à ó æ³íîê ÎÃ2 – íàïðóãè (87,8 %) ìàëè çíà÷óùèõ ðîçá³æíîñòåé çàëåæíî â³ä òðè- ³ òðèâîãè (82,9 %). Íåãàòèâíà äèíàì³êà ìàëà âàëîñò³ çàõâîðþâàííÿ ÷îëîâ³êà íà ÏØ. Íàé- ì³ñöå ³ äëÿ òèï³â ñòàâëåííÿ äî ïñèõ³÷íî¿ õâî- á³ëüø ïðîáëåìíèìè ñôåðàìè ôóíêö³îíóâàííÿ, ðîáè ðîäè÷à: ÿêùî ñåðåä îñ³á ÎÃ1 ïðåâàëþ- ÿê³ íàéá³ëüøå âïëèâàëè íà çíèæåííÿ ÿêîñò³ ¿õ âàëè äðàìàòèçóþ÷èé (64,6 %) ³ àäåêâàòíèé æèòòÿ, âèÿâèëèñü ïèòàííÿ, ïîâ’ÿçàí³ ç íàâêî- (27,8 %), òî ñåðåä ÎÃ2 – íåãàòèâíèé (61,0 %) ëèøí³ì ñåðåäîâèùåì, à ñàìå, áðàê ìåäè÷íî¿ ³ äðàìàòèçóþ÷èé (29,3 %) òèïè. Öå áóëî ñâ³ä- òà ñîö³àëüíî¿ äîïîìîãè, íèçüêèé ð³âåíü ÷åííÿì âòðàòè â³ðè ó ïîçèòèâíèé ðåçóëüòàò ô³íàíñîâèõ ðåñóðñ³â, áðàê â³ä÷óòòÿ ô³çè÷íî¿

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 18 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

áåçïåêè òà çàõèùåíîñò³, à òàêîæ ñôåðà ñîö- îáèðàëè äåñòðóêòèâí³ øëÿõè êàíàë³çàö³¿ ïñèõî- ³àëüíèõ â³äíîñèí, â ÿê³é íàéá³ëüø çíà÷óùèìè åìîö³éíî¿ íàïðóãè âíàñë³äîê â³ä÷óòò³â åìîö³é- áóëè ïèòàííÿ áðàêó ïðàêòè÷íî¿ ñîö³àëüíî¿ íî¿ â³äòîðãíóòîñò³ òà ñàìîòíîñò³ àáî ÷åðåç ïðàã- ï³äòðèìêè òà îñîáèñò³ñíèõ ñòîñóíê³â. íåííÿ ïåðåêëàñòè â³äïîâ³äàëüí³ñòü íà ³íøèõ, àáî Àíàë³ç îñîáëèâîñòåé ñòðåñ-äîëàþ÷î¿ ïî- ÷åðåç êîíôë³êòíó ïîâåä³íêó â³äíîñíî õâîðîãî âåä³íêè ó äðóæèí õâîðèõ íà ÏØ äàâ çìîãó òà, ïî÷àñòó, ìåäè÷íîãî ïåðñîíàëó, çàä³ÿíîãî ñòâåðäæóâàòè, ùî ¿õ êîï³íãîâèé ðåïåðòóàð áóâ ó ë³êóâàíí³ ÷îëîâ³êà ç ÏØ. äåôîðìîâàíèì, ïðè÷îìó ç³ çá³ëüøåííÿì òðè- Íåàäàïòèâí³ ñòðàòå㳿 ïîäîëàííÿ, õàðàê- âàëîñò³ õâîðîáè ÷îëîâ³êà â³äáóâàëèñü ÿê³ñí³ òåðí³ æ³íêàì ÎÃ2, ñêëàäàëè ³íø³ êîï³íãîâ³ çì³íè â àðñåíàë³ çàñòîñîâàíèõ íåêîíñòðóêòèâ- ïðîô³ë³, ïîð³âíÿíî ç ÎÃ1. Òàê, ìîçà¿÷íèé ðîç- íèõ êîï³íã³â. Ïðîâ³äíèìè êîï³íã-ñòðàòåã³ÿìè ïîä³ë íåêîíñòðóêòèâíèõ êîãí³òèâíèõ êîï³íã³â, ñåðåä á³ëüøå í³æ 70 % æ³íîê ÎÃ1 áóëè âòå÷à- ïðèçâîäèâ äî ôîðìóâàííÿ êîãí³òèâíî-áåçïî- óíèêíåííÿ (21,3 %), äèñòàíö³þâàííÿ (20,0 %), ðàäíîãî òèïó ðåàãóâàííÿ, ïðè ÿêîìó æ³íêè êîíôðîíòàö³ÿ (18,8 %) ³ ïîøóê ñîö³àëüíî¿ ÎÃ2 â³äìîâëÿëèñÿ âèçíàâàòè ñâîþ ðîëü ó ë³êó- ï³äòðèìêè (12,5 %). Ñåðåä á³ëüøå í³æ 80 % âàíí³ ÷îëîâ³êà òà ï³äòðèìö³ íàëåæíîãî ð³âíÿ äðóæèí ÎÃ2 çóñòð³÷àëèñü ñòðàòå㳿 âòå÷³– ñ³ìåéíîãî ôóíêö³îíóâàííÿ, ïðàãíó÷³ â³äñòîðî- óíèêíåííÿ (33,8 %), äèñòàíö³þâàííÿ (27,5 %) íèòèñÿ â³ä ïñèõîòðàâìóþ÷î¿ ñèòóàö³¿. Êîìï³- òà ïîøóêó ñîö³àëüíî¿ ï³äòðèìêè (20,0 %). Òà- ëÿö³ÿ íåêîíñòðóêòèâíèõ åìîö³éíèõ êîï³íã³â êèì ÷èíîì, ç³ çðîñòàííÿì òðèâàëîñò³ ïñèõ³÷- ïðèçâîäèëà äî âèíèêíåííÿ â íèõ åìîö³éíî-äåç- íî¿ õâîðîáè ÷îëîâ³êà, ê³ëüê³ñòü âèêîðèñòàííÿ àäàïòèâíîãî òèïó ðåàãóâàííÿ, ÿêèé õàðàêòå- êîï³íã-ñòðàòåã³é âòå÷³–óíèêíåííÿ òà äèñòàí- ðèçóâàâñÿ àìïë³òóäîþ íåãàòèâíèõ åìîö³éíèõ ö³þâàííÿ çá³ëüøóâàëàñü, à êîíôðîíòàö³ÿ çàì³- ðåàêö³é â³ä äåìîíñòðàö³¿ àêòèâíî¿ ä³ÿëüíîñò³ ùóâàëàñü ïîøóêîì ñîö³àëüíî¿ ï³äòðèìêè, ïî- ç âèðàæåíèìè íåãàòèâíèìè åìîö³éíèìè ïåðå- òðåáà â ÿêî¿ çðîñòàëà ç ÷àñîì. æèâàííÿìè, äî ïîâíî¿ áåçä³ÿëüíîñò³ òà ñïîí- Òðåáà çàçíà÷èòè, ùî äðóæèíè õâîðèõ íà òàííèì áàæàííÿì óñóíóòèñÿ â³ä âèð³øåííÿ ÏØ, íåçàëåæíî â³ä òðèâàëîñò³ çàõâîðþâàííÿ, áóäü-ÿêèõ ïðîáëåì. Ìîçà¿êà íåêîíñòðóêòèâ- íå âèêîðèñòîâóâàëè àäàïòèâíèõ êîï³íã-ñòðà- íèõ ïîâåä³íêîâèõ êîï³íã³â ôîðìóâàëà ïîâåä³í- òåã³é áóäü-ÿêî¿ ìîäàëüíîñò³. Îäíàê, ñåðåä ÎÃ1 êîâî-óíèêàþ÷èé òèï ðåàãóâàííÿ, ïðè ÿêîìó á³ëüø í³æ òðåòèíà âèêîðèñòîâóâàëà â³äíîñíî æ³íêè â³ä÷óâàëè îáðàçó íà íåñïðàâåäëèâ³ñòü àäàïòèâí³ êîãí³òèâí³ (41,8 %), åìîö³éí³ (39,2 %) âëàñíî¿ äîë³, ãí³â òà àãðåñ³þ äî îòî÷óþ÷èõ, òà ïîâåä³íêîâ³ (36,7 %) êîï³íãè, â òîé ÷àñ ÿê ïîêëàäàþ÷è íà íèõ â³äïîâ³äàëüí³ñòü çà ïîðó- ñåðåä äðóæèí ÎÃ2 ïåðåâàæíà á³ëüø³ñòü îñ³á øåííÿ çäîðîâ’ÿ ÷îëîâ³êà òà òðàíñôîðìàö³þ êîðèñòóâàëàñü âèêëþ÷íî íåàäàïòèâíèìè ðîäèííèõ ñòîñóíê³â, ùî ñóïðîâîäæóâàëîñü ïðî- êîãí³òèâíèìè (92,7 %), åìîö³éíèìè (87,8 %) é ÿâàìè áàéäóæîñò³ òà ³ãíîðóâàííÿì ïðîáëåìè. ïîâåä³íêîâèìè (90,2 %) êîï³íãîâèìè ñòðàòå- Âèâ÷åííÿ ñòàíó êîï³íãîâî¿ ðåñóðñíî¿ áàçè ã³ÿìè. âèñâ³òëèëî ïðîöåñ âèñíàæåííÿ êîìóí³êàòèâíèõ Äëÿ æ³íîê ÎÃ1 õàðàêòåðíîþ âèÿâèëàñü êîï³íã-ðåñóðñ³â ç³ çá³ëüøåííÿì òðèâàëîñò³ çà- êîìá³íàö³ÿ íåàäàïòèâíèõ êîãí³òèâíèõ êîï³íã³â, õâîðþâàííÿ ÷îëîâ³êà íà ÏØ. Ç îäíîãî áîêó, ÿêà áóëà âèçíà÷åíà ÿê êîãí³òèâíî-íåêðèòè÷íèé íåäîñòàòí³ñòü åìïàòè÷íèõ ³ àô³ë³àòèâíèõ òåí- òèï ðåàãóâàííÿ, ïðè ÿêîìó âîíè â³äìîâëÿëèñü äåíö³é ó æ³íîê ÎÃ1 òðàíñôîðìóâàëîñü ó âè- ïðèéíÿòè ðåàëüíèé ä³àãíîç àáî ïðîãíîç çàõâî- ðàæåíèé ¿õ áðàê ó æ³íîê ÎÃ2, à ç ³íøîãî – ï³ä- ðþâàííÿ ÷îëîâ³êà òà ïîäàëüøó íåãàòèâíó âèùåíà ñåíñèòèâí³ñòü äî çíåõòóâàííÿ, ïðèòà- òðàíñôîðìàö³þ ¿õ æèòòºâî¿ ïåðñïåêòèâè, ùî ìàííà îñîáàì ÎÃ1 ñòàâàëà äóæå âèñîêîþ ó ïðîÿâëÿëîñü àáî ó íåñê³í÷åííîìó ïîøóêó íî- æ³íîê ÎÃ2. Öå íàâîäèëî íà äóìêó ïðî â³äñóò- âèõ ë³êàð³â òà ìåòîä³â ë³êóâàííÿ, àáî ðîç÷à- í³ñòü ñòðåñ-ïðîòåêòèâíèõ ìîæëèâîñòåé îá- ðóâàííÿì ó ìåäè÷íèõ âòðó÷àííÿõ òà çíåâ³ðîþ ñòåæåíèõ òà ðîçòëóìà÷óâàëî âñòàíîâëåí³ çà- ó ïåðñïåêòèâó íîðìàë³çàö³¿ ñ³ìåéíîãî æèòòÿ. êîíîì³ðíîñò³ ùîäî íåãàòèâíî¿ äèíàì³êè ñòðåñ- Îñîáëèâîñò³ åìîö³éíîãî êîï³íãó ÎÃ1 âèä³ëåíî äîëàþ÷î¿ ïîâåä³íêè ó á³ê íåêîíñòðóêòèâíèõ ³ ÿê åìîö³éíî-íåêîìïåòåíòíèé òèï ðåàãóâàííÿ, íåàäàïòèâíèõ êîï³íã-ñòðàòåã³é, òà ïàòîëîã³÷- ùî ïðîÿâëÿëîñÿ àáî ó ñïðîáàõ ã³ïåðîï³êè ÷î- íî¿ òðàíñôîðìàö³¿ òèï³â êîï³íãîâî¿ â³äïîâ³ä³ ëîâ³êà, àáî ðîçäðàòóâàííÿì â³äíîñíî íüîãî. â óñ³õ ¿¿ ìîäàëüíîñòÿõ, à ñàìå, êîãí³òèâíî-íå- Íåàäàïòèâí³ ïîâåä³íêîâ³ ñòðàòå㳿 ïîäîëàííÿ, êðèòè÷íîãî òèïó, õàðàêòåðíîãî æ³íêàì ÎÃ1, âñòàíîâëåí³ ó äàíîãî êîíòèíãåíòó, áóëè òèïî- ó êîãí³òèâíî-áåçïîðàäíèé, ïðèòàìàííèé ÎÃ2; ëîã³çîâàí³ ÿê íåñàìîñò³éíî-êîíôë³êòíèé òèï åìîö³éíî-íåêîìïåòåíòíîãî, âñòàíîâëåíîãî ïîâåä³íêîâîãî ðåàãóâàííÿ, ïðè ÿêîìó æ³íêè â ÎÃ1, äî åìîö³éíî-äåçàäàïòèâíîãî, âèÿâëå-

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 19

íîãî â ÎÃ2; íåñàìîñò³éíî-êîíôë³êòíîãî, âèÿâ- íîãî äî äóæå âàãîìîãî) áóëè âñòàíîâëåí³ äëÿ ëåíîãî â ÎÃ1, äî ïîâåä³íêîâî-óíèêàþ÷îãî óñ³õ ïîêàçíèê³â êîï³íã-ïîâåä³íêè òà óñ³õ âèä³- ó æ³íîê ÎÃ2. Öå, â ñâîþ ÷åðãó, ïðèçâîäèëî äî ëåíèõ îçíàê ïñèõ³÷íî¿ äåçàäàïòàö³¿. ïîòÿæ÷åííÿ äåçàäàïòèâíèõ ïðîÿâ³â ó ïñèõ³÷- Ñåðåä ïðîâ³äíèõ ïðîÿâ³â ñ³ìåéíî¿ äåçàäàï- í³é, ñ³ìåéí³é ³ ïñèõîñîö³àëüí³é ñôåðàõ îáñòå- òàö³¿ íàéá³ëüø âàãîìîãî âïëèâó ïîêàçíèê³â æåíèõ æ³íîê. ñòðåñ-äîëàþ÷î¿ ïîâåä³íêè ä³ñòàëè îçíàêè äå- Äëÿ ³äåíòèô³êàö³¿ ðîë³ ³ ì³ñöÿ ñòðåñ-äîëà- ôîðìàö³¿ ñ³ìåéíî¿ çãóðòîâàíîñò³, ÿê³ íàéá³ëüø þ÷î¿ ïîâåä³íêè â ôîðìóâàíí³ ïñèõîëîã³÷íî¿ ñèëüíî çàëåæàëè â³ä âèðàæåíîñò³ äèñòàíö³þ- äåçàäàïòàö³¿ ó äðóæèí, ÷îëîâ³êè ÿêèõ ñòðàæ- âàííÿ (ïðÿìèé çâ’ÿçîê) òà åìïàò³¿ (çâîðîòíèé äàþòü íà ÏØ, çàëåæíî â³ä òðèâàëîñò³ çàõâî- çâ’ÿçîê), óñ³ ³íø³ ïàðàìåòðè êîï³íã-ïîâåä³íêè ðþâàííÿ, áóëè äîñë³äæåí³ âçàºìîçâ’ÿçêè ì³æ (îêð³ì êîíôðîíòàö³¿), íàäàâàëè íà ñòàí ñ³ìåéíî¿ âèðàæåí³ñòþ êîï³íã³â, ùî íàéá³ëüøå çóñòð³÷à- çãóðòîâàíîñò³ âàãîìîãî âïëèâó (âòå÷à–óíèê- ëèñÿ ñåðåä îáñòåæåíèõ, ñòàíîì ¿õ êîï³íã-ðå- íåííÿ ³ ñåíñèòèâí³ñòü äî çíåõòóâàííÿ – ïðÿ- ñóðñíî¿ áàçè òà ³íòåíñèâí³ñòþ îçíàê äåçàäàï- ìèé, àôô³ë³àö³öÿ – çâîðîòíèé). Íà ³íòåíñèâí³ñòü Òàáëèöÿ 2. Ðåçóëüòàòè àíàë³çó íàÿâíîñò³ òà ³íòåíñèâíîñò³ âçàºìîçâ’ÿçê³â ì³æ ïîêàçíèêàìè ñòðåñ-äîëàþ÷î¿ ïîâåä³íêè ³ îçíàêàìè ïñèõîëîã³÷íî¿ äåçàäàïòàö³¿ äðóæèí õâîðèõ íà ÏØ ÷îëîâ³ê³â

òàö³¿ â ïñèõ³÷í³é, ñ³ìåéí³é ³ ïñèõîñîö³àëüí³é ñ³ìåéíî¿ òðèâîãè âàãîìèé ïðÿìèé âïëèâ ìàëà ñôåðàõ (òàáë. 2). Ïðè öüîìó ñòóï³íü çâ’ÿçêó âèðàæåí³ñòü êîï³íãó âòå÷³–óíèêíåííÿ, à ñòðà- ì³æ äîñë³äæåíèìè çì³ííèìè âèçíà÷àëè çà íà- òåã³ÿ êîíôðîíòàö³¿ òà âèðàæåí³ñòü àôô³ë³àòèâ- ñòóïíîþ ãðàäàö³ºþ: «0» – çâ’ÿçîê íå âñòàíîâ- íèõ òåíäåíö³é íå âïëèâàëè íà ñòàí äàíîãî ïî- ëåíî; «+» – 0,60–0,69 – â³ðîã³äíèé ïðÿìèé êàçíèêà. âïëèâ; «++» – 0,70–0,79 – âàãîìèé ïðÿìèé гâåíü ÿêîñò³ æèòòÿ âèÿâèâñÿ ïðÿìî ïî- âïëèâ; «+++» – 0,80 – äóæå âàãîìèé ïðÿìèé â’ÿçàíèì ç âèðàæåí³ñòþ åìïàòè÷íèõ ³ àô³ë³à- âïëèâ; «-» – -0,60–0,69 – â³ðîã³äíèé çâîðîòíèé òèâíèõ òåíäåíö³é, ³ çâîðîòíî ïîâ’ÿçàíèì ç³ âïëèâ; «- -» – -0,70–0,79 – âàãîìèé çâîðîòíèé ñòðàòå㳺þ âòå÷³–óíèêíåííÿ íà ð³âí³ âàãîìî- âïëèâ; «- - -» – -0,80 – äóæå âàãîìèé çâîðîò- ãî âïëèâó. íèé âïëèâ. Òàêèì ÷èíîì, ìîæíà âïåâíåíî ñòâåðäæó-  ðåçóëüòàò³ àíàë³çó ç’ÿñîâàíî, ùî ñåðåä âàòè, ùî íàÿâí³ñòü ³ âèðàæåí³ñòü äåçàäàïòèâ- ñèìïòîì³â ïñèõ³÷íî¿ äåçàäàïòàö³¿ íàéñèëüí³øå íèõ îçíàê â ïñèõ³÷í³é, ñ³ìåéí³é ³ ïñèõîñîö³àëüí³é â³ä ïîêàçíèê³â ñòðåñ-äîëàþ÷î¿ ïîâåä³íêè çà- ñôåð³ äðóæèí õâîðèõ íà ÏØ ÷îëîâ³ê³â, ò³ñíî ëåæèòü ð³âåíü ïñèõîñîö³àëüíîãî ñòðåñó, ùî âè- ïîâ’ÿçàí³ ç³ ñòàíîì ¿õ êîï³íãîâîãî ðåïåðòóàðó ïðîáîâóþòü îáñòåæåí³ (äëÿ íåêîíñòðóêòèâíèõ ³ êîï³íãîâî¿ ðåñóðñíî¿ áàçè. Öå îá´ðóíòîâóº êîï³íã³â âòå÷³–óíèêíåííÿ, äèñòàíö³þâàííÿ êîí- êëþ÷îâó ðîëü ³ ïðîâ³äíå ì³ñöå ñòðåñ-äîëàþ- ôðîíòàö³¿, à òàêîæ ñåíñèòèâí³ñòþ äî çíåõòó- ÷î¿ ïîâåä³íêè ó ôîðìóâàíí³ ïñèõîëîã³÷íî¿ äå- âàííÿ âèÿâëåíî ïðÿìèé, à äëÿ ðåñóðñ³â åìïàò³¿ çàäàïòàö³¿ ó çàçíà÷åíîãî êîíòèíãåíòó. òà àô³ë³àö³¿ – çâîðîòíèé äóæå âàãîìèé êîðåëÿö³é- Óçàãàëüíåííÿ îòðèìàíèõ äàíèõ äîçâîëèëî íèé çâ’ÿçîê), à òàêîæ ð³âåíü íåâðîòèçàö³¿ (äóæå ñòâîðèòè ìîäåëü ôîðìóâàííÿ ïñèõîëîã³÷íî¿ äåç- âàãîìèé ïðÿìèé çâ’ÿçîê âñòàíîâëåíî äëÿ àäàïòàö³¿ ó äðóæèí ïñèõ³÷íîõâîðèõ ÷îëîâ³ê³â ñòðàòå㳿 âòå÷³–óíèêíåííÿ òà ñåíñèòèâíîñò³ äî ç ð³çíîþ òðèâàë³ñòþ çàõâîðþâàííÿ (ðèñóíîê). çíåõòóâàííÿ, âàãîìèé çâ’ÿçîê – ñòðàòå㳿 äè-  ðåçóëüòàò³ äîñë³äæåííÿ âñòàíîâëåíî äâà ñòàíö³þâàííÿ (ïðÿìèé), ðåñóðñ³â åìïàò³¿ (çâî- êë³í³êî-ïñèõîëîã³÷íèõ âàð³àíòè äåçàäàïòàö³¿ ðîòí³) ³ àô³ë³àö³¿ (ïðÿìèé)). Òðåáà çàçíà÷èòè, äðóæèí ÷îëîâ³ê³â, õâîðèõ íà ÏØ. Ó æ³íîê, ùî êîðåëÿö³éí³ çâ’ÿçêè ð³çíî¿ ñèëè (â³ä â³ðîã³ä- çàõâîðþâàííÿ ÷îëîâ³ê³â ÿêèõ ñòàíîâèëî â³ä

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 20 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

Ìîäåëü ôîðìóâàííÿ ïñèõîëîã³÷íî¿ äåçàäàïòàö³¿ ó äðóæèí ÷îëîâ³ê³â, õâîðèõ íà ÏØ, ç ð³çíîþ òðèâàë³ñòþ çàõâîðþâàííÿ îäíîãî äî âîñüìè ðîê³â, ò³ºþ ÷è ³íøîþ ì³ðîþ ö³ë³ñíîãî ôåíîìåíó ïñèõîëîã³÷íî¿ äåçàäàïòàö³¿ âèðàæåíîñò³ çóñòð³÷àëèñü ïðîÿâè ñóáäåç- æ³íîê, ùî ð³çíèòüñÿ çàëåæíî â³ä òðèâàëîñò³ àäàïòèâíîãî ç÷åïëåíî-ñï³âçàëåæíîãî âà- õâîðîáè, òà ìîæå áóòè ðåàë³çîâàíà ó äâîõ ð³àíòó, ùî õàðàêòåðèçóâàâñÿ äðàìàòèçàö³ºþ êë³í³êî-ïñèõîëîã³÷íèõ âàð³àíòàõ. ñèòóàö³¿, íàäì³ðíîþ åìîö³éíîþ çàëó÷åí³ñòþ â Ñóáäåçàäàïòèâíèé ç÷åïëåíî-ñï³âçàëåæíèé ïðîáëåìó, íåêðèòè÷í³ñòþ äî âëàñíî¿ ïîâåä³íêè, âàð³àíò, äëÿ ÿêîãî õàðàêòåðíà ÷àñòêîâà ïñèõ³- îáóìîâëåíî¿ ñèíäðîìîì ñï³âçàëåæíîñò³ òà íå- ÷íà äåçàäàïòàö³ÿ, äåç³íòåãðàö³ÿ ñ³ìåéíî¿ ñèñ- àäåêâàòíèì ñòðåñ-ïîäîëàííÿì. Äðóæèíàì ÷î- òåìè, ïðîáëåìè ïñèõîñîö³àëüíîãî ôóíêö³îíó- ëîâ³ê³â ç òðèâàë³ñòþ çàõâîðþâàííÿ íà ÏØ â³ä âàííÿ ç³ çíèæåííÿì ÿêîñò³ æèòòÿ òà ñïåöèô³÷í³ âîñüìè äî ï’ÿòíàäöÿòè ðîê³â áóëè ïðèòàìàíí³ ïðîÿâè îñîáèñò³ñíî-ïîâåä³íêîâî¿ äåçàäàïòàö³¿, ïðîÿâè äåçàäàïòèâíîãî ðîç’ºäíàíî-äèñòàí- ïðèòàìàííèé äðóæèíàì ÷îëîâ³ê³â ç òðèâàë³ñòþ ö³éíîãî âàð³àíòà, ïðîâ³äíèìè ñèìïòîìàìè ÿêî- ïñèõ³÷íî¿ õâîðîáè äî 8 ðîê³â. ãî áóëè ðîçäðàòóâàííÿ, âòîìà, áàéäóæ³ñòü ³ Äåçàäàïòèâíèé ðîç’ºäíàíî-äèñòàíö³éíèé óíèêàííÿ ïðîáëåì, ïîâ’ÿçàíèõ ç õâîðîáîþ ÷î- âàð³àíò ÿâëÿº ñîáîþ êîíñòåëÿö³þ ñèìïòîì³â ëîâ³êà, ÿê³, íà òë³ âèñíàæåííÿ êîï³íã-ðåñóðñ³â ñôîðìîâàíî¿ ïñèõ³÷íî¿ äåçàäàïòàö³¿, ïàòîëîã³- òà ïàòîëîã³÷íî¿ òðàíñôîðìàö³¿ íåêîíñòðóêòèâ- ÷íî¿ äåôîðìàö³¿ ñ³ìåéíî¿ ñèñòåìè, ïîðóøåííÿ íèõ ³ íåàäàïòèâíèõ êîï³íã³â, ïîòåö³þâàëè ïî- ïñèõîñîö³àëüíîãî ôóíêö³îíóâàííÿ, íèçüêî¿ äàëüøå ïðîãðåñóâàííÿ äåçàäàïòèâíîãî ñòàíó. ÿêîñò³ æèòòÿ é ñâîºð³äíèõ ïðîÿâ³â îñîáèñò³ñ- Âèñíîâêè íî-ïîâåä³íêîâî¿ äåçàäàïòàö³¿, âèíèêຠâ ðåçóëü-  ðåçóëüòàò³ äîñë³äæåííÿ áóëî ï³äòâåðä- òàò³ ïðîãðå䳺íòíîãî ðîçâèòêó ïîïåðåäíüîãî æåíî ã³ïîòåçó ïðî íàÿâí³ñòü ó äðóæèí õâîðèõ ñóáäåçàäàïòèâíîãî âàð³àíòó òà ïîäàëüøî¿ íà ÏØ ÷îëîâ³ê³â îçíàê ïñèõ³÷íî¿, ñ³ìåéíî¿, íåãàòèâíî¿ òðàíñôîðìàö³¿ êëþ÷îâèõ îçíàê äå- ïñèõîñîö³àëüíî¿ òà îñîáèñò³ñíî-ïîâåä³íêîâî¿ çàäàïòàö³¿, ÿêà ä³àãíîñòóºòüñÿ ó äðóæèí ÷î- äåçàäàïòàö³¿ ð³çíîãî íàïîâíåííÿ é âèðàæåíîñò³, ëîâ³ê³â ç äàâí³ñòþ çàõâîðþâàííÿ â³ä 8 äî êîíñòåëÿö³ÿ ÿêèõ ñêëàäຠêë³í³÷íó êàðòèíó 15 ðîê³â.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 21

Ó õîä³ äîñë³äæåííÿ äîâåäåíî, ùî â ïðî- ñîãåííèõ ÷èííèê³â, ùî âèíèêàþòü ÷åðåç õâî- öåñ³ ôîðìóâàííÿ òà äèíàì³ö³ ðîçâèòêó ³ ïðî- ðîáó ÷îëîâ³êà íà ÏØ, ùî îáóìîâëþº òðàíñ- ãðåñóâàííÿ ïñèõîëîã³÷íî¿ äåçàäàïòàö³¿ ïðî- ôîðìàö³þ âèõ³äíîãî äåô³öèòó ¿¿ íà ïî÷àòêîâîìó â³äíå ì³ñöå íàëåæèòü ñòðåñ-äîëàþ÷³é ïîâå- åòàï³ ðîçâèòêó äåçàäàïòàö³¿ äî çíà÷íîãî áðàêó ä³íö³, ÿêà îäíîìîìåíòíî º ¿¿ äåñêðèïòîðîì ³ òà áåçóìîâíîãî âèñíàæåííÿ â ïðîöåñ³ ðîçâèòêó ïðåäèêòîðîì. Äåñêðèïòèâíà ðîëü ïðèïàäຠíà äåçàäàïòèâíîãî ïðîöåñó. àêòóàëüíèé êîï³íãîâèé ðåïåðòóàð îñîáèñòîñò³, Îòðèìàí³ äàí³ ïîâèíí³ áóòè âðàõîâàí³ ïðè ïðåäèêòîðíà – íà äèñêîíãðóåíòí³ñòü ñòàíó ðîçðîáö³ ïåðñîí³ô³êîâàíèõ çàõîä³â ïñèõîëîã³÷íî¿ êîï³íã-ðåñóðñíî¿ áàçè òà ³íòåíñèâíîñò³ ñòðå- ï³äòðèìêè äëÿ äðóæèí ÷îëîâ³ê³â, õâîðèõ íà ÏØ. ˳òåðàòóðà 1. Kageyamaa Ì. Psychological Distress and Violence Towards Parents of Patients with Schizophrenia / M. Kageyamaa, P. Solomonb, K. Yokoyamac // Archives of Psychiatric Nursing. – 2015. – ¹ 2. – Ð. 42–46. 2. The cost of caring: the relative with schizophrenia / E. Papastavrou, A. Charalambous, H. Tsanari, G. Karayiannis // Scandinavian Journal of Caring Sciences. – 2010. – Vol. 24. – P. 817–823. 3. Ìàðêîâà Ì. Â. Îñîáëèâîñò³ ñ³ìåéíî¿ âçàºìî䳿 òà àäàïòàö³¿ â ðîäèí³ ó ïàö³ºíò³â, õâîðèõ íà øèçîôðåí³þ, ç òî÷êè çîðó ïñèõîòåðàïåâòè÷íîãî ïîòåíö³àëó ñ³ì'¿ / Ì. Â. Ìàðêîâà, Â. Î. ijõòÿð // Óêðà¿íñüêèé â³ñíèê ïñèõîíåâðîëî㳿. – 2010. – Ò. 13, âèï. 3 (64). – Ñ. 133–134. 4. Æèçíü ñ øèçîôðåíèåé. ×òî äåëàòü?: êðàòêîå ðóêîâîäñòâî äëÿ ïàöèåíòîâ, ñòðàäàþùèõ øèçî- ôðåíèåé è èõ ðîäñòâåííèêîâ / [Í. À. Ìàðóòà, À. Ì. Êîæèíà, Â. È. Êîðîñòèé, Ë. Ì. Ãàé÷óê]. – Õàðüêîâ, 2011. – 25 ñ. 5. Ïøóê Í. Ã. Äèíàì³êà ðåñóðñó ñ³ì'¿, äå ïðîæèâຠõâîðèé íà ïàðàíî¿äíó øèçîôðåí³þ / Í. Ã. Ïøóê, Ì. Â. Ìàðêîâà, ª. ß. Ïøóê // Óêðà¿íñüêèé â³ñíèê ïñèõîíåâðîëî㳿. – 2012. – Ò. 20, âèï. 3 (72). – Ñ. 215. 6. Shamsaei F. Burden on Family Caregivers Caring for Patients with Schizophrenia / F. Shamsaei, F. Cheraghi, S. Bashirian // Iranian Journal of Psychiatry. – 2015. – Vol. 10 (4). – P. 239–245. 7. Effects of Psychoeducation on Stigma in Family Caregivers of Patients with Schizophrenia: A Clinical Trial / S. Vaghee, A. Salarhaji, N. Asgharipour, H. Chamanzari // Journal of Evidence Based Care. – 2015. – Vol. 5, Issue 3. – P. 63–76. 8. Êóðèëî Â. À. Ñåìåéíûé äèàãíîç êàê èíòåãðàëüíûé ïîêàçàòåëü âûðàæåííîñòè ñåìåéíîé äåçàäàïòà- öèè / Â. À. Êóðèëî, Ì. Â. Ìàðêîâà // Òàâðè÷åñêèé æóðíàë ïñèõèàòðèè. – 2012. – Ò. 16, ¹ 2 (59). Ñ. 41–43. 9. Þðüºâà Ë. Ì. Êë³í³êî-ïñèõîïàòîëîã³÷í³ îñîáëèâîñò³ ïñèõ³÷íî¿ äåçàäàïòàö³¿ ó ðîäè÷³â õâîðèõ íà ïåðøèé ïñèõîòè÷íèé åï³çîä / Ë. Ì. Þðüºâà, Ò. É. Øóñòåðìàí // Óêðà¿íñüêèé â³ñíèê ïñèõîíåâðî- ëî㳿. – 2007. – Ò. 15, âèï. 1 (50). – Ñ. 93–96. 10. Iseselo M. K. The psychosocial problems of families caring for relatives with mental illnesses and their coping strategies: a qualitative urban based study in Dar es Salaam, Tanzania / M. K. Iseselo, L. Ka- jula, Ê. I. Yahya-Malima // BMC Psychiatry. – 2016. – Vol. 16. – P. 146–154. 11. Ðîìàíîâà Å. Â. Ïðîáëåìà êà÷åñòâà æèçíè ñåìåé ïàöèåíòîâ ñ õðîíè÷åñêèìè ïñèõè÷åñêèìè ðàññòðîéñòâàìè / Å. Â. Ðîìàíîâà // Ñîöèîë. è ïñèõîë. àñïåêòû ñåìüè. – 2001. – Ñ. 527–533. 12. Øèðøêîâ È. À. Ê âîïðîñó î ñóïðóæåñêîé àäàïòàöèè / È. À. Øèðøêîâ // Ñá. òåêñòîâ V íàó÷íî- ïðàêòè÷åñêîé èíòåðíåò-êîíôåðåíöèè. Áåëîðóññêèé ãîñóäàðñòâåííûé ïåäàãîãè÷åñêèé óíèâåðñèòåò èìåíè Ìàêñèìà Òàíêà. – Ïåíçà: ÍÈÖ «Ñîöèîñôåðà», 2010. – ¹ 6. – Ñ. 32–34. 13. Øêîäà Ê. Â. Êë³í³êî-ïñèõîëîã³÷íà õàðàêòåðèñòèêà ³ êîìïëåêñíà ïñèõîêîðåêö³ÿ äåçàäàïòàö³¿ ó äðóæèí ³ ìàòåð³â õâîðèõ íà ïàðàíî¿äíó øèçîôðåí³þ ç òðèâàëèìè òåðì³íàìè çàõâîðþâàííÿ, òà ¿¿ åôåêòèâí³ñòü / Ê. Â. Øêîäà // ³ñíèê íàóêîâèõ äîñë³äæåíü. – 2016. – ¹ 4 (85). – Ñ. 108–113. 14. Äðþ÷åíêî Ì. Î. Îñîáëèâîñò³ ïñèõîåìîö³éíîãî ñòàíó ÷îëîâ³ê³â, æ³íêè ÿêèõ õâîð³þòü íà ïà- ðàíî¿äíó øèçîôðåí³þ / Ì. Î. Äðþ÷åíêî // ³ñíèê íàóêîâèõ äîñë³äæåíü. – 2016. – ¹ 4. – Ñ. 93–97. 15. Äðþ÷åíêî Ì. Î. Ñòàí ïîäðóæíüî¿ òà äèòÿ÷å-áàòüê³âñüêî¿ âçàºìî䳿 â ñòðóêòóð³ ñ³ìåéíîãî ôóíêö³îíóâàííÿ æ³íîê, õâîðèõ íà ïàðàíî¿äíó øèçîôðåí³þ / Ì. Î. Äðþ÷åíêî, Ì. Â. Ìàðêîâà // Science Rise: Medical Science. – 2017. – ¹ 1 (9). – Ñ. 39–48. 16. Ãóðîâè÷ È. ß. Ïñèõîñîöèàëüíàÿ òåðàïèÿ è ïñèõîñîöèàëüíàÿ ðåàáèëèòàöèÿ â ïñèõèàòðèè / Ãóðîâè÷ È. ß., Øìóêëåð À. Á., Ñòîðîæàêîâà ß. À. – Ì.: ÈÄ Ìåäïðàêòèêà-Ì, 2004. – 492 ñ. 17. Ðàéãîðîäñêèé Ä. ß. Ïðàêòè÷åñêàÿ ïñèõîäèàãíîñòèêà. Ìåòîäèêè è òåñòû / Ä. ß. Ðàéãîðîä- ñêèé. – Ñàìàðà: Èçä. äîì «Áàõðàõ-Ì», 1998. – Ñ. 73–82. 18. Ïîäêîðûòîâ Â. Ñ. Äåïðåññèè. Ñîâðåìåííàÿ òåðàïèÿ / Â. Ñ. Ïîäêîðûòîâ, Þ. Þ. ×àéêà. – Õàðüêîâ: «Òîðíàäî», 2003. – 349 ñ.

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11. Romanova E.V. (2001). Problema kachestva zhizni semej pacientov s hronicheskimi psihicheskimi rasstrojstvami [The problem of the quality of life of families of patients with chronic mental disorders]. Sociol. i psihol. aspekty semi – Sociol. and psychol. family aspects, pp. 527–533 [in Russian]. 12.Shirshkov I.A. (2010). K voprosu o supruzheskoj adaptacii [On the question of matrimonial adaptation]. Sb. tekstov V nauchno-prakticheskoj internet-konferencii Belorusskij gosudarstvennyj pedagogicheskij universitet imeni Maksima Tanka – Sat. texts of the V scientific and practical Internet conference Belarusian State Pedagogical University named after Maxim Tank., ¹ 6 (pp. 32–34). Penza: NIC «Sociosfera» [in Russian]. 13.Shkoda K.V. (2016). Kliniko-psihologichna harakteristika i kompleksna psihokorekciya dezadaptaciyi u druzhin i materiv hvorih na paranoyidnu shizofreniyu z trivalimi terminami zahvoryuvannya, ta yiyi efektivnist [Clinical and psychological characteristics and complex psychocorrection of maladaptation in wives and mothers of patients with paranoid schizophrenia with long-term disease, and its effectiveness]. Visnik naukovih doslidzhen – Bulletin of scientific research, vol. 4 (85), pp. 108–113 [in Ukrainian]. 14.Dryuchenko M.O. (2016). Osoblivosti psihoemocijnogo stanu cholovikiv, zhinki yakih hvoriyut na paranoyidnu shizofreniyu [Features of the psycho-emotional state of men whose women suffer from paranoid schizophrenia]. Visnik naukovih doslidzhen – Bulletin of scientific research, vol. 4, pp. 93–97 [in Ukrainian]. 15.Dryuchenko M.O., Markova M.V. (2017). Stan podruzhnoyi ta dityache-batkivskoyi vzayemodiyi v strukturi simejnogo funkcionuvannya zhinok, hvorih na paranoyidnu shizofreniyu [The state of marital and child-parent interaction in the structure of family functioning of women with paranoid schizophrenia]. Science Rise: Medical Science, vol. 1 (9), pp. 39–48 [in Ukrainian]. 16.Gurovich I.Ya., Shmukler A.B., Storozhakova Ya.A. (2004). Psihosocialnaya terapiya i psihosocialnaya reabilitaciya v psihiatrii [Psychosocial therapy and psychosocial rehabilitation in psychiatry]. M.: ID Medpraktika-M, 492 p. [in Russian]. 17.Rajgorodskij D.Ya. (1998). Prakticheskaya psihodiagnostika. Metodiki i testy [Practical psychodiagnostics. Techniques and tests]. Samara: Izd. dom «Bahrah-M», pp. 73–82 [in Russian]. 18.Podkorytov V.S., Chajka Yu.Yu. (2003). Depressii. Sovremennaya terapiya [Depression. Modern therapy]. Harkov: «Tornado», 349 p. [in Russian]. 19.Kornackij V.M., Markova M.V. (2007). Ocinka psihosocialnih chinnikiv riziku hvorob sistemi krovoobigu u paciyentiv pervinnoyi lanki mediko-sanitarnoyi dopomogi (metodichni rekomendaciyi) [Assessment of psychosocial risk factors for diseases of the circulatory system in patients of primary care (guidelines)], Kiyiv, 12 p. [in Ukrainian]. 20.Vodopyanova N.E. (2009). Psihodiagnostika stressa [Psychodiagnostics of stress], SPb.: Piter, 336 p. [in Russian]. 21.Ejdemiller E.G. (Eds). (2002). Sistemnaya semejnaya psihoterapiya [Systemic family psychotherapy], Moskva – Harkov – Minsk: «Piter», pp. 83–95 [in Russian]. 22.Abramov V.A., Zhigulina I.V., Ryapolova T.L. (2009). Psihosocialnaya reabilitaciya bolnyh shizofreniej: Monografiya [Psychosocial rehabilitation of patients with schizophrenia: Monograph], Doneck: Kashtan, 584 p. [in Russian]. 23.Liders A.G. (2007). Psihologicheskoe obsledovanie semi [Family psychological examination] (2d ed.). M.: Akademiya, 432 p. [in Russian]. 24.Kozlovskij V.L., Maslovskij S.Yu. (2011). Ocenka kachestva zhizni bolnyh shizofreniej pri provedenii podderzhivayushej terapii [Assessment of the quality of life of patients with schizophrenia during maintenance therapy]. SPb NIPNI im. V.M. Behtereva, 22 p. [in Russian]. 25.Kryukova T.L., Kuftyak E.V. (2007). Oprosnik sposobov sovladaniya (adaptaciya metodiki WCQ) [Coping questionnaire (adaptation of WCQ methodology)]. Zhurnal prakticheskogo psihologa – Practical Psychologist's Journal (Moskva), ¹ 3, pp. 93–112 [in Russian]. 26.Nabiullina R.R., Tuhtarova I.V. (2003). Mehanizmy psihologicheskoj zashity i sovladaniya so stressom (opredelenie, struktura, funkcii, vidy, psihoterapevticheskaya korrekciya) [Mechanisms of psychological defense and coping with stress (definition, structure, functions, types, psychotherapeutic correction)]. Kazan, pp. 23–29 [in Russian]. 27.Mehrabian A. (1976). Public places and privat space: The psychology work, play and living environments N. Y.: Basic Books, 125 p.

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Â.À. Ãåðàñèìóê, Í.Ê. Àãèøåâà ÐÎËÜ È ÌÅÑÒÎ ÑÒÐÅÑÑ-ÏÐÅÎÄÎËÅÂÀÞÙÅÃÎ ÏÎÂÅÄÅÍÈß Â ÔÎÐÌÈÐÎÂÀÍÈÈ ÏÑÈÕÎËÎÃÈ- ×ÅÑÊÎÉ ÄÅÇÀÄÀÏÒÀÖÈÈ Ó ÆÅÍ, ÌÓÆÜß ÊÎÒÎÐÛÕ ÑÒÐÀÄÀÞÒ ØÈÇÎÔÐÅÍÈÅÉ Èçó÷åíû ðîëè è ìåñòà ñòðåññ-ïðåîäîëåâàþùåãî ïîâåäåíèÿ â ôîðìèðîâàíèè ïñèõîëîãè÷åñêîé äåçàäàïòàöèè ó æåí, ìóæüÿ êîòîðûõ ñòðàäàþò ïàðàíîèäíîé øèçîôðåíèåé (ÏÆ), â çàâèñèìîñòè îò äëèòåëüíîñòè çàáîëåâàíèÿ. Íà áàçå ÊÓ «Âèííèöêàÿ îáëàñòíàÿ ïñèõîíåâðîëîãè÷åñêàÿ áîëüíèöà èì. À.È. Þùåíêî» áûëî îáñëåäîâàíî 120 æåíùèí, ìóæüÿ êîòîðûõ áîëåëè ÏÆ, è 50 æåíùèí, ìóæüÿ êîòîðûõ íå èìåëè ïñèõè÷åñêèõ è ïîâåäåí÷åñêèõ ðàññòðîéñòâ.  ðåçóëüòàòå èññëåäîâàíèÿ ïîäòâåðæ- äåíà ãèïîòåçà î íàëè÷èè ó æåí áîëüíûõ ÏØ ìóæ÷èí ïðèçíàêîâ ïñèõè÷åñêîé, ñåìåéíîé, ïñèõîñîöè- àëüíîé è ëè÷íîñòíî-ïîâåäåí÷åñêîé äåçàäàïòàöèè ðàçëè÷íîãî íàïîëíåíèÿ è âûðàæåííîñòè, êîíñòåë- ëÿöèÿ êîòîðûõ ñîñòàâëÿåò êëèíè÷åñêóþ êàðòèíó öåëîñòíîãî ôåíîìåíà ïñèõîëîãè÷åñêîé äåçàäàïòà- öèè æåíùèí è ðàçëè÷àåòñÿ â çàâèñèìîñòè îò ïðîäîëæèòåëüíîñòè áîëåçíè, è ìîæåò áûòü ðåàëèçîâà- íà â äâóõ êëèíèêî-ïñèõîëîãè÷åñêèõ âàðèàíòàõ: ñóáäåçàäàïòèâíîì ñöåïëåíî-ñîçàâèñèìîì, ïðèñó- ùåìó æåíàì ìóæ÷èí ñ ïðîäîëæèòåëüíîñòüþ ïñèõè÷åñêîé áîëåçíè äî 8 ëåò, è äåçàäàïòèâíûå ðàçîá- ùåííî-äèñòàíöèîííîì, õàðàêòåðíîì äëÿ æåí ìóæ÷èí ñ äàâíîñòüþ çàáîëåâàíèÿ îò 8 äî 15 ëåò.  õîäå èññëåäîâàíèÿ äîêàçàíî, ÷òî â ïðîöåññå ôîðìèðîâàíèÿ è äèíàìèêå ðàçâèòèÿ è ïðîãðåññèðîâà- íèÿ ïñèõîëîãè÷åñêîé äåçàäàïòàöèè âåäóùåå ìåñòî ïðèíàäëåæèò ñòðåññ-ïðåîäîëåâàþùåìó ïîâåäå- íèþ, êîòîðîå ìãíîâåííî ÿâëÿåòñÿ åå äåñêðèïòîðîì è ïðåäèêòîðîì. Êëþ÷åâûå ñëîâà: æåíà ïñèõè÷åñêèáîëüíîãî, ïàðàíîèäíàÿ øèçîôðåíèÿ, ïñèõîëîãè÷åñêàÿ äåç- àäàïòàöèÿ, ñòðåññ-ïðåîäîëåâàþùåå ïîâåäåíèå, êîïèíã-ñòðàòåãèè, êîïèíã- ðåñóðñû.

V.A. Gerasimuk, N.K. Agisheva THE ROLE AND PLACE OF STRESS-COPING BEHAVIOR IN THE FORMATION OF PSYCHOLOGICAL MALADAPTATION IN WIVES OF PATIENTS WITH PARANOID SCHIZOPHRENIA In order to study the role and place of stress-coping behavior in the formation of psychological maladaptation in wives whose husbands are suffering from paranoid schizophrenia (PS), depending on the duration of the disease, on the basis of the «Vinnitsa Regional Psychoneurological Hospital named Yushchenko» surveyed 120 women, whose men were ill with PS and 50 women, whose men had no mental and behavioral disorders. The comprehensive examination included the use of clinical, psychological, psychodiagnostic and statistical methods of investigation. As a result of the study, the hypothesis about the presence in wives of patients with PS of the signs of mental, family, psychosocial and personality- behavioral disadaptation of different content and expression, the constellation of which constitutes a clinical picture of the holistic phenomenon of psychological disadaptation of women, can be confirmed. It implemented in two clinical and psychological variants: submaladaptive coupling-dependent, inherent in the wives of men with a duration of mental illness up to 8 years, and maladaptation separation-distance, inherent in the wives of men with disease duration from 8 to 15 years. In the course of the research it is proved that in the process of formation and dynamics of development and progression of psychological maladaptation the leading place belongs to stress-overcoming behavior, which is simultaneously its descriptor and predictor. The findings should be taken into account in the development of personalized psychological support measures for the wives of male patients with PS. Keywords: wife of mentally ill man, paranoid schizophrenia, psychological maladaptation, stress- coping behavior, coping strategies, coping resources.

Íàä³éøëà äî ðåäàêö³¿ 30.10.2019 Êîíòàêòíà ³íôîðìàö³ÿ Ãåðàñèìóê Âàëåð³ÿ Àíàòî볿âíà – àñèñòåíò êàôåäðè ìåäè÷íî¿ ïñèõîëî㳿 ³ ïñèõ³àò𳿠ç êóð- ñîì ï³ñëÿäèïëîìíî¿ îñâ³òè ³ííèöüêîãî íàö³îíàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó ³ì. Ì.². Ïèðîãîâà. Àäðåñà: Óêðà¿íà, 21018, ì. ³ííèöÿ, âóë. Ïèðîãîâà, 56. Òåë.: +380432570360 E-mail: [email protected] ORCID: https://orcid.org/0000-0003-4998-1885

Àã³øåâà Íà¿ëÿ Êà¿ñ³âíà – êàíäèäàò ïñèõîëîã³÷íèõ íàóê, äîöåíò, äîöåíò êàôåäðè ñåêñîëî㳿, ìåäè÷íî¿ ïñèõîëî㳿, ìåäè÷íî¿ ³ ïñèõîëîã³÷íî¿ ðåàá³ë³òàö³¿ Õàðê³âñüêî¿ ìåäè÷íî¿ àêàäå쳿 ï³ñëÿ- äèïëîìíî¿ îñâ³òè. Àäðåñà: Óêðà¿íà, 61176, ì. Õàðê³â, âóë. Àìîñîâà, 5. Òåë.: +380974919189 E-mail: [email protected] ORCID: https://orcid.org/0000-0003-0332-8952

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 25

https://doi.org/10.35339/ekm.2019.85.04.04 ÓÄÊ 616.89::616.895+616.891:616-057

Ê.À. Êîñåíêî ÊÍÏ «Îäåñüêèé îáëàñíèé ìåäè÷íèé öåíòð ïñèõ³÷íîãî çäîðîâ’ÿ» ÑÒÐÓÊÒÓÐÍÎ-ÔÅÍÎÌÅÍÎËÎò×ÍÀ ÕÀÐÀÊÒÅÐÈÑÒÈÊÀ ÀÃÐÅÑÈÂÍÎÑÒ² ² ÂÎÐÎÆÈÕ ÐÅÀÊÖ²É Ó ÊÎÌÀÍÄÍÎÃÎ ÑÊËÀÄÓ ÒÎÐÃÎÂÅËÜÍÎÃÎ ² ÏÀÑÀÆÈÐÑÜÊÎÃÎ ÌÎÐÑÜÊÎÃÎ ÔËÎҲ Óïðîäîâæ 2016–2019 ðîê³â áóëî îáñòåæåíî 110 ÷ëåí³â êîìàíäíîãî ñêëàäó òîðãîâåëü- íîãî ìîðñüêîãî ôëîòó (ÊÒÔ) òà 70 êîìàíäèð³â ïàñàæèðñüêîãî ôëîòó (ÊÏÔ). Äîñë³- äæåíî ñòðóêòóðíî-ôåíîìåíîëîã³÷íó õàðàêòåðèñòèêó àãðåñèâíîñò³ ³ âîðîæèõ ðåàêö³é ó êîìàíäíîãî ñêëàäó òîðãîâåëüíîãî ³ ïàñàæèðñüêîãî ìîðñüêîãî ôëîò³â, ÿê äåñòðóêòèâ- íî¿ â³äïîâ³ä³ îñîáèñòîñò³ íà íàäíîðìîâ³ ïðîôåñ³éí³ ñòðåñ-ôàêòîðè, çàëåæíî â³ä ñïåöè- ô³êè ¿õ ïðîôåñ³éíî¿ ä³ÿëüíîñò³. Ïîêàçàíî, ùî ÊÒÔ õàðàêòåðèçóþòüñÿ á³ëüøîþ ³íòåí- ñèâí³ñòþ ïðîÿâ³â àãðåñèâíîñò³, ÿê³ âèðàæåí³ â íèõ íà ð³âí³ ï³äâèùåíèõ çíà÷åíü òà ìàþòü á³ëüøó ê³ëüê³ñòü îñ³á ç âèñîêèì ð³âíåì ¿õ âèðàæåíîñò³, ïîð³âíÿíî ç ÊÏÔ, ÿê³ äåìîíñò- ðóþòü ñåðåäíþ ³íòåíñèâí³ñòü ïðîÿâ³â òà á³ëüøó ê³ëüê³ñòü îñ³á ç íèçüêèì ð³âíåì àãðå- ñèâíèõ ïðîÿâ³â. Öå â³äáóâàºòüñÿ çà ðàõóíîê ï³äâèùåííÿ òàêèõ ñêëàäîâèõ àãðåñèâíîñò³, ÿê ðîçäðàòóâàííÿ ³ âåðáàëüíà àãðåñ³ÿ, íà òë³ ñåðåäí³õ ïîêàçíèê³â ñõèëüíîñò³ äî ô³çè÷íî¿ àãðåñ³¿. Ïåðåâàæíà á³ëüø³ñòü êîìàíäèð³â îáîõ âèä³â ìîðñüêîãî ôëîòó âèÿâëÿþòü ðåàêö³¿ âîðîæîñò³ ï³äâèùåíîãî ð³âíÿ âèðàæåíîñò³, õî÷à ñåðåä ÊÏÔ ê³ëüê³ñòü îñ³á ç ñåðåäí³ì ¿¿ ð³âíåì º á³ëüøîþ, í³æ ñåðåä ÊÒÔ. Öå ñâ³ä÷èòü ïðî íàÿâí³ñòü äåñòðóêòèâíîãî âåêòîðà àôåêòèâíî-ïîâåä³íêîâîãî ðåàãóâàííÿ ó çàçíà÷åíîãî êîíòèíãåíòó. Öüîìó ÷àñòêîâî ñïðèÿº ï³äâèùåíå â³ä÷óòòÿ ïðîâèíè, ÿêå â³äì³÷àºòüñÿ ÿê â ö³ëîìó ïî âèá³ðêàõ, òàê ³ ó á³ëüøî¿ ê³ëüêîñò³ ÊÏÔ, ïîð³âíÿíî ç ÊÒÔ. Êëþ÷îâ³ ñëîâà: ìîðÿêè äàëåêîãî ïëàâàííÿ, êîìàíäíèé ñêëàä òîðãîâåëüíîãî ìîðñüêîãî ôëîòó, êîìàíäíèé ñêëàä ïàñàæèðñüêîãî ìîðñüêîãî ôëîòó, àãðåñèâí³ñòü, âîðîæ³ñòü.

Âñòóï ÷íîãî ðåàãóâàííÿ, àñîö³éîâàíèõ ç àãðåñ³ºþ àáî Ìîðÿêè äàëåêîãî ïëàâàííÿ íàëåæàòü äî âîðîæ³ñòþ [8]. ïðîôåñ³éíèõ ãðóï, ÿê³ íàéá³ëüøå ï³ääàþòüñÿ Ìåòà ðîáîòè – íàäàòè ñòðóêòóðíî-ôåíî- 䳿 ïðîôåñ³éíîãî ñòðåñó, ÿêèé, ÿê â³äîìî, íåãà- ìåíîëîã³÷íó õàðàêòåðèñòèêó àãðåñèâíîñò³ ³ òèâíî âïëèâຠíà ïñèõ³÷íå çäîðîâ'ÿ [1–3]. Ïñè- âîðîæèõ ðåàêö³é ó êîìàíäíîãî ñêëàäó òîðãî- õîãåíí³ òðèâîæí³, äåïðåñèâí³ ñòàíè, àáî ïñè- âåëüíîãî ³ ïàñàæèðñüêîãî ìîðñüêîãî ôëîòó, ÿê õ³÷í³ ³ ïîâåä³íêîâ³ ðîçëàäè, ïîâ'ÿçàí³ ³ç âæè- äåñòðóêòèâíî¿ â³äïîâ³ä³ îñîáèñòîñò³ íà íàä- âàííÿì ïñèõîàêòèâíèõ ðå÷îâèí, º âèçíàíèìè íîðìîâ³ ïðîôåñ³éí³ ñòðåñ-ôàêòîðè, çàëåæíî â³ä ïðîáëåìàìè îõîðîíè çäîðîâ'ÿ â ìîðñüêîìó ñïåöèô³êè ¿õ ïðîôåñ³éíî¿ ä³ÿëüíîñò³. ñåêòîð³ [4–7]. Íà òë³ íàÿâíîñò³ çíà÷íî¿ ê³ëüêîñò³ Äèçàéí, êîíòèíãåíò ³ ìåòîäè äîñë³ä- äîñë³äæåíü, ùî ïåðåêîíëèâî ïîâ'ÿçóþòü âè- æåííÿ íèêíåííÿ îñòàíí³õ àôåêòèâíî-ïîâåä³íêîâèõ Äëÿ äîñÿãíåííÿ ïîñòàâëåíî¿ ìåòè íà çà- ôåíîìåí³â ç 䳺þ ïðîôåñ³éíèõ ñòðåñîð³â, íà ñàäàõ ³íôîðìîâàíî¿ çãîäè ç äîòðèìàííÿì ïðèí- ñüîãîäí³ â íàóêîâ³é ë³òåðàòóð³ ç'ÿâèëèñü äîêà- öèï³â á³îåòèêè ³ äåîíòîëî㳿 ïðîòÿãîì 2016– çè íàÿâíîñò³ çâ`ÿçêó 䳿 ôàêòîð³â ïðîôåñ³éíîãî 2019 ðîê³â áóëî îáñòåæåíî 180 ïðåäñòàâíèê³â ñòðåñó òà ôîðìóâàííÿ ïðîÿâ³â ïñèõîïàòîëîã³- ìîðñüêîãî ôëîòó: 110 ÷ëåí³â êîìàíäíîãî ñêëà-

© Ê.À. Êîñåíêî , 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 26 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

äó òîðãîâåëüíîãî ìîðñüêîãî ôëîòó (ÊÒÔ) òà ðåñèâíîñò³ ³ âîðîæèõ ðåàêö³é À. Áàññà ³ 70 êîìàíäèð³â ïàñàæèðñüêîãî ôëîòó (ÊÏÔ). À. Äàðê³» â àäàïòàö³¿ À.À. Õâàíà, Þ.À. Çàé- Óñ³õ ðåñïîíäåíò³â áóëî îáñòåæåíî â ïåð³îä öåâà, Þ.À. Êóçíåöîâà [9]. Ñòàòèñòèêî-ìàòå- ï³ñëÿ ïîâåðíåííÿ ç ðåéñó íà áàç³ äåê³ëüêîõ ìàòè÷íèé àíàë³ç ïîëÿãàâ ó ôîðìóâàíí³ îïèñî- ìåäè÷íèõ óñòàíîâ (ÊÍÏ «Îäåñüêèé îáëàñ- âî¿ ñòàòèñòèêè òà àíàë³ç³ ðîçá³æíîñòåé ç âè- íèé ìåäè÷íèé öåíòð ïñèõ³÷íîãî çäîðîâ'ÿ» ÎÎÐ, êîðèñòàííÿì íåïàðàìåòðè÷íèõ ìåòîä³â: òåñ- êàôåäðà ïñèõ³àòð³¿, íàðêîëî㳿 òà ïñèõîëî㳿 òó Ìàííà–Ó¿òí³ òà òî÷íîãî êðèòåð³þ Ô³øåðà. Îäåñüêîãî íàö³îíàëüíîãî ìåäè÷íîãî óí³âåð- Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ ñèòåòó, ìåäè÷íèé öåíòð «Àêàäåììàð³í» ÍÓ ÎÌÀ, Ñåðåäíÿ ³íòåíñèâí³ñòü àãðåñèâíîñò³ ìåäè÷í³ öåíòðè «Øàã äî æèòòÿ», «Â³òà» òà ³í.), (òàáë. 1), çà ïîêàçíèêàìè îäíîéìåííîãî ï³ä ÷àñ äîáðîâ³ëüíîãî çâåðíåííÿ çà êîíñóëü- ³íäåêñó, áóëà çíà÷óùå á³ëüøîþ ó ÊÒÔ, ïîð³âíÿ- òàö³ºþ ë³êàðÿ-ïñèõ³àòðà. íî ç ÊÏÔ: ñåðåä ÊÒÔ âîíà âêëàäàëàñü â àì- Ïåðåâàæíà ê³ëüê³ñòü îáñòåæåíèõ ç îáîõ ãðóï ïë³òóä³ ï³äâèùåíèõ çíà÷åíü 56,65±11,51, à ì³æ áóëà ó â³ö³ 36–50 ðîê³â (53,6 % ÊÒÔ ³ 68,5 % ÊÏÔ – ñåðåäí³õ 48,73±14,65, ð<0,01. Ñõèëü- ÊÏÔ); ñåðåä îñ³á 25–35 ðîê³â áóëî 20,9 % ÊÒÔ í³ñòü äî ô³çè÷íî¿ àãðåñ³¿ áóëà íà ð³âí³ ñåðåäí³õ ³ 12,8 % ÊÏÔ, ñòàðøå 50 ðîê³â – 25,4 % ÊÒÔ çíà÷åíü ó ïðåäñòàâíèê³â îáîõ ãðóï (ÊÒÔ – ³ 18,6 % ÊÏÔ (ðèñ. 1). 32,73±11,08, ÊÏÔ - 30,14±7,32, ð>0,05); âèðà-

Ðèñ. 1. Ðîçïîä³ë îáñòåæåíèõ çà â³êîì Á³ëüøå ïîëîâèíè ÷îëîâ³ê³â áóëè îäðóæåí³ æåí³ñòü ðîçäðàòóâàííÿ âèÿâèëàñü âèñîêîþ ó (48,5 % ÊÒÔ ³ 62,7 % ÊÏÔ), ³íø³ – ðîçëó÷åí³ ÊÒÔ 62,78±25,34 é ñóòî ï³äâèùåíîþ ó ÊÏÔ (ðèñ. 2). 56,89±26,35 áåç çíà÷óùî¿ ð³çíèö³ ì³æ ãðóïàìè, Ó äîñë³äæåíí³ âèêîðèñòàíî êë³í³êî-ïñèõî- ð>0,05. Íàòîì³ñòü, ñõèëüí³ñòü äî âåðáàëüíî¿ ïàòîëîã³÷íèé ³ ïñèõîä³àãíîñòè÷íèé ìåòîäè. àãðåñ³¿ áóëà ñóòòºâî âèùîþ (ð<0,01) ó ÊÒÔ Ñïåöèô³êó àãðåñèâíîñò³ ³ âîðîæîñò³ îö³íþâà- 74,43±15,46, ïîêàçíèêè ÿêî¿ çíàõîäèëèñü â àì- ëè çà äîïîìîãîþ «Îïèòóâàëüíèêà âèì³ðó àã- ïë³òóä³ âèñîêèõ çíà÷åíü, ïîð³âíÿíî ç ÊÏÔ

Ðèñ. 2. ѳìåéíèé ñòàí îáñòåæåíèõ

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 27

Òàáëèöÿ 1. Ñåðåäíÿ ³íòåíñèâí³ñòü àãðåñèâíîñò³ òà ¿¿ ñêëàäîâèõ ó îáñòåæåíèõ îáîõ ãðóï, ñåð. áàë±m

59,19±21,53, â ÿêèõ ñåðåäí³é ïîêàçíèê âåðáàëü- íîñò³ ñõèëüíîñò³ äî ô³çè÷íî¿ àãðåñ³¿, ê³ëüê³ñòü íî¿ àãðåñ³¿ îïèíèâñÿ â ìåæàõ íåçíà÷íîãî ï³äâè- îñ³á ç ñåðåäí³ì ¿¿ ð³âíåì âèÿâèëàñü á³ëüøîþ ùåííÿ 59,19±21,53. ñåðåä ÊÒÔ, à ç íèçüêèì – ñåðåä ÊÏÔ. Ñõèëüí³ñòü äî âîðîæîãî ðåàãóâàííÿ âèÿ- Ðîçïîä³ë ê³ëüêîñò³ îñ³á çà ð³âíåì âèðàæå- âèëàñü ñóòòºâî ï³äâèùåíîþ ó êîìàíäèð³â îáîõ íîñò³ ðîçäðàòóâàííÿ (òàáë. 5) áóâ, ó ö³ëîìó, âèä³â ìîðñüêîãî ôëîòó, à ñàìå, ó ÊÒÔ – 49,94± îäíîð³äíèì, çà âèêëþ÷åííÿì òîãî, ùî ñåðåä 10,34, ó ÊÏÔ - 47,06±12,82 òà íå ìàëà çíà÷ó- ÊÏÔ âèÿâèëîñü äîñòîâ³ðíî á³ëüøå îñ³á ç éîãî ùèõ ðîçá³æíîñòåé ì³æ íèìè, ð>0,05. Âèðà- ñåðåäí³ì ð³âíåì (28,6 %), ïîð³âíÿíî ç ÊÒÔ æåí³ñòü îáðàçè, ÿê ïåðøî¿ ñêëàäîâî¿ âîðî- (11,8 %), ð<0,01. ʳëüê³ñòü îñ³á ç ï³äâèùåíèì, æîñò³, òàêîæ íå ìàëà çíà÷óùèõ â³äì³ííîñòåé âèñîêèì ³ äóæå âèñîêèì éîãî ð³âíÿìè íå ìàëà çà âèðàæåí³ñòþ ó ïðåäñòàâíèê³â îáîõ ãðóï ðîçá³æíîñòåé ì³æ ãðóïàìè (ð>0,05). (ð>0,05) òà áóëà â ìåæàõ íåçíà÷íîãî ï³äâèùåí- Çà ñõèëüí³ñòþ äî âåðáàëüíî¿ àãðåñ³¿ (òàáë. 6) íÿ (ÊÒÔ – 42,79±12,44, ÊÏÔ – 41,27±15,81). ãðóïè îáñòåæåíèõ çíà÷óùå â³äð³çíÿëèñÿ ì³æ Íà â³äì³íó â³ä îáðàçè, ïðè àíàë³ç³ ³íòåíñèâ- ñîáîþ. Òàê, á³ëüøå ïîëîâèíè ÊÏÔ (54,3 %) íîñò³ äðóãî¿ ñêëàäîâî¿ ôåíîìåíó âîðîæîñò³ – ìàëè ñåðåäí³é ð³âåíü ¿¿ âèðàæåíîñò³, â òîé ÷àñ ï³äîçð³ëîñò³, ì³æ ãðóïàìè áóëè âèÿâëåí³ çíà- ÿê ñåðåä ÊÒÔ – ò³ëüêè 8,2 %, ð<0,01. Ïåðå- ÷óù³ ðîçá³æíîñò³ (ð<0,05). Íå äèâëÿ÷èñü íà âàæíà á³ëüø³ñòü ÊÒÔ ìàëè ï³äâèùåíèé (29,1 % òå, ùî â îáîõ ãðóïàõ ñåðåäí³ ïîêàçíèêè ï³äî- ïðîòè 27,1 % ÊÏÔ, ð>0,05), âèñîêèé (33,6 % çð³ëîñò³ áóëè ñóòòºâî ï³äâèùåí³, ¿¿ âèðàæåí³ñòü ïðîòè 5,7 % ÊÏÔ, ð<0,01) òà äóæå âèñîêèé ¿¿ ó ÊÒÔ áóëà íà ìåæ³ ñóòòºâî ï³äâèùåíèõ ³ âè- ð³âåíü (27,3 % ïðîòè 12,9 % ÊÏÔ, ð<0,01). ñîêèõ çíà÷åíü, ó òîé ÷àñ ÿê ó ÊÏÔ – ïðîñòî Íèçüêèé ³íäåêñ àãðåñèâíîñò³ (òàáë. 7) áóâ ñóòòºâî ï³äâèùåíîþ (òàáë. 2). ïðèòàìàííèé çíà÷óùå á³ëüø³é ê³ëüêîñò³ îñ³á Òàáëèöÿ 2. Ñåðåäíÿ ³íòåíñèâí³ñòü ïðîÿâ³â âîðîæîãî ðåàãóâàííÿ òà éîãî ñêëàäîâèõ ó îáñòåæåíèõ îáîõ ãðóï, ñåð. áàë±m

Ñåðåäíÿ ³íòåíñèâí³ñòü ³íøèõ ïîêàçíèê³â, ÊÏÔ (42,9 %), ïîð³âíÿíî ç ÊÒÔ (30,0 %), ùî âèçíà÷åí³ À. Áàññîì ³ Å. Äàðê³ âàæëèâèìè ð<0,05, âèñîêèé – íàâïàêè, çóñòð³÷àâñÿ çíà÷ó- äëÿ ê³íöåâî¿ îö³íêè àãðåñèâíîñò³ ³íäèâ³äóóìà, ùå ÷àñò³øå ñåðåä ÊÒÔ (13,6 %), ïîð³âíÿíî ç à ñàìå, â³ä÷óòòÿ ïðîâèíè, íåïðÿìî¿ àãðåñ³¿ òà ÊÏÔ (4,2 %), ð<0,05. ʳëüê³ñòü îñ³á ç ñåðåäí³ì íåãàòèâ³çìó (òàáë. 3), áóëà òðîõè ï³äâèùåíà ð³âíåì àãðåñèâíîñò³ áóëà ïðèáëèçíî îäíàêî- â îáîõ ãðóïàõ, ³ íå ìàëà ñòàòèñòè÷íî¿ ð³çíèö³ âîþ â îáîõ ãðóïàõ (56,4 % ÊÒÔ ³ 52,9 % ÊÏÔ), ì³æ ãðóïàìè (ð>0,05) çà óñ³ìà äîñë³äæóâàíè- ð>0,05. ìè êàòåãîð³ÿìè. Ðîçïîä³ë îáñòåæåíèõ çà âèðàæåí³ñòþ Àíàë³ç ê³ëüê³ñíîãî ðîçïîä³ëó çà ð³âíåì âèðà- ñõèëüíîñò³ äî îáðàçè (òàáë. 8) íå ìàâ æîäíèõ æåíîñò³ ñõèëüíîñò³ äî ô³çè÷íî¿ àãðåñ³¿ (òàáë. 4) çíà÷óùèõ ðîçá³æíîñòåé ì³æ ãðóïàìè, ïðîòå â äîçâîëèâ âñòàíîâèòè, ùî íèçüê³ ¿¿ ïîêàçíèêè ö³ëîìó, âêàçóâàâ íà ïåðåâàæàííÿ ñåðåäíüîãî áóëè çíà÷óùå ìåíøî¿ ê³ëüêîñò³ ÊÒÔ (56,4 %), (35,5 % ÊÒÔ ³ 42,9 % ÊÏÔ, ð>0,05) ³ ï³äâèùå- í³æ ÊÏÔ (78,6 %), ð<0,01, à ñåðåäí³ – íàâïà- íîãî (54,4 % ÊÒÔ ³ 42,9 % ÊÏÔ, ð>0,05) ð³âí³â. êè, á³ëüøî¿ ê³ëüêîñò³ ÊÒÔ (42,7 %), ïîð³âíÿíî Àíàë³ç ê³ëüêîñò³ îñ³á, ñõèëüíèõ äî ï³äîçð³- ç ÊÏÔ (21,4), ð<0,01. Òàêèì ÷èíîì, íà òë³ ëîñò³ (òàáë. 9) âèÿâèâ ïðèáëèçíî îäíàêîâèé â³äñóòíîñò³ ðîçá³æíîñòåé ó ñåðåäí³é âèðàæå- ðîçïîä³ë â îáîõ ãðóïàõ çà óñ³ìà ð³âíÿìè âèðà-

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 28 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

Òàáëèöÿ 3. Ñåðåäíÿ ³íòåíñèâí³ñòü â³ä÷óòòÿ ïðîâèíè, íåïðÿìî¿ àãðåñ³¿ òà íåãàòèâ³çìó ó îáñòåæåíèõ îáîõ ãðóï, ñåð. áàë±m

Òàáëèöÿ 4. ʳëüê³ñíèé ðîçïîä³ë îáñòåæåíèõ çà âèðàæåí³ñòþ ñõèëüíîñò³ äî ô³çè÷íî¿ àãðåñ³¿

Òàáëèöÿ 5. ʳëüê³ñíèé ðîçïîä³ë îáñòåæåíèõ çà âèðàæåí³ñòþ ñõèëüíîñò³ äî ðîçäðàòóâàííÿ

Òàáëèöÿ 6. ʳëüê³ñíèé ðîçïîä³ë îáñòåæåíèõ çà âèðàæåí³ñòþ ñõèëüíîñò³ äî âåðáàëüíî¿ àãðåñ³¿

Òàáëèöÿ 7. ʳëüê³ñíèé ðîçïîä³ë îáñòåæåíèõ çà âèðàæåí³ñòþ ³íäåêñó àãðåñèâíîñò³

Òàáëèöÿ 8. ʳëüê³ñíèé ðîçïîä³ë îáñòåæåíèõ çà âèðàæåí³ñòþ ñõèëüíîñò³ äî îáðàçè

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 29

Òàáëèöÿ 9. ʳëüê³ñíèé ðîçïîä³ë îáñòåæåíèõ çà âèðàæåí³ñòþ ñõèëüíîñò³ äî ï³äîçð³ëîñò³

æåíîñò³, êð³ì ï³äâèùåíîãî, ÿêèé áóëî çàô³êñî- ðîçá³æíîñòåé ì³æ ïðåäñòàâíèêàìè îáîõ ãðóï âàíî ó çíà÷óùå á³ëüøî¿ ê³ëüêîñò³ ÊÏÔ (52,9 %), (ð>0,05), çà âèíÿòêîì äóæå âèñîêîãî, ÿêèé áóâ ïîð³âíÿíî ç ÊÒÔ (39,1 %), ð<0,05. Ïðè öüîìó âèÿâëåíèé ó 10,0 % ÊÏÔ ³ 1,8 % ÊÒÔ, ð<0,05. çâåðòàëà íà ñåáå óâàãó çíà÷íà ê³ëüê³ñòü îñ³á  ö³ëîìó, íàéá³ëüøà ê³ëüê³ñòü îñ³á ìàëè ñå- ç äóæå âèñîêèì ð³âíåì ï³äîçð³ëîñò³ (30,9 % ðåäí³é (37,3 % ÊÒÔ ³ 38,6 % ÊÏÔ) ³ ï³äâèùå- ÊÒÔ ³ 24,3 % ÊÏÔ, ð>0,05), ùî, â ö³ëîìó, áóëî íèé (51,8 % ÊÒÔ ³ 45,7 % ÊÏÔ) ð³âí³ ¿¿ âèðà- íåõàðàêòåðíî äëÿ ³íøèõ ïîêàçíèê³â àãðåñèâ- æåíîñò³. íîñò³ ³ âîðîæîñò³. Âèðàæåí³ñòü ñõèëüíîñò³ äî íåãàòèâ³çìó ²íäåêñ âîðîæîñò³ (òàáë. 10) ó ïåðåâàæíî¿ (òàáë. 13) áóëà ðîçïîä³ëåíà ïðèáëèçíî ð³âíî- ê³ëüêîñò³ îáñòåæåíèõ îáîõ ãðóï áóâ íà ð³âí³ ì³ðíî ñåðåä îñ³á îáîõ ãðóï (ð>0,05), ïðè÷îìó ï³äâèùåíî¿ âèðàæåíîñò³ (78,2 % ÊÒÔ ³ 67,1 % ïåðåâàæíà ê³ëüê³ñòü îñ³á ìàëà ñåðåäí³é (23,6 % Òàáëèöÿ 10. ʳëüê³ñíèé ðîçïîä³ë îáñòåæåíèõ çà âèðàæåí³ñòþ ³íäåêñó âîðîæîñò³

ÊÏÔ, ð>0,05), îäíàê ñåðåä ÊÏÔ âèÿâèëîñü ÊÒÔ ³ 30,0 % ÊÏÔ), ï³äâèùåíèé (38,2 % ÊÒÔ çíà÷óùå á³ëüøå îñ³á ç ñåðåäí³ì ð³âíåì âîðî- ³ 31,4 % ÊÏÔ) ³ âèñîêèé (20,9 % ÊÒÔ ³ 15,7 % æîñò³ (21,4 %), ïîð³âíÿíî ç ÊÒÔ (8,2 %), ÊÏÔ) ¿¿ ð³âí³. ð<0,01. Òðåáà çàçíà÷èòè, ùî íèçüêîãî ð³âíþ Âèñíîâêè íå âèÿâëåíî â æîäíîãî îáñòåæåíîãî. ÊÒÔ õàðàêòåðèçóþòüñÿ á³ëüøîþ ³íòåíñèâ- ʳëüê³ñòü îñ³á ç ñåðåäíüîþ (34,5 % ÊÒÔ ³ í³ñòþ ïðîÿâ³â àãðåñèâíîñò³, ÿê³ âèðàæåí³ â íèõ 30,0% ÊÏÔ, ð>0,05), âèñîêîþ (16,4 % ÊÒÔ ³ íà ð³âí³ ï³äâèùåíèõ çíà÷åíü òà ìàþòü á³ëüøó 14,3 % ÊÏÔ, ð>0,05) ³ äóæå âèñîêîþ (8,2 % ê³ëüê³ñòü îñ³á ç âèñîêèì ð³âíåì ¿õ âèðàæåíîñò³, ÊÒÔ ³ 2,9 % ÊÏÔ, ð>0,05) âèðàæåí³ñòþ â³ä÷óò- ïîð³âíÿíî ç ÊÏÔ, ÿê³ äåìîíñòðóþòü ñåðåäíþ òÿ ïðîâèíè (òàáë. 11) íå ìàëà ðîçá³æíîñòåé ³íòåíñèâí³ñòü ïðîÿâ³â òà á³ëüøó ê³ëüê³ñòü îñ³á ì³æ ãðóïàìè, â òîé ÷àñ ÿê ñåðåä ÊÏÔ âñòà- ç íèçüêèì ð³âíåì àãðåñèâíèõ ïðîÿâ³â. Ñõèëü- íîâëåíà çíà÷óùå á³ëüøà ê³ëüê³ñòü îñ³á ç ï³ä- í³ñòü äî ô³çè÷íî¿ àãðåñ³¿ ó êîìàíäèð³â îáîõ âèùåíèì ¿¿ ð³âíåì (52,7 %), ïîð³âíÿíî ç ÊÒÔ âèä³â ôëîò³â âèðàæåíà íà ñåðåäíüîìó ð³âí³, (39,1 %), ð<0,05. ïðîòå ñåðåä ÊÒÔ çóñòð³÷àºòüñÿ ìåíøà ê³ëü- Ðîçïîä³ë îñ³á ç ð³çíèì ð³âíåì âèðàæåíîñò³ ê³ñòü îñ³á ç íèçüêèì ¿¿ ð³âíåì, ïîð³âíÿíî ç ÊÏÔ. íåïðÿìî¿ àãðåñ³¿ (òàáë. 12) íå ìàâ çíà÷óùèõ Âèðàæåí³ñòü ïðîÿâ³â âåðáàëüíî¿ àãðåñ³¿ º ï³äâè- Òàáëèöÿ 11. ʳëüê³ñíèé ðîçïîä³ë îáñòåæåíèõ çà âèðàæåí³ñòþ ïî÷óòòÿ ïðîâèíè

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 30 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

Òàáëèöÿ 12. ʳëüê³ñíèé ðîçïîä³ë îáñòåæåíèõ çà âèðàæåí³ñòþ ñõèëüíîñò³ äî íåïðÿìî¿ àãðåñ³¿

Òàáëèöÿ 13. ʳëüê³ñíèé ðîçïîä³ë îáñòåæåíèõ çà âèðàæåí³ñòþ ñõèëüíîñò³ äî íåãàòèâ³çìó

ùåíîþ â îáîõ ãðóïàõ, ïðîòå, ó ÊÏÔ âîíà ìຠñåðåä ÊÏÔ ê³ëüê³ñòü îñ³á ç ñåðåäí³ì ¿¿ ð³âíåì ³íòåíñèâí³ñòü íà ð³âí³ ï³äâèùåíèõ, à ó ÊÒÔ – º á³ëüøîþ, í³æ ñåðåä ÊÒÔ. Âèõîäÿ÷è ç òîãî, âèñîêèõ çíà÷åíü; â³äïîâ³äíî äî öüîãî, ñåðåä ùî âîðîæ³ñòü êîíöåïòóàë³çóºòüñÿ ÿê «ñò³éêå ÊÒÔ ê³ëüê³ñòü îñ³á ç âèñîêèì ð³âíåì ñõèëü- ïåðìàíåíòíå íå êîíòåéíîâàíå â³ä÷óòòÿ ³íäèâ³- íîñò³ äî âåðáàëüíî¿ àãðåñ³¿ º çíà÷íî á³ëüøîþ, äîì íåãàòèâó ³íòðà- ³ ³íòåð- ³íäèâ³äíîãî ñïðÿ- í³æ ñåðåä ÊÏÔ. ² ÊÒÔ, ³ ÊÏÔ äåìîíñòðóþòü ìóâàííÿ, ùî áàçóºòüñÿ íà â³ä÷óòòÿõ îáðàçè íà ñõèëüí³ñòü äî ï³äâèùåíîãî ðîçäðàòóâàííÿ, ÿêå íàâêîëèøí³é ñâ³ò ³ ï³äîçð³ëîñò³ ùîäî éîãî íå- ó ÊÒÔ ìຠâèðàæåí³ñòü íà ð³âí³ âèñîêèõ, à ó äîáðîçè÷ëèâîñò³ äî ñåáå, ç ÿêèì â³í ³ñíóº òðè- ÊÏÔ – ï³äâèùåíèõ ïîêàçíèê³â. âàëèé ÷àñ» [10], ïàòîãåííèì äëÿ îñîáèñòîñò³ º Âèðàæåí³ñòü â³ä÷óòòÿ îáðàçè º òðîõè ï³ä- íàâ³òü ñåðåäí³é ¿¿ ð³âåíü, à âèðàæåí³ñòü ¿¿ âèùå âèùåíîþ ó ïðåäñòàâíèê³â îáîõ ãðóï, ïðèáëèçíî ñåðåäíüîãî, ÿêà çàô³êñîâàíà ó ïåðåâàæíî¿ á³ëü- îäíàêîâà ê³ëüê³ñòü ÿêèõ ìàþòü ñåðåäí³ ³ ï³äâè- øîñò³ îáñòåæåíèõ, ñâ³ä÷èòü ïðî íàÿâí³ñòü äå- ùåí³ ¿¿ ïîêàçíèêè. Íàòîì³ñòü, ³íòåíñèâí³ñòü ï³- ñòðóêòèâíîãî âåêòîðó àôåêòèâíî-ïîâåä³íêîâî- äîçð³ëîñò³, ÿêà º ñóòòºâî ï³äâèùåíîþ â îáîõ ãðó- ãî ðåàãóâàííÿ ó çàçíà÷åíîãî êîíòèíãåíòó. Öüî- ïàõ, ìຠá³ëüøó âèðàçí³ñòü ó ÊÒÔ, ñåðåä ÿêèõ ìó ÷àñòêîâî ñïðèÿº ï³äâèùåíå â³ä÷óòòÿ ïðî- çóñòð³÷àþòüñÿ îñîáè ç ï³äâèùåíèì, âèñîêèì ³ âèíè, ÿêå â³äì³÷àºòüñÿ ÿê â ö³ëîìó ïî âèá³ðêàõ, äóæå âèñîêèì ¿¿ ð³âíÿìè, â òîé ÷àñ ÿê ñåðåä òàê ³ ó á³ëüøî¿ ê³ëüêîñò³ ÊÏÔ, ïîð³âíÿíî ç ÊÒÔ. ÊÏÔ ïåðåâàæíà á³ëüø³ñòü ìàþòü ï³äâèùåíèé Îòðèìàí³ ðåçóëüòàòè íåîáõ³äíî âðàõîâóâà- ð³âåíü ¿¿ âèðàæåíîñò³. òè ïðè ðîçðîáö³ ñïåöèô³÷íèõ çàõîä³â ïñèõîòå- Ïåðåâàæíà á³ëüø³ñòü êîìàíäèð³â îáîõ ðàﳿ ³ ïñèõîïðîô³ëàêòèêè äëÿ äàíîãî êîíòèí- âèä³â ìîðñüêîãî ôëîòó âèÿâëÿþòü ðåàêö³¿ âî- ãåíòó, ùî ñòàíîâèòü ïåðñïåêòèâó äàíîãî äî- ðîæîñò³ ï³äâèùåíîãî ð³âíÿ âèðàæåíîñò³, õî÷à ñë³äæåííÿ.

˳òåðàòóðà 1. Identifying Predictors of Stress and Job Satisfaction in a Sample of Merchant Seafarers Using Structural Equation Modeling / J. McVeigh, M. MacLachlan, F. Vallieres et al. // Front Psychol. – 2019. – Feb 5; Vol. 10. – p. 70. – doi: 10.3389/fpsyg.2019.00070. eCollection 2019. 2. Øàôðàí Ë. Ì. Ô³ç³îëîãî-ã³ã³ºí³÷í³ îñîáëèâîñò³ ïðîôåñ³éíî¿ ä³ÿëüíîñò³ ìîðÿê³â ñïåö³àë³çîâà- íîãî ôëîòó / Ë. Ì. Øàôðàí, Â. Â. Ãîë³êîâà // Óêðà¿íñüêèé æóðíàë ç ïðîáëåì ìåäèöèíè ïðàö³. – 2014. – ¹ 3 (40). – Ñ. 29–39. 3. Shafran L. M. Seafarer's health savings competencies: goals, professional features, formation and development / L. M. Shafran, V. V. Golikova // ³ñíèê Ìîðñüêî¿ Ìåäèöèíè. – 2018. – ¹ 3 (80). – Ñ. 4–12. 4. Psychological stress in seafarers: a review / A. Carotenuto, I. Molino, A. M. Fasanaro, F. Amenta // International Maritime Health. – 2012. – Vol. 63 (4). – Ð. 188–194.

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5. Jezewska M. Stress and fatigue at sea versus quality of life / M. Jezewska, R. Iversen // Int Marit Health. – 2012. – Vol. 63 (3). – Ð. 106–115. 6. Consumption of addictive substances in mariners / R. Pougnet, L. Pougnet, B. Lodde // Int Marit Health. – 2014. – Vol. 65, Issue 4. – Ð. 199–204. 7. Mellbye A. Seafarers' depression and suicide / A. Mellbye, T. Carter // International Maritime Health. – 2017. – Vol. 68 (2). – P. 108–114. 8. Aggression in Teachers is Related to Role Conflict and Role Ambiguity as Occupational Stress / M. Kanchika, S. Iwasaki, A. Konish [et al.] // Osaka City Med J. – 2015. – Dec; Vol. 61 (2). – P. 93–104. 9. Õâàí À. À. Ñòàíäàðòèçàöèÿ îïðîñíèêà À. Áàññà è À. Äàðêè / À. À. Õâàí, Þ. À. Çàéöåâ, Þ. À. Êóçíåöîâà // Ïñèõîëîãè÷åñêàÿ äèàãíîñòèêà. – 2008. – ¹ 1. – Ñ. 35–58. 10. Ãàïîíîâ Ê. Ä. Àíàë³ç ôåíîìåí³â âîðîæîñò³ ³ ïðîâèíè ó îñ³á ç ð³çíèì ð³âíåì ïñèõîñîö³àëüíîãî ñòðåñó, õâîðèõ íà àëêîãîëüíó çàëåæí³ñòü / Ê. Ä. Ãàïîíîâ // Ìåäèöèíà ñüîãîäí³ ³ çàâòðà. – 2018. – ¹ 4 (81). – Ñ. 24–35. References 1. McVeigh J., MacLachlan M., Vallieres F., Hyland P., Stilz R., Cox H., Fraser A. (2019). Identifying Predictors of Stress and Job Satisfaction in a Sample of Merchant Seafarers Using Structural Equation Modeling. Front Psychol., vol. 10, p. 70, doi: 10.3389/fpsyg.2019.00070. 2. Shafran L.M., Holikova V.V. (2014). Fizioloho-hihiienichni osoblyvosti profesiinoi diialnosti moriakiv spetsializovanoho flotu [Physiological and hygienic features of professional activity of sailors of the specialized fleet]. Ukrainskyi zhurnal z problem medytsyny pratsi – Ukrainian Journal of Occupational Medicine, vol. 3 (40), pp. 29–39 [in Ukrainian]. 3. Shafran L.M., Golikova V.V. (2018). Seafarer's health savings competencies: goals, professional features, formation and development. ³ñíèê Ìîðñüêî¿ Ìåäèöèíè – Bulletin of Marine Medicine, vol. 3 (80), pp. 4–12. 4. Carotenuto A., Molino I., Fasanaro A.M., Amenta F. (2012). Psychological stress in seafarers: a review. International Maritime Health, vol. 63 (4), pp. 188–194. 5. Jezewska M, Iversen R. (2012). Stress and fatigue at sea versus quality of life. Int Marit Health, vol. 63 (3), pp. 106–115. 6. Pougnet R., Pougnet L., Lodde B., Canals L., Bell S., Lucas D., Dewitte J.D. (2014). Consumption of addictive substances in mariners. Int Marit Health, vol. 65 (4), pp. 199–204. 7. Mellbye A., Carter T. (2017). Seafarers depression and suicide. International Maritime Health, vol. 68 (2), pp. 108–114. 8. Kanchika M., Iwasaki S., Konish A., Deguchi Y., Kobayashi Y., Nakada A,. Inoue K. (2015). Aggression in Teachers is Related to Role Conflict and Role Ambiguity as Occupational Stress. Osaka City Med J., vol. 61 (2), pp. 93–104. 9. Khvan A.A., Zaitsev Yu.A., Kuznetsova Yu.A. (2008). Standartyzatsyia oprosnyka A. Bassa y A. Darky [Standardization of the questionnaire by A. Bass and A. Darka]. Psykholohycheskaia dyahnostyka – Psychological diagnosis, vol. 1, pp. 35–58 [jn Russian]. 10. Gaponov K.D. (2018). Analiz fenomeniv vorozhosti i provyny u osib z riznym rivnem psykhosotsialnoho stresu, khvorykh na alkoholnu zalezhnist [Analysis of the phenomena of hostility and guilt in people with different levels of psychosocial stress, patients with alcohol dependence]. Medytsyna sohodni i zavtra – Medicine today and tomorrow, ¹ 4 (81), pp. 24–35 [in Ukrainian].

Ê.À. Êîñåíêî ÑÒÐÓÊÒÓÐÍÎ-ÔÅÍÎÌÅÍÎËÎÃÈ×ÅÑÊÎß ÕÀÐÀÊÒÅÐÈÑÒÈÊÀ ÀÃÐÅÑÑÈÂÍÎÑÒÈ È ÂÐÀÆÄÅÁÍÛÕ ÐÅÀÊÖÈÉ Ó ÊÎÌÀÍÄÍÎÃÎ ÑÎÑÒÀÂÀ ÒÎÐÃÎÂÎÃÎ È ÏÀÑÑÀÆÈÐÑÊÎÃÎ ÌÎÐÑÊÎÃÎ ÔËÎÒÀ  òå÷åíèå 2016–2019 ãîäîâ áûëî îáñëåäîâàíî 110 ÷ëåíîâ êîìàíäíîãî ñîñòàâà òîðãîâîãî ìîð- ñêîãî ôëîòà (ÊÒÔ) è 70 êîìàíäèðîâ ïàññàæèðñêîãî ôëîòà (ÊÏÔ). Èññëåäîâàëè ñòðóêòóðíî-ôåíî- ìåíîëîãè÷åñêóþ õàðàêòåðèñòèêó àãðåññèâíîñòè è âðàæäåáíûõ ðåàêöèé ó êîìàíäíîãî ñîñòàâà òîð- ãîâîãî è ïàññàæèðñêîãî ìîðñêîãî ôëîòà, êàê äåñòðóêòèâíîãî îòâåòà ëè÷íîñòè íà ñâåðõóðî÷íûå ïðîôåññèîíàëüíûå ñòðåññ-ôàêòîðû, â çàâèñèìîñòè îò ñïåöèôèêè èõ ïðîôåññèîíàëüíîé äåÿòåëüíî- ñòè. Ïîêàçàíî, ÷òî ÊÒÔ õàðàêòåðèçóþòñÿ áîëüøåé èíòåíñèâíîñòüþ ïðîÿâëåíèé àãðåññèâíîñòè, âû- ðàæåííûå ó íèõ íà óðîâíå ïîâûøåííûõ çíà÷åíèé, è èìåþò áîëüøåå êîëè÷åñòâî ëèö ñ âûñîêèì óðîâíåì èõ âûðàæåííîñòè ïî ñðàâíåíèþ ñ ÊÏÔ, êîòîðûå äåìîíñòðèðóþò ñðåäíþþ èíòåíñèâíîñòü ïðîÿâëåíèé è áîëüøåå êîëè÷åñòâî ëèö ñ íèçêèì óðîâíåì àãðåññèâíûõ ïðîÿâëåíèé. Ýòî ïðîèñõîäèò

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 32 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

çà ñ÷åò ïîâûøåíèÿ òàêèõ ñîñòàâëÿþùèõ àãðåññèâíîñòè, êàê ðàçäðàæåíèå è âåðáàëüíàÿ àãðåññèÿ, íà ôîíå ñðåäíèõ ïîêàçàòåëåé ñêëîííîñòè ê ôèçè÷åñêîé àãðåññèè.Ïîäàâëÿþùåå áîëüøèíñòâî êîìàí- äèðîâ îáîèõ âèäîâ ìîðñêîãî ôëîòà ïðîÿâëÿþò ðåàêöèè âðàæäåáíîñòè ïîâûøåííîãî óðîâíÿ âûðà- æåííîñòè, õîòÿ ñðåäè ÊÏÔ êîëè÷åñòâî ëèö ñî ñðåäíèì åå óðîâíåì ÿâëÿåòñÿ áîëüøåé, ÷åì ñðåäè ÊÒÔ. Ýòî ñâèäåòåëüñòâóåò î íàëè÷èè äåñòðóêòèâíîãî âåêòîðà àôôåêòèâíî-ïîâåäåí÷åñêîãî ðåàãèðî- âàíèÿ ó äàííîãî êîíòèíãåíòà. Ýòîìó îò÷àñòè ñïîñîáñòâóåò ïîâûøåííîå ÷óâñòâî âèíû, êîòîðîå îòìå- ÷àåòñÿ êàê â öåëîì ïî âûáîðêàì, òàê è ó áîëüøåãî ÷èñëà ÊÏÔ ïî ñðàâíåíèþ ñ ÊÒÔ. Êëþ÷åâûå ñëîâà: ìîðÿêè äàëüíåãî ïëàâàíèÿ, êîìàíäíûé ñîñòàâ òîðãîâîãî ìîðñêîãî ôëîòà, êîìàíäíûé ñîñòàâ ïàññàæèðñêîãî ìîðñêîãî ôëîòà, àãðåññèâíîñòü, âðàæäåáíîñòü.

K.A. Kosenko STRUCTURAL-PHENOMENOLOGICAL CHARACTERISTICS OF AGGRESSIVENESS AND HOSTILE REACTIONS IN THE COMMAND WAREHOUSE OF THE COMMERCIAL AND PASSENGER NAVY During 2016–2019, 110 members of the command staff of the Merchant Navy (KTF) and 70 commanders of the passenger fleet (KPF) were surveyed. The study included the use of clinical and psychopathological, psychodiagnostic and statistical methods. The purpose of the work is to provide structural and phenomenological characteristics of aggression and hostile reactions in the command staff of the merchant and passenger navy, as a destructive response of the individual to excessive occupational stressors, depending on the specifics of their professional activities. Design, contingent and research methods. KTF are characterized by a higher intensity of manifestations of aggression, which are expressed in them at the level of increased values, and have a higher number of people with a high level of their severity, compared with KPF, which show a medium intensity of manifestations and a higher number of people with a low level of aggressive manifestations. This is due to an increase in such components of aggression as irritation and verbal aggression, against the background of average susceptibility to physical aggression. The vast majority of commanders of both types of navy show hostility reactions of increased severity, although among the CPF the number of people with an average level is higher than among the CTF. This indicates the presence of a destructive vector of affective-behavioral response in this contingent. This is partly due to the increased sense of guilt, which is observed both in the sample as a whole and in a larger number of KPF, compared with KTF. The obtained data should be taken into account when developing specific measures of psychotherapy and psychoprophylaxis for this contingent, which is the perspective of this study. Keywords: long-distance sailors, command staff of the merchant navy, command staff of the passenger navy, aggression, hostility.

Íàä³éøëà äî ðåäàêö³¿ 29.11.2019

Êîíòàêòíà ³íôîðìàö³ÿ Êîñåíêî Êîðíåë³ÿ Àðòóð³âíà – êàíäèäàò ìåäè÷íèõ íàóê, çàâ³äóâà÷ â³ää³ëåííÿì ÊÍÏ «Îäåñüêèé îáëàñíèé ìåäè÷íèé öåíòð ïñèõ³÷íîãî çäîðîâ'ÿ» Îäåñüêî¿ îáëàñíî¿ ðàäè; àñèñòåíò êàôåäðè ïñèõ³àò𳿠òà íàðêîëî㳿 Îäåñüêîãî íàö³îíàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó. Àäðåñà: Óêðà¿íà, 65006, ì. Îäåñà, âóë. Âîðîáéîâà, 9. Òåë.: +380674848814. E-mail: [email protected]. ORCID: https://orcid.org/0000-0001-6656-1802.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 33

https://doi.org/10.35339/ekm.2019.85.04.05 ÓÄÊ 616.89-008.44+616.89-008.442]:616.65-002-036.1

Â.Î. Êðèâèöüêèé Õàðê³âñüêà ìåäè÷íà àêàäåì³ÿ ï³ñëÿäèïëîìíî¿ îñâ³òè ÑÒÀÍ ÏÑÈÕÎÅÌÎÖ²ÉÍί ÑÔÅÐÈ Ó ÕÂÎÐÈÕ ÍÀ ÕÐÎͲ×ÍÈÉ ÏÐÎÑÒÀÒÈÒ Ç Ð²ÇÍÈÌ ÑÒÀÍÎÌ ÏÎÄÐÓÆÍÜί ÇÀÄÎÂÎËÅÍÎÑÒ² Îáñòåæåíî 109 ÷îëîâ³ê³â, õâîðèõ íà õðîí³÷íèé ïðîñòàòèò (ÕÏ), òà ¿õ äðóæèíè. Çà êðè- òåð³ºì íàÿâíîñò³/â³äñóòíîñò³ ïîäðóæíüî¿ çàäîâîëåíîñò³, îáñòåæåí³ ïàðè áóëè ðîçä³ëåí³ íà äâ³ ãðóïè. Âñòàíîâëåíî, ùî ÷îëîâ³êàì, õâîðèì íà ÕÏ, âèÿâèëèñü ïðèòàìàííèìè ïðîÿâè òðèâîæíî-äåïðåñèâíîãî ðåàãóâàííÿ, çíà÷óùå á³ëüøå âèðàæåí³ ñåðåä îñ³á, íåçàäîâîëå- íèõ ïîäðóæí³ìè ñòîñóíêàìè. Òàêîæ äëÿ íèõ õàðàêòåðíèì áóëî ïåðåâàæàííÿ åìîö³é íåãàòèâíîãî ñïåêòðà â ïàë³òð³ åìîö³éíîãî ðåàãóâàííÿ, â òîé ÷àñ ÿê ó ïàö³ºíò³â, ùî â³ä÷ó- âàëè ïîäðóæíþ çàäîâîëåí³ñòü, â åìîö³éíîìó ñïåêòð³ ïðåâàëþâàëî ïîçèòèâíå åìîö³éíå çà- áàðâëåííÿ. Ñåðåä äðóæèí õâîðèõ ñïîñòåð³ãàëàñÿ ñõîæà òåíäåíö³ÿ á³ëüøî¿ ðîçïîâñþä- æåíîñò³ ³ âèðàæåíîñò³ ñèìïòîì³â ïàòîëîã³÷íî¿ òðèâîæíîñò³ òà äåïðåñ³¿ ñåðåä æ³íîê, ùî â³ä÷óâàëè ïîäðóæíþ íåçàäîâîëåí³ñòü. Òàêèì ÷èíîì, íå äèâëÿ÷èñü íà íàÿâí³ñòü ó âñ³õ îáñòåæåíèõ ÷îëîâ³ê³â çàõâîðþâàííÿ íà ÕÏ, ùî ñòàâàëî ïðîâîêóþ÷èì ôàêòîðîì ôîð- ìóâàííÿ â íèõ íåãàòèâíîãî åìîö³éíîãî òëà òà ðåàêö³é òðèâîæíî-äåïðåñèâíîãî ñïåêòðó, õâîð³, ÿê³ áóëè çàäîâîëåí³ ïîäðóæí³ìè ñòîñóíêàìè, ïðîäåìîíñòðóâàëè çíà÷óùå êðàù³ ïîêàçíèêè ñòàíó ïñèõîåìîö³éíî¿ ñôåðè, í³æ ïàö³ºíòè, íåçàäîâîëåí³ ïîäðóæí³ìè âçàº- ìèíàìè. Óñï³øí³ñòü ïîäðóæí³õ ñòîñóíê³â â äàíîìó âèïàäêó ñòàâàëà àìîðòèçàòîðîì íåãàòèâíèõ ïñèõîãåííèõ åôåêò³â õâîðîáè, ùî çàáåçïå÷óâàëî çíà÷óùó ð³çíèöþ â ïñèõî- åìîö³éíîìó ñòàí³ õâîðèõ íà ÕÏ ÷îëîâ³ê³â. Êëþ÷îâ³ ñëîâà: õðîí³÷íèé ïðîñòàòèò, ïñèõîåìîö³éíèé ñòàí, òðèâîæí³ñòü, äåïðåñ³ÿ, ïîäðóæíÿ çàäîâîëåí³ñòü. Âñòóï ñïîñòåð³ãàëè âäâ³÷³ ÷àñò³øå, í³æ â àíàëîã³÷í³é Õðîí³÷íèé àáàêòåð³àëüíèé ïðîñòàòèò – íàé- çà â³êîì ãðóï³ êîíòðîëþ [5]. Êð³ì òîãî, ³ñíó- ïîøèðåí³øèé âàð³àíò õðîí³÷íîãî çàïàëåííÿ þòü ïóáë³êàö³¿, â ÿêèõ ðîçãëÿäàºòüñÿ ðîëü ÕÏ ïåðåäì³õóðîâî¿ çàëîçè, ÿêèé º îêðåìèì âèïàä- ÿê ôàêòîðó íåãàòèâíîãî âïëèâó íà ñòàí ïîä- êîì õðîí³÷íîãî áîëüîâîãî ñèíäðîìó. Îñîáëèâ- ðóæí³õ ñòîñóíê³â, ç îäíîãî áîêó òà ìîæëèâèé ³ñòþ öüîãî çàõâîðþâàííÿ º â³äñóòí³ñòü ÷³òêîãî ïðîòåêòèâíèé/íåãàòèâíèé âïëèâ ïîäðóæíüîãî çâ'ÿçêó ì³æ ñóá'ºêòèâíèìè â³ä÷óòòÿìè ïàö³º- ðåñóðñó íà ïñèõîëîã³÷íèé ³, îïîñåðåäêîâàíî, íòà òà îá'ºêòèâíèìè îçíàêàìè [1–3]. ³äîìî, ñîìàòè÷íèé ñòàí õâîðîãî [6–8]. ùî ñèìïòîìè õðîí³÷íîãî ïðîñòàòèòó (ÕÏ) òà Ìåòîþ äàíî¿ ðîáîòè áóëî äîñë³äæåííÿ âèêëèêàí³ íèìè íåðâîâî-ïñèõ³÷í³ ðîçëàäè âçàº- ñòàíó ïñèõîåìîö³éíî¿ ñôåðè õâîðèõ íà ÕÏ òà ìíî ï³äñèëþþòüñÿ, íåãàòèâíî âïëèâàþ÷è íà ¿õ äðóæèí, äëÿ âèçíà÷åííÿ, â ïîäàëüøîìó, ÿê³ñòü æèòòÿ [4]. Ïîÿñíåííÿ öüîãî ôåíîìåíó ì³øåíåé ìåäèêî-ïñèõîëîã³÷íî¿ äîïîìîãè äà- ïîëÿãຠó ìåæàõ êîíöåïö³¿ ïîðóøåííÿ ³ìóíî- íîìó êîíòèíãåíòó. íåéðîåíäîêðèííî¿ ðåãóëÿö³¿ çàïàëåííÿ ïåðåä- Ìàòåð³àë ³ ìåòîäè ì³õóðîâî¿ çàëîçè òà ðîçâèòêó ïàòîëîã³÷íîãî Äëÿ äîñÿãíåííÿ ïîñòàâëåíî¿ ìåòè, ç äî- áîëþ. Äîñë³äæåííÿ CPCRN ïîêàçàëî, ùî â òðèìàííÿì ïðèíöèï³â á³îåòèêè ³ äåîíòîëî㳿 íà àíàìíåç³ ïàö³ºíò³â ç ÕÏ òðèâîãó òà äåïðåñ³þ áàç³ äåê³ëüêîõ óñòàíîâ óðîëîãî-àíäðîëîã³÷íî-

© Â.Î. Êðèâèöüêèé, 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 34 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

ãî ïðîô³ëþ ì. Õàðêîâà, óïðîäîâæ 2012–2018 ðð. áèñò³ñíèõ â³äíîñèí, åìîö³¿ âèñòóïàþòü ÿê áóëî îáñòåæåíî 109 ÷îëîâ³ê³â, õâîðèõ íà ÕÏ, ïñèõ³÷í³ ÿâèùà, áóäó÷è ñâîºð³äíîþ ôîðìîþ òà ¿õ äðóæèí. Êðèòåð³ºì âêëþ÷åííÿ â äîñë³ä- â³äîáðàæåííÿ ä³éñíîñò³. Ó ñâîþ ÷åðãó, íåãà- æåííÿ, îêð³ì íàÿâíîñò³ çàõâîðþâàííÿ íà ÕÏ òèâí³ åìîö³¿ ìàþòü çàõèñíó ñïðÿìîâàí³ñòü, ó ÷îëîâ³ê³â, áóëà â³äñóòí³ñòü â àíàìíåç³ ïñèõ³- êîëè ¿õ ïåðåâàãà â óìîâàõ ïñèõ³÷íî¿ òðàâìè ÷íèõ ³ ïîâåä³íêîâèõ ðîçëàä³â ó îáîõ ç ïàðè. çàáåçïå÷óº àêòèâàö³þ ³ ìîá³ë³çàö³þ àäàïòèâ- ³ê îáñòåæåíèõ ñòàíîâèâ â³ä 25 äî 40 ðîê³â. íèõ ìîçêîâèõ ìåõàí³çì³â, ñïðÿìîâàíó íà âèð³- Îáèäâà ç ïîäðóææÿ, ÿê ïðàâèëî, âõîäèëè â øåííÿ êîíôë³êòíî¿ ñèòóàö³¿. îäíó â³êîâó ãðóïó (ç ð³çíèöåþ äî 5 ðîê³â). Ñòàí ïîì³ðíîãî åìîö³éíîãî íàïðóæåííÿ,  ïåðøîìó øëþá³ òðèâàë³ñòþ â³ä òðüîõ äî ÿêå ñêëàäຠîïòèìàëüíèé ð³âåíü íåðâîâî-ïñè- ñåìè ðîê³â ïåðåáóâàëè 60,6 % ïîäðóæí³õ ïàð, õ³÷íîãî òîíóñó, íåñå â ö³ëîìó ïîçèòèâíèé, ó äðóãîìó øëþá³ (òðèâàë³ñòü â ñåðåäíüîìó àäàïòèâíèé âïëèâ íà ïðîöåñè ä³ÿëüíîñò³ ëþ- â³ä äâîõ äî ï’ÿòè ðîê³â) – 39,4 %. Êë³í³÷íà äèíè, ñïðèÿº ïðèñêîðåííþ òà óòî÷íåííþ éîãî êàðòèíà ÕÏ ó âñ³õ îáñòåæåíèõ ñóïðîâîäæó- ðåàêö³é, ïðèéíÿòòþ ð³øåííÿ â ñèòóàö³¿, ÿêà ïî- âàëàñü ïîðóøåííÿì ñåêñóàëüíî¿ ôóíêö³¿, ùî òðåáóº âèáîðó. Îäíàê, ïðè íàäì³ðíîìó åìî- ó 70 (64,2 %) îñ³á áóëî ïðåäñòàâëåíî âàð³àö³ÿ- ö³éíîìó íàïðóæåíí³, ïðè ïñèõîòðàâìóþ÷èõ ìè åðåêòèëüíî¿ äèñôóíêö³¿ (ÅÄ), ó ³íøèõ 39 âïëèâàõ, ùî ïåðåâèùóþòü ìîæëèâîñò³ ïñèõ³- (35,8 %) – ïîºäíàíèì óðàæåííÿì åðåêòèëüíî¿ ÷íî¿ àäàïòàö³¿ ³íäèâ³äà, ðîçâèâàºòüñÿ ñêëàä- ³ åÿêóëÿòîðíî¿ ôóíêö³¿. íèé êîìïëåêñ ïñèõ³÷íèõ ³ ñîìàòè÷íèõ ïîðó- Çà êðèòåð³ºì íàÿâíîñò³/â³äñóòíîñò³ ïîä- øåíü – åìîö³éíèé äèñòðåñ. Ïðè öüîìó âèíè- ðóæíüî¿ çàäîâîëåíîñò³, ñòàí ÿêî¿ âèçíà÷àâñÿ êຠðîçá³æí³ñòü âíóòð³øí³õ íàì³ð³â îñîáèñòîñò³ íàìè çà äîïîìîãîþ îïèòóâàëüíèêà ïîäðóæ- òà îá'ºêòèâíèõ óìîâ ¿¿ ä³ÿëüíîñò³; êîíôë³êò ìî- íüî¿ çàäîâîëåíîñò³ À. Ëàçàðóñà (1997), îáñòå- òèâ³â ³ ö³ëåé ñòâîðþº ´ðóíò äëÿ ôîðìóâàííÿ æåí³ ïàðè áóëè ðîçä³ëåí³ íà äâ³ ãðóïè. Äî ïåð- åìîö³éíî-ñòðåñîâèõ ðåàêö³é (òàáëèöÿ). øî¿ ãðóïè (ãðóïà 1) áóëè â³äíåñåí³ 73 (67,0 %) Ïðè àíàë³ç³ ðåçóëüòàò³â âèâ÷åííÿ åìîö³é- ïîäðóæí³õ ïàðè ç íèçüêèì (ìåíøå 80 áàë³â) íîãî ñïåêòðó, õàðàêòåðíîãî äëÿ îáñòåæåíèõ àáî çíèæåíèì (80–112 áàë³â) ð³âíåì ïîäðóæ- òà ¿õ äðóæèí, çâåðòàëà íà ñåáå óâàãó ñòàòèñ- íüî¿ çàäîâîëåíîñò³. Äî äðóãî¿ (ãðóïà 2) óâ³éø- òè÷íî çíà÷óùà íåð³âíîì³ðí³ñòü ¿õ ðîçïîä³ëó ëè 36 (33,0 %) ïîäðóæí³õ ïàð, çàäîâîëåíèõ ì³æ îñîáàìè îñíîâíî¿ ãðóïè (ÎÃ) ³ ãðóïè ïî- âëàñíèìè ñòîñóíêàìè (115–160 áàë³â). ð³âíÿííÿ (ÃÏ). Ñåðåä ïîäðóææ³â ÎÃ, íà â³ä- Êîìïëåêñíå îáñòåæåííÿ âêëþ÷àëî, îêð³ì ì³íó â³ä ÃÏ, çàô³êñîâàíî ïðåâàëþâàííÿ íåãà- ñòàíäàðòíèõ êë³í³÷íèõ ìåòîä³â, ïðîâåäåííÿ òèâíèõ åìîö³é: íåâäîâîëåííÿ ñîáîþ – ó 87,7 % êë³í³êî-ïñèõîëîã³÷íîãî ³ ïñèõîä³àãíîñòè÷íîãî ÷îëîâ³ê³â é 69,9 % ¿õ äðóæèí; æàëþ äî ñåáå – äîñë³äæåííÿ. Ñòàí ïñèõîåìîö³éíî¿ ñôåðè îö³- ó 71,2 é 63,0 %, â³äïîâ³äíî; òðèâîãè – ó 67,1 é íþâàëè çà äåê³ëüêîìà ïîêàçíèêàìè: ñòðóêòó- 58,9 %, â³äïîâ³äíî; ñìóòêó – ó 64,4 ³ 58,9 %, ðó ïàë³òðè åìîö³éíîãî ðåàãóâàííÿ – çà «Êàð- â³äïîâ³äíî; ñîðîìó – ó 56,2 é 31,5 %, â³äïîâ³ä- òîþ ñàìîîö³íêè åìîö³éíîãî ñòàíó Í.Î. Ìà- íî; îáðàçè – ó 47,9 é 53,4 %, â³äïîâ³äíî; äîñà- ðóòè» (2004) [10]; ïàòîïñèõîëîã³÷íå òëî ðîç- äè – ó 39,7 é 65,8 %, â³äïîâ³äíî; ãí³âó – ó 35,6 âèòêó íåâðîòè÷íî¿ ñèìïòîìàòèêè òà ³íòåí- é 57,5 %, â³äïîâ³äíî. Òðåáà â³äì³òèòè, ùî ïå- ñèâí³ñòü ïðîÿâ³â ïàòîëîã³÷íî¿ òðèâîãè – çà ðåâàæíà á³ëüø³ñòü íåãàòèâíèõ åìîö³é (íåâäî- «Ìåòîäèêîþ âèçíà÷åííÿ ð³âíÿ îñîáèñò³ñíî¿ ³ âîëåííÿ ñîáîþ, æàëþ äî ñåáå, òðèâîãà, ñìó- ðåàêòèâíî¿ òðèâîæíîñò³ ×.Ä. Ñï³ëáåðãåðà – òîê, ñîðîì) ðåºñòðóâàëàñÿ ñåðåä á³ëüøî¿ ê³ëü- Þ.Ë. Õàí³íà, íàÿâí³ñòü ³ âèðàæåí³ñòü äåïðå- êîñò³ ÷îëîâ³ê³â ÎÃ, í³æ ñåðåä ¿õ äðóæèí, â òîé ñèâíîãî ðåàãóâàííÿ – çà îäíîéìåííîþ ìåòî- ÷àñ ÿê îáðàçà, äîñàäà òà ãí³â, íàâïàêè, áóëè äèêîþ Â. Çóíãå [11]». Ñòàòèñòè÷íèé ìåòîä áóâ á³ëüø ðîçïîâñþäæåí³ ñåðåä äðóæèí õâîðèõ âèêîðèñòàíèé äëÿ îö³íêè ðîçá³æíîñòåé ì³æ ÷îëîâ³ê³â, í³æ ñåðåä íèõ ñàìèõ (ì³æ ïîäðóæ- ãðóïàìè òà çàëåæíîñòåé ì³æ ôàêòîðàìè. æÿìè ðîçá³æíîñò³ áóëè ñòàòèñòè÷íî çíà÷óù³ Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ çà åìîö³ÿìè íåâäîâîëåííÿ ñîáîþ, ñìóòêîì, Âèâ÷åííÿ ñòðóêòóðè åìîö³éíîãî ñòàíó ÷î- ñîðîìîì, äîñàäîþ òà ãí³âîì, ð<0,05). ëîâ³ê³â äîâåëî íàñòóïíå. ³äîìî, ùî åìîö³¿ º Ñåðåä ïîäðóææ³â ÃÏ, íå äèâëÿ÷èñü íà ñêëàäíèì âèðàçîì çâîðîòíî¿ ðåàêö³¿ îðãàí³ç- íàÿâí³ñòü çàõâîðþâàííÿ íà ÕÏ ó ÷îëîâ³êà, â ìó ëþäèíè íà á³îëîã³÷íî ³ ñîö³àëüíî çíà÷óùèé ö³ëîìó ïåðåâàæàëè åìîö³¿ ïîçèòèâíîãî ñïåêò- âïëèâ. Ðàçîì ç òèì, âèíèêàþ÷è ïåðâèííî, ÿê ðó. Íàéá³ëüø ïîøèðåíèì âèÿâèëîñü â³ä÷óòòÿ ÿâèùå ô³ç³îëîã³÷íå ³, íå âòðà÷àþ÷è ñâîãî äîâ³ðè äî ïàðòíåðà – éîãî â³ä÷óâàëè 72,2 % çì³ñòó íà ð³âí³ ñîö³àëüíèõ ôàêòîð³â ³ ì³æîñî- ÷îëîâ³ê³â ³ 77,8 % ¿õ äðóæèí (íà â³äì³íó â³ä

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 35

Ïîð³âíÿëüíèé àíàë³ç ñòðóêòóðè ïàë³òðè åìîö³éíîãî ðåàãóâàííÿ ó ÷îëîâ³ê³â ç ÕÏ òà ¿õ äðóæèí çàëåæíî â³ä ñòàíó ïîäðóæí³õ ñòîñóíê³â, %

íèõ, ñåðåä ïîäðóææ³â Îà äîâ³ðÿëè ïàðòíåðàì ñåáå, ñîðîìîì ³ íåâäîâîëåííÿì ñîáîþ ì³æ 9,6 % ÷îëîâ³ê³â ³ 8,2 % äðóæèí; ð³çíèöÿ ì³æ ÷îëîâ³êàìè òà ¿õ äðóæèíàìè áóëà íàÿâíà ñòà- â³äïîâ³äíèìè ãðóïàìè ñòàíîâèëà ð<0,01). 58,3 % òèñòè÷íà çíà÷óùà ð³çíèöÿ ó á³ê çá³ëüøåííÿ ÷îëîâ³ê³â ³ 61,1 % æ³íîê ÃÏ â³äð³çíÿëèñü âïåâ- ñåðåä ÷îëîâ³ê³â, ð<0,05. íåí³ñòþ, ÿêà áóëà âèÿâëåíà ò³ëüêè ó 15,1 % Àíàë³ç ïàòîïñèõîëîã³÷íîãî òëà íåâðîòè÷íî¿ ÷îëîâ³ê³â ³ 13,7 % æ³íîê Îà (ñòàòèñòè÷íî çíà- ãîòîâíîñò³ ³ç çàñòîñóâàííÿì ìåòîäèêè ×.Ä. Ñï³ë- ÷óùà ð³çíèöÿ ì³æ â³äïîâ³äíèìè ãðóïàìè áåðãåðà – Þ.Ë. Õàí³íà (ðèñ. 1, 2) òà Â. Çóíãà ð<0,05). 38,9 % ÷îëîâ³ê³â ÃÏ æèëè ç ïîñò³éíèì (â àäàïòàö³¿ Ò.². Áàëàøîâî¿) (ðèñ. 3), äîçâîëèâ â³ä÷óòòÿì áåçïåêè, à òàêîæ ðàäîñò³ (ñåðåä ¿õ îòðèìàòè òàê³ ðåçóëüòàòè. äðóæèí ïåðåâàæàííÿ â³ä÷óòòÿ áåçïåêè âñòà- Òðåáà çàçíà÷èòè, ùî íà ñüîãîäí³ â íàóêî- íîâëåíî ó 58,3 %, ðàäîñò³ – ó 41,7 %), â òîé âîìó ïðîñòîð³ ³ñíóº ÷³òêà äèôåðåíö³àö³ÿ ïî- ÷àñ ÿê ñåðåä Îà â³ä÷óòòÿì áåçïåêè ìîãëè ïî- íÿòü «òðèâîãè» ³ «òðèâîæíîñò³». Çà ïîÿñíåí- õâàëèòèñÿ 13,7 % ÷îëîâ³ê³â é 17,8 % æ³íîê íÿì êîðîòêîãî ïñèõîëîã³÷íîãî ñëîâíèêà «òðè- (ð³çíèöÿ ì³æ â³äïîâ³äíèìè ãðóïàìè ð<0,05), à âîãà – öå åìîö³éíèé ñòàí, ùî âèíèêຠó ñèòó- ðàäîñò³ – 11,0 % ÷îëîâ³ê³â é 8,2 % ¿õ äðóæèí àö³¿ íåâèçíà÷åíî¿ íåáåçïåêè ³ âèÿâëÿºòüñÿ â (ð³çíèöÿ ì³æ â³äïîâ³äíèìè ãðóïàìè ð<0,01). î÷³êóâàíí³ íåáëàãîïîëó÷íîãî ðîçâèòêó ïîä³é». ʳëüê³ñòü îñ³á ç ïåðåâàæàííÿì íåãàòèâíîãî Íà â³äì³íó â³ä òðèâîãè, òðèâîæí³ñòü ðîçãëÿ- åìîö³éíîãî òëà ñåðåä ïîäðóææ³â ÃÏ áóëà íå- äàºòüñÿ ÿê ïñèõ³÷íà âëàñòèâ³ñòü ³ âèçíà÷àºòüñÿ çíà÷íîþ â îáîõ ç ïàðè, ïðîòå, çà æàëåì äî ÿê «ñõèëüí³ñòü ³íäèâ³äà äî ïåðåæèâàííÿ òðè-

Ðèñ. 1. Ðîçïîä³ë îáñòåæåíèõ çà ð³âíåì âèðàæåíîñò³ ÐÒ

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Ðèñ. 2. Ðîçïîä³ë îáñòåæåíèõ çà ð³âíåì âèðàæåíîñò³ ÎÒ

âîãè, ùî õàðàêòåðèçóºòüñÿ íèçüêèì ïîðîãîì ìàâ òàêó êîíô³ãóðàö³þ: 9,6 % – íèçüêèé ð³âåíü, âèíèêíåííÿ ðåàêö³¿ òðèâîãè» [12]. Îòæå, òåðì³í 38,4 % – ïîì³ðíèé, 52,1 % – âèñîêèé ¿¿ ð³âåíü «òðèâîæí³ñòü» âèêîðèñòîâóºòüñÿ äëÿ ïîçíà÷åí- (ðîçá³æíîñò³ ì³æ ïîäðóææÿìè âèÿâèëèñü çíà- íÿ â³äíîñíî ñò³éêèõ ³íäèâ³äóàëüíèõ â³äì³ííî- ÷óùèìè ì³æ îñîáàìè ç íèçüêîþ ³ âèñîêîþ ÐÒ, ñòåé ó ñõèëüíîñò³ ³íäèâ³äà â³ä÷óâàòè öåé ñòàí. ð<0,05). Ïîð³âíÿííÿ ðîçïîä³ëó âèðàæåíîñò³ ÐÒ Öÿ îñîáëèâ³ñòü áåçïîñåðåäíüî íå âèÿâëÿºòü- ó ÷îëîâ³ê³â Îà ³ ÃÏ çàô³êñóâàëî çíà÷óù³ ñÿ â ïîâåä³íö³, àëå ¿¿ ð³âåíü ìîæíà âèçíà÷èòè, â³äì³ííîñò³ çà óñ³ìà ¿¿ ð³âíÿìè: 11,1 % ÷îëîâ³ê³â âèõîäÿ÷è ç òîãî, ÿê ÷àñòî ³ ÿê ³íòåíñèâíî ó ÃÏ ç íèçüêîþ ÐÒ ïðîòè æîäíîãî â Îà (ð<0,05); ëþäèíè ñïîñòåð³ãàºòüñÿ ñòàí òðèâîãè. Îñî- 52,8 % îáñòåæåíèõ ÃÏ ç ïîì³ðíîþ ÎÒ ïðîòè áèñò³ñòü ³ç âèðàæåíîþ òðèâîæí³ñòþ ñõèëüíà 27,4 % â Îà (ð<0,01); 36,1 % ÷îëîâ³ê³â ÃÏ ç ñïðèéìàòè íàâêîëèøí³é ñâ³ò ÿê òàêèé, ùî âèñîêèì ð³âíåì ÐÒ ïðîòè 72,6 % â Îà (ð<0,01). ì³ñòèòü ó ñîá³ íåáåçïåêó ³ çàãðîçó çíà÷íî á³ëü- Ñòàòèñòè÷íî çíà÷óù³ â³äì³ííîñò³ â ðîçïîä³ë³ øîþ ì³ðîþ, í³æ îñîáèñò³ñòü ³ç íèçüêèì ð³âíåì ð³âí³â ÐÒ ñåðåä äðóæèí õâîðèõ íà ÕÏ áóëè òðèâîæíîñò³ [13]. Ïðîáëåìó òðèâîæíîñò³ áóëî âèÿâëåí³ ì³æ îñîáàìè ç íèçüêèì ¿¿ ð³âíåì (9,6 % âïåðøå ïîñòàâëåíî ³ ï³ääàíî ñïåö³àëüíîìó â Îà ïðîòè 16,7 % â ÃÏ), ñåðåä ³íøèõ – ðîç- ðîçãëÿäó â ïðàöÿõ Ç. Ôðåéäà, ÿêèé âèçíà÷àâ ¿¿ á³æíîñò³ âèÿâèëèñü íåçíà÷óùèìè. ÿê «íåïðèºìíå åìîö³éíå ïåðåæèâàííÿ, ùî º Âèðàæåí³ñòü ÎÒ òàêîæ ìàëà äåÿê³ ñòàòè- ñèãíàëîì àíòèöèï³ðóâàíî¿ íåáåçïåêè, çì³ñò ÿêî¿ – ñòè÷íî çíà÷óù³ ðîçá³æíîñò³ ì³æ ÷îëîâ³êàìè ïåðåæèâàííÿ íåâèçíà÷åíîñò³ é â³ä÷óòòÿ áåç- Îà ³ ÃÏ (ðèñ. 2). Òàê, ñåðåä ÃÏ áóëî âèÿâëå- ïîðàäíîñò³, à ïðîÿâè õàðàêòåðèçóþòüñÿ òðüî- íî çíà÷óùå á³ëüøó ê³ëüê³ñòü îñ³á ç ïîì³ðíèì ìà îñíîâíèìè îçíàêàìè: ñïåöèô³÷íèì â³ä÷óò- ð³âíåì ÎÒ (58,3% ó ÃÏ ïðîòè 37,0% ó ÎÃ, òÿì íåïðèºìíîãî; â³äïîâ³äíèìè ñîìàòè÷íèìè ð<0,01), à ñåðåä Îà – á³ëüøó ê³ëüê³ñòü ðåñ- ðåàêö³ÿìè, íàñàìïåðåä ïîñèëåííÿì ñåðöåáèò- ïîíäåíò³â ç âèñîêèì ¿¿ ð³âíåì (52,1% ó Îà òÿ; óñâ³äîìëåííÿì öüîãî ïåðåæèâàííÿ» [14]. ïðîòè 25,0% ó ÃÏ, ð<0,01). ̳æ ðîçïîä³ëîì Òàêèì ÷èíîì, îáðàíèé íàìè ïñèõîä³àãíî- ÎÒ ñåðåä ïîäðóææ³â Îà çíà÷óùèõ ðîçá³æíî- ñòè÷íèé ³íñòðóìåíòàð³é äîçâîëèâ äîñë³äèòè ÿê ñòåé íå âñòàíîâëåíî, ÿê ³ ïðè ïîð³âíÿíí³ ïî- ðåàêòèâíó òðèâîæí³ñòü (ÐÒ) (ÿê êîìïëåêñíå êàçíèê³â äðóæèí õâîðèõ îáîõ ãðóï. òèì÷àñîâå åìîö³éíå ïñèõîô³ç³îëîã³÷íå ïî÷óò- Ðîçá³æíîñò³ çà ³íòåíñèâí³ñòþ ïðîÿâ³â äå- òÿ, âèêëèêàíå âïëèâîì êîíêðåòíî¿ åìîö³îãåí- ïðåñèâíîãî ðåàãóâàííÿ âèÿâèëèñü ùå á³ëüø íî¿ ñèòóàö³¿, ÎÒ), òàê ³ îñîáèñò³ñíó òðèâîæí³ñòü âèðàæåíèìè, í³æ ïðîÿâè ïàòîëîã³÷íî¿ òðèâîæ- (ÿê ñò³éêå ïåðåæèâàííÿ êîìïëåêñó ïî÷óòò³â íîñò³ (ðèñ. 3). Òàê, ñåðåä ÷îëîâ³ê³â Îà ò³ëüêè íåãàòèâíî¿ ìîäàëüíîñò³ òà ðèñè õàðàêòåðó). ó 2,7 % íå áóëî âèÿâëåíî îçíàê äåïðåñ³¿, â òîé Ñåðåä ÷îëîâ³ê³â Îà îñ³á ç íèçüêèì ð³âíåì ÷àñ ÿê ñåðåä ÷îëîâ³ê³â ÃÏ òàêèõ áóëî 27,8 % ÐÒ íå áóëî çîâñ³ì (ðèñ. 1). Ïåðåâàæíà á³ëü- (ð<0,01). Îêðåì³ ïðîÿâè ñèòóàòèâíî¿ äåïðåñ³¿ ø³ñòü ç íèõ (72,6 %) – ìàëè âèñîêó ÐÒ, ³íø³ áóëè ïðèòàìàíí³ 31,5 % ÷îëîâ³ê³â Îà ³ 61,1 % (27,4 %) - ïîì³ðíó. Ðîçïîä³ë ÐÒ ó ¿õ äðóæèí ÃÏ (ð<0,01), ìàñêîâàíî¿ (ñîìàòèçîâàíî¿) äå-

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Ðèñ. 3. Ðîçïîä³ë îáñòåæåíèõ çà âèðàæåí³ñòþ ïðîÿâ³â äåïðåñèâíîãî ðåàãóâàííÿ ïðåñ³¿ – 46,6 % Îà ³ 11,1 % (ð<0,01), à ³ñòèííèé íà çàõâîðþâàííÿ, ÿê³ ´ðóíòóþòüñÿ íà ñòàí³ äåïðåñèâíèé ñòàí áóâ âèÿâëåíèé ó 19,2 % ÷î- ïîäðóæí³õ ñòîñóíê³â îáñòåæåíèõ. Òàê, ïðè ëîâ³ê³â Îà ³ â æîäíîãî – ç ÃÏ (ð<0,01). Ó ÷î- íàÿâíîñò³ ïñèõîëîã³÷íî¿ ï³äòðèìêè ç áîêó äðó- ëîâ³ê³â ç ñèòóàòèâíèì äåïðåñèâíèì ñòàíîì ñïî- æèíè, ïàö³ºíòè ÃÏ áóëè ñõèëüí³ äî á³ëüøî¿ ñòåð³ãàëèñü îêðåì³ ïðîÿâè ³äåé ñàìîçâèíóâà- àäàïòèâíîñò³ ñòîñîâíî â³äíîøåííÿ äî âëàñ- ÷åííÿ, ïî÷óòòÿ ïðîâèíè, ïîêàðàííÿ é ïåñèì³ç- íî¿ õâîðîáè íà ÕÏ. Ó ñâîþ ÷åðãó, ïðè â³äñóò- ìó, ñëüîçëèâ³ñòü; äëÿ ðåñïîíäåíò³â ç ñèìïòî- íîñò³ ï³äòðèìóþ÷èõ ÷èííèê³â, ìîá³ë³çóþ÷à ìàìè ìàñêîâàíî¿ äåïðåñ³¿ áóëè õàðàêòåðí³ âè- àäàïòèâíà ïîâåä³íêà ïàö³ºíò³â Îà øâèäêî ðóé- ðàæåí³ îçíàêè àñòåí³çàö³¿, à ñàìå, äèñîìí³ÿ, çíè- íóâàëàñÿ, ³ ó á³ëüøîñò³ ç íèõ ìàëè ì³ñöå âè- æåííÿ ïðàöåçäàòíîñò³ é àïåòèòó; ÷îëîâ³êè ç ³ñ- ïàäêè òðèâîæíî-äåïðåñèâíîãî ðåàãóâàííÿ, ùî òèííîþ äåïðåñ³ºþ õàðàêòåðèçóâàëèñü ðîçäðà- ñóïðîâîäæóâàëèñü ïîøóêîì òàê çâàíî¿ «àôåê- òîâàí³ñòþ, âèñîêèì ïî÷óòòÿì ïðîâèíè é ñàìî- òèâíî¿ ì³øåí³», òîáòî â ïåðøó ÷åðãó, âëàñíèõ çâèíóâà÷åííÿ, íåçàäîâîëåí³ñòþ, àíãåäîí³ºþ, ïî- äðóæèí – íà ÿêèõ âîíè ìîãëè áåçïðè÷èííî âè- ðóøåííÿì ñîö³àëüíèõ çâ`ÿçê³â, à òàêîæ íàÿâí³- ì³ñòèòè âëàñí³ íåãàòèâí³ ïåðåæèâàííÿ. ñòþ ñîìàòè÷íèõ êîðåëÿò³â äåïðåñ³¿ – ðîçëàäà- Âèñíîâîê ìè ñíó, àïåòèòó òà ï³äâèùåíî¿ ñòîìëþâàíîñò³. Ó ÷îëîâ³ê³â, õâîðèõ íà ÕÏ, ïðîÿâè òðèâîæ- ̳æ ïñèõîåìîö³éíèì ñòàíîì äðóæèí Îà ³ íî-äåïðåñèâíîãî ðåàãóâàííÿ çíà÷óùå á³ëüøå ÃÏ òàêîæ áóëè âèÿâëåí³ ðîçá³æíîñò³: ñåðåä ÃÏ âèðàæåí³ ñåðåä îñ³á, íåçàäîâîëåíèõ ïîäðóæ- áóëî çíà÷óùå á³ëüøå îñ³á ç â³äñóòí³ñòþ äå- í³ìè ñòîñóíêàìè. Òàêîæ äëÿ íèõ áóëî õàðàê- ïðåñèâíèõ îçíàê (33,3 % îñ³á ÃÏ ïðîòè 12,3 % òåðíèì ïåðåâàæàííÿ åìîö³é íåãàòèâíîãî ñïåê- æ³íîê ÎÃ, ð<0,01), é ìåíøå – ç ïðîÿâàìè ìàñ- òðà â ïàë³òð³ åìîö³éíîãî ðåàãóâàííÿ, â òîé ÷àñ êîâàíî¿ (8,3 % ç ÃÏ ïðîòè 43,8 % ÎÃ, ð<0,01) ÿê ó ïàö³ºíò³â, ùî â³ä÷óâàëè ïîäðóæíþ çàäî- òà ³ñòèííî¿ (æîäíî¿ æ³íêè ç ÃÏ ïðîòè 4,1 % âîëåí³ñòü, â åìîö³éíîìó ñïåêòð³ ïðåâàëþâàëî ÎÃ, ð<0,05) äåïðåñ³¿. ïîçèòèâíå åìîö³éíå çàáàðâëåííÿ. Ñåðåä äðó- Óçàãàëüíþþ÷è îòðèìàí³ äàí³, ìîæíà ä³éòè æèí õâîðèõ ñïîñòåð³ãàëàñü ñõîæà òåíäåíö³ÿ, âèñíîâêó, ùî ìîçà¿÷í³ ïðîÿâè ÿê òðèâîæíî¿, òàê á³ëüøà ðîçïîâñþäæåí³ñòü ³ âèðàæåí³ñòü ñèì- ³ äåïðåñèâíî¿ ñèìïòîìàòèêè, çóñòð³÷àëèñÿ ó ïòîì³â ïàòîëîã³÷íî¿ òðèâîæíîñò³ òà äåïðåñ³¿ ïåðåâàæíî¿ á³ëüøîñò³ ïàö³ºíò³â Îà òà ó äåÿ- ñïîñòåð³ãàëàñü ñåðåä æ³íîê, ùî â³ä÷óâàëè ïîä- êî¿ ê³ëüêîñò³ õâîðèõ ÃÏ. Ïðîòå, ñòóï³íü âèðà- ðóæíþ íåçàäîâîëåí³ñòü. æåíîñò³ ïñèõîïàòîëîã³÷íèõ ïðîÿâ³â çíà÷íî Òàêèì ÷èíîì, íå äèâëÿ÷èñü íà íàÿâí³ñòü ð³çíèâñÿ: ñåðåä ÷îëîâ³ê³â Îà âñòàíîâëåíî íå- ó âñ³õ îáñòåæåíèõ ÷îëîâ³ê³â çàõâîðþâàííÿ íà ãàòèâíèé ê³ëüê³ñíèé äðåéô ó á³ê ïîòÿæ÷åííÿ ÕÏ, ùî, áåçóìîâíî, ñòàâàëî ïðîâîêóþ÷èì òðèâîæíî-äåïðåñèâíèõ ïðîÿâ³â, ì³æ òèì ÿê ôàêòîðîì ôîðìóâàííÿ â íèõ íåãàòèâíîãî åìî- ñåðåä ÃÏ òàêî¿ òåíäåíö³¿ íå áóëî âñòàíîâëåíî. ö³éíîãî òëà òà ðåàêö³é òðèâîæíî-äåïðåñèâíî- Òàêó ñèòóàö³þ ìîæíà îá´ðóíòóâàòè ð³çíèìè ãî ñïåêòðó, õâîð³, ÿê³ áóëè çàäîâîëåí³ ïîäðóæ- ìîòèâàö³éíî-â³äïîâ³äàëüíèìè ìåõàí³çìàìè, í³ìè ñòîñóíêàìè, ïðîäåìîíñòðóâàëè çíà÷óùå çàä³ÿíèìè ïðè ôîðìóâàíí³ ñòèëþ ðåàãóâàííÿ êðàù³ ïîêàçíèêè ñòàíó ïñèõîåìîö³éíî¿ ñôåðè,

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 38 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

í³æ ïàö³ºíòè, íåçàäîâîëåí³ ïîäðóæí³ìè âçàº- Ïåðñïåêòèâîþ ïîäàëüøî¿ ðîáîòè âáà- ìèíàìè. Óñï³øí³ñòü ïîäðóæí³õ ñòîñóíê³â â ÷àºìî äîñë³äæåííÿ îñîáëèâîñòåé ïîäðóæíüî- äàíîìó âèïàäêó ñòàâàëà àìîðòèçàòîðîì íå- ãî ôóíêö³îíóâàííÿ õâîðèõ òà âèçíà÷åííÿ äè- ãàòèâíèõ ïñèõîãåííèõ åôåêò³â õâîðîáè, ùî ôåðåíö³éîâàíèõ ì³øåíåé ìåäèêî-ïñèõîëîã³÷- çàáåçïå÷óâàëî çíà÷óùó ð³çíèöþ â ïñèõîåìî- íî¿ ðîáîòè ç äàíèì êîíòèíãåíòîì, çàëåæíî â³ä ö³éíîìó ñòàí³ õâîðèõ íà ÕÏ ÷îëîâ³ê³â. ñòàíó ïîäðóæí³õ ñòîñóíê³â.

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ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 39

3. Schaeffer A.J., Knauss J.S., Landis J.R. et al. (2002). Chronic Prostatitis Collaborative Research Network Study Group. Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: the national institutes of health chronic prostatitis cohort study. J. Urol., vol. 168, pp. 1048–1053. 4. Krsmanovic A., Tripp D.A., Nickel J.C. et al. (2014). Psychosocial mechanisms of the pain and quality of life relationship for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Can. Urol. Assoc. J., vol. 8 (11–12), pp. 403–408. 5. Pontari M.A., McNaughton-Collins M., O'leary M.P. et.al. (2005). CPCRN Study G A case-control study of risk factors in men with chronic pelvic pain syndrome. B.J.U. Int., vol. 96, pp. 559–565. 6. Smith K.B., Tripp D., Pukall C., Nickel J.C. (2007). Predictors of sexual and relationship functioning in couples with Chronic Prostatitis/Chronic Pelvic Pain Syndrome. J Sex Med., vol. 4 (3), pp. 734–744, doi: 10.1111/j.1743-6109.2007.00466.x. 7. Smith K.B., Pukall C.F., Tripp D.A., Nickel J.C. (2007). Sexual and relationship functioning in men with chronic prostatitis/chronic pelvic pain syndrome and their partners. Arch Sex Behav., vol. 36 (2), pp. 301–311. 8. Potapenko O.A. (2007). Seksualnaia dezadaptatsyia supruzheskoi pary pry urolohycheskoi patolohyy u muzha y ee psykhoterapyia [Sexual maladaptation of a married couple with urological pathology in her husband and her psychotherapy]. Medychna psykholohiia – Medical psychology, vol. 2 (1), pp. 66–68 [in Russian]. 9. Domoratskyi V.A. (2009). Medytsynskaia seksolohyia y psykhoterapyia seksualnykh rasstroistv [Medical sexology and psychotherapy for sexual disorders]. M.: Akademycheskyi Proekt; Kultura, 470 p. [in Russian]. 10. Maruta N.A. et al. (2004). Kryteryi kachestva zhyzny v psykhyatrycheskoi praktyke [Criterion of quality of life in psychiatric practice]. Kh.: RYF «Arsys», LTD, 240 p. [in Russian]. 11.Raihorodskyi D.Y. (1999). Praktycheskaia psykhodyahnostyka [Practical psychodiagnostics]. Samara-Bakhrakh, 260 p. [in Russian]. 12. Petrovsky A.V., Yaroshevsky M.H. Eds. (1985). Kratkyi psykholohycheskyi slovar [Brief psychological dictionary]. M. [in Russian]. 13. Spylberher Ch.D. (1983). Kontseptualnie y metodycheskye problemi yssledovanyia trevohy [Conceptual and methodological problems of anxiety research]. Stress y trevoha v sporte. Mezhdunar. sb. – Stress and anxiety in sports. International collection. Yu. L. Khanyn (Ed.). M., pp. 12–24 [in Russian]. 14. Asotskyi V.V. (2014). Osoblyvosti vyiaviv tryvozhnosti u pozhezhnykh-riatuvalnykiv Derzhavnoi Sluzhby Ukrainy z nadzvychainykh sytuatsii [Peculiarities of anxiety in firefighters and rescuers of the State Emergency Service of Ukraine]. Zbirnyk naukovykh prats Natsionalnoi Akademii Derzhavnoi Prykordonnoi Sluzhby Ukrainy seriia: pedahohichni ta psykholohichni nauky – Collection of scientific works of the National Academy of the State Border Guard Service of Ukraine series: pedagogical and psychological sciences, vol. 3 (72), pp. 259–271 [in Ukrainian]. Â.À. Êðèâèöêèé ÑÎÑÒÎßÍÈÅ ÏÑÈÕÎÝÌÎÖÈÎÍÀËÜÍÎÉ ÑÔÅÐÛ Ó ÁÎËÜÍÛÕ ÕÐÎÍÈ×ÅÑÊÈÌ ÏÐÎÑÒÀÒÈÒÎÌ Ñ ÐÀÇËÈ×ÍÛÌ ÑÎÑÒÎßÍÈÅÌ ÑÓÏÐÓÆÅÑÊÎÉ ÓÄÎÂËÅÒÂÎÐÅÍÍÎÑÒÈ Îáñëåäîâàíî 109 ìóæ÷èí, áîëüíûõ ÕÏ, è èõ æåíû. Óñòàíîâëåíî, ÷òî ìóæ÷èíàì, áîëüíûì ÕÏ, îêàçàëèñü ïðèñóùèìè ïðîÿâëåíèÿ òðåâîæíî-äåïðåññèâíîãî ðåàãèðîâàíèÿ, çíà÷èìî áîëüøå âûðà- æåíûå ñðåäè ëèö, íåäîâîëüíûõ ñóïðóæåñêèìè îòíîøåíèÿìè. Òàêæå äëÿ íèõ áûëî õàðàêòåðíî ïðå- îáëàäàíèå ýìîöèé îòðèöàòåëüíîãî ñïåêòðà â ïàëèòðå ýìîöèîíàëüíîãî ðåàãèðîâàíèÿ, â òî âðåìÿ êàê ó ïàöèåíòîâ, èñïûòûâàâøèõ ñóïðóæåñêóþ óäîâëåòâîðåííîñòü â ýìîöèîíàëüíîì ñïåêòðå ïðåâàëè- ðîâàëà ïîëîæèòåëüíàÿ ýìîöèîíàëüíàÿ îêðàñêà. Ñðåäè æåí áîëüíûõ íàáëþäàëàñü ïîõîæàÿ òåíäåí- öèÿ, áîëüøàÿ ðàñïðîñòðàíåííîñòü è âûðàæåííîñòü ñèìïòîìîâ ïàòîëîãè÷åñêîé òðåâîæíîñòè è äå- ïðåññèè áûëà ñðåäè æåíùèí, êîòîðûå ÷óâñòâîâàëè ñóïðóæåñêóþ íåóäîâëåòâîðåííîñòü. Òàêèì îá- ðàçîì, íåñìîòðÿ íà íàëè÷èå ó âñåõ îáñëåäîâàííûõ ìóæ÷èí çàáîëåâàíèÿ ÕÏ, ñòàíîâèëîñü ïðîâîöè- ðóþùèì ôàêòîðîì ôîðìèðîâàíèå ó íèõ íåãàòèâíîãî ýìîöèîíàëüíîãî ôîíà è ðåàêöèé òðåâîæíî- äåïðåññèâíîãî ñïåêòðà. Áîëüíûå, êîòîðûå áûëè óäîâëåòâîðåíû ñóïðóæåñêèìè îòíîøåíèÿìè, ïðî- äåìîíñòðèðîâàëè çíà÷èìî ëó÷øèå ïîêàçàòåëè ñîñòîÿíèÿ ïñèõîýìîöèîíàëüíîé ñôåðû, ÷åì ïàöèåí- òû, íåäîâîëüíûå ñóïðóæåñêèìè âçàèìîîòíîøåíèÿìè. Óñïåøíîñòü ñóïðóæåñêèõ îòíîøåíèé â äàí- íîì ñëó÷àå ñòàíîâèëàñü àìîðòèçàòîðîì íåãàòèâíûõ ïñèõîãåííûõ ýôôåêòîâ áîëåçíè, îáåñïå÷èâàëî çíà÷èìóþ ðàçíèöó â ïñèõîýìîöèîíàëüíîì ñîñòîÿíèè áîëüíûõ ÕÏ ìóæ÷èí. Êëþ÷åâûå ñëîâà: õðîíè÷åñêèé ïðîñòàòèò, ïñèõîýìîöèîíàëüíîå ñîñòîÿíèå, òðåâîæíîñòü, äåïðåññèÿ, ñóïðóæåñêàÿ óäîâëåòâîðåííîñòü.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 40 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

V. Kryvytskyi THE STATE OF THE PSYCHO-EMOTIONAL SPHERE IN PATIENTS WITH CHRONIC PROSTATITIS WITH DIFFERENT STATUS OF MARRIAGE SATISFACTION 109 men with CP and their wives were examined. According to the criterion of presence/absence of marital satisfaction, the surveyed couples were divided into two groups. The first group (group 1) included 73 (67.0 %) couples with low or low levels of marital satisfaction. The second (group 2) included 36 (33.0 %) married couples who were satisfied with their own relationship. The comprehensive examination included, in addition to standard clinical methods, a clinical-psychological and psychodiagnostic study. As a result of the study, it was found that men with CP were found to have manifestations of anxiety and depression, much more pronounced among people dissatisfied with marital relations. They were also characterized by a predominance of negative spectrum emotions in the palette of emotional response, while in patients experiencing marital satisfaction, the emotional spectrum was dominated by positive emotional coloration. Among the wives of patients, there was a similar trend of greater prevalence and severity of symptoms of pathological anxiety and depression among women who experienced marital dissatisfaction. Thus, despite the presence of CP in all surveyed men, which became a provoking factor in the formation of a negative emotional background and reactions of the anxiety-depressive spectrum, patients who were satisfied with the marital relationship showed significantly better psychoemotional performance than patients, dissatisfied with marital relations. The success of marital relations in this case became a shock absorber of the negative psychogenic effects of the disease, which provided a significant difference in the psycho-emotional state of men with CP. Keywords: chronic prostatitis, psychoemotional state, anxiety, depression, marital satisfaction.

Íàä³éøëà äî ðåäàêö³¿ 04.12.2019

Êðèâèöüêèé ³òàë³é Îëåêñàíäðîâè÷ – çäîáóâà÷ êàôåäðè ñåêñîëî㳿, ìåäè÷íî¿ ïñèõîëî㳿, ìåäè÷íî¿ ³ ïñèõîëîã³÷íî¿ ðåàá³ë³òàö³¿ Õàðê³âñüêî¿ ìåäè÷íî¿ àêàäå쳿 ï³ñëÿäèïëîìíî¿ îñâ³òè; óðî- ëîã-ñåêñîïàòîëîã ÒΠ«Ìåäè÷íèé öåíòð "Çäîðîâ’ÿ"» (ì. Õàðê³â). Àäðåñà: Óêðà¿íà, 61176, ì. Õàðê³â, âóë. Àìîñîâà, 5. Òåë.: +380509068653 E-mail: [email protected]. https://orcid.org/0000-0002-0521-4660.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 41

https://doi.org/10.35339/ekm.2019.85.04.06 ÓÄÊ 616-006(091):159.9

Ò.Ã. Êðèâîí³ñ ³ííèöüêèé íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ì. Ì.². Ïèðîãîâà ÀÍÀË²Ç ÎÑÎÁÈÑÒ²ÑÍÎ-ÏÎÂÅIJÍÊÎÂÈÕ ÏÐÎÔ²Ë²Â Ó ÎÍÊÎËÎò×ÍÈÕ ÏÀÖ²ªÍҲ ÇÀËÅÆÍÎ Â²Ä ¯Õ Ê˲Ͳ×ÍÈÕ, ѲÌÅÉÍÈÕ ÒÀ ÃÅÍÄÅÐÍÈÕ ÎÑÎÁËÈÂÎÑÒÅÉ Ïðîâåäåíî àíàë³ç îñîáèñò³ñíèõ òà ïîâåä³íêîâèõ îñîáëèâîñòåé ó îíêîëîã³÷íèõ ïàö³ºíò³â â êîíòåêñò³ íàÿâíîñò³ ïñèõîëîã³÷íîãî ïðîô³ëþ ç ïåâíèì ð³âíåì àäàïòàö³¿. Îáñòåæåíî 288 îíêîëîã³÷íèõ ïàö³ºíò³â: 174 æ³íêè òà 114 ÷îëîâ³ê³â. Äîñë³äæåííÿ îñîáèñò³ñíèõ âëà- ñòèâîñòåé ïðîâîäèëè çà äîïîìîãîþ Freiburg Personality Inventory, FPI-Â, ïîâåä³íêîâèõ ïàòåðí³â Ways of Coping Questionnaire, WCQ Ð. Ëàçàðóñà òà Ñ. Ôîëêìàíà. Îíêîëîã³÷íå çàõâîðþâàííÿ ñïðè÷èíÿº àêòóàë³çàö³þ ïñèõîëîã³÷íèõ êîíñòðóêò³â òà íàïðóæåííÿ çàõèñ- íèõ ìåõàí³çì³â, çàä³ÿíèõ ó ïîäîëàíí³ ñòðåñó. Ó ðîäèíàõ ç ïîðóøåííÿìè ñ³ìåéíî¿ àäàï- òàö³¿ âèÿâëåíî âèùó çóñòð³÷àëüí³ñòü ïàö³ºíò³â ç äåçàäàïòèâíèì îñîáèñò³ñíî-ïîâåä³íêî- âèì ïðîô³ëåì. Ïàö³ºíòè ç äèñãàðìîí³éíèì ïðîô³ëåì ñòàíîâëÿòü ãðóïó ðèçèêó ùîäî ðîçâèòêó ïñèõîëîã³÷íî¿ äåçàäàïòàö³¿ ó ñòðåñîâ³é ñèòóàö³¿ íàÿâíîñò³ çàãðîçëèâîãî äëÿ æèòòÿ çàõâîðþâàííÿ. Îñîáèñò³ñíî-ïîâåä³íêîâèé ïðîô³ëü îíêîëîã³÷íîãî ïàö³ºíòà âèñòó- ïຠâàæëèâèì êðèòåð³ºì âèáîðó çàõîä³â ìåäèêî-ïñèõîëîã³÷íî¿ äîïîìîãè òà ìຠâðàõî- âóâàòèñÿ ïðè çàñòîñóâàíí³ ïñèõîëîã³÷íèõ ³íòåðâåíö³é äëÿ õâîðîãî òà éîãî íàéáëèæ÷îãî îòî÷åííÿ (ðîäèíè). Êëþ÷îâ³ ñëîâà: îíêîëîã³÷í³ ïàö³ºíòè, îñîáèñò³ñí³ îñîáëèâîñò³, ïîâåä³íêîâ³ ïàòåðíè, ïñèõîëîã³÷íèé ïðîô³ëü, ìåäèêî-ïñèõîëîã³÷íà äîïîìîãà, ïñèõîîíêîëîã³ÿ.

Àêòóàëüí³ñòü ìóºòüñÿ íà îñíîâ³ ñóá'ºêòèâíîãî â³äîáðàæåí- Äîñë³äæåííÿ â ðàìêàõ ïñèõîîíêîëî㳿 íÿ õâîðîáè ó ïñèõ³ö³, âîäíî÷àñ çíà÷íèé âïëèâ çä³éñíþºòüñÿ, ç îäíîãî áîêó, ó íàïðÿìêó âè- íà ìåõàí³çìè ïñèõîëîã³÷íî¿ àäàïòàö³¿ ìàþòü çíà÷åííÿ âïëèâó ïñèõîãåííèõ ôàêòîð³â íà âè- âëàñíå îñîáèñò³ñí³ îñîáëèâîñò³ ³íäèâ³äó. íèêíåííÿ îíêîïàòîëî㳿, ç ³íøîãî – îö³íêè ìå- Ó â³ò÷èçíÿí³é ìåäè÷í³é ïñèõîëî㳿 âïëèâ õàí³çì³â òà ôàêòîð³â ïñèõîëîã³÷íî¿ àäàïòàö³¿. õâîðîáè íà îñîáèñò³ñòü ðîçãëÿäàºòüñÿ ó êîí- Ó äîñë³äæåííÿõ íå áóëî äîâåäåíî âçàºìî- òåêñò³ ïñèõîëîã³÷íî¿ òåî𳿠â³äíîñèí, ÿêà âè- çâ'ÿçêó ì³æ îñîáèñò³ñíèìè ðèñàìè òà ðèçèêîì çíà÷ຠîñîáèñò³ñòü ÷åðåç ñèñòåìó â³äíîñèí ³í- ðåöèäèâó îíêîïàòîëî㳿 [1–3]. Ïðîòå äëÿ êë³- äèâ³äà, ÿêó çàõâîðþâàííÿ çì³íþº.  äàí³é ïàðà- í³÷íî¿ ïðàêòèêè âàæëèâîãî çíà÷åííÿ íàäàþòü äèãì³ ñèñòåìà â³äíîñèí ðîçãëÿäàºòüñÿ ÿê ÿäðî ïåðñîíàëüíèì õàðàêòåðèñòèêàì ïàö³ºíò³â îñîáèñòîñò³, íàéá³ëüø ÷óòëèâå äî ðîçâèòêó ó êîíòåêñò³ ïîâ³äîìëåííÿ ä³àãíîçó, âèáîðó êî- õâîðîáè ³ âîäíî÷àñ òàêå, ùî âèçíà÷ຠàäàï- ìóí³êàòèâíî¿ òàêòèêè [4, 5]. òàö³éíèé ïîòåíö³àë, çäàòí³ñòü ïðèéìàòè çì³íè, Ïñèõîëîã³÷íà àäàïòàö³ÿ îáóìîâëþºòüñÿ çóìîâëåí³ ñîìàòè÷íèì çàõâîðþâàííÿì [6]. êîìïëåêñîì âíóòð³øíüîîñîáèñò³ñíèõ êîíñò- Ðåàêö³ÿ íà îíêîëîã³÷íå çàõâîðþâàííÿ ïà- ðóêò³â, òàêèõ ÿê ñòðåñ-äîëàþ÷à ïîâåä³íêà, ö³ºíòà â³äîáðàæàºòüñÿ íà â³äíîñèíàõ ó ðîäèí³. ïñèõîëîã³÷í³ çàõèñòè, ó âèïàäêó çàõâîðþâàí- «Çàõèñíà» ïîâåä³íêà ïîäðóæíüî¿ ïàðè â³ä íÿ – âíóòð³øíÿ êàðòèíà õâîðîáè, ÿêà ôîð- ïñèõîòðàâìóþ÷îãî ôàêòó õâîðîáè ïîçáàâëÿº

© Ò.Ã. Êðèâîí³ñ, 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 42 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

ìîæëèâîñò³ áóäóâàòè âçàºìîâ³äíîñèíè íà ðåà- Ó äèçàéí³ äîñë³äæåííÿ âèä³ëåíî ðÿä êðè- ë³ñòè÷í³é îñíîâ³, ùî çàãàëîì çíèæóº ÿê³ñòü òåð³¿â ïîä³ëó: ñ³ìåéíîãî æèòòÿ [7]. – ñòàòü – 174 îíêîõâîð³ æ³íêè (ÃÆ) òà 114 – Âèÿâëåíî, ùî ñóòòºâèé âïëèâ íà ÿê³ñòü ÷îëîâ³ê³â (Ã×); æèòòÿ â óìîâàõ çàõâîðþâàííÿ ìàþòü ïñèõî- – åòàï ïåðåá³ãó îíêîëîã³÷íîãî çàõâîðþâàí- ëîã³÷í³ êîíñòðóêòè, óìîâíî íàçâàí³ «ïðîô³ë³» íÿ – ïðè ïåðøîìó ç³òêíåíí³ ç³ ñêëàäíèì ä³à- îñîáèñòîñò³, ÿê³ ³íòåãðóþòü òàê³ ïñèõîëîã³÷í³ ãíîçîì (ÃÏ) – 78 îñ³á æ³íî÷î¿ (ÃÆ1) òà 51 ÷î- óòâîðåííÿ, ÿê ïåðñîíàëüí³ îñîáëèâîñò³, ö³í- ëîâ³÷î¿ ñòàò³ (Ã×1) òà ï³ñëÿ ïðîãðåñóâàííÿ ÷è í³ñíî-ñìèñëîâó òà ìîòèâàö³éíó ñïðÿìîâàí³ñòü, ðåöèäèâó õâîðîáè (ÃÂ) – 96 æ³íîê (ÃÆ2) òà à òàêîæ â³äíîøåííÿ äî õâîðîáè, ùî, ó ñâîþ 63 – ÷îëîâ³êè (Ã×2); ÷åðãó, âèçíà÷àºòüñÿ õàðàêòåðîì ïàòîëîã³÷íîãî – ð³âåíü àäàïòîâàíîñò³ ñ³ìåéíî¿ ñèñòåìè – ïðîöåñó, òèïîëîã³÷íèìè ïñèõîëîã³÷íèìè îñîá- 55 «àäàïòîâàíèõ» ðîäèí, 127 ñ³ìåé ç «ìåæî- ëèâîñòÿìè ³ õàðàêòåðèñòèêàìè ïñèõîñîö³àëü- âîþ» àäàïòàö³ºþ òà 106 – «äåçàäàïòîâàíèõ». íî¿ ñèòóàö³¿ ïàö³ºíòà [8]. Äîñë³äæåííÿ îñîáèñò³ñíèõ âëàñòèâîñòåé Äî ïñèõîëîã³÷íèõ õàðàêòåðèñòèê, ÿê³ âêà- ïðîâîäèëè çà äîïîìîãîþ Ôðàéáóðçüêîãî îñî- çóþòü íà äîñòàòí³é ð³âåíü ïñèõîëîã³÷íî¿ àäàï- áèñò³ñíîãî îïèòóâàëüíèêà ôîðìè  (Freiburg òàö³¿, â³äíîñÿòü íàÿâí³ñòü ö³ëåé íà ìàéáóòíº, Personality Inventory, FPI-Â) [10], ïîâåä³íêîâèõ ïåðåæèâàííÿ åìîö³éíî¿ íàïîâíåíîñò³ æèòòÿ, ïàòåðí³â – îïèòóâàëüíèê «Ñïîñîáè ñòðåñ-äî- çàäîâîëåí³ñòü ñàìîðåàë³çàö³ºþ, â³ä÷óòòÿ êîíò- ëàþ÷î¿ ïîâåä³íêè» (Ways of Coping Questionnaire, ðîëþ íàä æèòòÿì, âèñîêèé ð³âåíü ñàìîñâ³äî- WCQ) Ð. Ëàçàðóñà òà Ñ. Ôîëêìàíà (çà Ò. Ë. Êðþ- ìîñò³, ãîòîâí³ñòü äî îòðèìàííÿ íîâîãî äîñâ³- êîâîþ, Î. Â. Êóôòÿê, 2007) [11]. Ñòàòèñòè÷íà äó òà ñàìîðîçâèòêó, òîä³ ïåðåá³ëüøåííÿ òÿæ- îáðîáêà îòðèìàíèõ ðåçóëüòàò³â âêëþ÷àëà ôîð- êîñò³ õâîðîáè, ðåàãóâàííÿ ïî òèïó äðàò³âëèâî¿ ìóâàííÿ îïèñîâî¿ ñòàòèñòèêè òà ÿê³ñíèé àíàë³ç. ñëàáêîñò³, êîíöåíòðàö³ÿ íà õâîðîáëèâèõ â³ä÷óò- Îö³íêà îñîáèñò³ñíèõ âëàñòèâîñòåé ïðîâî- òÿõ, ïàðàíîÿëüíå òà äèñôîðè÷íå â³äíîøåííÿ äèëàñÿ çà ïàðàìåòðàìè íåâðîòè÷íîñò³, ñïîí- äî õâîðîáè ïîòåíö³þþòü çíèæåííÿ ÿêîñò³ æèò- òàííî¿ òà ðåàêòèâíî¿ àãðåñèâíîñò³, ðåïðåñèâ- òÿ ïàö³ºíò³â ç îíêîëîã³÷íîþ ïàòîëî㳺þ [9]. íîñò³, äðàò³âëèâîñò³, êîìóí³êàáåëüíîñò³, óð³âíî- Âèâ÷åííÿ îñîáèñò³ñíèõ òà ïîâåä³íêîâèõ âàæåíîñò³, ñîðîì'ÿçëèâîñò³, â³äêðèòîñò³, åêñòðà- õàðàêòåðèñòèê, ùî âïëèâàþòü íà ïñèõîëîã³÷- âåðñ³¿-³íòðàâåðñ³¿, åìîö³éíî¿ ëàá³ëüíîñò³, ìàñ- íó àäàïòàö³þ ïàö³ºíò³â ç îíêîëîã³÷íîþ ïàòî- êóë³í³çìó-ôåì³í³çìó. Êîï³íã àíàë³çóâàâñÿ çà ëî㳺þ ìຠâàæëèâå ïðàêòè÷íå çíà÷åííÿ äëÿ ïðîÿâàìè êîíôðîíòàö³¿, äèñòàíö³þâàííÿ, ñàìî- îðãàí³çàö³¿ òà ïðîâåäåííÿ ìåäèêî-ïñèõîëîã³÷- êîíòðîëþ, ïîøóêó ñîö³àëüíî¿ ï³äòðèìêè, ïðèé- íèõ çàõîä³â. íÿòòÿ â³äïîâ³äàëüíîñò³, óíèêíåííÿ, ïëàíóâàí- Ìåòà ðîáîòè – äîñë³äèòè îñîáèñò³ñí³ òà íÿ ð³øåííÿ ïðîáëåìè òà ïîçèòèâíî¿ ïåðåîö³íêè. ïîâåä³íêîâ³ îñîáëèâîñò³ â îíêîëîã³÷íèõ ïà- Êðèòåð³ÿìè ôîðìóâàííÿ òà ðîçïîä³ëó íà ö³ºíò³â â êîíòåêñò³ íàÿâíîñò³ ïñèõîëîã³÷íîãî ãðóïè ç ãàðìîí³éíèì, óìîâíî-ãàðìîí³éíèì òà ïðîô³ëþ ç ïåâíèì ð³âíåì àäàïòàö³¿. äèñãàðìîí³éíèì ïðîô³ëÿìè, áóëè: âèðàæåí³ñòü Êîíòèíãåíò òà ìåòîäè äîñë³äæåííÿ îñîáèñò³ñíèõ òà ïîâåä³íêîâèõ ïàòåðí³â, ¿õ çì³ñò Íà îñíîâ³ ³íôîðìîâàíî¿ çãîäè, åòè÷íèõ òà òà âçàºìîïîºäíàííÿ. äåîíòîëîã³÷íèõ ïðèíöèï³â ïðîâåäåííÿ êë³- Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ í³÷íèõ äîñë³äæåíü íà áàç³ Ìåäèêî-ïñèõîëîã³- Àíàë³ç îñîáèñò³ñíî-ïîâåä³íêîâèõ ïðîô³ë³â ÷íîãî öåíòðó ÂÍÌÓ ³ì. Ì.². Ïèðîãîâà òà ³í- çàëåæíî â³ä åòàïó ïåðåá³ãó îíêîëîã³÷íîãî çà- íèöüêîãî îáëàñíîãî êë³í³÷íîãî îíêîëîã³÷íîãî õâîðþâàííÿ íå âèÿâèâ ñóòòºâèõ â³äì³ííîñòåé äèñïàíñåðó óïðîäîâæ 2015–2019 ðð. áóëî îá- ó ïîêàçíèêàõ (òàáë. 1). Ó ñòðóêòóð³ äîì³íó- ñòåæåíî 288 îíêîëîã³÷íèõ ïàö³ºíò³â. âàëè ãàðìîí³éíèé – 44,2 % ó ÃÏ òà 42,1 %

Òàáëèöÿ 1. Îñîáèñò³ñíî-ïîâåä³íêîâ³ ïðîô³ë³ â îíêîëîã³÷íèõ ïàö³ºíò³â çàëåæíî â³ä åòàïó õâîðîáè, %

Ïðèì³òêà. Ï – ïðè ïåðâèííîìó ç³òêíåíí³ ç çàõâîðþâàííÿì, Â – ïðè ïðîãðåñóâàíí³ õâîðîáè.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 43

ó ÃÂ, ³ ïðîì³æíèé òèïè ïðîô³ë³â – â³äïîâ³äíî íèé – â³äïîâ³äíî 45,4 òà 44,8 %, äèñãàðìîí³é- 45,7 òà 44,7 %, ùî âêàçóâàëî íà ïîòåíö³éíî íèé – 10,3 òà 14,0 %. Îíêîëîã³÷íå çàõâîðþ- âèñîêó çäàòí³ñòü äî ïñèõîëîã³÷íî¿ àäàïòàö³¿, âàííÿ âèñòóïàëî óí³âåðñàëüíèì ïîòóæíèì ïñèõî- äèñãàðìîí³éíèé ïðîô³ëü ðåºñòðóâàâñÿ ó 10,1 òðàâìóþ÷èì ôàêòîðîì, ùî âèêëèêàëî ñóòòºâ³ òà 13,2 % îïèòóâàíèõ òà âêàçóâàâ íà íàÿâí³ñòü çðóøåííÿ ó ïñèõîëîã³÷íîìó ñòàí³ òà îáóìîâ- ïñèõîïàòîãåííîãî ï³ä´ðóíòÿ äëÿ ïîðóøåííÿ ëþâàëî íàïðóæåííÿ ïîâåä³íêîâèõ òà îñîáèñ- ïñèõîëîã³÷íî¿ àäàïòàö³¿ ó ñòðåñîâ³é òà ïñèõî- ò³ñíèõ ðåñóðñ³â, ÿê³ âèçíà÷àëè õàðàêòåð òà òðàâìàòè÷í³é ñèòóàö³¿. ñèëó ïñèõîëîã³÷íî¿ â³äïîâ³ä³. Âèÿâëåíî â³äì³ííîñò³ ó ñòðóêòóð³ òèï³â Ó òàáë. 4 ïîêàçàíî ðåçóëüòàòè âèâ÷åííÿ îñîáèñò³ñíî-ïîâåä³íêîâèõ ïðîô³ë³â çàëåæíî â³ä îñîáèñò³ñíî-ïîâåä³íêîâèõ ïðîô³ë³â ó îíêîõâî- îñîáëèâîñòåé ñ³ìåéíî¿ ñèñòåìè (òàáë. 2). ðèõ æ³íîê. Âèÿâëåíî çì³íó ñòðóêòóðè ïðîô³ë³â Ðîçïîä³ë çà êðèòåð³ºì ð³âíÿ ñ³ìåéíî¿ àäàïòàö³¿ ñåðåä ïàö³ºíòîê-æ³íîê çàëåæíî â³ä åòàïó õâî- Òàáëèöÿ 2. Îñîáèñò³ñíî-ïîâåä³íêîâ³ ïðîô³ë³ â îíêîëîã³÷íèõ ïàö³ºíò³â çàëåæíî â³ä ð³âíÿ ñ³ìåéíî¿ àäàïòàö³¿, %

âèÿâèâ, ùî â «àäàïòîâàíèõ» ðîäèíàõ îñîáèñ- ðîáè: ãàðìîí³éíèé òèï ðåºñòðóâàâñÿ ó 46,2 % ò³ñíî-ïîâåä³íêîâ³ ïðîô³ë³ áóëè ïðåäñòàâëåí³ ó ÃÆ1 òà 42,7 % ó ÃÆ2, ïðîì³æíèé – â³äïîâ³- ãàðìîí³éíèì – 65,6 % òà ïðîì³æíèì òèïàìè – äíî ó 44,9 òà 45,8 %, ³ äèñãàðìîí³éíèé – 9,0 òà 34,5 %. Ó ñ³ì'ÿõ ç «ìåæîâèì» ñ³ìåéíèì ïðè- 11,5 %, ùî âêàçóâàëî íà çðîñòàííÿ íàïðóæå- ñòîñóâàííÿì îêð³ì ãàðìîí³éíîãî – 47,2 % òà íîñò³ âíóòð³øíüî îñîáèñò³ñíèõ ðåñóðñ³â ó â³ä- ïðîì³æíîãî – 44,1 % òèï³â îñîáèñò³ñíî-ïîâå- ïîâ³äü íà ä³þ ñòðåñîãåííî¿ ñèòóàö³¿, ÿêîþ âè- ä³íêîâèõ ïðîô³ë³â áóâ íàÿâíèé ó 8,7 % ïàö³ºíò³â ñòóïàëî îíêîëîã³÷íå çàõâîðþâàííÿ. Òàêîæ äèñãàðìîí³éíèé. Ó «äåçàäàïòîâàíèõ» ðîäèíàõ ñïîñòåð³ãàëàñÿ ÷³òêà òåíäåíö³ÿ äî çðîñòàííÿ ó ñòðóêòóð³ ïðîô³ë³â äîì³íóâàâ ïðîì³æíèé òèï – äèñãàðìîí³éíèõ îñîáèñò³ñíî-ïîâåä³íêîâèõ 51,9 %, ãàðìîí³éíèé âèÿâëåíî ó 26,4 % òà äèñ- òèï³â ïðîô³ë³â ó ðîäèíàõ ç ïîðóøåííÿìè ñ³ìåé- ãàðìîí³éíèé ó 21,7 %. Òàêèì ÷èíîì, ó ñ³ìåé- íî¿ àäàïòàö³¿. íèõ ñèñòåìàõ, ùî õàðàêòåðèçóâàëèñÿ ïîðóøåí- Ó òàáë. 5 ïðåäñòàâëåíî ðåçóëüòàòè àíàë³- íÿìè âíóòð³øíüîñ³ìåéíèõ â³äíîñèí òà íåçáà- çó îñîáèñò³ñíî-ïîâåä³íêîâèõ ïðîô³ë³â ó îíêî- ëàíñîâàíîñò³ âçàºìî䳿, áóëî á³ëüøå õâîðèõ, ùî õâîðèõ ÷îëîâ³ê³â. Ñåðåä ïàö³ºíò³â-÷îëîâ³ê³â çà- ïðîÿâëÿëè äåçàäàïòèâí³ îñîáèñò³ñí³ òà ïîâå- ô³êñîâàíî ãàðìîí³éíèé òèï ïðîô³ëþ ó 41,2 % ä³íêîâ³ ïàòåðíè.  îñíîâ³ ïîä³áíîãî ïñèõîëî- ó Ã×1 òà 41,2 % ó Ã×2, ïðîì³æíèé – â³äïîâ³ä- ã³÷íîãî ôåíîìåíà ïåðøîïðè÷èíîþ ïñèõîëîã³- íî 47,1 òà 42,9 %, äèñãàðìîí³éíèé – 11,8 òà ÷íî¿ äåçàäàïòàö³¿ âèñòóïàëè ³íäèâ³äóàëüíî- 15,9 %, ùî ñâ³ä÷èëî ïðî âïëèâ õâîðîáè ÿê ïñèõîëîã³÷í³ âëàñòèâîñò³, ÿê³ ³ âèçíà÷àëè õà- ñòðåñîâîãî ôàêòîðà íà îñîáèñò³ñòü òà àêòóà- ðàêòåð ðåàãóâàííÿ, âçàºìîâ³äíîñèí, ñàìîñòàâ- ë³çàö³þ ñïîñîá³â ïîäîëàííÿ ñòðåñó. Ïîä³áíî ëåííÿ, â³äíîøåííÿ äî îòî÷óþ÷îãî ñâ³òó òà äî æ³íîê, ó ðîäèíàõ ÷îëîâ³ê³â òàêîæ áóëî íà- ïîä³é, òîä³ ÿê ïîðóøåííÿ ñ³ìåéíî¿ àäàïòàö³¿ ÿâíèì çá³ëüøåííÿ ê³ëüêîñò³ îñ³á ç äèñãàðìî- áóëî íàñë³äêîì íàÿâíèõ îñîáëèâîñòåé. í³éíèì òèïîì ó äåçàäàïòèâíèõ ñ³ìåéíèõ ñèñ- Äîñë³äæåííÿ îñîáèñò³ñíî-ïñèõîëîã³÷íèõ òåìàõ. ïðîô³ë³â çàëåæíî â³ä ñòàò³ íå âèÿâèëî ñòàòèñ- Àíàë³ç îñîáèñò³ñíî-ïîâåä³íêîâîãî ïðîô³ëþ òè÷íî çíà÷óùèõ â³äì³ííîñòåé (òàáë. 3). Ãàð- ïàö³ºíò³â âèñòóïàâ âàæëèâîþ ñêëàäîâîþ ó ìîí³éíèé îñîáèñò³ñíî-ïîâåä³íêîâèé ïðîô³ëü âèçíà÷åíí³ õàðàêòåðó òà çì³ñòó ìåäèêî-ïñè- âèÿâëåíî ó 44,3 òà 41,2 % – ÷îëîâ³ê³â, ïðîì³æ- õîëîã³÷íèõ çàõîä³â.

Òàáëèöÿ 3. Îñîáèñò³ñíî-ïîâåä³íêîâ³ ïðîô³ë³ â îíêîëîã³÷íèõ ïàö³ºíò³â çàëåæíî â³ä ãåíäåðó, %

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 44 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

Òàáëèöÿ 4. Îñîáèñò³ñíî-ïîâåä³íêîâ³ ïðîô³ë³ â îíêîõâîðèõ æ³íîê, %

Òàáëèöÿ 5. Îñîáèñò³ñíî-ïîâåä³íêîâ³ ïðîô³ë³ â îíêîõâîðèõ ÷îëîâ³ê³â, %

Âèñíîâêè Ïàö³ºíòè ç äèñãàðìîí³éíèì ïðîô³ëåì ñòà- Îíêîëîã³÷íå çàõâîðþâàííÿ òà â îñîáëè- íîâëÿòü ãðóïó ðèçèêó ùîäî ðîçâèòêó ïñèõîëî- âîñò³ éîãî ïðîãðåñóâàííÿ çóìîâëþâàëè àêòóà- ã³÷íî¿ äåçàäàïòàö³¿ ó ñòðåñîâ³é ñèòóàö³¿ íàÿâ- ë³çàö³þ ïñèõîëîã³÷íèõ êîíñòðóêò³â òà íàïðó- íîñò³ çàãðîçëèâîãî äëÿ æèòòÿ çàõâîðþâàííÿ. æåííÿ çàõèñíèõ ìåõàí³çì³â çàä³ÿíèõ ó ïîäî- Ðîçðîáêà òà âïðîâàäæåííÿ ìåäèêî-ïñèõî- ëàíí³ ñòðåñó. ëîã³÷íèõ çàõîä³â äëÿ ïàö³ºíò³â â îíêîëîã³÷í³é Ó ðîäèíàõ ³ç ïîðóøåííÿìè ñ³ìåéíî¿ àäàï- ïðàêòèö³ ìຠîáîâ'ÿçêîâî âðàõîâóâàòè ³íäèâ³- òàö³¿ ìîæíà î÷³êóâàòè âèùó çóñòð³÷àëüí³ñòü äóàëüíî-ïñèõîëîã³÷í³ îñîáëèâîñò³ õâîðèõ ó ¿õ ïàö³ºíò³â ç äåçàäàïòèâíèì îñîáèñò³ñíî-ïîâå- âçàºìîçâ'ÿçêó ç ìåòîþ âèçíà÷åííÿ îïòèìàëü- ä³íêîâèì ïðîô³ëåì, ùî ìîæå âèñòóïàòè ³íäè- íîãî îá'ºìó òà çì³ñòó ³íòåðâåíö³é ÿê äëÿ ñà- êàòîðîì äëÿ äèôåðåíö³þâàííÿ ìåäèêî-ïñèõî- ìîãî ïàö³ºíòà òàê ³ éîãî íàéáëèæ÷îãî îòî÷åí- ëîã³÷íèõ çàõîä³â. íÿ (ðîäèíè).

˳òåðàòóðà 1. Dong X. Y. Personality risk factors of occurrence of female breast cancer: a case-control study in China / X. Y. Dong, J. Jin // Psychol Health Med. – 2018. – Vol. 23 (10). – P. 1239–1249. 2. Personality traits in cancer patients / N. S. Turhal, S. Demirhan, C. Satici [et al.] // Asian Pac. J. Cancer Prev. – 2013. – Vol. 14 (8). – P. 4515–4518. 3. Personality traits and cancer risk and survival based on Finnish and Swedish registry data / N. Nakaya, P. E. Bidstrup, K. Saito-Nakaya [et al.] // Am. J. Epidemiol. – 2010. – Vol. 15, Issue 172 (4). – P. 377–385. 4. Kallergis G. Informing cancer patient based on his type of personality:The self-sacrificing patient / G. Kallergis // J. BUON. – 2015. – Vol. 20 (2). – P. 645–649. 5. The complex role of personality in cancer treatment: impact of dependency-detachment on health status, distress, and physician-patient relationship / J. H. Porcerelli, R. F. Bornstein, D. Porcerelli, V. E. Arterbery // J. Nerv. Ment. Dis. – 2015. – Vol. 203 (4). – P. 264–268. 6. Ïñèõîëîãè÷åñêèå èññëåäîâàíèÿ â îíêîëîãèè / Ì. Â. Âàãàéöåâà, Â. À. ×óëêîâà, Ý. Á. Êàðïîâà, Ñ. À. Ëåîíåíêîâà // Âåñòíèê Þæíî-Óðàëüñêîãî ãîñóäàðñòâåííîãî óíèâåðñèòåòà. Ñåðèÿ: Ïñèõîëî- ãèÿ. – 2015. – Vol. 8, ¹ 3. – Ñ. 28–35. 7. Îöåíêà ïñèõîëîãè÷åñêîãî ñòàòóñà îíêîãèíåêîëîãè÷åñêèõ áîëüíûõ â ïðîöåññå ïñèõîëîãè÷åñ- êîé ðåàáèëèòàöèè / Å. Â. Ïåñòåðåâà, Â. À. ×óëêîâà, Ò. Þ. Ñåìèãëàçîâà è äð. // Ó÷åíûå çàïèñêè ÑÏáÃÌÓ èì. È.Ï. Ïàâëîâà. – 2018. – Vol. 25, ¹ 1. – Ñ. 62–67. 8. Ïñèõîëîãè÷åñêàÿ äèàãíîñòèêà òèïîâ îòíîøåíèÿ ê áîëåçíè / Ë. È. Âàññåðìàí, Ý. Á. Êàðïîâà, Á. Â. Èîâëåâ, À. ß. Âóêñ // Ïñèõîëîã. äèàãíîñòèêà ðàññòðîéñòâ ýìîöèîí. ñôåðû è ëè÷íîñòè: êîë- ëåêò. ìîíîãðàôèÿ. Ãë. 1. – ÑÏá.: Ñêèôèÿ-ïðèíò, 2014. – Ñ. 214–237. 9. Ïñèõîëîãè÷åñêàÿ àäàïòàöèÿ ê áîëåçíè è êà÷åñòâî æèçíè ïàöèåíòîâ ñ îïóõîëåâûì ïîðàæåíèåì êîñòåé / Î. Þ. Ùåëêîâà, Å. Á. Óñìàíîâà, È. À. Ãîðáóíîâ, Å. À. Ñóøåíöîâ // Ó÷åíûå çàïèñêè ÑÏáÃÌÓ èì. È.Ï. Ïàâëîâà. – 2018. – Âûï. 25, ¹ 3. – Ñ. 62–72. 10. Ïðàêòèêóì ïî ýêñïåðèìåíòàëüíîé è ïðàêòè÷åñêîé ïñèõîëîãèè: Ó÷åá. ïîñîáèå / Ë. È. Âàí- ñîâñêàÿ, Â. Ê. Ãàéäà, Â. Ê. Ãåðáà÷åâñêèé [è äð.]; Ïîä ðåä. À. À. Êðûëîâà. – ÑÏá, 1997. – 312 ñ. 11. Êðþêîâà Ò. Ë. Îïðîñíèê ñïîñîáîâ ñîâëàäàíèÿ (àäàïòàöèÿ ìåòîäèêè WCQ) / Ò. Ë. Êðþêîâà, Å. Â. Êóôòÿê // Æóðíàë ïðàêòè÷åñêîãî ïñèõîëîãà. – 2007. – ¹ 3. – Ñ. 93–112.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 45

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Ò.Ã. Êðèâîíîñ ÀÍÀËÈÇ ËÈ×ÍÎÑÒÍÎ-ÏÎÂÅÄÅÍ×ÅÑÊÈÕ ÏÐÎÔÈËÅÉ ÎÍÊÎËÎÃÈ×ÅÑÊÈÕ ÁÎËÜÍÛÕ Â ÇÀÂÈÑÈÌÎÑÒÈ ÎÒ ÈÕ ÊËÈÍÈ×ÅÑÊÈÕ, ÑÅÌÅÉÍÛÕ È ÃÅÍÄÅÐÍÛÕ ÎÑÎÁÅÍÍÎÑÒÅÉ Ïðîâåäåí àíàëèç ëè÷íîñòíûõ è ïîâåäåí÷åñêèõ îñîáåííîñòåé ó îíêîëîãè÷åñêèõ ïàöèåíòîâ â êîí- òåêñòå íàëè÷èÿ ïñèõîëîãè÷åñêîãî ïðîôèëÿ ñ îïðåäåëåííûì óðîâíåì àäàïòàöèè. Íà ïðîòÿæåíèè 2015– 2019 ãã. áûëî îáñëåäîâàíî 288 îíêîëîãè÷åñêèõ ïàöèåíòîâ: 174 æåíùèíû è 114 ìóæ÷èí. Èññëåäîâà- íèå ëè÷íîñòíûõ ñâîéñòâ ïðîâîäèëè ñ ïîìîùüþ Freiburg Personality Inventory, FPI-Â, ïîâåäåí÷åñ- êèõ ïàòòåðíîâ – Ways of Coping Questionnaire, WCQ Ð. Ëàçàðóñà è Ñ. Ôîëêìàíà. Îíêîëîãè÷åñêîå çàáîëåâàíèå âûçûâàåò àêòóàëèçàöèþ ïñèõîëîãè÷åñêèõ êîíñòðóêòîâ è íàïðÿæåíèå çàùèòíûõ ìåõà- íèçìîâ, çàäåéñòâîâàííûõ â ïðåîäîëåíèè ñòðåññà.  ñåìüÿõ ñ íàðóøåíèÿìè ñåìåéíîé àäàïòàöèè îáíàðóæåíî ÷àñòîå íàëè÷èå ïàöèåíòîâ ñ äåçàäàïòèâíûì ëè÷íîñòíî-ïîâåäåí÷åñêèì ïðîôèëåì. Ïà- öèåíòû ñ äèñãàðìîíè÷íûì ïðîôèëåì ñîñòàâëÿþò ãðóïïó ðèñêà êàñàòåëüíî ðàçâèòèÿ ïñèõîëîãè÷åñ- êîé äåçàäàïòàöèè â ñòðåññîâîé ñèòóàöèè íàëè÷èÿ óãðîæàþùåãî æèçíè çàáîëåâàíèÿ. Ëè÷íîñòíî- ïîâåäåí÷åñêèé ïðîôèëü îíêîëîãè÷åñêîãî ïàöèåíòà âûñòóïàåò âàæíûì êðèòåðèåì âûáîðà ìåðîïðè- ÿòèé ìåäèêî-ïñèõîëîãè÷åñêîé ïîìîùè è äîëæåí ó÷èòûâàòüñÿ ïðè ïðèìåíåíèè ïñèõîëîãè÷åñêèõ èí- òåðâåíöèé äëÿ áîëüíîãî è åãî áëèæàéøåãî îêðóæåíèÿ (ñåìüè). Êëþ÷åâûå ñëîâà: îíêîëîãè÷åñêèå ïàöèåíòû, ëè÷íîñòíûå îñîáåííîñòè, ïîâåäåí÷åñêèå ïàò- òåðíû, ïñèõîëîãè÷åñêèé ïðîôèëü, ìåäèêî-ïñèõîëîãè÷åñêàÿ ïîìîùü, ïñèõîîíêîëîãèÿ.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 46 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

T.G. Krivonis PERSONAL AND BEHAVIORAL PROFILES IN CANCER PATIENTS, DEPENDING ON THEIR CLINICAL, FAMILY AND GENDER FEATURES The study analyzed the personal and behavioral characteristics of cancer patients in the context of having a psychological profile with a certain level of adaptation. Based on informed consent in Medical- psychological center of Vinnitsa National Pirogov Memorial Medical University and Vinnytsa Regional Clinical Oncology Clinic during 2015–2019 years 288 cancer patients were examined. Assessment of personality traits conducted using the Freiburg Personality Inventory, FPI-B, behavioral patterns – Ways of Coping Questionnaire, WCQ by R. Lazarus and S. Folkman. Cancer causes the actualization of psychological constructs and the stress-protective mechanisms involved in overcoming stress. In families with impaired family adaptation, a higher incidence of patients with maladaptive personality and behavioral profiles was found. Patients with a disharmonious profile are at risk for developing psychological maladaptation in the stressful situation of a life-threatening illness. The personal and behavioral profile of the cancer patient is an important criterion for the choice of medical-psychological help and should be taken into account when applying psychological interventions to the patient and his immediate family (family). Keywords: cancer patients, personal traits, behavioral patterns, psychological profile, medical- psychological help, psycho-oncology.

Íàä³éøëà äî ðåäàêö³¿ 27.11.2019

Êîíòàêòíà ³íôîðìàö³ÿ Êðèâîí³ñ Òàìàðà Ãðèãîð³âíà – êàíäèäàò ìåäè÷íèõ íàóê, äîöåíò êàôåäðè ìåäè÷íî¿ ïñèõî- ëî㳿 òà ïñèõ³àò𳿠ç êóðñîì ï³ñëÿäèïëîìíî¿ îñâ³òè ³ííèöüêîãî íàö³îíàëüíîãî ìåäè÷íîãî óí³âåð- ñèòåòó ³ì. Ì.². Ïèðîãîâà. Àäðåñà: Óêðà¿íà, 21018, ì. ³ííèöÿ, âóë. Ïèðîãîâà, 56. Òåë.: +380689507514. E-mail: [email protected]. ORCID: https://orcid.org/0000-0001-6060-7152.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 47

https://doi.org/10.35339/ekm.2019.85.04.07 ÓÄÊ 616.1+159.923:316.6-036.66

Í.Î. Ìàðóòà1, Ê.Â. Øåâ÷åíêî–Á³òåíñüêèé2 1ÄÓ «²íñòèòóò íåâðîëî㳿, ïñèõ³àò𳿠òà íàðêîëî㳿 ÍÀÌÍ Óêðà¿íè» 2ÄÓ «Óêðà¿íñüêèé íàóêîâî-äîñë³äíèé ³íñòèòóò ìåäè÷íî¿ ðåàá³ë³òàö³¿ òà êóðîðòîëî㳿 ÌÎÇ Óêðà¿íè» ÏÐÎÃÐÀÌÀ ÏÑÈÕÎÑÎÖ²ÀËÜÍί ÐÅÀÁ²Ë²ÒÀÖ²¯ ÏÀÖ²ªÍÒ²Â Ç ÃÀËÞÖÈÍÀÒÎÐÍÎ-ÏÀÐÀÍίÄÍÈÌÈ ÐÎÇËÀÄÀÌÈ ÏÐÈ ÄÅÌÅÍÖ²ßÕ Ð²ÇÍÎÃÎ ÃÅÍÅÇÓ ² ÑÒÀIJ¯ ÐÎÇÂÈÒÊÓ ² ÎÖ²ÍÊÀ ¯¯ ÅÔÅÊÒÈÂÍÎÑÒ² Ðîçðîáèëè ïðîãðàìè êîìïëåêñíî¿ ïåðñîí³ô³êîâàíî¿ ïðîãðàìè ïñèõîñîö³àëüíî¿ ðåàá³ë³- òàö³¿ ïàö³ºíò³â ç ãàëþöèíàòîðíî-ïàðàíî¿äíèìè ðîçëàäàìè (ÃÏÐ) ïðè äåìåíö³ÿõ ð³çíîãî ãåíåçó ³ ñòà䳿 ðîçâèòêó. Ðåçóëüòàòè àïðîáàö³¿ ðîçðîáëåíî¿ ïðîãðàìè êîìïëåêñíî¿ ïåðñî- í³ô³êîâàíî¿ ïñèõîñîö³àëüíî¿ ðåàá³ë³òàö³¿ ïàö³ºíò³â ç ÃÏÐ ïðè äåìåíö³ÿõ ð³çíîãî ´åíåçó ³ ñòà䳿 ðîçâèòêó ñâ³ä÷àòü ïðî á³ëüøó ¿¿ åôåêòèâíîñò³ â ïîð³âíÿíí³ ç òðàäèö³éíèìè ñõåìàìè ïñèõîñîö³àëüíî¿ ðåàá³ë³òàö³¿ õâîðèõ ö³º¿ êàòåãîð³¿, ÿê³ íå âðàõîâóþòü âèä³ëåíèõ íàìè îñ- íîâíèõ êë³í³êî-ïñèõîïàòîëîã³÷íèõ, êîãí³òèâíèõ, êîíñòèòóö³éíî-á³îëîã³÷íèõ, ñîö³àëüíî- äåìîãðàô³÷íèõ, ïñèõîñîö³àëüíèõ îñîáëèâîñòåé ðîçâèòêó ³ ïåðåá³ãó ÃÏÐ ó õâîðèõ íà äåìåíö³¿. ³äì³ííîñòÿìè ðîçðîáëåíî¿ ïðîãðàìè º äèôåðåíö³àö³ÿ ðåàá³ë³òàö³éíèõ âïëèâ³â â çàëåæíîñò³ â³ä äîì³íóþ÷îãî ñåêòîðó (íåêîãí³òèâí³ ïñèõîïàòîëîã³÷í³ ðîçëàäè, êîãí³- òèâí³ ïîðóøåííÿ, ïîðóøåííÿ ñîö³àëüíîãî ôóíêö³îíóâàííÿ òà çàãàëüíî-ìåäè÷í³ ïðîáëå- ìè); âðàõóâàííÿ õàðàêòåðó äóàëüíèõ â³äíîñèí «õâîðèé íà ÃÏÐ ïðè äåìåíö³ÿõ – äîãëÿ- äàþ÷à îñîáà»; ñòàíó çáåðåæåíîãî ðåñóðñó ïàö³ºíòà â êîãí³òèâí³é ïñèõ³÷í³é, ñîìàòè÷í³é ³ ïñèõîñîö³àëüí³é ñôåðàõ; ïîñë³äîâíîñò³ òà åòàïíîñò³ â³äíîâëþþ÷èõ ï³äõîä³â. Êëþ÷îâ³ ñëîâà: ãàëþöèíàòîðíî-ïàðàíî¿äí³ ðîçëàäè, äåìåíö³¿ ð³çíîãî ãåíåçó ³ ñòà䳿 ðîçâèòêó, ïðîãðàìà êîìïëåêñíî¿ ïñèõîñîö³àëüíî¿ ðåàá³ë³òàö³¿, àïðîáàö³ÿ, îö³íêà åôåê- òèâíîñò³.

Âñòóï äåïðåñ³ÿ, òðèâîãà, ãàëþöèíàö³¿, ìàÿ÷í³ ³äå¿, Çà äàíèìè ÂÎÎÇ, ó ñâ³ò³ çàðåºñòðîâàíî äåë³ð³é, çáóäæåííÿ, àãðåñèâíà ïîâåä³íêà 35,6 ìëí. ïàö³ºíò³â ç äåìåíö³ºþ. Çà ïðîãíîçà- [7–12]. ìè ¿õ ÷èñåëüí³ñòü äî 2020 ðîêó çá³ëüøèòüñÿ Ðàçîì ç òèì, íàéá³ëüøèé âïëèâ íà ñîö³àëü- âäâ³÷³, à äî 2050 ðîêó – á³ëüø, í³æ âòðè÷³ [1]. íå ôóíêö³îíóâàííÿ ³ ÿê³ñòü æèòòÿ ïàö³ºíòà Ðîçïîâñþäæåí³ñòü äåìåíö³¿, ¿¿ åêîíîì³÷íèé ç äåìåíö³ºþ òà éîãî îòî÷åííÿ íàäàþòü ñàìå âïëèâ íà ðîäèíè ïàö³ºíò³â, íà äîãëÿäàþ÷èõ ãàëþöèíàòîðíî-ìàÿ÷í³ ðîçëàäè, ÿê³ ñïðè÷èíÿ- îñ³á, ñóñï³ëüñòâî ó ö³ëîìó ïðèºäíóþòü äàíó þòü ñòèãìàòèçàö³þ òà ñîö³àëüíó ³çîëÿö³þ äàíî¿ ïàòîëîã³þ äî êàòåãî𳿠íàéá³ëüø çíà÷óùèõ êàòåãî𳿠õâîðèõ [4, 13–16]. ïðîáëåì ñóñï³ëüíî¿ îõîðîíè çäîðîâ'ÿ [2–6]. Ìåòîþ äàíîãî äîñë³äæåííÿ âèçíà÷åíà Ó ñòðóêòóð³ êë³í³÷íèõ ïðîÿâ³â äåìåíö³¿ âè- ðîçðîáêà êîìïëåêñíî¿ ïåðñîí³ô³êîâàíî¿ ïðîãðà- ä³ëÿþòü êîãí³òèâí³ ³ íåêîãí³òèâí³ ïîðóøåííÿ. ìè ïñèõîñîö³àëüíî¿ ðåàá³ë³òàö³¿ ïàö³ºíò³â ç ãà- Íåêîãí³òèâí³ ïðîÿâè äåìåíö³¿ âêëþ÷àþòü øè- ëþöèíàòîðíî-ïàðàíî¿äíèìè ðîçëàäàìè ïðè äå- ðîêèé ñïåêòð ïñèõîïàòîëîã³÷íèõ ïîðóøåíü ìåíö³ÿõ ð³çíîãî ãåíåçó ³ ñòà䳿 ðîçâèòêó òà ð³çíîãî ð³âíÿ òÿæêîñò³, äî ÿêèõ â³äíîñÿòüñÿ: îö³íêà ¿¿ åôåêòèâíîñò³.

© Ò.Ã. Êðèâîí³ñ, 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 48 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

Ìàòåð³àë ³ ìåòîäè Îñíîâíèìè çàâäàííÿìè â ìåæàõ âèä³ëå-  ïðîöåñ³ äîñë³äæåííÿ áóëè îáñòåæåí³ 147 íèõ ñåêòîð³â ÏÊÏÏÐ ïàö³ºíò³â ç äåìåíö³ÿìè ïàö³ºíò³â ç ãàëþöèíàòîðíî-ïàðàíî¿äíèìè ðîç- ð³çíîãî ãåíåçó ³ ñòà䳿 ðîçâèòêó º íàñòóïí³: ëàäàìè (ÃÏÐ) ïðè äåìåíö³ÿõ (75 ïàö³ºíò³â ç I. Ó ñåêòîð³ íåêîãí³òèâíèõ ïñèõîïàòîëîã³- ñóäèííîþ äåìåíö³ºþ (ÑÄ) òà 72 ïàö³ºíòè ç³ ÷íèõ ðîçëàä³â: çì³øàíîþ äåìåíö³ºþ (ÇÄ) ñåðåäíüî¿ (ÑÑÐ) òà – êóï³ðóâàííÿ ãîñòðèõ ³ ðåöèäèâ³â õðîí³÷- ï³çíüî¿ ñòà䳿 ðîçâèòêó (ÏÑÐ)), ÿê³ ñêëàëè îñ- íèõ ïñèõîòè÷íèõ, àôåêòèâíèõ ³ ïîâåä³íêîâèõ íîâíó ãðóïó. ðîçëàä³â;  ÿêîñò³ êîíòðîëüíî¿ ãðóïè â äîñë³äæåíí³ – ñòàá³ë³çàö³ÿ ïñèõ³÷íîãî ñòàíó ³ ïðîô³ëàê- áðàëè ó÷àñòü 124 ïàö³ºíòè ç ÑÄ òà ÇÄ (íà òèêà ïîâòîðíèõ ðåöèäèâ³â ïñèõîòè÷íèõ, àôåê- ð³çíèõ ñòàä³ÿõ ðîçâèòêó) áåç ÃÏÐ. òèâíèõ ³ ïîâåä³íêîâèõ ðîçëàä³â; Çàñòîñîâàíèé êîìïëåêñ êë³í³êî-ïñèõîïàòî- – òåðàï³ÿ êîìîðá³äíèõ ïñèõ³÷íèõ ³ àäèê- ëîã³÷íèõ, ïñèõîìåòðè÷íèõ, ïñèõîä³àãíîñòè÷íèõ òèâíèõ ðîçëàä³â (ïðè ¿õ íàÿâíîñò³). äîñë³äæåíü, à òàêîæ ñòàòèñòè÷íà îáðîáêà îò- II.Ó ñåêòîð³ êîãí³òèâíèõ ïîðóøåíü: ðèìàíèõ äàíèõ äîçâîëèëè âèçíà÷èòè îñíîâí³ – â³äíîâëåííÿ êîãí³òèâíèõ ôóíêö³é õâîðèõ çàêîíîì³ðíîñò³ òà âèìîãè äî åôåêòèâíèõ ðåà- ç ÃÏÐ ïðè äåìåíö³ÿõ. á³ë³òàö³éíèõ âòðó÷àíü ó äàíîãî êîíòèíãåíòó III. Ó ñåêòîð³ ïîðóøåíü ñîö³àëüíîãî ôóíê- ïàö³ºíò³â. ö³îíóâàííÿ: Äëÿ îö³íêè åôåêòèâíîñò³ ðîçðîáëåíî¿ ïðî- – â³äíîâëåííÿ ³ ï³äòðèìàííÿ îñîáèñò³ñíèõ, ãðàìè êîìïëåêñíî¿ ïåðñîí³ô³êîâàíî¿ ïñèõîñî- ïðîôåñ³éíèõ ³ ñîö³àëüíèõ ôóíêö³é ³ ðîëåé õâîðèõ ö³àëüíî¿ ðåàá³ë³òàö³¿ (ÏÊÏÏÐ) ïàö³ºíò³â ç ÃÏÐ ç ÃÏÐ ïðè äåìåíö³ÿõ, ÿêîñò³ ¿õ æèòòºä³ÿëüíîñò³, ïðè äåìåíö³ÿõ áóâ âèêîðèñòàíèé êîìïëåêñíèé ð³âíÿ ïñèõîñîö³àëüíî¿ àäàïòàö³¿ òà ÿêîñò³ æèòòÿ; ï³äõ³ä, ùî âêëþ÷àâ çàñòîñóâàííÿ êë³í³êî-ïñèõî- – ïñèõîñîö³àëüíà äîïîìîãà äîãëÿäàþ÷èì ïàòîëîã³÷íîãî ìåòîäó, ïñèõîìåòðè÷íèõ øêàë îñîáàì. (øêàëà ïîâåä³íêîâèõ ðîçëàä³â (BEHAVE-AD); IV. Ó çàãàëüíîìåäè÷íîìó ñåêòîð³: Áðèñòîëüñêà øêàëà àêòèâíîñò³ â ïîâñÿêäåí- – ï³äâèùåííÿ ïðèõèëüíîñò³ õâîðèõ ç ÃÏÐ íîìó æèòò³ (BADL)), êðèòå𳿠îö³íêè ìåäèêà- ïðè äåìåíö³ÿõ äî ïðèçíà÷åíî¿ òåðàﳿ; ìåíòîçíîãî êîìïëàºíñó Expert Consensus – òåðàï³ÿ êîìîðá³äíî¿ ñîìàòè÷íî¿ ³ íåâðî- Guidelines òà ìåòîäè ìàòåìàòè÷íî¿ îáðîáêè ëîã³÷íî¿ ïàòîëî㳿. îòðèìàíèõ äàíèõ [17–20]. Çã³äíî ç ïðèíöèïîì êîìïëåêñíîãî äèôåðåí- Îñíîâíèìè ïðèíöèïàìè ðîçðîáëåíî¿ ö³éîâàíîãî ñåêòîðíî-îð³ºíòîâàíîãî ï³äõîäó, ó ÏÊÏÏÐ ïàö³ºíò³â ç äåìåíö³ÿìè ð³çíîãî ãåíå- êîæíîìó ñåêòîð³ ïðè â³äáîð³ ìåòîä³â ³ çàñîá³â çó ³ ñòà䳿 ðîçâèòêó º: á³îëîã³÷íî¿ òà ïñèõîñîö³àëüíî¿ òåðàﳿ õâîðèõ 1) ïðèíöèï êîìïëåêñíîãî äèôåðåíö³éîâà- íà äåìåíö³¿, âðàõîâóþòüñÿ âèä³ëåí³ â öüîìó íîãî ñåêòîðíî-îð³ºíòîâàíîãî ï³äõîäó; äîñë³äæåíí³: 2) ïðèíöèï ïåðñîí³ô³êîâàíîãî ï³äõîäó 1) ôàêòîðè ðèçèêó ðîçâèòêó ÃÏÐ ó õâîðèõ íà â äóàëüíèõ â³äíîñèíàõ «õâîðèé íà ÃÏÐ ïðè äåìåíö³¿ ð³çíîãî ïîõîäæåííÿ ³ ñòà䳿 ðîçâèòêó; äåìåíö³ÿõ – äîãëÿäàþ÷à îñîáà»; 2) êë³í³êî-ïñèõîïàòîëîã³÷í³ îñîáëèâîñò³ 3) ïðèíöèï ðåñóðñíî-îð³ºíòîâàíîãî ï³äõîäó; ÃÏÐ ³ ñóïóòí³õ ïñèõîïàòîëîã³÷íèõ ðîçëàä³â 4) ïðèíöèï ïîåòàïíîãî áåçïåðåðâíîãî ó õâîðèõ ç äåìåíö³ÿìè; ï³äõîäó. 3) ñòðóêòóðà êîãí³òèâíèõ ïîðóøåíü ó õâî- Ïðèíöèï êîìïëåêñíîãî äèôåðåíö³éîâà- ðèõ ç äåìåíö³ÿìè; íîãî ñåêòîðíî-îð³ºíòîâàíîãî ï³äõîäó â 4) õàðàêòåð ïîðóøåííÿ ñîö³àëüíîãî ôóíê- ðåàá³ë³òàö³¿ õâîðèõ íà äåìåíö³¿ âêëþ÷ຠñó- ö³îíóâàííÿ ó õâîðèõ ç äåìåíö³ÿìè; êóïí³ñòü á³îëîã³÷íèõ ³ ïñèõîñîö³àëüíèõ âïëèâ³â 5) êîìîðá³äí³ ïñèõ³÷í³, àäèêòèâí³ ³ ñîìà- íà âñ³ åò³îïàòîãåíåòè÷í³ ëàíêè ðîçâèòêó ³ ïðî- òè÷í³ ðîçëàäè; ãðåñóâàííÿ äåìåíö³¿, âèä³ëåí³, çà ïðèíöèïîì 6) ôàêòîðè çíèæåííÿ ÌÊ ó õâîðèõ ç ÃÏÐ åò³îïàòîãåíåòè÷íîãî ³ êë³í³÷íîãî ãðóïóâàííÿ ïðè äåìåíö³ÿõ (ôàêòîðè, ïîâ'ÿçàí³ ç êë³í³êîþ ³ ì³øåíåé âïëèâó, â ÷îòèðè îñíîâí³ ñåêòîðè: ãåíåçîì äåìåíö³é, îñîáëèâîñòÿìè ïñèõîòè÷- 1) ñåêòîð íåêîãí³òèâíèõ ïñèõîïàòîëîã³÷íèõ íèõ ðîçëàä³â, îñîáëèâîñòÿìè òåðàﳿ, îðãàí³- ðîçëàä³â; çàö³ºþ ë³êóâàííÿ, â³äíîñèíàìè ç ë³êàðåì, ñîö- 2) ñåêòîð êîãí³òèâíèõ ïîðóøåíü; ³àëüíèìè ôàêòîðàìè). 3) ñåêòîð ïîðóøåíü ñîö³àëüíîãî ôóíêö³î- Öåé ïðèíöèï òàêîæ ïåðåäáà÷àº: íóâàííÿ; 1) ñâîº÷àñí³ñòü ïðîâåäåííÿ ä³àãíîñòè÷íèõ 4) çàãàëüíîìåäè÷íèé ñåêòîð. ³ ë³êóâàëüíî-ðåàá³ë³òàö³éíèõ çàõîä³â õâîðèì;

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 49

2) ºäí³ñòü á³îëîã³÷íèõ (ïåðåâàæíî ôàðìà- îñîáà» âêëþ÷ຠñîö³àëüíî-ïñèõîëîã³÷íó ðîáî- êîëîã³÷íèõ) ³ ïñèõîñîö³àëüíèõ (ïñèõîòåðàïåâ- òó ç ïàö³ºíòîì ³ ç äîãëÿäàþ÷îþ îñîáîþ. òè÷íèõ, ïñèõîëîã³÷íèõ, ñîö³àëüíèõ) ìåòîä³â Âèêîðèñòàííÿ ö³º¿ ôîðì ïñèõîñîö³àëüíî¿ ðåàá³ë³òàö³¿ õâîðèõ ö³º¿ êàòåãîð³¿; ðîáîòè â ä³àä³ «õâîðèé íà äåìåíö³þ – äîãëÿ- 3) ñïàäêîºìí³ñòü ì³æ ñïåö³àë³çîâàíèìè äàþ÷à îñîáà» äîçâîëÿº ìàêñèìàëüíî â³äòâî- ë³êóâàëüíèìè (ïñèõ³àòðè÷í³ ³ ñîìàòè÷í³ ñòàö³î- ðèòè âòðà÷åí³ (ïîðóøåí³) ñóñï³ëüí³ çâ'ÿçêè ³ íàðè, ïñèõîíåâðîëîã³÷í³ äèñïàíñåðè, áóäèíêè- â³äíîñèíè ïàö³ºíòà, óñóíóòè éîãî ñîö³àëüí³ ³íòåðíàòè äëÿ õâîðèõ ç õðîí³÷íîþ ïñèõ³÷íîþ îáìåæåííÿ, ï³äâèùèòè ð³âåíü æèòòºä³ÿëüíîñò³ ïàòîëî㳺þ ³ ò.³í.) ³ ñîö³àëüíèìè óñòàíîâàìè òà ÿêîñò³ æèòòÿ. (ñïåö³àë³çîâàí³ ðåàá³ë³òàö³éí³ öåíòðè, ñëóæáè Ïðèíöèï ðåñóðñíî-îð³ºíòîâàíîãî ï³äõîäó ñîö³àëüíî¿ äîïîìîãè ³ ò.³í.), ÿê³ áåðóòü ó÷àñòü â ïðîâåäåíí³ ÏÊÏÏÐ õâîðèõ íà äåìåíö³¿ ç â ë³êóâàíí³ òà ðåàá³ë³òàö³¿ õâîðèõ íà äåìåíö³¿; ÃÏÐ âðàõîâóº ðåñóðñ (çáåðåæåíèé ïîòåíö³àë) 4) ñïàäêîºìí³ñòü ì³æ ôàõ³âöÿìè, ÿê³ áå- õâîðîãî â êîãí³òèâí³é, ïñèõ³÷í³é, ñîìàòè÷í³é ³ ðóòü ó÷àñòü â ÏÊÏÏÐ (ë³êàð³ ïñèõ³àòðè, ë³êàð³ ïñèõîñîö³àëüí³é (çáåðåæåííÿ îñîáèñò³ñíèõ ³íòåðí³ñòè, ë³êàð³ íåâðîëîãè, ë³êàð³ ðåàá³ë³òî- ÿêîñòåé ³ ð³âíÿ ïðîôåñ³éíèõ, ñîö³àëüíèõ ôóíêö³é ëîãè, ë³êàð³ ïñèõîòåðàïåâòè, ë³êàð³ ìåäè÷í³ ³ æèòòºä³ÿëüíîñò³) ñôåðàõ. ïñèõîëîãè, ñîö³àëüí³ ïðàö³âíèêè, ñåðåäí³é ìå- Öåé ðåñóðñ õàðàêòåðèçóº ñòàí ñàíîãåííèõ äè÷íèé ïåðñîíàë). á³îëîã³÷íèõ ³ ñîö³àëüíî-ïñèõîëîã³÷íèõ ôàêòîð³â, Ïðè âèêîðèñòàíí³ öüîãî ï³äõîäó êîæåí ç ùî ïðîòèñòîÿòü ïîäàëüøîìó ðîçâèòêó êîãí³- ôàõ³âö³â, ùî áåðå ó÷àñòü â ðåàë³çàö³¿ ÏÊÏÏÐ òèâíîãî, ïñèõ³÷íîãî ³ ñîö³àëüíîãî äåô³öèòó ïàö³ºíò³â ç äåìåíö³ÿìè ìຠñâî¿ ñóâîðî îêðåñ- õâîðèõ ç äåìåíö³ÿìè ³ âèçíà÷ຠìåæó ìîæëè- ëåí³ ôóíêö³¿, ÿê³ êîîðäèíóþòüñÿ ë³êàðåì-ïñè- âîãî â³äíîâëåííÿ ïîðóøåíèõ ôóíêö³é. õ³àòðîì. Ïîñë³äîâíèé ³ êîìïëåêñíèé âïëèâ íà êîã- Ïðèíöèï ïåðñîí³ô³êîâàíîãî ï³äõîäó í³òèâíó, ïñèõ³÷íó, ñîìàòè÷íó òà ïñèõîñîö³àëü- â äóàëüíèõ â³äíîñèíàõ «õâîðèé íà äåìåí- íó ñôåðó ïàö³ºíò³â çàáåçïå÷óº ö³ëåñïðÿìîâà- ö³þ-äîãëÿäàþ÷à îñîáà» ðîçøèðþº çíà÷åííÿ íèé ïàòîãåíåòè÷íèé åôåêò, ñïðèÿº êîìïåíñàö³¿ ñèñòåìè ñîö³àëüíî-ïñèõîëîã³÷íèõ çâ'ÿçê³â ì³æ ³ â³äíîâëåííþ âòðà÷åíèõ ôóíêö³é õâîðèõ íà äå- õâîðèì ³ äîãëÿäàþ÷îþ îñîáîþ â ñòðóêòóð³ ìåíö³¿. Ðåçóëüòàòîì öüîãî âïëèâó ñòຠçíè- ÏÊÏÏÐ õâîðèõ íà äåìåíö³¿. æåííÿ ñîö³àëüíî-ïîáóòîâî¿ çàëåæíîñò³ õâîðî- Òàêèé ï³äõ³ä ó ïðîâåäåíí³ ïñèõîñîö³àëüíî¿ ãî ç ÃÏÐ ïðè äåìåíö³ÿõ â çàäîâîëåíí³ ñâî¿õ ðåàá³ë³òàö³¿ õâîðèõ íà äåìåíö³¿ º âêðàé âàæëè- æèòòºâèõ ïîòðåá â³ä äîãëÿäàþ÷èõ îñ³á, ÷ëåí³â âèì â çâ'ÿçêó ç íåäîñòàòí³ìè ñîö³àëüíî-ïñè- ñ³ì'¿ òà ñîö³àëüíîãî îòî÷åííÿ. õîëîã³÷íèìè, ïðîôåñ³éíèìè ³ ñîö³àëüíî-ïîáó- Ïðèíöèï ïîåòàïíîãî áåçïåðåðâíîãî òîâèìè ìîæëèâîñòÿìè ïàö³ºíò³â ç ÃÏÐ ïðè äå- ï³äõîäó â ðîçðîáëåí³é ÏÊÏÏÐ. Êîãí³òèâí³, ìåíö³ÿõ. ïñèõ³÷í³ òà ïñèõîñîö³àëüí³ ïîðóøåííÿ ó õâî- Àíàë³ç ñîö³àëüíî-ïñèõîëîã³÷íîãî ôóíêö³îíó- ðèõ ç ÃÏÐ ïðè äåìåíö³ÿõ ðîçâèâàþòüñÿ âíà- âàííÿ, ÿê ïàö³ºíòà, òàê ³ äîãëÿäàþ÷î¿ îñîáè äîç- ñë³äîê äèôóçíîãî, äèôóçíî-îñåðåäêîâîãî äå- âîëÿº âèÿâèòè îñíîâí³ ïðîáëåìè ¿õ ïñèõîëîã³÷- ãåíåðàòèâíîãî ïðîöåñó, â öèõ âèïàäêàõ íåîá- íî¿, ñîö³àëüíî-ïîáóòîâî¿ òà ìåäè÷íî¿ âçàºìî䳿 õ³äíå ïðîâåäåííÿ ïîåòàïíî¿ áåçïåðåðâíî¿ ïñè- ³ ï³ä³áðàòè íåîáõ³äí³ ìåòîäè ³ çàñîáè êîðåêö³¿ õîñîö³àëüíî¿ ðåàá³ë³òàö³¿ ç ìåòîþ ïðîô³ëàêòè- ö³º¿ âçàºìî䳿, ç ìåòîþ ï³äâèùåííÿ åôåêòèâíîñò³ êè íàðîñòàííÿ ³ (àáî) êîìïåíñàö³¿ âæå íàÿâíèõ ðåàá³ë³òàö³éíèõ çàõîä³â ó õâîðèõ ç ÃÏÐ ïðè äå- ïîðóøåíü ïñèõ³÷íèõ ïðîöåñ³â òà ñîö³àëüíîãî ìåíö³ÿõ ð³çíîãî ãåíåçó ³ ñòà䳿 ðîçâèòêó. ôóíêö³îíóâàííÿ. Ðåçóëüòàòîì âèêîðèñòàííÿ öüîãî ïðèíöè- Ó ðîçðîáëåí³é ÏÊÏÏÐ õâîðèõ ç ÃÏÐ ïðè ïó º ðîçðîáêà ³íäèâ³äóàëüíî¿ ïðîãðàìè äåìåíö³ÿõ âèä³ëÿþòüñÿ ãîñï³òàëüíèé ³ äèñïàí- ïñèõîñîö³àëüíî¿ ðåàá³ë³òàö³¿, â ÿê³é âðàõîâó- ñåðíèé åòàï. þòüñÿ êë³í³÷í³ îñîáëèâîñò³ äåìåíö³¿, ïñèõî- Êîæåí ç åòàï³â ïîä³ëÿºòüñÿ íà ñòà䳿. Òàê, òè÷íèõ, àôåêòèâíèõ ³ ïîâåä³íêîâèõ ðîçëàä³â, ãîñï³òàëüíèé åòàï ïñèõîñîö³àëüíî¿ ðåàá³ë³òàö³¿ ð³âåíü ïñèõîñîö³àëüíîãî ôóíêö³îíóâàííÿ õâî- âêëþ÷ຠíàñòóïí³ ñòà䳿: ðèõ, à òàêîæ îñíîâí³ ïðîáëåìè ¿õ ïñèõîñîö³- – ðîçøèðåíî¿ ä³àãíîñòèêè (êë³í³êî-ïñèõî- àëüíî¿ ³ ìåäè÷íî¿ âçàºìî䳿 ç äîãëÿäàþ÷èìè ïàòîëîã³÷í³, ïñèõîä³àãíîñòè÷í³, ïñèõîìåòðè÷í³ îñîáàìè. ìåòîäè); Ïñèõîñîö³àëüíèé àñïåêò ðåàá³ë³òàö³éíî¿ – íåâ³äêëàäíî¿ ïñèõ³àòðè÷íî¿ äîïîìîãè ðîáîòè, ùî ïðîâîäèòüñÿ â ðàìêàõ äóàëüíèõ (êóï³ðóâàííÿ ãîñòðèõ ³ ðåöèäèâ³â õðîí³÷íèõ â³äíîñèí «õâîðèé íà äåìåíö³þ – äîãëÿäàþ÷à ïñèõîòè÷íèõ, àôåêòèâíèõ ³ ïîâåä³íêîâèõ ðîç-

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 50 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

ëàä³â, òåðàï³ÿ êîìîðá³äíèõ ïñèõ³÷íèõ ³ àäèê- êë³í³êî-ïñèõîïàòîëîã³÷íèõ, êîãí³òèâíèõ, êîíñòè- òèâíèõ ðîçëàä³â); òóö³éíî-á³îëîã³÷íèõ, ñîö³àëüíî-äåìîãðàô³÷íèõ, – áàçîâî¿ ïñèõîôàðìàêîòåðàﳿ, ïñèõîòå- ïñèõîñîö³àëüíèõ îñîáëèâîñòåé ðîçâèòêó ³ ïå- ðàﳿ, ïñèõîñîö³àëüíî¿ òåðàﳿ (â³äíîâëåííÿ ïñè- ðåá³ãó ÃÏÐ ó õâîðèõ ÑÄ ³ ÇÄ â ÑÑÐ ³ ÏÑÐ. õ³÷íèõ ôóíêö³é, êîðåêö³ÿ ñîìàòè÷íî¿ ³ íåâðî-  àïðîáàö³¿ ðîçðîáëåíî¿ ïðîãðàìè ïñèõî- ëîã³÷íî¿ ïàòîëî㳿). ñîö³àëüíî¿ ðåàá³ë³òàö³¿ áðàëî ó÷àñòü 76 õâî-  ñòðóêòóð³ äèñïàíñåðíîãî åòàïó âèä³ëÿ- ðèõ ç ÃÏÐ ïðè äåìåíö³ÿõ, ùî ñêëàëè îñíîâíó þòü íàñòóïí³ ñòà䳿: ãðóïó (39 ïàö³ºíò³â ç ÑÄ â ÑÑÐ ³ ÏÑÐ; – ï³äòðèìóþ÷î¿ ïñèõîôàðìàêîòåðàﳿ 37 ïàö³ºíò³â ç³ ÇÄ â ÑÑÐ ³ ÏÑÐ). Ó êîíòðîëüíó (ñòàá³ë³çàö³ÿ ïñèõ³÷íîãî ñòàíó ³ ïðîô³ëàêòèêà ãðóïó óâ³éøëè 65 õâîðèõ ç ÃÏÐ ïðè äåìåíö³ÿõ ïîâòîðíèõ ðîçâèòê³â ïñèõîòè÷íèõ, àôåêòèâíèõ (31 ïàö³ºíò ç ÑÄ â ÑÑÐ ³ ÏÑÐ; 34 ïàö³ºíòà ³ ïîâåä³íêîâèõ ðîçëàä³â, â³äíîâëåííÿ êîãí³òèâ- ç ÇÄ â ÑÑÐ ³ ÏÑÐ). íèõ ôóíêö³é, ï³äâèùåííÿ ïðèõèëüíîñò³ õâîðèõ Õâîð³ ç ÃÏÐ ïðè äåìåíö³ÿõ îñíîâíî¿ ãðóïè íà äåìåíö³¿ äî òåðàﳿ, ñòàá³ë³çàö³ÿ ñîìàòè÷- ïðîéøëè êóðñ ïñèõîñîö³àëüíî¿ ðåàá³ë³òàö³¿ çà íîãî ñòàíó òà ïðîô³ëàêòèêà ðåöèäèâ³â ñîìà- ðîçðîáëåíîþ íàìè ïðîãðàìîþ (ÏÊÏÏÐ), òè÷íèõ çàõâîðþâàíü); õâîð³ ç ÃÏÐ ïðè äåìåíö³ÿõ êîíòðîëüíî¿ ãðóïè – – ñîö³àë³çàö³¿ ³ ðå³íòåãðàö³¿ õâîðîãî íà äå- êóðñ ðåàá³ë³òàö³¿ çà òðàäèö³éíèìè ðåàá³ë³òà- ìåíö³¿ â ñóñï³ëüñòâ³ (â³äíîâëåííÿ ³ ï³äòðèìàí- ö³éíèìè ïðîãðàìàìè äëÿ ö³º¿ êàòåãî𳿠ïàö³ºíò³â. íÿ îñîáèñò³ñíèõ, ïðîôåñ³éíèõ òà ñîö³àëüíèõ Êðèòåð³ÿìè, çà äîïîìîãîþ ÿêèõ îö³íþâà- ôóíêö³é ³ ðîëåé õâîðèõ, ÿêîñò³ ¿õ æèòòºä³ÿëü- ëàñü åôåêòèâí³ñòü ðîçðîáëåíî¿ ÏÊÏÏÐ ïà- íîñò³, ð³âíÿ ïñèõîñîö³àëüíî¿ àäàïòàö³¿ òà ÿêîñò³ ö³ºíò³â ç ÃÏÐ ïðè äåìåíö³ÿõ ð³çíîãî ãåíåçó ³ æèòòÿ, ïñèõîñîö³àëüíà òà ³íøà äîïîìîãà äîã- ñòà䳿 ðîçâèòêó, áóëè: ëÿäàþ÷èì îñîáàì). • êë³í³÷íà äèíàì³êà ïñèõ³÷íîãî ñòàíó; Ó ðîçðîáëåí³é äëÿ êîæíîãî åòàïó ÏÊÏÏÐ • äèíàì³êà êîãí³òèâíèõ ôóíêö³é (ïîã³ðøåí- âèçíà÷åíî ïîêàçàííÿ, ö³ë³, ì³ñöÿ ïðîâåäåííÿ, íÿ, â³äñóòí³ñòü åôåêòó, ì³í³ìàëüíå ïîë³ïøåí- ôàõ³âö³â, ÿê³ áåðóòü ó÷àñòü â ðåàá³ë³òàö³¿, ïå- íÿ, ïîì³ðíå ïîë³ïøåííÿ); ðåë³ê íåîáõ³äíèõ ìåäèêàìåíòîçíèõ (íåéðîëåï- • ð³âåíü ìåäèêàìåíòîçíîãî êîìïëàºíñó; òèêè, àíòèäåïðåñàíòè, òðàíêâ³ë³çàòîðè, ñíî- • ð³âåíü ãëîáàëüíîãî ñîö³àëüíîãî ôóíêö³î- ä³éí³, àíòàãîí³ñòè NMDA-ðåöåïòîð³â, ²ÕÅ, çà- íóâàííÿ ³ ñòóï³íü â³äíîâëåííÿ îñíîâíèõ ôóíê- ñîáè, ùî ñòèìóëþþòü ìåòàáîë³÷í³ ïðîöåñè ö³é æèòòºä³ÿëüíîñò³; ãîëîâíîãî ìîçêó, ñòàòèíè, àíòèàãðåãàíòè, âà- • äèíàì³êà ñòðåñîâîãî íàâàíòàæåííÿ äî- çîàêòèâí³ ³ çàãàëüíîçì³öíþþ÷³ çàñîáè), ïñè- ãëÿäàþ÷èõ çà õâîðèìè îñ³á. õîòåðàïåâòè÷íèõ (³íäèâ³äóàëüíà êîãí³òèâíà Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ ïñèõîòåðàï³ÿ, êîãí³òèâíà ðåìåä³àö³ÿ, ³íäèâ³äó- Àíàë³ç êë³í³÷íî¿ äèíàì³êè ïñèõ³÷íîãî ñòà- àëüíà ³ ãðóïîâà òåðàï³ÿ ìèñòåöòâîì ³ òâîð÷èì íó õâîðèõ îñíîâíî¿ ãðóïè, â ïîð³âíÿíí³ ç õâî- ñàìîâèðàæåííÿì, ñ³ìåéíà ïñèõîòåðàï³ÿ), ïñè- ðèìè êîíòðîëüíî¿ ãðóïè, ïîêàçàâ, ùî â îñíîâí³é õîñîö³àëüíèõ çàñîá³â (òåðàï³ÿ çàéíÿò³ñòþ, ãðóï³ ñåðåä îáñòåæåíèõ äîñòîâ³ðíî çìåíøè- òðåí³íã ç âèðîáëåííÿ ³ çáåðåæåííÿ ñîö³àëüíî- ëàñü ÷àñòîòà ÃÏÐ (ó 10,5 % âèïàäê³â, ïðè ïîáóòîâèõ íàâè÷îê, îñâ³òí³ ïðîãðàìè, ñîö³àëü- ð<0,05), ïîðóøåíü àêòèâíîñò³ (áðîäÿæíèöòâî, íî-ïñèõîëîã³÷íå êîíñóëüòóâàííÿ, ñîö³àëüíî- áåçö³ëüíà àêòèâí³ñòü, íåàäåêâàòíà ïîâåä³íêà) ñðåäîâèùíèé ³ ñîö³àëüíî-ïîáóòîâèé ñóïðîâ³ä), (ó 17,1 % âèïàäê³â, ïðè ð<0,05), ðîçãàëüìîâà- çàñîáè ô³çè÷íî¿ ðåàá³ë³òàö³¿ (ê³íåòîòåðàï³ÿ, íîñò³ ïîâåä³íêè (ó 3,9 % âèïàäê³â, ïðè ð<0,01) ë³êóâàëüíà ô³çêóëüòóðà ³ ìàñàæ). ³ àïàò³¿ (ó 6,6 % âèïàäê³â, ïðè ð<0,01).  êîíò- Ç ìåòîþ íàäàííÿ ïñèõîñîö³àëüíî¿ äîïîìî- ðîëüí³é ãðóï³ çìåíøåííÿ ïîêàçíèê³â áóëî äîñ- ãè äîãëÿäàþ÷èì çà õâîðèìè ç ÃÏÐ ïðè äå- òîâ³ðíî ìåíø âèðàæåíèì. ìåíö³ÿõ îñîáàì ðîçðîáëåíèé ³ àïðîáîâàíèé Âèâ÷åííÿ äèíàì³êè êîãí³òèâíîãî ñòàíó õâî- «ïñèõîîñâ³òí³é òðåí³íã äëÿ îñ³á, ÿê³ äîãëÿäà- ðèõ îñíîâíî¿ ãðóïè, ó ïîð³âíÿíí³ ç õâîðèìè êîíò- þòü çà õâîðèìè íà äåìåíö³¿». ðîëüíî¿ ãðóïè, ïîêàçàëî, ùî â îñíîâí³é ãðóï³ âè- Ç ìåòîþ îö³íêè åôåêòèâíîñò³ ðîçðîáëåíî¿ ùîþ âèÿâèëàñÿ ê³ëüê³ñòü õâîðèõ ç ì³í³ìàëüíèì ÏÊÏÏÐ áóëà ïðîâåäåíà ¿¿ àïðîáàö³ÿ. Àïðî- (ó 39,5 % âèïàäê³â, ïðè ð<0,05) ³ ïîì³ðíèì (ó áàö³ÿ ÏÊÏÏÐ ïàö³ºíò³â ç ÃÏÐ ïðè äåìåíö³ÿõ 21,1 % âèïàäê³â, ïðè ð<0,01) ïîë³ïøåííÿì êîãí³- ð³çíîãî ãåíåçó ³ ñòà䳿 ðîçâèòêó áóëà ïðîâåäå- òèâíèõ ôóíêö³é.  êîíòðîëüí³é ãðóï³ ö³ ïîêàçíè- íà ó ïîð³âíÿíí³ ç òðàäèö³éíèìè ñõåìàìè ïñè- êè äîð³âíþâàëè 23,1 % òà 7,7 % â³äïîâ³äíî. õîñîö³àëüíî¿ ðåàá³ë³òàö³¿ õâîðèõ ö³º¿ êàòåãîð³¿, Àíàë³ç ðåçóëüòàò³â âèâ÷åííÿ ð³âí³â ìåäè- ÿê³ íå âðàõîâóþòü âèä³ëåíèõ íàìè îñíîâíèõ êàìåíòîçíîãî êîìïëàºíñó (ÌÊ) õâîðèõ îñíîâ-

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 51

íî¿ òà êîíòðîëüíî¿ ãðóïè ïîêàçàâ, ùî â îñíîâí³é Ïðîàíàë³çóâàâøè ðåçóëüòàòè âèâ÷åííÿ ðå- ãðóï³ ï³ñëÿ ðåàá³ë³òàö³¿ âèÿâèëîñÿ á³ëüøå ñóðñó ñ³ìåéíî¿ ï³äòðèìêè ó õâîðèõ îñíîâíî¿ ïàö³ºíò³â ç ïîâíèì ÌÊ (ó 63,2 % âèïàäê³â, ïðè ãðóïè çàçíà÷åíî, ùî ó õâîðèõ îñíîâíî¿ ãðóïè ð<0,05), òîä³ ÿê ñåðåä õâîðèõ êîíòðîëüíî¿ ãðó- âèÿâëÿëîñÿ á³ëüøå îñ³á ç äîñòàòí³ì ðåñóðñîì ïè á³ëüøå ïàö³ºíò³â ç ÷àñòêîâèì (ó 33,8 % âè- ñ³ìåéíî¿ ï³äòðèìêè (ó 48,7 % âèïàäê³â, ïðè ïàäê³â, ïðè ð<0,05) ³ íèçüêèì (ó 26,2 % âè- ð<0,05) ³ ìåíøå – ç íèçüêèì ðåñóðñîì ñ³ìåé- ïàäê³â, ïðè ð<0,05) ÌÊ. íî¿ ï³äòðèìêè (â 21,0 % âèïàäê³â, ïðè ð<0,05). Çã³äíî ç ðåçóëüòàòàìè àïðîáàö³¿ ó õâîðèõ  êîíòðîëüí³é ãðóï³ çàðåºñòðîâàíî 29,2 % îñíîâíî¿ ãðóïè ñåðåäíüî-ãðóïîâà âåëè÷èíà (ð<0,05) ç äîñòàòí³ì ³ 38,5 % (ð<0,05) – ç íèçü- ãëîáàëüíîãî ôóíêö³îíóâàííÿ ñòàíîâèëà (49,3± êèì ð³âíåì ñ³ìåéíî¿ ï³äòðèìêè. 7,2) áàëè [42,1–56,5] (ïðè ð<0,05), òîä³ ÿê ó õâî- Âèñíîâêè ðèõ êîíòðîëüíî¿ ãðóïè – (36,4±5,1) áàëè [31,3– Òàêèì ÷èíîì, ðåçóëüòàòè àïðîáàö³¿ ðîçðîá- 41,5] (ïðè ð<0,05). ëåíî¿ ïðîãðàìè êîìïëåêñíî¿ ïåðñîí³ô³êîâàíî¿ Ðåçóëüòàòè âèâ÷åííÿ ôàêòîð³â îáìåæåííÿ ïñèõîñîö³àëüíî¿ ðåàá³ë³òàö³¿ ïàö³ºíò³â ç ÃÏÐ ïðè æèòòºä³ÿëüíîñò³ õâîðèõ îñíîâíî¿ ãðóïè ïîêà- äåìåíö³ÿõ ð³çíîãî ãåíåçó ³ ñòà䳿 ðîçâèòêó çàëè, ùî ó õâîðèõ, ÿê³ ïðîéøëè ðåàá³ë³òàö³þ ñâ³ä÷àòü ïðî á³ëüøó ¿¿ åôåêòèâí³ñòü â ïî- çà ÏÊÏÏÐ, íà â³äì³íó â³ä õâîðèõ êîíòðîëüíî¿ ð³âíÿíí³ ç òðàäèö³éíèìè ñõåìàìè ïñèõîñîö³- ãðóïè, ïîêðàùèëèñÿ ôóíêö³¿ æèòòºä³ÿëüíîñò³ â àëüíî¿ ðåàá³ë³òàö³¿ õâîðèõ ö³º¿ êàòåãîð³¿, ÿê³ íå ñôåðàõ: ïðèãîòóâàííÿ ¿æ³ [(1,2±0,2) áàëè, ïðè âðàõîâóþòü âèä³ëåíèõ â ðîáîò³ êë³í³êî-ïñèõî- ð<0,01)], êîìóí³êàö³¿ [(1,2±0,4) áàëè, ïðè ïàòîëîã³÷íèõ, êîãí³òèâíèõ, êîíñòèòóö³éíî-á³î- ð<0,01)], çäàòíîñò³ ðîáèòè ïîêóïêè (1,6±0,4 áàëè, ëîã³÷íèõ, ñîö³àëüíî-äåìîãðàô³÷íèõ, ïñèõîñî- ïðè ð<0,05) ³ ðîçïîðÿäæåííÿ ô³íàíñàìè [(1,7± ö³àëüíèõ îñîáëèâîñòåé ðîçâèòêó ³ ïåðåá³ãó 0,4) áàëè, ïðè ð<0,05)]. Ó ïàö³ºíò³â êîíòðîëüíî¿ ÃÏÐ ó õâîðèõ ÑÄ ³ ÇÄ â ÑÑÐ ³ ÏÑÐ. ãðóïè çàçíà÷åí³ ïîêàçíèêè ïîêðàùèëèñü äî- ³äì³ííîñòÿìè ðîçðîáëåíî¿ ïðîãðàìè º ñòîâ³ðíî ìåíøå. äèôåðåíö³àö³ÿ ðåàá³ë³òàö³éíèõ âïëèâ³â çàëåæ- Çã³äíî ç ðåçóëüòàòàìè âèâ÷åííÿ ÿêîñò³ âè- íî â³ä äîì³íóþ÷îãî ñåêòîðó (íåêîãí³òèâí³ ïñè- êîíàííÿ ñîö³àëüíèõ ðîëåé ³ ôóíêö³é õâîðèìè õîïàòîëîã³÷í³ ðîçëàäè, êîãí³òèâí³ ïîðóøåííÿ, îñíîâíî¿ ãðóïè, ñë³ä êîíñòàòóâàòè, ùî ó õâî- ïîðóøåííÿ ñîö³àëüíîãî ôóíêö³îíóâàííÿ òà çà- ðèõ îñíîâíî¿ ãðóïè, äîñòîâ³ðíî ïîêðàùèëèñÿ ãàëüíî-ìåäè÷í³ ïðîáëåìè); âðàõóâàííÿ õàðàê- ïîêàçíèêè âèêîíàííÿ áàòüê³âñüêî¿ ðîë³ [(2,5± òåðó äóàëüíèõ â³äíîñèí «õâîðèé íà ÃÏÐ ïðè 0,4) áàëè, ïðè ð<0,05)], ÿêîñò³ ñîö³àëüíèõ êîí- äåìåíö³ÿõ – äîãëÿäàþ÷à îñîáà»; ñòàíó çáå- òàêò³â [(2,0±0,3) áàëè, ïðè ð<0,05)], ³ óñï³øíîñò³ ðåæåíîãî ðåñóðñó ïàö³ºíòà â êîãí³òèâí³é ïñè- ïîâåä³íêè â íåñòàíäàðòíèõ ³ ñêëàäíèõ óìîâàõ õ³÷í³é, ñîìàòè÷í³é ³ ïñèõîñîö³àëüí³é ñôåðàõ; [(2,6±0,4) áàëè, ïðè ð<0,05)].  êîíòðîë³ òàêå ïîñë³äîâíîñò³ òà åòàïíîñò³ â³äíîâëþþ÷èõ ïîêðàùåííÿ áóëî ìåíø âèðàæåíèì. ï³äõîä³â. Çã³äíî ç ðåçóëüòàòàìè àïðîáàö³¿ â îñíîâí³é Ïåðñïåêòèâè äîñë³äæåííÿ, ïîâ'ÿçàí³ ç øè- ãðóï³ õâîðèõ ïåðåâàæàþòü äîãëÿäàþ÷³ îñîáè ðîêèì âïðîâàäæåííÿì â ñèñòåìó ðåàá³ë³òàö³¿ ç â³äñóòí³ñòþ ñòðåñîâîãî íàâàíòàæåííÿ â³ä ïàö³ºíò³â ç ÃÏÐ ïðè äåìåíö³ÿõ ï³äõîä³â, îð³ºí- âçàºìî䳿 ç õâîðèìè íà ÃÏÐ ïðè äåìåíö³ÿõ (ó òîâàíèõ íà: 15,8 % âèïàäê³â, ïðè ð<0,05) ³ ç íåçíà÷íèì – ôóíêö³îíàëüí³ ì³øåí³ (íåêîãí³òèâí³ òà ñòðåñîâèì íàâàíòàæåííÿì (â 47,4 % âèïàäê³â, êîãí³òèâí³ ïîðóøåííÿ, ðîçëàäè ñîö³àëüíîãî ôóíê- ïðè ð<0,01). Òîä³ ÿê â êîíòðîëüí³é ãðóï³ õâî- ö³îíóâàííÿ òà çàãàëüíî-ìåäè÷í³ ïðîáëåìè); ðèõ ïåðåâàæàþòü äîãëÿäàþ÷è îñîáè ç ïîì³ð- – çáåðåæåí³ ðåñóðñè (â ïñèõ³÷í³é, ñîìà- íèì ñòðåñîâèì íàâàíòàæåííÿì â³ä âçàºìî䳿 òè÷í³é, êîãí³òèâí³é òà ïñèõîñîö³àëüí³é ñôåðàõ); ç õâîðèìè íà ÃÏÐ ïðè äåìåíö³ÿõ (ó 41,5 % – äóàëüí³ â³äíîñèíè «õâîðèé íà ÃÏÐ ïðè âèïàäê³â, ïðè ð<0,01) ³ ç³ çíà÷íèì ñòðåñîâèì äåìåíö³ÿõ – äîãëÿäàþ÷à îñîáà»; íàâàíòàæåííÿì (â 27,7 % âèïàäê³â, ïðè ð<0,05). – áåçïåðåðâí³ñòü ðåàá³ë³òàö³éíèõ ï³äõîä³â.

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7. Maruta N.A. (2019). Ranneye vmeshatelstvo pri dementsii: problemy i resheniya [Early intervention for dementia: problems and solutions]. Ukrayinskyy medychnyy chasopys – Ukrainian medical journal, https://www.umj.com.ua/wp/wpcontent/uploads/2019/04/Cognit.pdf?upload [in Russian]. 8. Mishchenko T.S. (2014). Sosudistaya dementsiya (evolyutsiya vzglyadov na problemu) [Vascular dementia (evolution of views on the problem)]. Ukrains'kiy visnik psikhonevrologi – Ukrainian Bulletin of Psychoneurology, vol. 22, ¹ 1 (78), pp. 5–10. [in Russian]. 9. Mukadam N., Cooper C., Livingston G. (2011). A systematic review of ethnicity and pathways to care in dementia. International Journal of Geriatric Psychiatry, vol. 26, pp. 12–20. 10. Levin O.S. (2014). Diagnostika i lecheniye dementsii v klinicheskoy praktike [Diagnosis and treatment of dementia in clinical practice]. M.: MEDpress-inform, 256 p. [in Russian]. 11. Suvorova I.A. (2011). Sosudistaya dementsiya: klinicheskoye techeniye, faktory riska, differentsirovannaya terapiya [Vascular dementia: clinical course, risk factors, differentiated therapy]. Doktor’s thesis. 14.01.11. Irkutsk [in Russian]. 12. Koch T., Iliffe S. (2010). Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: a systematic review. BMC Family Practice, vol. 11 (52), pp. 1–8. 13. Teri L., McKenzie G.L., Pike K.C., Farran C.J. et al. (2010). Staff training in assisted living: evaluating treatment fidelity. International Journal of Geriatric Psychiatry, vol.18, pp. 502–509. 14. Lustenberger I., Schupbach B., Von Gunten A., Mosimann U. (2011). Psychotropic medication use in Swiss nursing homes. Swiss Medical Weekly, vol. 141, w13254. 15. Dua T., Barbui C., Clark N., Fleischmann A., Poznyak V. (2011). Evidence-based guidelines for mental, neurological, and substance use disorders in low – and middle-income countries: Summary of WHO recommendations. PLoS Medicine, vol. 8 (11), e1001122. 16. Low L.F., Anstey K.J., Lackersteen S.M., Camit M., Harrison F. et al. (2010). Recognition, attitudes and causal beliefs regarding dementia in Italian, Greek and Chinese Australians. Dementia and Geriatric Cognitive Disorders, vol. 30 (6), pp. 499–508. 17. Reisberg B., Auer S.R., Monteiro I.M. (1996). Behavioral pathology in Alzheimer's disease (BEHAVE-AD) rating scale. Int. Psychogeriatr., vol. 8 (3), pp. 301–308. 18. Havrylyuk A.O. (2016). Unifikovanyy klinichnyy protokol pervynnoyi, vtorynnoyi (spetsializovanoyi), tretynnoyi (vysokospetsializovanoyi) ta paliatyvnoyi medychnoyi dopomohy. Dementsiya [Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) and palliative care. Dementia]. K., 57 ð. [in Ukrainian]. 19. Lutova N.B. (Eds.) et al. (2007). Metod prohnozyrovanyya medykamentoznoho komplayensa v psykhyatryy: metodycheskye rekomendatsyy [A method for predicting drug compliance in psychiatry: guidelines]. NYPNY ym. VM Bekhtereva: SPb., 24 p. [in Russian] 20. Antomonov M.Yu. (2006) Matematicheskaya obrabotka i analiz mediko-biologicheskikh dannykh [Mathematical processing and analysis of medical and biological data]. Kiyev, 556 p. [in Russian]. Í.À. Ìàðóòà, Ê.Â. Øåâ÷åíêî-Áèòåíñêèé ÏÐÎÃÐÀÌÌÀ ÏÑÈÕÎÑÎÖÈÀËÜÍÎÉ ÐÅÀÁÈËÈÒÀÖÈÈ ÏÀÖÈÅÍÒÎÂ Ñ ÃÀËËÞÖÈÍÀÒÎÐÍÎ- ÏÀÐÀÍÎÈÄÍÛÌÈ ÐÀÑÑÒÐÎÉÑÒÂÀÌÈ ÏÐÈ ÄÅÌÅÍÖÈßÕ ÐÀÇËÈ×ÍÎÃÎ ÃÅÍÅÇÀ È ÑÒÀÄÈÈ ÐÀÇÂÈÒÈß È ÎÖÅÍÊÀ ÅÅ ÝÔÔÅÊÒÈÂÍÎÑÒÈ Ðàçðàáàòûâàëè ïðîãðàììû êîìïëåêñíîé ïåðñîíèôèöèðîâàííîé ïðîãðàììû ïñèõîñîöèàëüíîé ðå- àáèëèòàöèè ïàöèåíòîâ ñ ãàëëþöèíàòîðíî-ïàðàíîèäíûìè ðàññòðîéñòâàìè (ÃÏÐ) ïðè äåìåíöèÿõ ðàç- ëè÷íîãî ãåíåçà è ñòàäèè ðàçâèòèÿ. Ðåçóëüòàòû àïðîáàöèè ðàçðàáîòàííîé ïðîãðàììû êîìïëåêñíîé ïåðñîíèôèöèðîâàííîé ïñèõîñîöèàëüíîé ðåàáèëèòàöèè ïàöèåíòîâ ñ ÃÏÐ ïðè äåìåíöèÿõ ðàçëè÷íîãî ãåíåçà è ñòàäèè ðàçâèòèÿ ñâèäåòåëüñòâóþò î áîëüøåé åå ýôôåêòèâíîñòè ïî ñðàâíåíèþ ñ òðàäèöèîí- íûìè ñõåìàìè ïñèõîñîöèàëüíîé ðåàáèëèòàöèè áîëüíûõ ýòîé êàòåãîðèè, íå ó÷èòûâàþò âûäåëåííûõ îñíîâíûõ êëèíèêî-ïñèõîïàòîëîãè÷åñêèõ, êîãíèòèâíûõ, êîíñòèòóöèîííî-áèîëîãè÷åñêèõ, ñîöèàëü- íî-äåìîãðàôè÷åñêèõ, ïñèõîñîöèàëüíûõ îñîáåííîñòåé ðàçâèòèÿ è òå÷åíèÿ ÃÏÐ ó áîëüíûõ äåìåíöè- åé. Ðàçëè÷èÿìè ðàçðàáîòàííîé ïðîãðàììû ÿâëÿåòñÿ äèôôåðåíöèàöèÿ ðåàáèëèòàöèîííûõ âîçäåéñòâèé â çàâèñèìîñòè îò äîìèíèðóþùåãî ñåêòîðà (íåêîãíèòèâíûå ïñèõîïàòîëîãè÷åñêèå ðàññòðîéñòâà, êîã- íèòèâíûå íàðóøåíèÿ, íàðóøåíèÿ ñîöèàëüíîãî ôóíêöèîíèðîâàíèÿ è îáùå-ìåäèöèíñêèå ïðîáëåìû); ó÷åòà õàðàêòåðà äóàëüíûõ îòíîøåíèé «áîëüíîé ÃÏÐ ïðè äåìåíöèÿõ – óõàæèâàþùåå ëèöî»; ñîñòîÿ- íèÿ ñîõðàíåííîãî ðåñóðñà ïàöèåíòà â êîãíèòèâíîé ïñèõè÷åñêîé, ñîìàòè÷åñêîé è ïñèõîñîöèàëüíîé ñôåðàõ; ïîñëåäîâàòåëüíîñòè è ýòàïíîñòè âîññòàíîâèòåëüíûõ ïîäõîäîâ. Êëþ÷åâûå ñëîâà: ãàëëþöèíàòîðíî-ïàðàíîèäíûå ðàññòðîéñòâà, äåìåíöèè ðàçëè÷íîãî ãåíåçà è ñòàäèè ðàçâèòèÿ, ïðîãðàììà êîìïëåêñíîé ïñèõîñîöèàëüíîé ðåàáèëèòàöèè, àïðîáàöèÿ, îöåíêà ýô- ôåêòèâíîñòè.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 54 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

N.O. Maruta, K.V. Shevchenko–Bitensky PROGRAM OF PSYCHOSOCIAL REHABILITATION OF PATIENTS WITH HALLUCINATORY-PARANOID DISORDERS IN DEMENTIAS OF DIFFERENT GENESIS AND STAGE OF DEVELOPMENT AND EVALUATION OF ITS EFFECTIVENESS The purpose of this study is to develop a program of complex personalized program of psychosocial rehabilitation for patients with hallucinatory-paranoid disorders (HPR) in dementias of different genesis and stage of development and evaluate its effectiveness. The results of approbation of the developed program of complex personalized psychosocial rehabilitation of patients with HPR in dementias of different genesis and stage of development indicate its greater efficiency in comparison with traditional schemes of psychosocial rehabilitation patients of this category which do not consider socio-demographic, psychosocial features of the development and course of HPR in patients with dementia. The differences of the developed program are the differentiation of rehabilitation effects depending on the dominant sector (non-cognitive psychopathological disorders, cognitive disorders, social dysfunction and general medical problems); taking into account the nature of dual relations «patient with HPR in dementia – caregiver»; the state of the preserved resource of the patient in the cognitive mental, somatic and psychosocial spheres; sequence and phasing of restorative approaches. Keywords: hallucinatory-paranoid disorders, dementias of different genesis and stage of development, program of complex psychosocial rehabilitation, approbation, evaluation of efficiency.

Íàä³éøëà äî ðåäàêö³¿ 15.11.2019

Êîíòàêòíà ³íôîðìàö³ÿ Ìàðóòà Íàòàë³ÿ Îëåêñàíäð³âíà – äîêòîð ìåäè÷íèõ íàóê, ïðîôåñîð, çàñòóïíèê äèðåêòîðà ç íàóêîâî-äîñë³äíî¿ ðîáîòè, êåð³âíèê â³ää³ëó ïîãðàíè÷íî¿ ïñèõ³àò𳿠Äåðæàâíî¿ óñòàíîâè «²íñòè- òóò íåâðîëî㳿, ïñèõ³àò𳿠³ íàðêîëî㳿 Íàö³îíàëüíî¿ àêàäå쳿 ìåäè÷íèõ íàóê Óêðà¿íè». Àäðåñà: Óêðà¿íà, 61068, ì. Õàðê³â, âóë. Àê. Ïàâëîâà, 46. Òåë.: +380577255813. E-mail: [email protected]. ORCID: https://orcid.org/0000-0002-6619-9150.

Øåâ÷åíêî-Á³òåíñüêèé Êîñòÿíòèí Âàëåð³éîâè÷ – ñòàðøèé íàóêîâèé ñï³âðîá³òíèê Äåð- æàâíî¿ óñòàíîâè «Óêðà¿íñüêèé íàóêîâî-äîñë³äíèé ³íñòèòóò ìåäè÷íî¿ ðåàá³ë³òàö³¿ òà êóðîðòîëî㳿 ̳í³ñòåðñòâà îõîðîíè çäîðîâ'ÿ Óêðà¿íè», ì. Îäåñà. Àäðåñà: Óêðà¿íà, 65014, ì. Îäåñà, ïðîâ. Ëåðìîíòîâñüêèé, 6. Òåë.: +380631113694. E-mail: [email protected]. ORCID: https://orcid.org/0000-0003-4572-3539.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 55

https://doi.org/10.35339/ekm.2019.85.04.08 ÓÄÊ 616.895.1-616.895.6

Þ.². Ìèñóëà Òåðíîï³ëüñüêèé íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ì. ².ß. Ãîðáà÷åâñüêîãî ÑÓ×ÀÑͲ ϲÄÕÎÄÈ ÄΠ˲ÊÓÂÀÍÍß ÕÂÎÐÈÕ Ç ÏÅÐÂÈÍÍÈÌ ÅϲÇÎÄÎÌ Á²ÏÎËßÐÍÎÃÎ ÀÔÅÊÒÈÂÍÎÃÎ ÐÎÇËÀÄÓ Çàïðîïîíîâàíà êîìïëåêñíà ñèñòåìà ë³êóâàëüíî-ðåàá³ë³òàö³éíèõ çàõîä³â ïðè ïåðâèííîìó åï³çîä³ á³ïîëÿðíîãî àôåêòèâíîãî ðîçëàäó, ÿêà ðåàë³çóºòüñÿ ó òðè âçàºìîïîâ'ÿçàí³ åòàïè: ïñèõîä³àãíîñòè÷íèé åòàï, íà ÿêîìó ïðîâîäèòüñÿ êîìïëåêñíèé êë³í³êî-ïñèõîä³àãíîñòè÷- íèé àíàë³ç ç âèçíà÷åííÿì êë³í³÷íîãî âàð³àíòó; åòàï êîìïëåêñíî¿ òåðàﳿ, ÿêèé ïåðåäáà÷ຠïîºäíàííÿ ïñèõîôàðìàêîëî㳿 íîðìîòèì³êàìè, àíòèäåïðåñàíòàìè, àòèïîâèìè íåéðîëåï- òèêàìè ç ïñèõîîñâ³òîþ, êîìïëàºíñ-òåðàﳺþ, ñ³ìåéíîþ òåðàﳺþ, ðîáîòîþ ç êîìîðá³ä- íîþ ïñèõ³÷íîþ ³ íàðêîëîã³÷íîþ ïàòîëî㳺þ; åòàï ïñèõîñîö³àëüíî¿ ðåàá³ë³òàö³¿ òà ïðî- ô³ëàêòèêè, ÿêèé âêëþ÷ຠï³äòðèìóþ÷ó ïñèõîôàðìàêîëîã³÷íó òåðàï³þ ³ çàõîäè ç ïñèõî- ñîö³àëüíî¿ òåðàﳿ òà ðåàá³ë³òàö³¿. Ïîð³âíÿëüíèé àíàë³ç çàñâ³ä÷èâ âèùó åôåêòèâí³ñòü çà- ïðîïîíîâàíî¿ òåðàﳿ ó ïîð³âíÿíí³ ç òðàäèö³éíîþ â³äíîñíî êë³í³÷íîãî åôåêòó, íîðìàë³- çàö³¿ àôåêòèâíî¿ ñôåðè òà ïîêðàùåííÿ ÿêîñò³ æèòòÿ õâîðèõ. Êëþ÷îâ³ ñëîâà: á³ïîëÿðíèé àôåêòèâíèé ðîçëàä, ïåðâèííèé åï³çîä, ë³êóâàííÿ, ðåàá³- ë³òàö³ÿ.

Âñòóï ìîãà á³ëüø ðàííº ðîçï³çíàâàííÿ ³ ë³êóâàííÿ Ïðîáëåìà á³ïîëÿðíîãî àôåêòèâíîãî ðîç- çàõâîðþâàííÿ. Äîñë³äæåííÿìè îñòàíí³õ ðîê³â ëàäó (ÁÀÐ) ðîçãëÿäàºòüñÿ â ÿêîñò³ îäí³º¿ ç íàé- ïîêàçàíî, ùî õàðàêòåð ìàéáóòíüîãî á³ïîëÿð- àêòóàëüí³øèõ ïðîáëåì ñó÷àñíî¿ ïñèõ³àòð³¿, ùî íîãî ðîçëàäó çíà÷íîþ ì³ðîþ âèçíà÷àºòüñÿ ïîâ'ÿçàíî ç³ çíà÷íîþ ïîøèðåí³ñòþ (0,6–1,0 %), ïåðåá³ãîì éîãî ïåðâèííîãî åï³çîäó (ÏÅ), ïðè â³äíîñíîþ ñòàá³ëüí³ñòþ çàõâîðþâàíîñò³ óïðî- öüîìó îñîáëèâîñò³ ÏÅ º àêòóàëüíèì ÷èííè- äîâæ òðèâàëîãî ÷àñó ³ âàãîìèìè ñîö³àëüíèìè êîì ïðîãíîçóâàííÿ âàæêîñò³ çàõâîðþâàííÿ, íàñë³äêàìè, âêëþ÷àþ÷è âèñîêèé ð³âåíü ñìåðò- éîãî ôóíêö³îíàëüíèõ íàñë³äê³â òà â³äêëèêó íà íîñò³ òà íàÿâí³ñòü ñåðéîçíèõ ïñèõîëîã³÷íèõ ë³êóâàííÿ [7]. Ó ðÿä³ äîñë³äæåíü ï³äêðåñ- ïðîáëåì ïðîòÿãîì óñüîãî æèòòÿ [1–4]. Íà äóì- ëþºòüñÿ, ùî ïåðâèíí³ ïðîÿâè ÁÀÐ âèÿâëÿþòü- êó Í.Î. Ìàðóòè, ÁÀÐ º ïàòîëî㳺þ ç âàãîìè- ñÿ çà ê³ëüêà ðîê³â äî ñèíäðîìàëüíî îôîðìëå- ìè ìåäèêî-ñîö³àëüíèìè íàñë³äêàìè, àäæå ðîç- íîãî ðîçëàäó; ïðè öüîìó ÷èííà ñèñòåìà âèÿâ- âèâàºòüñÿ ó ìîëîäîìó â³ö³ òà õàðàêòåðèçóºòü- ëåííÿ ³ ë³êóâàííÿ ÏÅ ÁÀÐ çàëèøàºòüñÿ íåäî- ñÿ õðîí³÷íèì ïåðåá³ãîì, âèñîêîþ êîìîðá³äí³- ñêîíàëîþ, ùî ïðèçâîäèòü äî â³äòåðì³íóâàííÿ ñòþ, çíà÷íîþ ñîö³àëüíîþ äåçàäàïòàö³ºþ, âòðà- àäåêâàòíîãî ë³êóâàííÿ ³ ïîã³ðøàííÿ ñòàíó ïà- òîþ ïðàöåçäàòíîñò³ òà ³íâàë³äèçàö³ºþ, çíèæåí- ö³ºíò³â [1, 7–10]. Âèõîäÿ÷è ç öüîãî, ðîçðîáêà íÿì ÿêîñò³ æèòòÿ, âèñîêèì ñó¿öèäàëüíèì ðè- íàóêîâî îá´ðóíòîâàíî¿ ñèñòåìè ðàííüîãî âè- çèêîì, à òàêîæ çìåíøåííÿì òðèâàëîñò³ æèò- ÿâëåííÿ òà ë³êóâàííÿ ÏÅ ÁÀÐ º âàæëèâèì, òÿ õâîðèõ â ñåðåäíüîìó íà 10 ðîê³â ³ ïîòðå- àêòóàëüíèì çàâäàííÿì ³ ìຠâàãîìå òåîðåòè÷- áîþ â òðèâàë³é òåðàﳿ [5, 6]. íå ³ ïðàêòè÷íå çíà÷åííÿ. Íàäçâè÷àéíî âàæëèâå çíà÷åííÿ äëÿ çàáåç- Ìåòà ³ çàâäàííÿ äîñë³äæåííÿ – ðîçðî- ïå÷åííÿ õâîðèõ ç ÁÀÐ ñâîº÷àñíîþ òà åôåê- áèòè ñó÷àñí³ ï³äõîäè äî ë³êóâàííÿ õâîðèõ ç ÏÅ òèâíîþ ïñèõ³àòðè÷íîþ äîïîìîãîþ ìຠÿêî- ÁÀÐ ç óðàõóâàííÿì éîãî êë³í³÷íîãî âàð³àíòà

© Þ.². Ìèñóëà, 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 56 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

òà îö³íèòè ¿õ åôåêòèâí³ñòü â³äïîâ³äíî äî ïðèí- â³äïîâ³äíî äî ÷èííèõ êðèòåð³¿â, éîãî íîçîëîã³- öèï³â äîêàçîâîñò³ ó íàóêîâèõ äîñë³äæåííÿõ. ÷íà äèôåðåíö³àö³ÿ, âèâ÷åííÿ îñîáëèâîñòåé Ìàòåð³àë ³ ìåòîäè äèíàì³êè çàõâîðþâàííÿ, à òàêîæ âèçíà÷åííÿ Ç äîòðèìàííÿì ïðèíöèï³â á³îìåäè÷íî¿ åòè- êë³í³÷íîãî âàð³àíòó ÏÅ ÁÀÐ – äåïðåñèâíîãî, êè íà ï³äñòàâ³ ³íôîðìîâàíî¿ çãîäè áóëî ïðîâå- ìàí³àêàëüíîãî ÷è çì³øàíîãî), ïñèõîä³àãíîñ- äåíî êë³í³êî-ïñèõîä³àãíîñòè÷íå îáñòåæåííÿ òè÷íå äîñë³äæåííÿ, à òàêîæ âèçíà÷åííÿ ïðî- 88 õâîðèõ ç ïåðâèííèì åï³çîäîì ÁÀÐ, ÿê³ ïå- ãíîçó çàõâîðþâàííÿ ³ ïîäàëüøîãî âàð³àíòà ðåáóâàëè íà ë³êóâàíí³ ó Òåðíîï³ëüñüê³é îáëàñí³é éîãî ðîçâèòêó. Íà äðóãîìó åòàï³ (êîìïëåêñ- ïñèõîíåâðîëîã³÷í³é ë³êàðí³ ó ïåð³îä 2011– íî¿ òåðàﳿ) ïðîâîäèëîñÿ êîìïëåêñíå òåðàïåâ- 2016 ðîê³â. Ç íèõ áóëè ñôîðìîâàí³ íàñòóïí³ òè÷íå âòðó÷àííÿ ç âèêîðèñòàííÿì êîìïëåêñó ãðóïè: 1) îñíîâíà ãðóïà 1 (ÎÃ1) – õâîð³ ç äå- á³îëîã³÷íî¿ òåðàﳿ, ùî âèçíà÷àëîñÿ âàð³àíòîì ïðåñèâíèì âàð³àíòîì ÏÅ ÁÀÐ, ÿê³ îòðèìóâà- ÏÅ ÁÀÐ ³ âêëþ÷àëî: ïðè äåïðåñèâíîìó âàð³- ëè ë³êóâàííÿ çà çàïðîïîíîâàíîþ ñõåìîþ, ÷è- àíò³ – ëàìîòðèäæèí (50–100 ìã/äîáó), êâåò³àï³í ñåëüí³ñòþ 34 îñîáè; 2) ãðóïà ïîð³âíÿííÿ 1 (300–450 ìã/äîáó), âàëüïðîàòè (20 ìã/êã ìàñè (ÃÏ1) – õâîð³ ç äåïðåñèâíèì âàð³àíòîì ÏÅ ò³ëà íà äîáó) òà àíòèäåïðåñàíòè ãðóïè ñåëåê- ÁÀÐ, ÿê³ îòðèìóâàëè ë³êóâàííÿ çà òðàäèö³é- òèâíèõ ³íã³á³òîð³â çâîðîòíîãî çàõîïëåííÿ ñå- íîþ ñõåìîþ, ÷èñåëüí³ñòþ 33 îñîáè; 3) îñíîâ- ðîòîí³íó (ôëóîêñåòèí – 20 ìã/äîáó, ñåðòðàë³í – íà ãðóïà 2 (ÎÃ2) – õâîð³ ç ìàí³àêàëüíèì âà- 25-50 ìã/äîáó); ïðè ìàí³àêàëüíîìó âàð³àíò³ ÏÅ ð³àíòîì ÏÅ ÁÀÐ, ÿê³ îòðèìóâàëè ë³êóâàííÿ çà ÁÀÐ – âàëüïðîàòè (20 ìã/êã ìàñè ò³ëà íà äîáó) çàïðîïîíîâàíîþ ñõåìîþ, ÷èñåëüí³ñòþ 11 îñ³á; ó ïîºäíàíí³ ç àòèïîâèìè àíòèïñèõîòè÷íèìè ïðå- 4) ãðóïà ïîð³âíÿííÿ 2 (ÃÏ2) – õâîð³ ç ìàí³à- ïàðàòàìè (ðèñïåðèäîí – 4–6 ìã/äîáó, êâåò³à- êàëüíèì âàð³àíòîì ÏÅ ÁÀÐ, ÿê³ îòðèìóâàëè ï³í – 400–800 ìã/äîáó, îëàíçàï³í – 10 ìã/äîáó); ë³êóâàííÿ çà òðàäèö³éíîþ ñõåìîþ, ÷èñåëüí³- ïðè çì³øàíîìó âàð³àíò³ ÏÅ ÁÀÐ – âàëüïðîàòè ñòþ 10 îñ³á. Ïîð³âíÿííÿ ðåçóëüòàò³â ïðîâîäè- (20 ìã/êã ìàñè ò³ëà íà äîáó) ó ïîºäíàíí³ ç àòè- ëîñÿ ïîïàðíî ó êîæí³é ç êë³í³÷íèõ ãðóï çà ïîâèìè àíòèïñèõîòèêàìè (îëàíçàï³í – 10 ìã/ êë³í³÷íèì âàð³àíòîì ÏÅ ÁÀÐ. Îö³íêà ïðîâî- äîáó, àðèï³ïðàçîë – 15 ìã/äîáó) ç òðèâàë³ñòþ äèëàñÿ äî ïî÷àòêó ë³êóâàííÿ ³ ÷åðåç 6 ì³ñÿö³â àêòèâíî¿ ôàçè ôàðìàêîòåðàﳿ â³ä 6 äî 12 òèæ- ï³ñëÿ ïî÷àòêó ë³êóâàííÿ çà òðüîìà îñíîâíèìè í³â, ñòàá³ë³çóþ÷î¿ ôàðìàêîòåðàﳿ íå ìåíøå íàïðÿìêàìè: äèíàì³êà ïñèõ³÷íîãî ñòàíó (ïî- 4 ì³ñÿö³â äëÿ ìàí³àêàëüíîãî âàð³àíòó ÏÅ ÁÀÐ âíà êë³í³÷íà ðåì³ñ³ÿ, çíà÷íå ïîêðàùåííÿ ïñè- ³ íå ìåíøå 6 ì³ñÿö³â äëÿ äåïðåñèâíîãî ³ çì³øà- õ³÷íîãî ñòàíó, ïîêðàùåííÿ ïñèõ³÷íîãî ñòàíó, íîãî âàð³àíò³â ÏÅ ÁÀÐ ³ ôàçè ïðîô³ëàêòè÷íî¿ íåçíà÷íå ïîêðàùåííÿ ïñèõ³÷íîãî ñòàíó); äè- ôàðìàêîòåðàﳿ òðèâàë³ñòþ íå ìåíøå í³æ 12 ì³- íàì³êà çì³í ó ïñèõîåìîö³éíîìó ñòàí³ çà ðåçóëü- ñÿö³â; à òàêîæ êîìïëåêñó ïñèõîñîö³àëüíî¿ òå- òàòàìè îö³íêè ç âèêîðèñòàííÿì ñòàíäàðòèçî- ðàﳿ, ùî ñêëàäàºòüñÿ ç ïñèõîîñâ³òè ó âèãëÿä³ âàíèõ ïñèõîä³àãíîñòè÷íèõ ³íñòðóìåíò³â (øêàë ÷îòèðèåòàïíî¿ ñõåìè ïñèõîîñâ³òí³õ çàõîä³â, äåïðåñ³¿ òà òðèâîãè M. Hamilton, øêàëè äå- çàïðîïîíîâàíî¿ Í.Î. Ìàðóòîþ, Ã.Ì. Êîæèíîþ ïðåñ³¿ The Zungself-Rating Depression Scale, òà Ñ.Ï. Êîëÿäêî [11] ç óðàõóâàííÿì êë³í³÷íî- ä³àãíîñòè÷íî¿ øêàëè á³ïîëÿðíîãî ñïåêòðà); äè- ãî âàð³àíòó ÏÅ ÁÀÐ, êîìïëàºíñ-òåðàﳿ, ÿêà ïå- íàì³êà ïîêàçíèê³â ÿêîñò³ æèòòÿ çà äàíèìè øêà- ðåäáà÷àëà êîðîòêî÷àñíå ïñèõîòåðàïåâòè÷íå ëè îö³íêè ÿêîñò³ æèòòÿ Mezzich et al. â àäàï- âòðó÷àííÿ, çàñíîâàíå íà êîãí³òèâíèõ ï³äõîäàõ òàö³¿ Í.Î. Ìàðóòè. ó ïîºäíàíí³ ç ìîòèâàö³éíèì ³íòåðâ'þ, ñ³ìåéíî¿ Ðåçóëüòàòè äîñë³äæåíü òåðàﳿ, ðîáîòè ç êîìîðá³äíîþ ïñèõ³÷íîþ ïà- Êîìïëåêñ ë³êóâàëüíî-ðåàá³ë³òàö³éíèõ çà- òîëî㳺þ âèÿâëåííÿ ³ ë³êóâàííÿ çàëåæíîñòåé. õîä³â ïðè ÏÅ ÁÀÐ ðåàë³çîâóâàâñÿ ó òðè åòàïè, Íà òðåòüîìó åòàï³ (ïñèõîñîö³àëüíî¿ ðåàá³ë³- ÿê³ ïîâ'ÿçàí³ áåçïåðåðâí³ñòþ ³ ñïàäêîºìí³ñòþ òàö³¿ òà ïðîô³ëàêòèêè) òðèâàë³ñòþ íå ìåíøå ä³àãíîñòè÷íèõ òà ë³êóâàëüíî-ðåàá³ë³òàö³éíèõ 12 ì³ñÿö³â â³äáóâàëàñü ïîâíîö³ííà ðåàäàïòà- ï³äõîä³â. Ïåðøèé (ïñèõîä³àãíîñòè÷íèé) åòàï ö³ÿ ³ ðåñîö³àë³çàö³ÿ õâîðîãî, ïðîô³ëàêòèêà ðå- ïåðåäáà÷àâ êîìïëåêñíèé êë³í³êî-ïñèõîä³àãíî- öèäèâóâàííÿ ÁÀÐ: ïðîäîâæóâàëàñü ìåäèêà- ñòè÷íèé àíàë³ç íàÿâíî¿ ïñèõîïàòîëîã³÷íî¿ ñèì- ìåíòîçíà òåðàï³ÿ ÁÀÐ, ÿêà âêëþ÷àëà ïðèéîì ïòîìàòèêè çàõâîðþâàííÿ, éîãî ïàòîäèíàì³êè, ëàìîòðèäæèíó (50–400 ìã/äîáó) àáî âàëüïðîà- äàíèõ àíàìíåçó, ñòàíó ñîö³àëüíî-ïñèõîëîã³÷- ò³â (20 ìã/êã ìàñè ò³ëà íà äîáó), àáî ë³ò³þ (ö³ëüî- íîãî ôóíêö³îíóâàííÿ õâîðîãî, à òàêîæ ïðîãíî- âà êîíöåíòðàö³ÿ 0,60–0,80 ììîëü/ë), àáî êàðáà- çóâàííÿ ìîæëèâîãî ïîäàëüøîãî ðîçâèòêó çà- ìàçåï³íó (400–1600 ìã/äîáó), êâåò³àï³íó (300– õâîðþâàííÿ. Éîãî çì³ñòîì áóâ àíàë³ç ïñèõ³÷- 600 ìã/äîáó), àáî àðèï³ïðàçîëó (15–30 ìã/äåíü), íîãî ñòàíó (âñòàíîâëåííÿ êë³í³÷íîãî ä³àãíîçó àáî îëàíçàï³íó (5–20 ìã/äîáó), àáî äåïî-ðèñ-

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 57

ïåðèäîíó (25–50 ìã/2 òèæí³), à òàêîæ êîìá³- 3,18) áàëà (p<0,01), ïîêàçíèê ïñèõ³÷íî¿ òðèâî- íàö³é öèõ ïðåïàðàò³â; ïñèõîñîö³àëüíà òåðàï³ÿ ³ ãè – â³äïîâ³äíî, ç (13,60±3,64) äî (1,98±1,99) ðåàá³ë³òàö³ÿ, ÿêà âêëþ÷àëà ãðóïîâó ïñèõîòå- áàëà ³ ç (14,29±4,13) äî (3,80±2,20) áàëà (p<0,01), ðàï³þ, êîãí³òèâíó ³ ñ³ìåéíó ïñèõîòåðàï³þ; êîíò- ñîìàòè÷íî¿ òðèâîãè – â³äïîâ³äíî, ç (8,83±4,02) ðîëü çà àóòîàãðåñèâíîþ (ïåðåäóñ³ì ñó¿öèäàëü- äî (2,17±1,61) áàëà, ³ ç (8,56±4,17) äî(2,19±1,81) íîþ) òà àíòèñîö³àëüíîþ ïîâåä³íêîþ, çàõîäè ç áàëà (p>0,05). Ó ïàö³ºíò³â ÎÃ1 ñåðåäíº çíà÷åííÿ ïðîôåñ³éíî¿ òà ñîö³àëüíî¿ ðåàá³ë³òàö³¿ õâîðèõ. ïîêàçíèêà çà îïèòóâàëüíèêîì The Zungself- Ïðè ïîð³âíÿëüí³é îö³íö³ åôåêòèâíîñò³ çà- Rating Depression Scale äî ë³êóâàííÿ ñêëàëî ïðîïîíîâàíî¿ êîìïëåêñíî¿ ñèñòåìè ë³êóâàëüíî- (47,50±4,93) áàëà, ï³ñëÿ ë³êóâàííÿ – (10,45±8,89) ðåàá³ë³òàö³éíèõ çàõîä³â â³äíîñíî òðàäèö³éíî¿ áàëà, òîä³ ÿê ó ïàö³ºíò³â ÃÏ1 – â³äïîâ³äíî áóëî âèÿâëåíî, ùî ïðè äåïðåñèâíîìó âàð³àíò³ (48,22±5,44) ³ (20,34±8,54) áàëà (p<0,01). ÏÅ ÁÀÐ âèêîðèñòàííÿ çàïðîïîíîâàíî¿ ñèñòå- Ó õâîðèõ ç ìàí³àêàëüíèì âàð³àíòîì ÏÅ ìè äîçâîëèëî äîñÿãòè ïîâíî¿ ðåäóêö³¿ ñèìï- ÁÀÐ ïîêàçíèê çà øêàëîþ ðîçëàä³â á³ïîëÿðíîãî òîìàòèêè ó 53,3 %, ùî çíà÷óùå (p<0,05) ñïåêòðà ï³ä âïëèâîì çàïðîïîíîâàíî¿ òåðàﳿ á³ëüøå, í³æ ïðè òðàäèö³éíîìó ë³êóâàíí³, äå çìåíøèâñÿ ç (9,75±4,88) äî (3,58±1,78) áàëà, à ïîâíà ðåäóêö³ÿ ñèìïòîìàòèêè áóëà äîñÿãíó- ï³ä âïëèâîì òðàäèö³éíî¿ òåðàﳿ – ç (10,00±5,20) òà ó 35,6 % õâîðèõ. Çíà÷íå ïîêðàùåííÿ ñòàíó äî (6,09±2,66) áàëà (p<0,05). â ÎÃ1 áóëî äîñÿãíóòî ó 41,7 %, à ó ÃÏ1 – ó Çàïðîïîíîâàíà êîìïëåêñíà ñèñòåìà ë³êó- 40,7 % (p>0,05), ïîêðàùåííÿ – â³äïîâ³äíî ó 5,0 % âàëüíî-ðåàá³ë³òàö³éíèõ çàõîä³â äîçâîëèëà òà- ³ ó 20,3 % (p<0,01). Ó õâîðèõ ÃÏ1 ó 2 âèïàä- êîæ çíà÷óùå êðàùå ïîë³ïøèòè ÿê³ñòü æèòòÿ êàõ (3,4 %) ìàëî ì³ñöå íåçíà÷íå ïîêðàùåííÿ, ïàö³ºíò³â ó ïîð³âíÿíí³ ç òðàäèö³éíîþ: ïîêàçíèê à ó õâîðèõ ÎÃ1 òàêèõ âèïàäê³â íå áóëî. ÿêîñò³ æèòòÿ (ßÆ) çà ñôåðîþ ô³çè÷íîãî áëà- Ïðè ìàí³àêàëüíîìó âàð³àíò³ ÏÅ ÁÀÐ çà- ãîïîëó÷÷ÿ, çà îö³íêîþ ôàõ³âöÿ, ó õâîðèõ ÎÃ1 ñòîñóâàííÿ çàïðîïîíîâàíî¿ ñèñòåìè äîçâîëè- çð³ñ ç (6,35±1,82) äî (6,52±1,60) áàëà, ó ÃÏ1 – ëî äîñÿãòè ïîâíî¿ ðåäóêö³¿ ìàí³àêàëüíî¿ ñèìï- ç (6,20±1,99) äî (6,27±1,92) áàëà (ð>0,05), ïñè- òîìàòèêè ó 91,7 % õâîðèõ, òîä³ ÿê òðàäèö³éíà – õîëîã³÷íîãî (åìîö³éíîãî) áëàãîïîëó÷÷ÿ – ó 54,5 % (p<0,05), çíà÷íîãî ïîêðàùåííÿ – â³äïî- â³äïîâ³äíî ç (3,73±1,36) äî (6,73±1,66) áàëà òà â³äíî ó 8,3 % ³ 27,3 % (p<0,05). Ó õâîðèõ, ÿê³ ç (3,47±1,24) äî (5,47±1,24) áàëà (<0,01), ñàìî- îòðèìóâàëè òðàäèö³éíó òåðàï³þ, ó 18,2 % áóëî îáñëóãîâóâàííÿ ³ íåçàëåæíîñò³ ä³é – â³äïîâ³ä- âèÿâëåíî ïîêðàùåííÿ, òîä³ ÿê ó õâîðèõ, ÿê³ íî ç (5,90±1,22) äî (8,43±1,18) áàëà òà ç (5,90± îòðèìóâàëè çàïðîïîíîâàíó òåðàï³þ, ðåçóëüòà- 1,16) äî (7,86±0,96) áàëà (ð<0,01), ïðàöåçäàò- òîì ë³êóâàííÿ áóëè: ïîâíà ðåäóêö³ÿ ñèìïòî- íîñò³ – â³äïîâ³äíî ç (3,17±1,52) äî (6,63±1,51) ìàòèêè òà çíà÷íå ïîêðàùåííÿ. áàëà òà ç (2,81±1,40) äî (5,47±1,51) áàëà (ð<0,01), Á³ëüø âèñîêà åôåêòèâí³ñòü çàïðîïîíîâà- ì³æîñîáèñò³ñíî¿ âçàºìî䳿 – â³äïîâ³äíî ç (7,58± íî¿ êîìïëåêñíî¿ ñèñòåìè ë³êóâàëüíî-ðåàá³ë³- 0,96) äî (8,78±1,04) áàëà òà ç (7,36±1,28) äî òàö³éíèõ çàõîä³â ó ïîð³âíÿíí³ ç òðàäèö³éíîþ (7,86±1,38) áàëà (ð<0,01), ñîö³àëüíî-åìîö³éíî¿ áóëà ï³äòâåðäæåíà òàêîæ äàíèìè ïñèõîä³à- ï³äòðèìêè – â³äïîâ³äíî ç (8,85±1,89) äî (9,05± ãíîñòè÷íîãî îáñòåæåííÿ: ïðè äåïðåñèâíîìó 1,67) áàëà òà ç (9,00±1,82) äî (9,03±1,81) áàëà âàð³àíò³ ÏÅ ÁÀÐ â ÎÃ1 âäàëîñÿ äîñÿãòè çìåí- (ð>0,05), ãðîìàäñüêî¿ òà ñëóæáîâî¿ ï³äòðèìêè – øåííÿ çàãàëüíîãî ïîêàçíèêà äåïðåñ³¿ ç (22,69± â³äïîâ³äíî ç (8,92±2,28) äî (8,92±2,28) áàëà òà 3,31) äî (8,51±2,91) áàëà, òîä³ ÿê ó ÃÏ1 â³í çìåí- ç (8,97±2,20) äî (9,00±2,13) áàëà (ð>0,05), îñî- øèâñÿ ç (22,69±3,31) äî (8,51±2,91) áàëà (p<0,01), áèñò³ñíî¿ ðåàë³çàö³¿ – â³äïîâ³äíî ç (3,73±1,39) àäèíàì³÷íî¿ äåïðåñ³¿ – â³äïîâ³äíî, ç (17,27±2,70) äî (5,98±1,63) áàëà òà ç (3,66±1,42) äî (4,78± äî (7,41±2,41) áàëà òà ç (17,27±2,70) äî (7,41± 1,39) áàëà (ð<0,01), äóõîâíî¿ ðåàë³çàö³¿ – â³äïî- 2,41) áàëà (p<0,01), àæèòîâàíî¿ äåïðåñ³¿ – â³ä- â³äíî ç (7,73±2,66) äî (7,75±2,65) áàëà òà ç ïîâ³äíî, ç (10,03±2,83) äî (3,81±1,77) áàëà òà (7,83±2,72) äî (7,85±2,70) áàëà (ð>0,05), çàãàëü- ç (10,03±2,83) äî (3,81±1,77) áàëà (p<0,01), äå- íîãî ñïðèéíÿòòÿ æèòòÿ – â³äïîâ³äíî ç (4,47± ïðåñ³¿ ç³ ñòðàõîì – â³äïîâ³äíî, ç (9,56±2,64) äî 1,05) äî (6,67±1,07) áàëà òà ç (4,29±1,02) äî (3,56±1,51) áàëà òà ç (9,56±2,64) äî (3,56±1,51) (5,78±1,13) áàëà (ð<0,01). ²íòåãðàëüíèé ïîêàç- áàëà (p<0,01), íåäèôåðåíö³éîâàíî¿ äåïðåñ³¿ – íèê çà ñôåðîþ ñóá'ºêòèâíîãî áëàãîïîëó÷÷ÿ/ ç (5,07±1,14) äî (1,32±0,92) áàëà, òà ç (5,07±1,14) çàäîâîëåíîñò³ â ÎÃ1 çð³ñ ç (14,55±3,43) äî (19,92± äî (1,32±0,92) áàëà â³äïîâ³äíî (p<0,01). Çà- 3,25) áàëà, à ó ÃÏ1 – ç (13,97±3,45) äî (17,53± ãàëüíèé ïîêàçíèê òðèâîãè ó ÎÃ1 ï³ä âïëèâîì 3,44) áàëà (ð<0,01), âèêîíàííÿ ñîö³àëüíèõ ðî- ë³êóâàííÿ çìåíøèâñÿ ç (22,43±6,90) äî (4,15± ëåé – â³äïîâ³äíî ç (20,38±3,49) äî (29,83±3,45) 2,63) áàëà, à ó ÃÏ1 – ç (22,85±7,23) äî (5,98± áàëà òà ç (19,73±3,98) äî (25,98±3,67) áàëà

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 58 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

(ð<0,01), çîâí³øí³õ æèòòºâèõ óìîâ – â³äïîâ³äíî õâîðèõ, ÿê³ îòðèìóâàëè ë³êóâàííÿ çà òðàäè- ç (25,50±4,35) äî (25,72±4,25) áàëà òà ç (25,80± ö³éíîþ ñõåìîþ – ç (57,64±4,11) äî (68,45±4,72) 3,90) äî (25,88±3,87) áàëà (ð>0,05). Ñóìàðíèé áàëà (ð<0,01), à ïîêàçíèê ÿêîñò³ æèòòÿ – â³äïî- ïîêàçíèê ßÆ â ÎÃ1 ó ïðîöåñ³ ë³êóâàííÿ â³äíî ç (5,63±0,37) äî (7,69±0,29) áàëà òà ç çá³ëüøèâñÿ ç (60,43±8,02) äî (75,47±7,81) áàëà, (5,76±0,41) äî (6,85±0,47) áàëà (ð<0,01). à ó ÃÏ1 – ç (59,49±7,96) äî (69,39±7,61) áàëà Îáãîâîðåííÿ ðåçóëüòàò³â äîñë³äæåííÿ (ð<0,01), ïîêàçíèê ÿêîñò³ æèòòÿ – â³äïîâ³äíî ˳êóâàííÿ ÁÀÐ íà åòàï³ ïîâòîðíèõ åï³çîä³â ç (6,04±0,80) äî (7,55±0,78) áàëà òà ç (5,95±0,80) ðîçðîáëåíî äîñòàòíüî ïîâíî, îäíàê, ïðè öüîìó äî (6,94±0,76) áàëà (ð<0,01). Çà îö³íêîþ ôàõ³â- êîìïëåêñí³ ë³êóâàëüíî-ðåàá³ë³òàö³éí³ çàõîäè íà öÿ ïîêàçíèê çà ñôåðîþ ô³çè÷íîãî áëàãîïîëó÷- åòàï³ ÏÅ ïðàêòè÷íî íå ðîçðîáëåí³, ùî ïîâ'ÿ- ÷ÿ ó õâîðèõ ÎÃ2 ï³ä âïëèâîì ë³êóâàííÿ çð³ñ çàíå ç³ çíà÷íèìè òðóäíîùàìè ðîçï³çíàâàííÿ ç (8,75±0,97) äî (9,00±0,60) áàëà, à ó ÃÏ2 – çàõâîðþâàííÿ íà öüîìó åòàï³, â³äñóòí³ñòþ ç (8,18±0,98) äî (8,27±0,90) áàëà (ð<0,05), çà íàä³éíèõ ïðåäèêòîð³â á³ïîëÿðíîñò³, ïîë³ìîð- ñôåðîþ ïñèõîëîã³÷íîãî (åìîö³éíîãî) áëàãîïî- ô³çìîì êë³í³÷íèõ ïðîÿâ³â ð³çíèõ ôîðì ÏÅ ÁÀÐ, ëó÷÷ÿ – â³äïîâ³äíî ç (6,00±1,41) äî (7,92±1,00) à òàêîæ íåäîñòàòí³ì âèêîðèñòàííÿì ïñèõî- áàëà òà ç (6,00±1,55) äî (6,82±1,33) áàëà (ð<0,05), ä³àãíîñòè÷íèõ ³íñòðóìåíò³â. Çàïðîïîíîâàíà ñàìîîáñëóãîâóâàííÿ ³ íåçàëåæíîñò³ ä³é – ñèñòåìà ë³êóâàëüíî-ðåàá³ë³òàö³éíèõ çàõîä³â â³äïîâ³äíî ç (3,33±0,78) äî (6,75±1,06) áàëà òà ïåðåäáà÷ຠêîìïëåêñíó ä³àãíîñòèêó ç âèêîðè- ç (3,55±1,04) äî (5,82±0,98) áàëà (ð<0,05), ïðàöå- ñòàííÿì âàë³äíèõ ³ íàä³éíèõ ïñèõîä³àãíîñòè÷- çäàòíîñò³ – â³äïîâ³äíî ç (2,83±0,72) äî (6,00± íèõ ³íñòðóìåíò³â íà åòàï³ ÏÅ, äèôåðåíö³éî- 0,95) áàëà òà ç (2,91±1,04) äî (5,18±0,75) áàëà âàí³ñòü ³ ñèñòåìí³ñòü ë³êóâàëüíèõ ³ ðåàá³ë³òà- (ð<0,05), ì³æîñîáèñò³ñíî¿ âçàºìî䳿 – â³äïîâ³äíî ö³éíèõ ï³äõîä³â ç óðàõóâàííÿì êë³í³÷íîãî âà- ç (4,00±0,74) äî (7,33±1,23) áàëà òà ç (4,27±1,10) ð³àíòà ÏÅ ÁÀÐ, êîìïëåêñíèé õàðàêòåð òåðà- äî (6,36±0,92) áàëà (ð<0,05), ñîö³àëüíî-åìî- ïåâòè÷íèõ âïëèâ³â, ùî ïîºäíóº ìåòîäè á³îëî- ö³éíî¿ ï³äòðèìêè – â³äïîâ³äíî ç (7,42±2,31) äî ã³÷íî¿ òà ïñèõîñîö³àëüíî¿ òåðàﳿ, ñïàäêîºìí³ñòü (8,67±0,78) áàëà òà ç (8,27±1,74) äî (7,55±1,21) ë³êóâàëüíî-ðåàá³ë³òàö³éíèõ çàõîä³â, ÷³òêó ñèñ- áàëà (ð<0,05), ãðîìàäñüêî¿ òà ñëóæáîâî¿ ï³ä- òåìó êîíòðîëþ åôåêòèâíîñò³ ë³êóâàííÿ. Îö³- òðèìêè – â³äïîâ³äíî ç (8,50±1,45) äî (8,92±0,90) íêà ðåçóëüòàò³â ë³êóâàííÿ çà çàïðîïîíîâàíîþ áàëà òà ç (9,00±1,10) äî (9,09±0,94) áàëà (ð>0,05), ñèñòåìîþ äîâåëà ¿¿ åôåêòèâí³ñòü ó ïîð³âíÿíí³ îñîáèñò³ñíî¿ ðåàë³çàö³¿ – â³äïîâ³äíî ç (4,25± ç òðàäèö³éíèì ë³êóâàííÿì â³äïîâ³äíî äî ïðèí- 1,06) äî (7,42±1,24) áàëà òà ç (4,36±1,12) äî öèï³â äîêàçîâîñò³ ó ìåäèöèí³. (5,91±1,30) áàëà (ð<0,05), äóõîâíî¿ ðåàë³çàö³¿ – Âèñíîâêè â³äïîâ³äíî ç (4,75±1,66) äî (7,08±1,24) áàëà òà Çàïðîïîíîâàíà êîìïëåêñíà ñèñòåìà ë³êó- ç (4,45±1,04) äî (6,64±0,92) áàëà (ð>0,05), çà- âàëüíî-ðåàá³ë³òàö³éíèõ çàõîä³â ïðè ÏÅ ÁÀÐ ãàëüíîãî ñïðèéíÿòòÿ æèòòÿ – â³äïîâ³äíî ïðîäåìîíñòðóâàëà çíà÷óùå âèùó åôåêòèâ- ç (6,50±0,67) äî (7,83±0,39) áàëà òà ç (6,64±0,81) í³ñòü ó ïîð³âíÿíí³ ç òðàäèö³éíîþ ñõåìîþ ë³êó- äî (6,82±0,40) áàëà (ð<0,01). ²íòåãðàëüíèé ïî- âàííÿ â³äíîñíî êë³í³÷íèõ ïðîÿâ³â äåïðåñèâíî- êàçíèê çà ñôåðîþ ñóá'ºêòèâíîãî áëàãîïîëó÷÷ÿ/ ãî òà ìàí³àêàëüíîãî ñòàíó ÿê çà äàíèìè çàäîâîëåíîñò³ ï³ä âïëèâîì çàïðîïîíîâàíî¿ êë³í³÷íîãî, òàê ³ ïñèõîä³àãíîñòè÷íîãî îáñòå- ñèñòåìè ë³êóâàëüíî-ðåàá³ë³òàö³éíèõ çàõîä³â æåííÿ, à òàêîæ ùîäî ïîêðàùåííÿ ÿêîñò³ æèò- çá³ëüøèâñÿ ç (21,25±1,91) äî (24,75±1,42) áàëà, òÿ õâîðèõ ç ÏÅ ÁÀÐ. òîä³ ÿê ï³ä âïëèâîì òðàäèö³éíîãî ë³êóâàííÿ – Ïåðñïåêòèâí³ñòü äîñë³äæåííÿ ç (20,82±1,94) äî (21,91±1,87) áàëà (ð<0,01), çà Äàí³ öüîãî äîñë³äæåííÿ ìîæóòü áóòè âè- ñôåðîþ âèêîíàííÿ ñîö³àëüíèõ ðîëåé – â³äïî- êîðèñòàí³ ó ïðàêòèö³ îõîðîíè çäîðîâ'ÿ äëÿ ë³êó- â³äíî ç (14,42±1,83) äî (27,50±2,02) áàëà òà âàííÿ õâîðèõ ç ÏÅ ÁÀÐ ç ð³çíèìè êë³í³÷íèìè ç (15,09±2,43) äî (23,27±2,53) áàëà (ð<0,01), çà âàð³àíòàìè ïåðåá³ãó äëÿ ïîêðàùåííÿ êë³í³÷íî¿ ñôåðîþ çîâí³øí³õ æèòòºâèõ óìîâ – â³äïîâ³äíî åôåêòèâíîñò³ ë³êóâàííÿ òà ï³äâèùåííÿ ÿêîñò³ ç (20,67±2,93) äî (24,67±1,56) áàëà òà ç (21,73± æèòòÿ õâîðèõ. Ïåðñïåêòèâè ïîäàëüøèõ äîñë³- 2,72) äî (23,27±2,15) áàëà (ð>0,05). Ñóìàðíèé äæåíü ïîâ'ÿçàí³ ç óäîñêîíàëåííÿì ñèñòåìè ïîêàçíèê ÿêîñò³ æèòòÿ ó õâîðèõ, ÿê³ îòðèìó- ðàííüî¿ ä³àãíîñòèêè òà ïðîãíîçóâàííÿ ÁÀÐ, à âàëè ë³êóâàííÿ çà çàïðîïîíîâàíîþ ñõåìîþ çð³ñ òàêîæ ðîçðîáêîþ ïðîô³ëàêòè÷íèõ çàõîä³â ç ç (56,33±3,70) äî (76,92±2,91) áàëà, à ó ãðóï³ ìåòîþ çàïîá³ãàííÿ âèíèêíåííþ çàõâîðþâàííÿ.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 59

˳òåðàòóðà 1. Clinical risk factors for bipolar disorders: a systematic review of prospective studies / G. L. Faedda, G. Serra, C. Marangoni [et al.] // Journal of Affective Disorders. – 2014. – Vol. 168. – P. 314–321. 2. Delays before diagnosis and initiation of treatment in patients presenting to mental health services with bipolar disorder / R. Patel, H. Shetty, R. Jackson [et al.[ // PLoS One. – 2015. – Vol. 10. – P. 126–129. 3. A systematic review and meta-analysis of premature mortality in bipolar affective disorder / J. F. Hayes, J. Miles, K. Walters [et al.[ // Acta Psychiatrica Scandinavica. – 2015. – Vol. 131. – P. 417–425. 4. Cognitive functioning in first episode bipolar I disorder patients with and without history of psychosis / T. Chakrabarty, G. Alamian, J. M. Kozicky [et al.] // Journal of Affective Disorders. – 2018. – Vol. 227. – P. 109–116. 5. Ìàðóòà Í. À. Áèïîëÿðíîå àôôåêòèâíîå ðàññòðîéñòâî: äèàãíîñòèêà, òåðàïèÿ, ïðîôèëàêòèêà / Í. À. Ìàðóòà // ÍåéðîNews. – 2011. – ¹ 8 (35). – Ñ. 46–52. 6. Ìàðóòà Í. À. Äèàãíîñòèêà áèïîëÿðíîãî àôôåêòèâíîãî ðàññòðîéñòâà / Í. À. Ìàðóòà // ÍåéðîNews. – 2011. – ¹ 4 (31). – Ñ. 57–60. 7. Baldessarini R. J. First-episode types in bipolar disorder: predictive associations with later illness / R. J. Baldessarini, L. Tondo, C. Visioli // Acta Psychiatrica Scandinavica. – 2014. – Vol. 129. – P. 383–392. 8. Rowland T. A. Epidemiology and risk factors for bipolar disorder / T. A. Rowland, S. Marwaha // Therapeutic Advances in Psychopharmacology. – 2018. – Vol. 8 (9). – P. 251–269. 9. Antecedents of manic versus other first psychotic episodes in 263 bipolar I disorder patients / P. Salvatore, R. J. Baldessarini, H. M. Khalsa [et al.] // Acta Psychiatrica Scandinavica. – 2014. – Vol. 129. – P. 275–285. 10. Early recognition and intervention for bipolar disorders: state of research and perspectives (German) / A. Pfennig, C. U. Correll, K. Leopold [et al.[ // Nervenarzt. – 2012. – Vol. 83. – P. 897–902. 11. Ìàðóòà Í. À. Ðîëü ïñèõîîáðàçîâàíèÿ â êîìïëåêñíîì ëå÷åíèè áîëüíûõ ñ ðåêóððåíòíûì äåïðåññèâíûì ðàññòðîéñòâîì / Í. À. Ìàðóòà, À. Ì. Êîæèíà, Ñ. Ï. Êîëÿäêî // Óêðà¿íñüêèé â³ñíèê ïñèõîíåâðîëî㳿. – 2015. – Òîì 23, âèï. 4 (85). – Ñ. 53–57. References 1. Faedda G.L., Serra G., Marangoni C. et al. (2014). Clinical risk factors for bipolar disorders: a systematic review of prospective studies. Journal of Affective Disorders, vol. 168, pp. 314–321. 2. Patel R., Shetty H., Jackson R. et al. (2015). Delays before diagnosis and initiation of treatment in patients presenting to mental health services with bipolar disorder. PLoS One, vol. 10, pp. 126–129. 3. Hayes J.F., Miles J., Walters K. et al. (2015). A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatrica Scandinavica, vol. 131, pp. 417–425. 4. Chakrabarty T., Alamian G., Kozicky J. M. et al. (2018). Cognitive functioning in first episode bipolar I disorder patients with and without history of psychosis. Journal of Affective Disorders, vol. 227, pp. 109–116. 5. Maruta N.A. (2011). Bipolarnoye affektivnoye rasstroystvo: diagnostika, terapiya, profilaktika [Bipolar affective disorder: diagnostic, treatment, prophylaxis]. NeyroNews – NeuroNews, vol. 8 (35), pp. 46–52 [in Russian]. 6. Maruta N.A. (2011). Diagnostika bipolarnogo affektivnogo rasstroystva [Diagnostic of bipolar affective disorder]. NeyroNews – NeuroNews, vol. 4 (31), pp. 57–60 [in Russian]. 7. Baldessarini R.J., Tondo L., Visioli C. (2014). First-episode types in bipolar disorder: predictive associations with later illness. Acta Psychiatrica Scandinavica, vol. 129, pp. 383–392. 8. Rowland T.A., Marwaha S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology, vol. 8 (9), pp. 251–269. 9. Salvatore P., Baldessarini R.J., Khalsa H.M. et al. (2014). Antecedents of manic versus other first psychotic episodes in 263 bipolar I disorder patients. Acta Psychiatrica Scandinavica, vol. 129, pp. 275–285. 10. Pfennig A., Correll C.U., Leopold K. et al. (2012). Early recognition and intervention for bipolar disorders: state of research and perspectives (German). Nervenarzt, vol. 83, pp. 897–902.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 60 ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎòß

11. Maruta N.A., Kozhina H.M., Kolyadko S.P. (2015). Rol psikhoobrazovaniya v kompleksnom lechenii bolnykh s rekurrentnym depressivnym rasstroystvom [Role of psychical education in the complex therapy of patients with the recurrent depressive disorder]. Ukrayins'kyy visnyk psykhonevrolohiyi – Ukrainian Bulletin of Psychoneurology, vol. 23, issue 4 (85), pp. 53–57 [in Russian].

Þ.È. Ìèñóëà ÑÎÂÐÅÌÅÍÍÛÅ ÏÎÄÕÎÄÛ Ê ËÅ×ÅÍÈÞ ÁÎËÜÍÛÕ ÏÅÐÂÈ×ÍÛÌ ÝÏÈÇÎÄÎÌ ÁÈÏÎËßÐÍÎÃÎ ÀÔÔÅÊÒÈÂÍÎÃÎ ÐÀÑÑÒÐÎÉÑÒÂÀ Ïðåäëîæåíà êîìïëåêñíàÿ ñèñòåìà ëå÷åáíî-ðåàáèëèòàöèîííûõ ìåðîïðèÿòèé ïðè ïåðâè÷íîì ýïè- çîäå áèïîëÿðíîãî àôôåêòèâíîãî ðàññòðîéñòâà, êîòîðàÿ ðåàëèçóåòñÿ â òðè âçàèìîñâÿçàííûõ ýòàïà: ïñèõîäèàãíîñòè÷åñêèé ýòàï, íà êîòîðîì ïðîâîäèòñÿ êîìïëåêñíûé êëèíèêî-ïñèõîäèàãíîñòè÷åñêèé àíàëèç ñ îïðåäåëåíèåì êëèíè÷åñêîãî âàðèàíòà; ýòàï êîìïëåêñíîé òåðàïèè, êîòîðûé ïðåäóñìàòðèâà- åò ñî÷åòàíèå ïñèõîôàðìàêîëîãèè íîðìîòèìèêàìè, àíòèäåïðåññàíòàìè, àòèïè÷íûìè íåéðîëåïòèêàìè ñ ïñèõîîáðàçîâàíèåì, êîìïëàåíñ-òåðàïèåé, ñåìåéíîé òåðàïèåé, ðàáîòîé ñ êîìîðáèäíîé ïñèõè÷åñ- êîé è íàðêîëîãè÷åñêîé ïàòîëîãèåé è ýòàï ïñèõîñîöèàëüíîé ðåàáèëèòàöèè è ïðîôèëàêòèêè, âêëþ÷à- þùèé ïîääåðæèâàþùóþ ïñèõîôàðìàêîëîãè÷åñêóþ òåðàïèþ è ìåðîïðèÿòèÿ ïî ïñèõîñîöèàëüíîé òåðàïèè è ðåàáèëèòàöèè. Ñðàâíèòåëüíûé àíàëèç ïîêàçàë áîëåå âûñîêóþ ýôôåêòèâíîñòü ïðåäëîæåí- íîé òåðàïèè ïî ñðàâíåíèþ ñ òðàäèöèîííîé îòíîñèòåëüíî êëèíè÷åñêîãî ýôôåêòà, íîðìàëèçàöèè àô- ôåêòèâíîé ñôåðû è óëó÷øåíèÿ êà÷åñòâà æèçíè áîëüíûõ. Êëþ÷åâûå ñëîâà: áèïîëÿðíîå àôôåêòèâíîå ðàññòðîéñòâî, ïåðâè÷íûé ýïèçîä, ëå÷åíèå, ðåàáè- ëèòàöèÿ.

Yu.I. Mysula MODERN APPROACHES TO THE TREATMENT OF PATIENTS WITH A PRIMARY EPISODE OF BIPOLAR AFFECTIVE DISORDER A comprehensive system of treatment and rehabilitation measures for the initial episode of bipolar affective disorder is proposed, which is implemented in three interrelated stages: a psychodiagnostic stage, which provides a comprehensive clinical and psychodiagnostic analysis to determine the clinical option; the stage of complex therapy, which involves the combination of psychopharmacology with normotymics, antidepressants, atypical neuroleptics with psychoeducation, compliance therapy, family therapy, work with comorbid mental and narcological pathology; and the stage of psychosocial rehabilitation and prevention, which includes supportive psychopharmacological therapy and psychosocial therapy and rehabilitation activities. We conducted a clinical psychodiagnostic examination of 88 patients with a primary episode of Bipolar Affective Disorder (PE BAD) who were treated at the Ternopil Regional Psychoneurological Hospital during the period 2011–2016 in compliance with the principles of biomedical ethics. The following groups were formed from them: 1) 34 patients with depressed variant of PE BAD, who received treatment according to the proposed scheme; 2) 33 patients with depressive variant of PE BAD who received treatment according to the traditional scheme; 3) 11 patients with a manic variant of PE BAD who received treatment according to the proposed scheme; 4) 10 patients with a manic variant of PE BAD who received treatment according to the traditional scheme. The results were compared in pairs in each of the clinical groups according to the clinical version of PE BAD. The evaluation was performed before the start of treatment and 6 months after the start of treatment in three main areas: dynamics of mental state (complete clinical remission, significant improvement of mental state, improvement of mental state, slight improvement of mental state); dynamics of changes in psycho-emotional state based on the results of evaluation using standardized psychodiagnostic tools (M. Hamilton Depression and Anxiety Scales, The Zung self-Rating Depression Scale, Bipolar Diagnostic Scale); the dynamics of quality of life indicators according to the Scale of Quality of Life Mezzich et al. in the adaptation of N.O. Maruta. The comparative analysis showed a higher effectiveness of the proposed therapy compared to the traditional relative clinical effect, normalization of the affective sphere and improvement of the quality of life of patients. Keywords: bipolar affective disorder, primary episode, treatment, rehabilitation.

Íàä³éøëà äî ðåäàêö³¿ 03.12.2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÏÑÈÕ²ÀÒвß, ÍÀÐÊÎËÎÃ²ß ÒÀ ÌÅÄÈ×ÍÀ ÏÑÈÕÎËÎÃ²ß 61

Êîíòàêòíà ³íôîðìàö³ÿ Ìèñóëà Þð³é ²ãîðîâè÷ – êàíäèäàò ìåäè÷íèõ íàóê, äîöåíò êàôåäðè ïñèõ³àòð³¿, íàðêîëî㳿 òà ìåäè÷íî¿ ïñèõîëî㳿 Òåðíîï³ëüñüêîãî íàö³îíàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó ³ì. ².ß. Ãîðáà÷åâñü- êîãî ÌÎÇ Óêðà¿íè. Àäðåñà: Óêðà¿íà, 46000, ì. Òåðíîï³ëü, âóë. Ìàéäàí Âîë³, 1. Òåë.: +380982439901. E-mail: [email protected]. ORCID: https://orcid.org/0000-0001-7443-5304.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 62 ²ÍÔÅÊÖ²ÉͲ ÕÂÎÐÎÁÈ

ІНФЕКЦІЙНІ ХВОРОБИ https://doi.org/10.35339/ekm.2019.85.04.09 ÓÄÊ [616.98:579.854.15:578.825.12:612.017]-053.2

Ñ.Ì. Áóê³é Õàðê³âñüêèé íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ÃÓÌÎÐÀËÜÍÀ ²ÌÓÍÍÀ ²ÄÏβÄÜ Ä²ÒÅÉ, ÕÂÎÐÈÕ ÍÀ ØÈÃÅËÜÎÇ ÒÀ ²ÍÔ²ÊÎÂÀÍÈÕ ÖÈÒÎÌÅÃÀËβÐÓÑÎÌ Ïðîâåäåíî ïîð³âíÿëüíèé àíàë³ç ïîêàçíèê³â ãóìîðàëüíî¿ ³ìóííî¿ â³äïîâ³ä³ ïðè øèãåëüîç³ ó 90 ä³òåé â³êîì â³ä 4 äî 10 ðîê³â, ³íô³êîâàíèõ öèòîìåãàëîâ³ðóñîì. Âñòàíîâëåíî, ùî øèãåëüîç ó ä³òåé ðàííüîãî â³êó íà ôîí³ öèòîìåãàëîâ³ðóñíî¿ ³íôåêö³¿ õàðàêòåðèçóºòüñÿ ïîâ³ëüíèìè çì³íàìè ïîêàçíèê³â îñíîâíèõ êëàñ³â ³ìóíîãëîáóë³í³â ó äèíàì³ö³ õâîðîáè, çà âèíÿòêîì ñèðîâàòêîâîãî IgG. Âì³ñò IgG ó õâîðèõ íà øèãåëüîç òà ³íô³êîâàíèõ öèòîìåãàëî- â³ðóñîì º ñóòòºâî âèùèì ÿê ó ïîð³âíÿíí³ äî ãðóïè êîíòðîëþ, òàê ³ äî ïîêàçíèê³â õâîðèõ áåç ñóïóòíüîãî ³íô³êóâàííÿ. Âèçíà÷åí³ îñîáëèâîñò³ ðåàãóâàííÿ ãóìîðàëüíî¿ ³ìóííî¿ â³äïîâ³ä³ ìîæóòü áóòè äîïîì³æíèì ä³àãíîñòè÷íèì êðèòåð³ºì ³íô³êóâàííÿ öèòîìåãàëî- â³ðóñîì ä³òåé, õâîðèõ íà øèãåëüîç, à òàêîæ ïðè÷èíîþ ðîçâèòêó íåñïðèÿòëèâîãî ïåðå- á³ãó õâîðîáè, ùî âèìàãຠïîäàëüøîãî äîñë³äæåííÿ. Êëþ÷îâ³ ñëîâà: ãóìîðàëüíèé ³ìóí³òåò, ä³òè, øèãåëüîç, öèòîìåãàëîâ³ðóñíà ³íôåêö³ÿ.

Âñòóï òîì â ³ìóíí³é â³äïîâ³ä³ º äèôåðåíö³àö³ÿ Ò- ³ Êèøêîâ³ ³íôåêö³¿ (ʲ), çîêðåìà øèãåëüîç, Â-ë³ìôîöèò³â â åôåêòîðí³ êë³òèíè – öèòîòîê- íàëåæàòü äî íàéá³ëüø ïîøèðåíèõ ³íôåêö³éíèõ ñè÷í³ ë³ìôîöèòè òà ïëàçìàòè÷í³ êë³òèíè. ³äî- ïàòîëîã³é [1]. Îäíèì ç ôàêòîð³â øèðîêîãî ðîç- ìî, ùî íàäëèøêîâà àêòèâàö³ÿ áóäü-ÿêîãî ç òè- ïîâñþäæåííÿ øèãåëüîçó, îñîáëèâî ñåðåä ä³- ï³â Ò-õåëïåðíèõ êëîí³â ìîæå ñïðÿìóâàòè ³ìóí- òåé, º íå ò³ëüêè äåô³öèò ã³ã³ºí³÷íèõ íàâè÷îê, íó â³äïîâ³äü çà îäíèì ç àëüòåðíàòèâíèõ âàð³- àëå é â³äñóòí³ñòü ñïåöèô³÷íèõ ìåòîä³â ïðîô³- àíò³â, à íå çáàëàíñóâàííÿ ¿õ àêòèâàö³¿ ïðèçâî- ëàêòèêè õâîðîáè. Íà æàëü, äî ñüîãîäí³ ³ñíóº äèòü äî ³ìóííî¿ ïàòîëî㳿 [4]. Ó ñâîþ ÷åðãó îäíîá³÷íèé åò³îòðîïíî-ñèìïòîìàòè÷íèé ï³äõ³ä äèôåðåíö³þâàííÿ Ò-ë³ìôîöèò³â â T-õåëïåðè 2- äî ë³êóâàííÿ øèãåëüîçó ³ çîâñ³ì íå âðàõî- ãî òèïó (Òh2) ïðèçâîäèòü äî ñòèìóëÿö³¿ àíòè- âóºòüñÿ ³ìóííèé ñòàí õâîðèõ [2]. Îñòàííº ïî- ò³ëîóòâîðåííÿ ³ ïðèãí³÷åííÿ â³äïîâ³ä³ Òh1 øëÿ- â'ÿçàíî ç íåäîñòàòíüî ñèñòåìíèì âèñâ³òëåí- õîì ñåêðåö³¿ ïðîòèçàïàëüíèõ öèòîê³í³â. íÿì ö³º¿ ïðîáëåìè â ë³òåðàòóð³, îòðèìàí³ ðå- Ò³ñíî ïîâ'ÿçàíîþ ç êë³òèííîþ ³ìóííîþ çóëüòàòè äîñë³äæåíü ÷àñòî ìàþòü ñóïåðå÷- â³äïîâ³ääþ º ãóìîðàëüíà ëàíêà ³ìóí³òåòó, ÿê³é íèé õàðàêòåð. íàëåæèòü ÷èìàëà ðîëü â îäóæàíí³ îðãàí³çìó Çà îñòàíí³ ðîêè îòðèìàíî çíà÷í³ äîñÿãíåí- ïðè áàêòåð³àëüíèõ ³íôåêö³ÿõ, çîêðåìà øèãå- íÿ ó âèâ÷åíí³ ³ìóííîãî ãîìåîñòàçó ëþäñüêîãî ëüîç³. CD19+-êë³òèíè êîíòðîëþþòü àêòèâàö³þ îðãàí³çìó çàâäÿêè â³äêðèòòþ öèòîê³íîâî¿ ñè- òà äèôåðåíö³þâàííÿ Â-ë³ìôîöèò³â. Îñòàíí³, ñòåìè, àäæå âèðàçí³ñòü ïðîäóêö³¿ öèòîê³í³â â³äïîâ³äàëüí³ çà ïðîäóêóâàííÿ ñïåöèô³÷íèõ âèçíà÷ຠíå ò³ëüêè ³íòåíñèâí³ñòü çàõèñíèõ çà- àíòèò³ë, íàðîñòàííÿ âì³ñòó ÿêèõ â äèíàì³ö³ çà- ïàëüíèõ ïðîöåñ³â, àëå é ñïðÿìîâàí³ñòü ïðî- ïàëüíîãî ïðîöåñó º îäíèì ³ç ìåõàí³çì³â ñà- ô³ëþ ñïåöèô³÷íî¿ ³ìóííî¿ â³äïîâ³ä³ – êë³òèííî¿ íàö³¿ îðãàí³çìó, ùî ïðèçâîäèòü äî îäóæàííÿ, à ÷è ãóìîðàëüíî¿ [3]. Áàëàíñ ïðî- ³ ïðîòèçàïàëü- çáåðåæåííÿ ¿õ êîíöåíòðàö³¿ â ñèðîâàòö³ ïåâ- íèõ öèòîê³í³â º îäíèì ³ç ôàêòîð³â, ùî îáóìîâ- íèé ÷àñ º îñíîâîþ íåñïðèéíÿòëèâîñò³ äî çáóä- ëþº êë³í³÷íèé ñòàí äèòèíè. Îñíîâíèì ìîìåí- íèêà [5]. Ïðè ³íôåêö³éíîìó çàõâîðþâàíí³

© Ñ.Ì. Áóê³é, 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ²ÍÔÅÊÖ²ÉͲ ÕÂÎÐÎÁÈ 63

ïåðøèìè ç'ÿâëÿþòüñÿ íèçüêîàâèäí³ IgM, ÿê³ íå- Ìåòà ðîáîòè – âèâ÷åííÿ ð³âí³â îñíîâíèõ çàáàðîì çàì³íþþòüñÿ íà âèñîêîàâèäí³ IgG. Äî ³ìóíîãëîáóë³í³â êðîâ³ òà ñåêðåòîðíîãî ³ìóíî- âèñîêîàâèäíèõ íàëåæàòü òàêîæ IgÀ, ñåêðåòîðíà ãëîáóë³íó êèøê³âíèêà ó ð³çí³ ïåð³îäè ãîñòðîãî ôîðìà IgÀ (sIgA) â³ä³ãðຠâàæëèâó ðîëü ó çáå- øèãåëüîçó â ä³òåé, ³íô³êîâàíèõ ÖÌÂ. ðåæåíí³ ì³ñöåâîãî ³ìóí³òåòó. Çäàòí³ñòü sIgA Ìàòåð³àë ³ ìåòîäè ôîðìóâàòè ³ìóíí³ êîìïëåêñè ç ³íôåêö³éíèìè Íà áàç³ Îáëàñíî¿ äèòÿ÷î¿ ³íôåêö³éíî¿ êë³- àãåíòàìè òà ïðîäóêòàìè ¿õ æèòòºä³ÿëüíîñò³ ÿê í³÷íî¿ ë³êàðí³ ì. Õàðêîâà îáñòåæåíî 90 ä³òåé íà ïîâåðõí³ ñëèçîâî¿ îáîëîíêè êèøê³âíèêà, òàê â³êîì â³ä 4 äî 10 ðîê³â, õâîðèõ íà øèãåëüîç, ÿê³ ³ áåçïîñåðåäíüî â lamina propria, º îäíèì ³ç çà- áóëè ðîçïîä³ëåí³ íà äâ³ ãðóïè, ð³âí³ çà â³êîì òà ïîá³æíèê³â ðîçâèòêó õâîðîáè. Ñàìå ñâîº÷àñ- ñòàòòþ, (p>0,05). Äî ² ãðóïè óâ³éøëî 48 ä³òåé, í³ñòü òà äîñòàòí³ñòü àíòèò³ëîóòâîðåííÿ â³äïî- õâîðèõ íà øèãåëüîç áåç ñóïóòíüîãî ³íô³êóâàííÿ â³äàëüí³ çà ïîâíîö³ííå îäóæàííÿ ëþäèíè [6]. áóäü-ÿêèìè â³ðóñàìè (ìîíî³íôåêö³ÿ), ñåðåäí³é Àêòóàëüíèì º âèâ÷åííÿ ñòàíó ãóìîðàëü- â³ê ÿêèõ ñòàíîâèâ (8,23±1,71) ðîêó. ²² ãðóïó íî¿ ëàíêè ³ìóííî¿ â³äïîâ³ä³ õâîðèõ íà øèãåëüîç ñêëàëè 42 õâîðèõ íà øèãåëüîç íà òë³ ïåðñèñ- ä³òåé, îñîáëèâî çà óìîâ íàÿâíîñò³ ó íèõ ñó- òóþ÷î¿ íåàêòèâíî¿ ÖÌÂ-³íôåêö³¿ ñåðåäí³é â³ê ïóòíüî¿ ïàòîëî㳿. Çà îñòàíí³ äåñÿòèð³÷÷ÿ çðîñëà ÿêèõ ñòàíîâèâ (7,81±1,96) ðîêó. ˳êóâàííÿ ä³òåé ê³ëüê³ñòü ëþäåé, ³íô³êîâàíèõ ãåðïåñâ³ðóñàìè, ïðîâîäèëè â³äïîâ³äíî äî çàòâåðäæåíèõ ÷èííèõ çîêðåìà öèòîìåãàëîâ³ðóñîì (ÖÌÂ), ³íô³êó- êë³í³÷íèõ ïðîòîêîë³â. Äî ãðóïè êîíòðîëþ óâ³éø- âàííÿ ÿêèì â³äáóâàºòüñÿ â ðàííüîìó â³ö³ [7]. ëî 20 ïðàêòè÷íî çäîðîâèõ ä³òåé, ñåðåäí³é â³ê ÿêèõ ³äîìî, ùî ÖÌ ìîæå áóòè îäíèì ³ç ôàê- ñòàíîâèâ (7,21±1,22) ðîêó, àíàëîã³÷íèõ çà ñòàòòþ. òîð³â ðîçâèòêó ³ ìàðêåðîì ³ìóíîäåô³öèòíîãî Çàêëþ÷íèé ä³àãíîç øèãåëüîçó âñòàíîâëþ- ñòàíó òà ïîðóøåííÿ ó ä³ÿëüíîñò³ ³ìóííî¿ ñèñ- âàëè â³äïîâ³äíî äî ÌÊÕ-10 ç óðàõóâàííÿì òåìè ³ öå íåîáõ³äíî âðàõîâóâàòè îñîáëèâî ïðè äàíèõ àíàìíåçó, êë³í³÷íèõ ïðîÿâ³â, ðåçóëüòàò³â ³íôåêö³éíèõ çàõâîðþâàííÿõ. áàêòåð³îëîã³÷íîãî, â³ðóñîëîã³÷íîãî ³ ñåðîëîã³- Äëÿ îö³íêè ðîáîòè ãóìîðàëüíî¿ ëàíêè ³ìó- ÷íîãî äîñë³äæåíü. Âñ³ ä³òè áóëè îáñòåæåí³ íà í³òåòó îäíèì ç îñíîâíèõ ïîêàçíèê³â º âèçíà- ÖÌ ìåòîäîì ²ÔÀ (âèçíà÷åííÿ àíòèò³ë êëà- ÷åííÿ ð³âí³â ñèðîâàòêîâèõ ³ ñåêðåòîðíèõ ³ìó- ñó IgÌ òà IgG äî ÖÌ â ñèðîâàòö³ êðîâ³), âèç- íîãëîáóë³í³â (Ig) [8]. Äî 15 % â³ä çàãàëüíî¿ íà÷àëè íàÿâí³ñòü ÖÌ ìåòîäîì ÏËÐ â ñëèí³ ê³ëüêîñò³ ³ìóíîãëîáóë³í³â ñêëàäຠIgA, ùî çà- òà êðîâ³. Óìîâîþ âèêëþ÷åííÿ ³ç êîãîðòè äî- áåçïå÷óº ì³ñöåâèé ³ìóí³òåò â³ä ïàòîãåí³â, òîìó ñë³äæåííÿ áóëî âèÿâëåííÿ ó õâîðèõ ìàðêåð³â îñíîâíà éîãî ÷àñòêà çíàõîäèòüñÿ íà ïîâåðõí³ ³íøèõ ãåðïåñâ³ðóñ³â (Åïøòåéíà–Áàðð â³ðóñó, ñëèçîâèõ îáîëîíîê. Ñåêðåòîðíèé IgÀ, ùî ïðî- â³ðóñ ãåðïåñó 6-ãî òèïó), íàÿâí³ñòü ñóïóòíüî¿ äóêóºòüñÿ Â-êë³òèíàìè ñëèçîâèõ îáîëîíîê ïàòîëî㳿, ³ìóíîäåô³öèòíîãî ñòàíó. Ïîðÿä ³ç çà- øëóíêîâî-êèøêîâîãî òðàêòó, âèêîíóº âàæëèâ³ ãàëüíî ïðèéíÿòèìè äîñë³äæåííÿìè âèçíà÷à- çàõèñí³ ôóíêö³¿, çàïîá³ãàþ÷è àäãå糿 ïàòîãåí³â ëè ð³âí³ ñèðîâàòêîâèõ IgA, IgM, IgG òà ñåêðå- òà ¿õ ïðîíèêíåííþ â åíòåðîöèòè êèøê³âíèêà [9]. òîðíîãî IgA (sIgA) â êîïðîô³ëüòðàòàõ ìåòî- Äî 80 % âñ³õ ³ìóíîãëîáóë³í³â êðîâ³ ñêëà- äîì ðàä³àëüíî¿ ³ìóíîäèôó糿 çà Ìàí÷³í³. äàþòü IgG, ùî ñèíòåçóþòüñÿ çð³ëèìè Â-ë³ìôî- Ñòàòèñòè÷íó îáðîáêó îòðèìàíèõ ðåçóëü- öèòàìè. Ñàìå ö³ ïðîòå¿íè â³ä³ãðàþòü âåëèêó òàò³â ïðîâåäåíî çà äîïîìîãîþ êîìï'þòåðíèõ ðîëü ó ïðîöåñàõ íåéòðàë³çàö³¿ áàêòåð³àëüíèõ ïðîãðàì Excel ³ Statistica 6,0. òîêñèí³â, çàáåçïå÷óþòü òðèâàëèé çàõèñò â³ä Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ ³íôåêö³¿ [10]. Äî 10 % âñ³õ ³ìóíîãëîáóë³í³â Ïîêàçíèêè ãóìîðàëüíî¿ â³äïîâ³ä³ ä³òåé ãðóï ñêëàäàþòü IgÌ, ÿê³ ìàþòü äîñòàòíüî êîðîò- ñïîñòåðåæåííÿ â ð³çí³ ïåð³îäè øèãåëüîçó íà- êèé ïåð³îä íàï³âðîçïàäó (4–5 äí³â) òà âèðîá- âåäåíî ó òàáëèö³. ëÿþòüñÿ îðãàí³çìîì ï³ñëÿ ïåðøî¿ çóñòð³÷³  ãîñòðîìó ïåð³îä³ øèãåëüîçó â³äì³÷åíî ç ïàòîãåíîì – ïåðâèííà ³ìóííà â³äïîâ³äü [11]. ï³äâèùåííÿ ð³âí³â IgM ó õâîðèõ îáîõ ãðóï ñïî- Îñîáëèâî âàæëèâîþ º ãóìîðàëüíà â³ä- ñòåðåæåííÿ, àëå ó ïîð³âíÿíí³ ç äàíèìè ãðóïè ïîâ³äü ïðè ʲ, àäæå â³äîìî, ùî êèøê³âíèê êîíòðîëþ öå ï³äâèùåííÿ áóëî íå â³ðîã³äíèì ì³ñòèòü âåëèêó ê³ëüê³ñòü ë³ìôî¿äíèõ ³ 쳺ëî- (ð>0,05). Äî ïåð³îäó ðåêîíâàëåñöåíö³¿ ïîêàç- ¿äíèõ êë³òèí, á³ëüø³ñòü ç ÿêèõ ïåðåáóâàþòü â íèêè IgM ñóòòºâî çðîñòàëè: ìàêñèìàëüíó ð³ç- àêòèâîâàíîìó ñòàí³ òà â³ä³ãðàþòü âàæëèâó çà- íèöþ ó ïîð³âíÿíí³ äî ãðóïè êîíòðîëþ âèÿâëåíî õèñíó ðîëü [12]. Ñàìå öüîìó äîñë³äæåííÿ ó õâîðèõ ² ãðóïè (ð<0,01; t=2,75). Îäíàê, â³ðî- ð³âí³â ³ìóíîãëîáóë³í³â ïðè ʲ ö³êàâëÿòü áàãà- ã³äíî¿ ð³çíèö³ âì³ñòó IgM ì³æ ãðóïàìè ñïîñòå- òüîõ íàóêîâö³â ³ çàëèøàþòüñÿ àêòóàëüíèìè äî ðåæåííÿ â äèíàì³ö³ øèãåëüîçó íàìè íå âèÿâ- ñüîãîäí³ [ 13,14]. ëåíî (ð>0,05).

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 64 ²ÍÔÅÊÖ²ÉͲ ÕÂÎÐÎÁÈ

Ïîêàçíèêè îñíîâíèõ ³ìóíîãëîáóë³í³â êðîâ³ òà ñåêðåòîðíîãî ³ìóíîãëîáóë³íó À êîïðîô³ëüòðàòó õâîðèõ íà øèãåëüîç â ð³çí³ ïåð³îäè õâîðîáè, (M±m)

Ïðèì³òêè: 1 – â³ðîã³äí³ñòü îçíàêè äî êîíòðîëþ; 2 – â³ðîã³äí³ñòü îçíàêè ì³æ ãðóïàìè ñïîñòåðåæåííÿ. Ïîð³âíÿëüíèé àíàë³ç âèçíà÷èâ ñóòòºâå âì³ñòó ñèðîâàòêîâîãî IgÀ áóëà íå â³ðîã³äíîþ ï³äâèùåííÿ âì³ñòó IgG â ãîñòðîìó ïåð³îä³ ó (ð>0,05; t=1,49). Ó ïàö³ºíò³â ²² ãðóïè ìè ñïî- õâîðèõ ²² ãðóïè (ð<0,001; t=5,29), à ó õâîðèõ ñòåð³ãàëè àíàëîã³÷íó íàïðàâëåí³ñòü çì³í âì³ñòó ² ãðóïè öåé ïîêàçíèê íå â³äð³çíÿâñÿ â³ä äàíèõ ³ìóíîãëîáóë³í³â, àëå äîñòîâ³ðí³ñòü ð³çíèö³ ïîêàç- ãðóïè êîíòðîëþ (ð>0,05).  äèíàì³ö³ øèãåëüî- íèê³â â äèíàì³ö³ øèãåëüîçó áóëî âèÿâëåíî ëèøå çó ðåºñòðóâàëè â³ðîã³äíå ï³äâèùåííÿ ð³âíÿ IgG: ùîäî IgÀ (p<0,05; t=2,05). íàéá³ëüø âèðàçíå ï³äâèùåííÿ ñïîñòåð³ãàëè Îòðèìàí³ íàìè ðåçóëüòàòè ñâ³ä÷àòü, ùî ó õâîðèõ äðóãî¿ ãðóïè (ð<0,001; t=8,21). Íàìè øèãåëüîç ó ä³òåé íà òë³ ³íô³êóâàííÿ ÖÌ ñó- âèçíà÷åíî â³ðîã³äíó ð³çíèöþ çà ïîêàçíèêîì IgG ïðîâîäæóºòüñÿ «òîðï³äí³ñòþ» ðåàãóâàííÿ ãó- ó õâîðèõ îáîõ ãðóï ÿê ó ãîñòðîìó ïåð³îä³ ìîðàëüíî¿ ëàíêè ³ìóííî¿ â³äïîâ³ä³ â äèíàì³ö³ õâî- (ð<0,001; t=4,78), òàê ³ íà åòàï³ ðàííüî¿ ðåêîí- ðîáè. Âèçíà÷åí³ âèñîê³ ïîêàçíèêè âì³ñòó IgG ó âàëåñöåíö³¿ (ð<0,01; t=3,18). õâîðèõ ²² ãðóïè â ð³çí³ ïåð³îäè øèãåëüîçó, íà  ãîñòðîìó ïåð³îä³ øèãåëüîçó âì³ñò IgÀ â íàøó äóìêó, îáóìîâëåí³ òðèâàëèì ³íô³êóâàí- ãðóïàõ ñïîñòåðåæåííÿ ñóòòºâî íå â³äð³çíÿâñÿ íÿì ä³òåé ÖÌÂ. Âèÿâëåí³ âèñîê³ êîíöåíòðàö³¿ â³ä ãðóïè êîíòðîëþ (ð>0,05), àëå çðîñòàâ äî IgG ó õâîðèõ íà øèãåëüîç â ðàííüîìó ïåð³îä³ ïåð³îäó ðåêîíâàëåñöåíö³¿. ³ðîã³äíå ï³äâèùåí- õâîðîáè ïîâèíí³ áóòè ï³äñòàâîþ ùîäî ðåòåëü- íÿ êîíöåíòðàö³¿ IgÀ â äèíàì³ö³ øèãåëüîçó âèç- íîãî îáñòåæåííÿ õâîðèõ ç ìåòîþ âèÿâëåííÿ íà÷àëè ëèøå ó õâîðèõ ²² ãðóïè (ð>0,05; t=2,75). ñóïóòíüî¿ ïàòîëî㳿, çîêðåìà ÖÌÂ-³íôåêö³¿. Íàìè íå âèÿâëåíî â³ðîã³äíî¿ ð³çíèö³ ïîêàçíè- Âèñíîâêè êà IgÀ ì³æ ãðóïàìè ñïîñòåðåæåííÿ â äèíàì³ö³ 1. Ïåðåá³ã øèãåëüîçó ó ä³òåé ñóïðîâîäæóºòü- øèãåëüîçó (ð>0,05). ñÿ àêòèâàö³ºþ ãóìîðàëüíî¿ ëàíêè ³ìóí³òåòó. Äîñë³äæåííÿ êîïðîô³ëüòðàò³â â ãîñòðîìó 2. Ïåðåá³ã øèãåëüîçó ó ä³òåé ðàííüîãî â³êó ïåð³îä³ øèãåëüîçó âèÿâèëî â³ðîã³äíî âèù³ ð³âí³ íà ôîí³ ÖÌÂ-³íôåêö³¿ õàðàêòåðèçóºòüñÿ ïî- sIgA ó õâîðèõ îáîõ ãðóï ó ïîð³âíÿíí³ ç ïîêàçíè- ñòóïîâèìè «òîðï³äíèìè» çì³íàìè ïîêàçíèê³â êàìè êîíòðîëüíî¿ ãðóïè (ð<0,05). Ïðè öüîìó, ó îñíîâíèõ êëàñ³â ³ìóíîãëîáóë³í³â â äèíàì³ö³ ä³òåé ² ãðóïè âì³ñò sIgA áóâ â³ðîã³äíî âèùèì õâîðîáè, çà âèíÿòêîì ñèðîâàòêîâîãî IgG. çà ïîêàçíèêè õâîðèõ ç ôîíîâèì ³íô³êóâàííÿì 3. Âì³ñò ñèðîâàòêîâîãî IgG ó õâîðèõ íà (p<0,05; t=2,29). Äî ïåð³îäó ðàííüî¿ ðåêîíâàëåñ- øèãåëüîç òà ³íô³êîâàíèõ ÖÌ º ñóòòºâî âèùèì öåíö³¿ øèãåëüîçó ó ä³òåé â³äáóâàëîñü çíèæåííÿ ÿê ó ïîð³âíÿíí³ äî ãðóïè êîíòðîëþ, òàê ³ äî ïî- ê³ëüê³ñíîãî âì³ñòó sIgA, ÿêèé ñóòòºâî íå â³äð³ç- êàçíèê³â õâîðèõ áåç ñóïóòíüîãî ³íô³êóâàííÿ. íÿâñÿ â³ä äàíèõ ãðóïè êîíòðîëþ (ð>0,05). Àëå 4. Âèñîê³ êîíöåíòðàö³¿ IgG ó ä³òåé â ãîñò- íàìè âèÿâëåíî â³ðîã³äíó ð³çíèöþ êîíöåíòðàö³¿ ðîìó ïåð³îä³ øèãåëüîçó ìîæíà ðîçö³íþâàòè ÿê sIgA ì³æ ãðóïàìè ñïîñòåðåæåííÿ (ð<0,05; t= 3,88) îäèí ³ç ìàðêåð³â ñóïóòíüîãî ³íô³êóâàííÿ. ³ íàéá³ëüøèìè ö³ ïîêàçíèêè áóëè ó ä³òåé ²² ãðóïè. 5. Âèçíà÷åí³ îñîáëèâîñò³ ðåàãóâàííÿ ãó- Ïîð³âíÿëüíèé àíàë³ç âì³ñòó ³ìóíîãëîáóë³í³â ìîðàëüíî¿ ëàíêè ³ìóííî¿ â³äïîâ³ä³ äàþòü â ãîñòðîìó ïåð³îä³ õâîðîáè òà â ïåð³îä³ ðåêîí- ï³äñòàâó ââàæàòè íàÿâí³ñòü ÖÌÂ-³íôåêö³¿ ó âàëåñöåíö³¿ âèÿâèâ, ùî ó ïàö³ºíò³â ² ãðóïè øè- äèòèíè, õâîðî¿ íà øèãåëüîç, ÿê íåñïðèÿòëèâèé ãåëüîç ñóïðîâîäæóâàâñÿ ï³äâèùåííÿì ð³âí³â ôîí, ùî ïîòðåáóº ïîäàëüøîãî äîñë³äæåííÿ ³ ñèðîâàòêîâèõ IgM (p<0,01; t=3,05) ³ IgG (p<0,01; êîðåêö³¿ òåðì³í³â äèñïàíñåðíîãî ñïîñòåðåæåí- t=3,09) íà òë³ ñóòòºâîãî çðîñòàííÿ âì³ñòó sIgA íÿ çà õâîðèìè íà øèãåëüîç çàëåæíî â³ä ôîíî- â êîïðîô³ëüòðàòàõ (p<0,001; t=6,80), à äèíàì³êà âîãî ³íô³êóâàííÿ.

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9. Chen S.F., Tu W.W., Sharp M.A., Tongson E.C., He X.S. et al. (2009). Antiviral cells in the control of primary human cytomegalovirus infection in early childhood. J Infect Dis., May 1, vol. 179 (9), pp. 1619–1627. 10. Shakhgildyan V.I. (2013). Gerpesvirusnyye infektsii. VICH-infektsiya i SPID: natsional'noye rukovodstvo [Herpesvirus infections. HIV infection and AIDS: national leadership]. V.V. Pokrovsky (Ed.); M.: GEOTAR-Media, 608 ð. [in Russian]. 11. Revello M.G., Gerna G. (2012). Diagnosis and management of human cytomegalovirus infection in the mother, fetus and newborn infant. Clin. Microbiol. Rev., vol. 15, pp. 680–715. 12. Shyrobokova V.P. (Eds.). (2011). Medychna mikrobiolohiya, virusolohiya, imunolohiya [Medical microbiology, virology, immunology]. Vinnytsia: Nova knyha, 415 ð. [in Ukrainian]. 13. Kuznetsov S.V., Hubar S.O., Zharkova T.S., Olkhovskaia O.N., Kucherenko E.O. (2014). Kriterii prognozirovaniya techeniya shigelleza u detey rannego vozrasta [Criteria for predicting the course of shigellosis in young children]. Zdravookhraneniye Tadzhikistana – Healthcare of Tajikistan, ¹ 4 (323), pp. 75–81 [in Russian]. 14. Vasylieva N.A., Lokai B.A. (2006). Dyferentsiyna diahnostyka khvorob iz hostrym diareynym syndromom [Differential diagnosis of diseases with acute diarrheal syndrome]. Infektsiyni khvoroby – Infectious diseases, ¹ 1. – pp. 58–66 [in Ukrainian].

Ñ.Í. Áóêèé ÃÓÌÎÐÀËÜÍÛÉ ÈÌÌÓÍÍÛÉ ÎÒÂÅÒ ÄÅÒÅÉ, ÁÎËÜÍÛÕ ØÈÃÅËËÅÇÎÌ È ÈÍÔÈÖÈÐÎÂÀÍÍÛÕ ÖÈÒÎÌÅÃÀËÎÂÈÐÓÑÎÌ Ïðîâåäåí ñðàâíèòåëüíûé àíàëèç ïîêàçàòåëåé ãóìîðàëüíîãî èììóííîãî îòâåòà ïðè øèãåëëåçå ó 90 äåòåé â âîçðàñòå îò 4 äî 10 ëåò, èíôèöèðîâàííûõ öèòîìåãîëîâèðóñîì (ÖÌÂ). Óñòàíîâëåíî, ÷òî øèãåëëåç ó äåòåé ðàííåãî âîçðàñòà íà ôîíå ÖÌÂ-èíôåêöèè õàðàêòåðèçóåòñÿ òîðïèäíûìè èç- ìåíåíèÿìè ïîêàçàòåëåé îñíîâíûõ êëàññîâ èììóíîãëîáóëèíîâ â äèíàìèêå áîëåçíè, çà èñêëþ÷å- íèåì ñûâîðîòî÷íîãî IgG. Ñîäåðæàíèå IgG ó áîëüíûõ øèãåëëåçîì è èíôèöèðîâàííûõ ÖÌ ñó- ùåñòâåííî âûøå êàê â ñðàâíåíèè ñ ãðóïïîé êîíòðîëÿ, òàê è ïîêàçàòåëÿìè äåòåé áåç ñîïóòñòâóþ- ùåãî èíôèöèðîâàíèÿ. Âûÿâëåííûå îñîáåííîñòè ðåàãèðîâàíèÿ ãóìîðàëüíîãî èììóííîãî îòâåòà ìîãóò áûòü âñïîìîãàòåëüíûì äèàãíîñòè÷åñêèì êðèòåðèåì èíôèöèðîâàíèÿ ÖÌ äåòåé, áîëüíûõ øèãåëëåçîì, à òàêæå ïðè÷èíîé ðàçâèòèÿ íåáëàãîïðèÿòíîãî òå÷åíèÿ áîëåçíè, ÷òî òðåáóåò äàëüíåé- øåãî èññëåäîâàíèÿ. Êëþ÷åâûå ñëîâà: ãóìîðàëüíûé èììóíèòåò, äåòè, øèãåëëåç, öèòîìåãàëîâèðóñíàÿ èíôåêöèÿ.

S.M. Bukiy HUMORAL IMMUNE RESPONSE OF CHILDREN WITH SHIGELLOSIS AND INFECTED WITH CYTOMEGALOVIRUS A comparative analysis of the humoral immune response in shigellosis in 90 children aged four to ten years infected with cytomegolovirus (CMV) was performed. It was found that shigellosis in young children on the background of CMV infection is characterized by torpid changes in the parameters of the main classes of immunoglobulins in the dynamics of the disease, with the exception of serum IgG. The IgG content in patients with shigellosis and infected with CMV is significantly higher both in comparison with the control group, and in children without concomitant infection. The revealed features of the response of the humoral immune system can be an auxiliary diagnostic criterion for the infection of CMV in children with shigellosis, as well as the cause of the development of an unfavorable course of the disease, which requires further investigation. Keywords: humoral immunity, children, shigellosis, cytomegalovirus infection. Íàä³éøëà äî ðåäàêö³¿ 19.11.2019

Êîíòàêòíà ³íôîðìàö³ÿ Áóê³é Ñåðã³é Ìèêîëàéîâè÷ – àñï³ðàíò êàôåäðè äèòÿ÷èõ ³íôåêö³éíèõ õâîðîá Õàðê³âñüêîãî íàö³îíàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó. Àäðåñà: Óêðà¿íà, 61162, ì. Õàðê³â, ïðîñï. Ãåðî¿â Ñòàë³íãðàäó 160. Òåë.: +380966513638. E-mail: [email protected]. ORCID: https://orcid.org/0000-0003-1165-5611.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÍÅÂÐÎËÎÃ²ß 67

НЕВРОЛОГІЯ https://doi.org/10.35339/ekm.2019.85.04.10 ÓÄÊ 616.8-009-053.4-037:616.831-005.4-053.32

Î.Â. Âàðåøíþê1, Â.Â. Â'þí2 1Õàðê³âñüêà ìåäè÷íà àêàäåì³ÿ ï³ñëÿäèïëîìíî¿ îñâ³òè 2Õàðê³âñüêèé íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ÏÐÎÃÍÎÑÒÈ×Ͳ ÊÐÈÒÅв¯ ÐÎÇÂÈÒÊÓ ÏÎÐÓØÅÍÜ ÌÎÒÎÐÍÈÕ ÔÓÍÊÖ²É Ó ÍÅÄÎÍÎØÅÍÈÕ ÍÅÌÎÂËßÒ Ç ÏÅÐÈÍÀÒÀËÜÍÈÌ Ã²ÏÎÊÑÈ×ÍÎ-²ØÅ̲×ÍÈÌ ÓÐÀÆÅÍÍßÌ ÖÅÍÒÐÀËÜÍί ÍÅÐÂÎÂί ÑÈÑÒÅÌÈ Ïðîâåäåíî êîìïëåêñíå îáñòåæåííÿ 79 íåìîâëÿò îáîõ ñòàòåé, íàðîäæåíèõ ïåðåä÷àñíî ³ ç ïåðåíåñåíèì ïåðèíàòàëüíèì ã³ïîêñèêî-³øåì³÷íèì óðàæåííÿì öåíòðàëüíî¿ íåðâîâî¿ ñèñòåìè. Ïîêàçàíî, ùî ó 37,9 % ç íèõ ä³àãíîñòîâàíî ñïàñòè÷íèé öåðåáðàëüíèé ïàðàë³÷, ó 20,3 % – ñïàñòè÷íó äèïëåã³þ; 27,8 % – äèòÿ÷ó ãåì³ïëåã³þ; 13,9 % – ïðèäáàíó ã³äðî- öåôàë³þ. Ïðîãíîñòè÷í³ êðèòå𳿠éìîâ³ðíîñò³ ðîçâèòêó ïîðóøåíü ðóõîâèõ ôóíêö³é â îá- ñòåæóâàíèõ ä³òåé ï³äáèðàëè ç óðàõóâàííÿì ïîêàçíèê³â ¿õ íåâðîëîã³÷íîãî òà ðóõîâîãî ñòàíó, ãåñòàö³éíîãî â³êó, ñòàò³, ñòóïåíÿ ïåðè³íòðàâåíòðèêóëÿðíîãî êðîâîâèëèâó, ïåðè- âåíòðèêóëÿðíî¿ ëåéêîìàëÿö³¿, ïåðèâåíòðèêóëÿðíî¿ ³øå쳿. Ñèñòåìàòèçîâàíî ôàêòîðè, ùî âåäóòü äî êàòåãîð³é «õîäüáà áåç îáìåæåíü», «õîäüáà ç äîïîì³æíèìè ïðèñòðîÿìè», «õîäüáà íå îñâîºíà». Óñòàíîâëåíî, ùî ïîºäíàííÿ ïåðè³íòðàâåíòðèêóëÿðíèõ êðîâîâèëèâ³â II ñòó- ïåíÿ ç ³øåì³÷íèìè óðàæåííÿìè ìîçêó ëåãêîãî ñòóïåíÿ â á³ëüøîñò³ âèïàäê³â äຠá³ëüø ïîçèòèâíèé ïðîãíîç, à àñîö³àö³ÿ ç á³ëüø âèðàæåíèìè ³øåì³÷íèìè óðàæåííÿìè óòâîðþº âàæêèé ðóõîâèé ïðîãíîç ó ä³òåé, ÿê³ áóëè íàðîäæåí³ ïåðåä÷àñíî ³ çàçíàëè ïåðèíàòàëü- íîãî ã³ïîêñèêî-³øåì³÷íîãî óðàæåííÿ ìîçêó. Ïðîãíîñòè÷íèìè ôàêòîðàìè âèíèêíåííÿ ðóõîâèõ ïîðóøåíü ó íåäîíîøåíèõ ä³òåé º ïåðè³íòðàâåíòðèêóëÿðíèé êðîâîâèëèâ ²²–²V ñòó- ïåíÿ, ïåðèâåíòðèêóëÿðíà ëåéêîìàëÿö³ÿ ²²² ñòóïåíÿ òà ÷îëîâ³÷à ñòàòü äèòèíè. Êëþ÷îâ³ ñëîâà: öåðåáðàëüíèé ïàðàë³÷, ñïàñòè÷íà äèïëåã³ÿ, ãåñòàö³éíèé â³ê, ³øåì³÷íå óðàæåííÿ ìîçêó, ïåðèâåíòðèêóëÿðíà ëåéêîìàëÿö³ÿ.

Âñòóï ³øåì³÷íèì óðàæåííÿì öåíòðàëüíî¿ íåðâîâî¿ Ó ñòðóêòóð³ äèòÿ÷î¿ ³íâàë³äíîñò³ ïðîâ³äíå ñèñòåìè (ÖÍÑ) [1–3]. ì³ñöå çàéìàþòü çàõâîðþâàííÿ íåðâîâî¿ ñèñ- Àíàë³ç äàíèõ ë³òåðàòóðè ³ ïîñòàíîâêà òåìè. ²íòåíñèâíèé ðîçâèòîê íåîíàòàëüíèõ ðå- ïðîáëåìè àí³ìàö³éíèõ òåõíîëîã³é çíèæóº ñìåðòí³ñòü ³ Çà äàíèìè ë³òåðàòóðè, â ðîçâèòêó ïîðó- äîçâîëÿº âèæèòè ãëèáîêî íåäîíîøåíèì ä³òÿì øåíü ìîòîðíèõ ôóíêö³é âàæëèâó ðîëü â³ä³ãðà- ç íåâðîëîã³÷íîþ ïàòîëî㳺þ, àëå ã³ïîêñè÷íî- þòü âèðàæåí³ ïåðè- òà ³íòðàíàòàëüí³ ã³ïîêñè÷í³ ³øåì³÷íå óðàæåííÿ ãîëîâíîãî ìîçêó íåäîíî- åï³çîäè, ÿê³ ïðèçâîäÿòü äî ìåòàáîë³÷íî¿ àöè- øåíî¿ äèòèíè çàëèøàºòüñÿ îñíîâíîþ ïðè÷è- äå쳿 ó ïåð³îä âàã³òíîñò³ òà ïîëîã³â, ã³ïîêñè÷íî- íîþ ³íâàë³äèçàö³¿ òà ñîö³àëüíî¿ äåçàäàïòàö³¿. ³øåì³÷í³é åíöåôàëîïàò³¿, îêñèäàíòíîìó ñòðå- Ñàìå òîìó îäíèìè ç âàæëèâèõ íàïðÿìê³â ðîç- ñó ç åêñïðåñ³ºþ â³ëüíèõ ðàäèêàë³â [1, 4]. âèòêó ïåðèíàòàëüíî¿ íåâðîëî㳿 òà ñîö³àëüíî¿ ßê â³äîìî, ã³ïîêñ³ÿ º óí³âåðñàëüíèì ôàê- ïåä³àò𳿠º ïèòàííÿ ïðîãíîçó íàñë³äê³â é çàïî- òîðîì, ÿêèé óøêîäæóº ÖÍÑ íîâîíàðîäæåíîãî. á³ãàííÿ ôîðìóâàííþ íåâðîëîã³÷íîãî äåô³öèòó Íàñë³äêîì àíòå- òà ³íòðàíàòàëüíîãî íåáëàãî- ó íåäîíîøåíèõ íîâîíàðîäæåíèõ ç ã³ïîêñè÷íî- ïîëó÷÷ÿ ó íîâîíàðîäæåíèõ º ïåðèíàòàëüí³

© Î.Â. Âàðåøíþê, Â.Â. Â'þí, 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 68 ÍÅÂÐÎËÎòß

óðàæåííÿ ÖÍÑ, ÿê³ â³ä³ãðàþòü çíà÷íó ðîëü ó âèêîðèñòîâóâàëè êëàñèô³êàö³þ GMFCP (Gross ðîçâèòêó ïîðóøåíü ô³çè÷íîãî òà ïñèõ³÷íîãî Motor Function Classification System) òà ñòà- çäîðîâ'ÿ äèòèíè [5, 6]. òèñòè÷íèé. Äî êë³í³÷íèõ ñèíäðîì³â, ÿê³ àñîö³éîâàí³ Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ ç ïåðèíàòàëüíîþ ã³ïîêñ³ºþ ³ ôîðìóþòüñÿ ï³ñëÿ ßê ïîêàçàëè ðåçóëüòàòè äîñë³äæåííÿ, çà ïåð³îäó íîâîíàðîäæåíîñò³, â³äíîñÿòüñÿ òàê³: äàíèìè íåéðîñîíîãðàô³¿ ïåðèâåíòðèêóëÿðíà äèòÿ÷èé öåðåáðàëüíèé ïàðàë³÷, íàáóòà ã³äðî- ³øåì³ÿ (ϲ) ñïîñòåð³ãàëàñü ó 16,9 % ä³òåé, öåôàë³ÿ, çàòðèìêà ô³çè÷íîãî òà ïñèõ³÷íîãî âíóòð³øíüîøëóíî÷êîâ³ êðîâîâèëèâè (ÂØÊ) ðîçâèòêó, óðàæåííÿ çîðîâîãî òà ñëóõîâîãî àíà- ² ñòóïåíÿ (ñóáåïåíäèìàëüí³ êðîâîâèëèâè) – ë³çàòîð³â [7, 8]. ó 30,1 % ä³òåé, ÂØÊ ²² ñòóïåíÿ ç ïåðèâåíòðè- Òàêèì ÷èíîì, âèñîêà ïîøèðåí³ñòü ³ ð³çíî- êóëÿðíîþ ëåéêîìàëàö³ºþ – ó 32,1 % ä³òåé, ìàí³òí³ñòü íàñë³äê³â óðàæåííÿ íåðâîâî¿ ñèñ- ÂØÊ III ñòóïåíÿ ç ïåðèâåíòðèêóëÿðíîþ ëåéêî- òåìè ó íîâîíàðîäæåíèõ äèêòóþòü íåîáõ³ä- ìàëàö³ºþ ìàëè 20,9 % íîâîíàðîäæåíèõ. Ó íå- í³ñòü äåòàëüíîãî âèâ÷åííÿ ôàêòîð³â, ùî ôîð- âðîëîã³÷íîìó ñòàòóñ³ ïåð³îäó íîâîíàðîäæå- ìóþòü ð³çí³ êë³í³÷í³ ôîðìè ïåðèíàòàëüíîãî íîñò³ òà ó ðàííüîìó â³äíîâíîìó ïåð³îä³ ïåðå- óðàæåííÿ ÖÍÑ. Ñèñòåìàòèçàö³ÿ ÷èííèê³â íå- âàæàëè ñèíäðîìè öåðåáðàëüíîãî ïðèãí³÷åííÿ, ñïðèÿòëèâîãî ïðîãíîçó ðîçâèòêó íåâðîëîã³÷- âåãåòàòèâíî-â³ñöåðàëüíèõ äèñôóíêö³é òà ã³ïåð- íî¿ ïàòîëî㳿 º íåîáõ³äíèì äëÿ âñòàíîâëåííÿ òåíç³îííî-ã³äðîöåôàëüíèé. ïðîãíîñòè÷íî¿ çíà÷èìîñò³ êë³í³÷íèõ ôîðì óðà- Õîäüáó áåç îáìåæåíü (I ð³âåíü çà GMFCP) æåííÿ íåðâîâî¿ ñèñòåìè, à òàêîæ äëÿ îðãàí³- îñâî¿ëè 35,5 % ä³òåé (ç íèõ 27,8 % ç äèòÿ÷îþ çàö³¿ òà ïðîâåäåííÿ ðåàá³ë³òàö³éíèõ òà ë³êóâàëü- ãåì³ïëå㳺þ òà 7,7 % ä³òåé ç íàáóòîþ ã³äðîöå- íèõ çàõîä³â [9, 10]. ôà볺þ, ÿêèì áóëî âñòàíîâëåíî ë³êâîðíî-øóí- Âèùåâèêëàäåíå îáóìîâëþº àêòóàëüí³ñòü òóþ÷³ ñèñòåìè äî 6 ì³ñÿö³â æèòòÿ). íàøîãî äîñë³äæåííÿ, ìåòîþ ÿêîãî º âèä³ëåí- Õîäüáó ç äîïîì³æíèìè ïðèñòðîÿìè (II ð³- íÿ ïðîãíîñòè÷íèõ êðèòåð³¿â ðîçâèòêó ïîðóøåíü âåíü çà GMFCP) îñâî¿ëè 16,5 % õâîðèõ (ç íèõ ìîòîðíèõ ôóíêö³é ó íåäîíîøåíèõ íåìîâëÿò 15,3 % ç³ ñïàñòè÷íîþ ä³ïëå㳺þ òà 1,2 % ç íà- ç ïåðèíàòàëüíèì ã³ïîêñè÷íî-³øåì³÷íèì óðà- áóòîþ ã³äðîöåôà볺þ, ïðîîïåðîâàí³ äî 6 ì³- æåííÿì ÖÍÑ. ñÿö³â æèòòÿ). Ìàòåð³àë ³ ìåòîäè Íå îñâî¿ëè õîäüáó íà III ð³âí³ – 26,4 % (ç íèõ ²ç äîòðèìàííÿì ïðèíöèï³â á³îåòèêè é äå- 22,63 % ç³ ñïàñòè÷íîþ ä³ïëå㳺þ òà 3,8 % ç íà- îíòîëî㳿 íà áàç³ Ì³ñüêîãî äèòÿ÷îãî íåéðîõ³ðóð- áóòîþ ã³äðîöåôà볺þ, ïðîîïåðîâàí³ ï³ñëÿ 6 ì³- ã³÷íîãî öåíòðó (ÕÌÊËØÍÌÄ ³ì. ïðîô. Î.². ̺- ñÿö³â æèòòÿ), íà IV ð³âåíü GMFCP – 11,3 % ùàí³íîâà) òà êë³í³êè ÄÓ «Íàóêîâî-äîñë³äíèé îáñòåæåíèõ (ä³òè ç³ ñïàñòè÷íèì öåðåáðàëü- ³íñòèòóò ïðîòåçóâàííÿ, ïðîòåçîáóäóâàííÿ òà íèì ïàðàë³÷åì). â³äíîâëåííÿ ïðàöåçäàòíîñò³» ïðîâåäåíî êîìï- Âàæêè ðóõîâ³ ðîçëàäè V ð³âíÿ çà GMFCS ëåêñíå êë³í³êî-íåâðîëîã³÷íå, àíàìíåñòè÷íå, íåéðî- â³äì³÷àëèñÿ ó 10,3 % ä³òåé (ç íèõ 9,1 % – ä³òè â³çóàë³çàö³éíå, åëåêòîðîô³ç³îëîã³÷íå îáñòåæåí- ç³ ñïàñòè÷íèì öåðåáðàëüíèì ïàðàë³÷åì òà 1,2 % íÿ 79 íåìîâëÿò (45 õëîï÷èê³â òà 34 ä³â÷èíêè), ç íàáóòîþ ã³äðîöåôà볺þ áåç îïåðàòèâíîãî ó ñåðåäíüîìó â³ö³ (3,2±1,3) ðîêó, ÿê³ íàðîäèëè- âòðó÷àííÿ). ñÿ ïåðåä÷àñíî (ãåñòàö³éíèé â³ê 26–35 òèæí³â). ßê ïîêàçàâ àíàë³ç êîãí³òèâíèõ ôóíêö³é Óñ³ ä³òè ïåðåíåñëè ïåðèíàòàëüíå ã³ïîêñè÷íî- ó îáñòåæåíèõ õâîðèõ, âñ³ ä³òè ðîçâèâàëèñü ³øåì³÷íå óðàæåííÿ ÖÍÑ, áóëè ïåðåâåäåí³ ó â³ä- ³ç çàòðèìêîþ ìîâëåííºâî¿ ôóíêö³¿, ïàö³ºíòè ä³ëåííÿ ²² åòàïó âèõîäæóâàííÿ íîâîíàðîäæå- ç äèòÿ÷îþ ãåì³ïëå㳺þ òà 89,2 % ç³ ñïàñòè÷- íèõ. Ó 37,9 % îáñòåæåíèõ áóëî ä³àãíîñòîâàíî íîþ ä³ïëå㳺þ ó òðèð³÷íîìó â³ö³ íàçäîãíàëè îä- ñïàñòè÷íèé öåðåáðàëüíèé ïàðàë³÷; ó 20,3 % – íîë³òê³â. Ïàö³ºíòè ç³ ñïàñòè÷íèì öåðåáðàëü- ñïàñòè÷íó äèïëåã³þ; ó 27,8 % – äèòÿ÷ó ãåì³- íèì ïàðàë³÷åì ìàëè ãðóá³ ìîâëåííºâ³ òà êîã- ïëåã³þ; ó 13,9 % – íàáóòó ã³äðîöåôàë³þ, âíà- í³òèâí³ ïîðóøåííÿ. ñë³äîê íåòðàâìàòè÷íèõ âíóòð³øíüîøëóíî÷êî- Îòðèìàí³ äàí³ îáðîáëÿëèñÿ ìåòîäàìè âà- âèõ êðîâîâèëèâ³â. ð³àö³éíî¿ ñòàòèñòèêè ç îá÷èñëåííÿì ³ìîâ³ð- Ó ðîáîò³ áóëè âèêîðèñòàí³ íàñòóïí³ ìå- íîñò³ ðîçõîäæåííÿ (Ð), ³ìîâ³ðí³ñòü ðîçõîäæåí- òîäè îáñòåæåííÿ: êë³í³êî-íåâðîëîã³÷íèé, íåéðî- íÿ ì³æ äâîìà ñåðåäí³ìè âèçíà÷àëè ïî òàáëèö³ ñîíîãðàô³÷íèé, ìàãí³òíî-ðåçîíàíñíèé (ç îö³í- Ñò'þäåíòà, âèçíà÷àëè êîðåëÿö³éí³ çàëåæíîñò³. êîþ ñòóïåíÿ ïåðèâåíòðèêóëÿðíî¿ ëåéêîìàëàö³¿ ̳æ òåðì³íîì ãåñòàö³¿ äèòèíè ³ ôîðìóâàííÿì (ÏÂË) ³ ïåð³³íòðàâåíòð³êóëÿðíèõ êðîâîâè- íåâðîëîã³÷íîãî äåô³öèòó êîðåëÿö³éíà çà- ëèâ³â (ϲÂÊ)), äëÿ îö³íêè ðóõîâîãî ñòàòóñó ëåæí³ñòü ñëàáêà, â³ä 0,181 äî 0,271 ³ íå ìîæå

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÍÅÂÐÎËÎÃ²ß 69

áóòè äîñòîâ³ðíîþ. Ó ä³òåé ç ÂØÊ ²²² ñòóïåíÿ ßê ïîêàçàëè ðåçóëüòàòè êîðåëÿö³éíîãî àíà- ³ ïåðèâåíòðèêóëÿðíîþ ëåéêîìàëàö³ºþ ôîðìó- ë³çó âñòàíîâëåíî á³ëüø ÷³òêèé ïðîÿâ ò³ñíîòè âàâñÿ ðóõîâèé ³ ìîâëåííºâèé äåô³öèò, ì³æ öèìè çâ'ÿçêó ì³æ ðåçóëüòàòàìè ³ñõîäó òà ñòàòòþ äè- äâîìà ôàêòîðàìè âñòàíîâëåíà ïîçèòèâíà êî- òèíè, í³æ ì³æ ³ñõîäîì òà òåðì³íîì ãåñòàö³¿, ðåëÿö³ÿ ç êîåô³ö³ºíòîì 0,9, ùî ï³äòâåðäæóº îñòàííÿ ³ñòîòíà â êîæí³é êîíêðåòí³é ãðóï³ ðå- ë³í³éíó çàëåæí³ñòü ì³æ íèìè. çóëüòàò³â. ²ìîâ³ðí³ñòü âêëþ÷åííÿ ä³òåé ç òåð- Ó õîä³ ðîáîòè íàìè âèä³ëåíî ïðîãíîñòè÷í³ ì³íîì ãåñòàö³¿ 27–30 òèæí³â â ãðóïó ä³òåé, ÿê³ êðèòå𳿠³ìîâ³ðíîñò³ ðîçâèòêó ïîðóøåíü ìîòîð- çàñâî¿ëè õîäüáó áåç îáìåæåíü, ñêëàëà 0,224, íèõ ôóíêö³é ó îáñòåæåíèõ ä³òåé ç óðàõóâàí- à ³ìîâ³ðí³ñòü ïîïàäàííÿ â ãðóïó ä³òåé, ÿê³ íå íÿì ïîêàçíèê³â ¿õíüîãî íåâðîëîã³÷íîãî òà ìî- îñâî¿ëè ñàìîñò³éíó õîäüáó, ñêëàëà 0,232. òîðíîãî ñòàíó, ãåñòàö³éíîãî â³êó, ñòàò³, ñòóïå- Òàêèì ÷èíîì, ÿê ñâ³ä÷àòü îòðèìàí³ äàí³ ïî- íÿ ϲÂÊ, ÏÂË, ϲ. Ñèñòåìàòèçîâàíî ÷èí- ºäíàííÿ ϲÂÊ II ñòóïåíÿ ç ³øåì³÷íèì óðàæåí- íèêè, ùî ïðèçâîäÿòü äî êàòåãîð³é «õîäüáà áåç íÿì ìîçêó ëåãêîãî ñòóïåíÿ, ó á³ëüøîñò³ âèïàäê³â îáìåæåíü», «õîäüáà ç äîïîì³æíèìè ïðèñòðî- äຠá³ëüø ïîçèòèâíèé ïðîãíîç, à àñîö³àö³ÿ ç á³ëüø ÿìè», «õîäüáà íå çàñâîºíà». âèðàæåíèì ³øåì³÷íèì óðàæåííÿì, ôîðìóº âàæ- Ìåòîäîì ôàêòîðíîãî àíàë³çó áóëè âèä³ëåí³ êèé ðóõîâèé ïðîãíîç ó ä³òåé, ÿê³ íàðîäæåí³ ïå- íàéá³ëüø âàãîì³ ïîêàçíèêè ïîðóøåííÿ ðóõî- ðåä÷àñíî òà ïåðåíåñëè ïåðèíàòàëüíå ã³ïîêñè÷- âî¿ ôóíêö³¿ ó ä³òåé ð³çíîãî ãåñòàö³éíîãî â³êó. Ó íî-³øåì³÷íå óðàæåííÿ ãîëîâíîãî ìîçêó. õëîï÷èê³â ç ϲÂÊ I²²–IV ñòóïåíÿ òà ÏÂË I²– Âèñíîâêè III ñòóïåíÿ, íàðîäæåíèõ â òåðì³í³ ãåñòàö³¿ â³ä 1. Ïðîãíîñòè÷íî çíà÷óùèìè ôàêòîðàìè 27 äî 36 òèæíÿ ³ìîâ³ðí³ñòü çàñâîºííÿ õîäüáè ôîðìóâàííÿ ìîòîðíèõ ôóíêö³é ó íåäîíîøåíèõ áåç îáìåæåíü íåçíà÷íà ³ äîð³âíþº 0,275. Ó ä³òåé º: ñòàòü òà ñòóï³íü ïðîÿâó ïåðè³íòðàâåí- ôîðìóâàíí³ ïîçèòèâíîãî ïðîãíîçó íàéá³ëüø òðèêóëÿðíèõ êðîâîâèëèâ³â, ïåðèâåíòðèêóëÿð- âàãîìèìè º ϲ òà ÏÂË I–II ñòóïåíÿ, ϲÂÊ íî¿ ëåéêîìàëàö³³ òà ïåðè³íòðàâåíòðèêóëÿðíèõ I–II ñòóïåíÿ. êðîâîâèëèâ³â. Ó ä³â÷àòîê ³ìîâ³ðí³ñòü çàñâîºííÿ õîäüáè 2. Ïðîãíîñòè÷íî íåñïðèÿòëèâèìè ôàêòî- áåç îáìåæåíü ç òèìè æ ôàêòîðàìè ñêëàëà 0,393. ðàìè ôîðìóâàííÿ êîãíèòèâíîãî òà ìîâëåí- Ó ôîðìóâàíí³ ïîçèòèâíîãî ïðîãíîçó íàéá³ëüø íºâîãî äåô³öèòó ó íåäîíîøåíèõ ä³òåé º âíóò- âàãîìèìè º ϲ òà ÏÂË I–III ñòóïåíÿ, ϲÂÊ ð³øíüîøëóíî÷êîâ³ êðîâîâèëèâè ²²² ñòóïåíÿ òà III ñòóïåíÿ. ïåðèâåíòðèêóëÿðíà ëåéêîìàëàö³ÿ. Ñåðåä õâîðèõ, ÿê³ íå çàñâî¿ëè õîäüáó, ïåðå- 3. Ïðîãíîñòè÷íèìè ôàêòîðàìè âèíèêíåííÿ âàæàëè õëîï÷èêè ç ³ìîâ³ðí³ñòþ 0,35 (ä³â÷àòêà – ðóõîâèõ ïîðóøåíü ó íåäîíîøåíèõ ä³òåé º: ïåð³- 0,071). Ïðåäèêòîðàìè íåñïðèÿòëèâîãî ðîçâèò- ³íòðàâåíòðèêóëÿðí³ êðîâîâèëèâ³âè II–IV ñòó- êó ñòàëè íàñòóïí³ ôàêòîðè: ϲÂÊ II–IV ñòó- ïåíÿ, ïåðèâåíòðèêóëÿðíà ëåéêîìàëàö³ÿ III ñòó- ïåíÿ òà ÏÂË III ñòóïåíÿ. Ïðè öüîìó âñòàíîâ- ïåíÿ òà ÷îëîâ³÷à ñòàòü äèòèíè. ëåíî, ùî ñòàòü äèòèíè âïëèâຠíà ðóõîâèé ðå- Âðàõîâóþ÷è âèêëàäåí³ ðåçóëüòàòè, ïåðñ- çóëüòàò: çà ðåçóëüòàòàìè îáñòåæåíü â³äçíà- ïåêòèâîþ ïîäàëüøèõ äîñë³äæåíü º ðîçðîáêà ÷åíî ïåðåâàæàííÿ ä³â÷àòîê â ãðóï³ õâîðèõ, ÿê³ ñèñòåìè êîìïëåêñíî¿ ðåàá³ë³òàö³¿ ä³òåé, ÿê³ çàñâî¿ëè õîäüáó áåç îáìåæåíü ³ õîäüáó ç äî- íàðîäæåí³ ïåðåä÷àñíî òà ïåðåíåñëè ïåðèíà- ïîì³æíèìè ïðèñòðîÿìè, ç ³ìîâ³ðí³ñòþ òàêîãî òàëüíå ã³ïîêñè÷íî-³øåì³÷íå óðàæåííÿ ãîëîâ- ðåçóëüòàòó 0,929, äëÿ õëîï÷èê³â öåé ïîêàçíèê íîãî ìîçêó ç óðàõóâàííÿì ÷èííèê³â ðèçèêó ðåàë³çîâàíèé ç ³ìîâ³ðí³ñòþ 0,65. ðîçâèòêó ìîòîðíî¿ äèñôóíêö³¿. ˳òåðàòóðà 1. Ïàëü÷èê À. Á. Íåâðîëîãèÿ íåäîíîøåííûõ äåòåé / À. Á. Ïàëü÷èê, À. Å. Ôåäîðîâà, À. Å. Ïîíÿ- òèøèí. – [3-å èçä.]. – Ì. : ÌÅÄïðåññ-èíôîðì, 2012. – 352 ñ. 2. Ìàðòèíþê Â. Þ. Äèòÿ÷èé öåðåáðàëüíèé ïàðàë³÷ / Â. Þ. Ìàðòèíþê // Ñîö³àëüíà ïåä³àòð³ÿ òà ðåàá³ë³òîëîã³ÿ. – 2012. – ¹ 1 (2). – Ñ. 18–23. 3. Øóíüêî ª. ª. ijòè ç äóæå ìàëîþ ìàñîþ ò³ëà: ñó÷àñí³ ïðîáëåìè îðãàí³çàö³¿ ìåäè÷íî¿ äîïîìîãè, ³íòåíñèâíî¿ òåðàﳿ òà âèõîäæóâàííÿ / ª. ª. Øóíüêî, Î. Ñ. ßáëîíü // Ƴíî÷èé ë³êàð. – 2007. – ¹ 4. – Ñ. 13–17. 4. Prevalence of cerebral palsy in 8-year-old children in three areas of the United States in 2002: a multisite collaboration / M.Yeargin-Allsopp, K. Van Naarden Braun, N. S. Doernberg [et al.] // Pediatrics. – 2008. – ¹ 121 (3). – Ð. 547–554. 5. Pakula A. T. Cerebral palsy: classification and epidemiology / A. T. Pakula, K. Van Naarden Braun, M. Yeargin-Allsopp // Phys. Med. Rehabil. Clin. N. Am. – 2009. – ¹ 20 (3). – P. 425–452.

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6. Executive Committee for the Definition of Cerebral Palsy. Proposed definition and classification of cerebral palsy 2005 / M. Bax, M. Goldstein, P. Rosenbaum [et al.] // Dev Med Child Neurol. – 2005. – ¹ 47 (8). – Ð. 571–576. 7. Êà÷ìàð Î. Î. Ñèñòåìà êëàñèô³êàö³¿ âåëèêèõ ìîòîðíèõ ôóíêö³é ó ä³òåé ³ç öåðåáðàëüíèìè ïàðàë³÷àìè / Î. Î. Êà÷ìàð // ̳æíàðîäíèé íåâðîëîã³÷íèé æóðíàë. – 2008. – ¹ 1 (17). – Ñ. 90–93. 8. Content validity of the expanded and revised Gross Motor Function Classification System / R. Palisano, P. Rosenbaum, D. Bartlett [et al.] // Developmental Medicine & Child Neurology. – 2008. – Vîl. 50 (10). – P. 744–750. 9. Øåâ÷åíêî Ë. À. Ïåðèíàòàëüíûå ìîòîðíûå ñèíäðîìû è èõ òåðàïåâòè÷åñêàÿ êîððåêöèÿ : ìîíî- ãðàôèÿ [äëÿ âðà÷åé íåîíàòîëîãîâ, ïåäèàòðîâ, íåâðîëîãîâ, ñåìåéíûõ âðà÷åé, âðà÷åé-èíòåðíîâ, ñòó- äåíòîâ âûñø. ìåä. ó÷åá. çàâåäåíèé] / Ë. À. Øåâ÷åíêî, Â. È. Áîáðîâà. – Çàïîðîæüå, Êèåâ : Ïðîñâ³òà, 2017. – 158 ñ. 10. Ðîîç Ð. Íåîíàòîëîãèÿ. Ïðàêòè÷åñêèå ðåêîìåíäàöèè / Ð. Ðîîç ; [ïåð. ñ íåì. Ð. Ðîîç, Î. Ãåí- öåëü-Áîðîâè÷åíè, Ã. Ïðîêèòòå]. – Ì.: Ìåä. ëèò., 2011. – 592ñ. References 1. Palchik A.B., Fedorova A.Ye., Poniatishin A.Ye. (2012). Nevrolohiia nedonoshennykh detei [Neurology of premature babies]. (3d ed.). Ìoscow: MEDpress-inform, 352 p. [in Russian]. 2. Martyniuk V.Yu. (2012). Dytiachyi tserebralnyi paralich [Cerebral palsy]. Sotsialna pediatriia ta reabilitolohiia – Social Pediatrics and Rehabilitation, ¹ 1 (2), pp. 18–23 [in Ukrainian]. 3. Shunko Ye.Ye., Yablon O.S. (2007). Dity z duzhe maloiu masoiu tila: suchasni problemy orhanizatsii medychnoi dopomohy, intensyvnoi terapii ta vykhodzhuvannia [Children with very low body weight: modern problems of medical care, intensive care and nursing]. Zhinochyi likar – Female doctor, ¹ 4, pp. 13–17 [in Ukrainian]. 4. Yeargin-Allsopp M., Van Naarden Braun K., Doernberg N.S. et al. (2008). Prevalence of cerebral palsy in 8-year-old children in three areas of the United States in 2002: a multisite collaboration. Pediatrics, vol. 121 (3), pp. 547–554. 5. Pakula A.T., Van Naarden Braun K., Yeargin-Allsopp M. (2009). Cerebral palsy: classification and epidemiology. Phys. Med. Rehabil. Clin. N. Am., ¹ 20 (3), pp. 425–452. 6. Bax M., Goldstein M., Rosenbaum P. et al. (2005). Executive Committee for the Definition of Cerebral Palsy. Proposed definition and classification of cerebral palsy 2005. Dev Med Child Neurol, vol. 47 (8), pp. 571–576. 7. Kachmar O.O. (2008). Systema klasyfikatsii velykykh motornykh funktsii u ditei iz tserebralnymy paralichamy [System of classification of large motor functions in children with cerebral palsy]. Mizhnarodnyi nevrolohichnyi zhurnal – International Journal of Neurology, vol. 1 (17), pp. 90–93 [in Ukrainian]. 8. Palisano R., Rosenbaum P., Bartlett D. et al. (2008). Content validity of the expanded and revised Gross Motor Function Classification System. Developmental Medicine & Child Neurology, vol. 50 (10), pp. 744–750. 9. Shevchenko L.A., Bobrova V.Y. (2017). Perinatalnyie motornyie sindromy i ikh terapevticheskaia korrektsiia: monohrafiia dlia vrachei neonatolohov, pediatrov, nevrolohov, semeinykh vrachei, vrachei- internov, studentov vysshchikh meditsinskikh uchebnykh zavedenii [Perinatal motor syndromes and their therapeutic correction: a monograph for neonatologists, pediatricians, neurologists, family doctors, interns, students of higher medical schools]. Zaporozhie, Kiev: Prosvita, 158 p. [in Russian]. 10. Rooz R. (2011). Neonatologiya. Prakticheskiye rekomendatsii [Neonatology. Practical advice]. (R. Rooz, O. Hentsel-Borovycheny, H. Prokytte, Trans). M.: Med. lyt., 592 p. [in Russian].

Å.Â. Âàðåøíþê, Â.Â. Âüþí ÏÐÎÃÍÎÑÒÈ×ÅÑÊÈÅ ÊÐÈÒÅÐÈÈ ÐÀÇÂÈÒÈß ÍÀÐÓØÅÍÈÉ ÌÎÒÎÐÍÛÕ ÔÓÍÊÖÈÉ Ó ÍÅÄÎÍÎØÅÍÍÛÕ ÌËÀÄÅÍÖÅÂ Ñ ÏÅÐÈÍÀÒÀËÜÍÛÌ ÃÈÏÎÊÑÈ×ÅÑÊÈ-ÈØÅÌÈ×ÅÑÊÈÌ ÏÎÐÀÆÅÍÈÅÌ ÖÅÍÒÐÀËÜÍÎÉ ÍÅÐÂÍÎÉ ÑÈÑÒÅÌÛ Ïðîâåäåíî êîìïëåêñíîå îáñëåäîâàíèå 79 ìëàäåíöåâ îáîèõ ïîëîâ, ðîäèâøèõñÿ ïðåæäåâðåìåííî. Âñå äåòè ïåðåíåñëè ïåðèíàòàëüíîå ãèïîêñèêî-èøåìè÷åñêîå ïîðàæåíèå öåíòðàëüíîé íåðâíîé ñèñòåìû, ó 37,9 % èç íèõ äèàãíîñòèðîâàí ñïàñòè÷åñêèé öåðåáðàëüíûé ïàðàëè÷, ó 20,3 % – ñïàñòè÷åñêàÿ äèïëåãèÿ; 27,8 % – äåòñêàÿ ãåìèïëåãèÿ; 13,9 % – ïðèîáðåòåííàÿ ãèäðîöåôàëèÿ. Ïðîãíîñòè÷åñêèå êðèòåðèè âåðîÿòíîñòè ðàçâèòèÿ íàðóøåíèé äâèãàòåëüíûõ ôóíêöèé ó îáñëåäóåìûõ äåòåé ïîäáèðàëèñü

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÍÅÂÐÎËÎÃ²ß 71

ñ ó÷åòîì ïîêàçàòåëåé èõ íåâðîëîãè÷åñêîãî è äâèãàòåëüíîãî ñîñòîÿíèÿ, ãåñòàöèîííîãî âîçðàñòà, ïîëà, ñòåïåíè ïåðèèíòðàâåíòðèêóëÿðíîãî êðîâîèçëèÿíèÿ, ïåðèâåíòðèêóëÿðíîé ëåéêîìàëÿöèè, ïåðè- âåíòðèêóëÿðíîé èøåìèè. Ñèñòåìàòèçèðîâàíû ôàêòîðû, âåäóùèå ê êàòåãîðèÿì «õîäüáà áåç îãðàíè- ÷åíèé», «õîäüáà ñî âñïîìîãàòåëüíûìè óñòðîéñòâàìè», «õîäüáà íå îñâîåíà». Äîêàçàíî, ÷òî ñî÷åòàíèå ïåðèèíòðàâåíòðèêóëÿðíèõ êðîâîèçëèÿíèé ²² ñòåïåíè ñ èøåìè÷åñêèìè ïîðàæåíèÿìè ìîçãà ëåãêîé ñòåïåíè â áîëüøèíñòâå ñëó÷àåâ äàåò áîëåå ïîçèòèâíûé ïðîãíîç, à àññîöèàöèÿ ñ áîëåå âûðàæåííûìè èøåìè÷åñêèìè ïîðàæåíèÿìè îáðàçóåò òÿæåëûé äâèãàòåëüíûé ïðîãíîç ó äåòåé, êîòîðûå áûëè ðîæ- äåíû ïðåæäåâðåìåííî è ïåðåíåñëè ïåðèíàòàëüíîå ãèïîêñèêî-èøåìè÷åñêîå ïîðàæåíèå ìîçãà. Ïðî- ãíîñòè÷åñêèìè ôàêòîðàìè âîçíèêíîâåíèÿ äâèãàòåëüíûõ íàðóøåíèé ó íåäîíîøåííûõ äåòåé ÿâëÿåòñÿ ïåðèèíòðàâåíòðèêóëÿðíîå êðîâîèçëèÿíèå ²²–²V ñòåïåíè, ïåðèâåíòðèêóëÿðíàÿ ëåéêîìàëÿöèÿ III ñòå- ïåíè è ìóæñêîé ïîë ðåáåíêà. Êëþ÷åâûå ñëîâà: öåðåáðàëüíûé ïàðàëè÷, ñïàñòè÷åñêàÿ äèïëåãèÿ, ãåñòàöèîííûé âîçðàñò, èøå- ìè÷åñêîå ïîðàæåíèå ìîçãà, ïåðèâåíòðèêóëÿðíàÿ ëåéêîìàëÿöèÿ.

O.V. Vareshniuk, V.V. Vyun PROGNOSTIC CRITERIA FOR DEVELOPMENT OF IMPAIRED MOTOR FUNCTION IN PRETERM INFANTS WITH PERINATAL HYPOXIC-ISCHEMIC LESIONS OF THE CENTRAL NERVOUS SYSTEM In the course of work, in order to identify prognostic criteria for the development of impaired motor function in preterm infants with perinatal hypoxic-ischemic lesions of the central nervous system, a comprehensive examination of 79 infants of both gender born prematurely was performed. All children underwent perinatal hypoxic-ischemic lesions of the central nervous system, 37.9 % of them were diagnosed with spastic cerebral palsy, and 20.3 % had spastic diplegia; 27.8 % – childhood hemiplegia; 13.9 % – hydrocephalus acquired. All children were developed with delayed speech function, patients with infantile hemiplegia and 89.2 % with spastic diplegia at the age of 3 caught up with their peers. Patients with spastic cerebral palsy had speech and cognitive impairment. Prognostic criteria for the likelihood of development of motor function disorders in the examined children are selected taking into account the indicators of their neurological and motor status, gestational age, gender, degree of periintraventricular hemorrhage, periventricular leukomalacia, perivetricular ischemia. The factors leading to the categories «walking without restrictions», «walking with auxiliary devices», «walking not mastered» have been systematized. It has been proved that the combination of periintraventricular hemorrhages of the II degree with ischemic lesions of the brain of mild degree, in most cases gives a more positive prognosis, and the association with more pronounced ischemic lesions forms a heavy motor prognosis in children who were born prematurely and underwent perinatal hypoxic-ischemic brain damage. Predictably unfavorable factors for the formation of cognitive and speech deficits in premature infants are intraventricular hemorrhages of the III degree and periventricular leukomalacia. The prognostic factors for the occurrence of motor disorders in preterm infants are periintraventricular hemorrhage of the II–IV degree, periventricular leukomalacia of the II degree and male gender of the child. Keywords: cerebral palsy, spastic diplegia, gestational symptoms, cerebral ischemia, periventricular leukomalacia. Íàä³éøëà äî ðåäàêö³¿ 06.11.2019

Êîíòàêòíà ³íôîðìàö³ÿ Âàðåøíþê Îëåíà Âàñèë³âíà – äèòÿ÷èé ë³êàð-íåâðîëîã äèòÿ÷îãî íåéðîõ³ðóðã³÷íîãî â³ää³ëåííÿ «MÊËØÍÌÄ ³ì. ïðîô. Î.². Ìåùàí³íîâà» ÕÌÐ; çäîáóâà÷ êàôåäðè íåâðîëî㳿 òà äèòÿ÷î¿ íå- âðîëî㳿 ÕÌÀÏÎ. Àäðåñà:Óêðà¿íà, 61103, ì. Õàðê³â, ïðîâ. Áàëàê³ðºâà, 3à. Òåë.: +380505563099. E-mail: [email protected]. ORCID: https://orcid.org/0000-0001-9703-495X.

Â'þí Âàëåð³é Âàñèëüîâè÷ – äîêòîð ìåäè÷íèõ íàóê, ïðîôåñîð êàôåäðè ïñèõ³àòð³¿, íàðêîëî㳿 òà ìåäè÷íî¿ ïñèõîëî㳿, äèðåêòîð Íàâ÷àëüíî-íàóêîâîãî ³íñòèòóòó ï³ñëÿäèïëîìíî¿ îñâ³òè Õàðê³â- ñüêîãî íàö³îíàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó. Àäðåñà: Óêðà¿íà, 61022, ì. Õàðê³â, ïð. Íàóêè, 4. Òåë.: +380503007897. E-mail: vunvv2017@gmail. ORCID: https://orcid.org/0000-0001-8889-0228.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 72 ÍÅÂÐÎËÎòß

https://doi.org/10.35339/ekm.2019.85.04.11 ÓÄÊ 616.832-004.2:616.8-08

Ì.ª. ×åðíåíêî ÄÓ «²íñòèòóò íåâðîëî㳿, ïñèõ³àò𳿠òà íàðêîëî㳿 ÍÀÌÍ Óêðà¿íè», ì. Õàðê³â Õàðê³âñüêèé íàö³îíàëüíèé óí³âåðñèòåò ³ìåí³ Â.Í. Êàðàç³íà ÄÎ ÏÈÒÀÍÍß ÏÐÎ ÍÅÎÁÕ²ÄͲÑÒÜ ÐÎÇÐÎÁÊÈ ÊÎÌÏËÅÊÑÍÈÕ ÐÅÀÁ²Ë²ÒÀÖ²ÉÍÈÕ ÇÀÕÎÄ²Â Ó ÏÀÖ²ªÍÒ²Â Ç ÍÅÉÐÎÄÅÃÅÍÅÐÀÖ²ªÞ Ïîðóøåííÿ ñíó íåãàòèâíî ïîçíà÷àþòüñÿ íà ïðîöåñàõ íåéðîïëàñòè÷íîñò³ ãîëîâíîãî ìîçêó. Íåñïàííÿ ³ í³÷íèé ñîí – ò³ñíî âçàºìîïîâ'ÿçàí³ ôóíêö³îíàëüí³ ñòàíè, ÿê³ â ð³âí³é ì³ð³ îïîñåðåäêîâóþòü ³ çàáåçïå÷óþòü àäàïòàö³éíó àêòèâí³ñòü ³íäèâ³äà. Á³îëîã³÷í³ ðèòìè ëþ- äèíè çíàõîäÿòüñÿ â ³ºðàðõ³÷í³é çàëåæíîñò³ â³ä îñíîâíîãî âîä³ÿ ðèòìó, ðîçòàøîâàíîãî â ñóïðàõ³àçìàòè÷íèõ ÿäðàõ ã³ïîòàëàìóñà. Ðîëü ïîñåðåäíèêà, ùî äîíîñèòü ðåãóëþþ÷³ ñèã- íàëè äî îðãàí³â, âèêîíóº ãîðìîí ìåëàòîí³í, ÿêèé ñèíòåçóºòüñÿ êë³òèíàìè åï³ô³çà. Ðîç- ëàäè ñíó ñåðéîçíî ïîçíà÷àþòüñÿ íà ÿêîñò³ æèòòÿ ëþäèíè: íàðîñòàþòü åìîö³éíå íàïðó- æåííÿ, òðèâîãà, ðîçäðàòóâàííÿ ³, ÿê íàñë³äîê, çíèæóºòüñÿ ñò³éê³ñòü äî ñòðåñ³â, çìåí- øóºòüñÿ ïîòðåáà â ñï³ëêóâàíí³, ðîçâàãàõ. Ó ïåðåâàæí³é á³ëüøîñò³ âèïàäê³â ³íñîìí³ÿ º âòîðèííîþ, òîáòî âîíà ôîðìóºòüñÿ íà òë³ ðîçâèòêó çàõâîðþâàíü ³/àáî íåñïðèÿòëèâèõ îáñòàâèí. Äîñèòü ÷àñòî ïîðóøåííÿ ñíó çóñòð³÷àþòüñÿ ïðè äå쳺ë³í³çóþ÷èõ/íåéðîäåãå- íåðàòèâíèõ çàõâîðþâàííÿõ öåíòðàëüíî¿ íåðâîâî¿ ñèñòåìè. Îáñòåæåíî 30 ïàö³ºíò³â ³ç ä³àãíîçîì ðîçñ³ÿíèé ñêëåðîç, ÿêèõ áóëî ïîä³ëåíî íà äâ³ ãðóïè. Îñíîâíà ãðóïà îòðèìó- âàëà òåðàï³þ ìåëàòîí³í-âì³ñíèì ïðåïàðàòîì â êîìá³íàö³¿ ç êîãí³òèâíî-ïîâåä³íêîâîþ òå- ðàﳺþ. Ïàö³ºíòè êîíòðîëüíî¿ ãðóïè îòðèìóâàëè ëèøå òåðàï³þ ìåëàòîí³í-âì³ñíèì ïðå- ïàðàòîì. Ïîêàçàíî, ùî ð³âåíü êîðòèçîëó ó ïàö³ºíò³â îñíîâíî¿ ãðóïè çíèæóâàâñÿ ñèëüí³øå, í³æ ó ïàö³ºíò³â, ÿê³ íå îòðèìóâàëè ÊÏÒ. Ðåäóêö³ÿ êë³í³÷íèõ ïðîÿâ³â, ïîðÿä ç ïîë³ïøåí- íÿìè ëàáîðàòîðíèõ ïîêàçíèê³â åêñïðåñ³¿ äåííîãî ³ í³÷íîãî ìåëàòîí³íó, à òàêîæ åêñïðåñ³¿ êîðòèçîëó, ñïîñòåð³ãàëèñÿ âæå íà 14-é äåíü ë³êóâàííÿ, à íà 21-é äåíü äîñë³äæåííÿ ö³ ïîêàçíèêè ïîë³ïøóâàëèñÿ çíà÷íîþ ì³ðîþ. Êë³í³÷íà åôåêòèâí³ñòü â îñíîâí³é ãðóï³ äî- ñÿãíóòà ó 86,6 % âèïàäê³â, â êîíòðîëüí³é ãðóï³ – ó 60,0 % âèïàäê³â. Ïëàíóºòüñÿ âèêîðè- ñòàííÿ äàíîãî ìåòîäó ïðè ðîçðîáö³ êîìïëåêñíî¿ ðåàá³ë³òàö³éíî¿ ïðîãðàìè ó ïàö³ºíò³â ç íåéðîäåãåíåðàö³ºþ. Êëþ÷îâ³ ñëîâà: íåéðîäåãåíåðàö³ÿ, äå쳺ë³í³çàö³ÿ, ðîçñ³ÿíèé ñêëåðîç, íåéðîðåàá³ë³òàö³ÿ, êîãí³òèâíî-ïîâåä³íêîâà òåðàï³ÿ.

Àêòóàëüí³ñòü éîãî ôàçîþ. Òðàäèö³éíî ââàæàºòüñÿ, ùî îñ- Ñîí – öå ïîë³ôóíêö³îíàëüíèé, ñàìîðåãó- íîâíà ôóíêö³ÿ ôàçè ïîâ³ëüíîãî ñíó – â³äíîâ- ëþþ÷èé ³ áàãàòîåòàïíèé ïðîöåñ îñîáëèâèõ ëåííÿ. Òàê, â ãëèáîêîìó ïîâ³ëüíîìó (äåëüòà) ôóíêö³îíàëüíèõ ñòàí³â ìîçêó. ³í âêëþ÷ຠäî ñí³ âèÿâëÿºòüñÿ ìàêñèìàëüíèé ð³âåíü ñåêðåö³¿ ñåáå ïåðøó, äðóãó, òðåòþ ³ ÷åòâåðòó ñòà䳿 ñîìàòîòðîïíîãî ãîðìîíó, â³äáóâàºòüñÿ ïîïîâ- ôàçè ïîâ³ëüíîãî ñíó ³ ôàçó øâèäêîãî, àáî ïà- íåííÿ ê³ëüêîñò³ êë³òèííèõ á³ëê³â ³ ðèáîíóêëå¿- ðàäîêñàëüíîãî, ñíó. Êîæíà ç ïåðåðàõîâàíèõ íîâèõ êèñëîò, âèíèêíåííÿ ìàêðîåðã³÷íèõ ôîñ- ôàç ³ ñòàä³é ìຠñâî¿ ñïåöèô³÷í³ íåéðîô³ç³î- ôàòíèõ çâ'ÿçê³â, â³äíîâëþºòüñÿ çàãàëüíèé ³ ëîã³÷í³ òà âåãåòàòèâí³ õàðàêòåðèñòèêè. Ç âèä³- åëåêòðîë³òíèé ãîìåîñòàç ìîçêîâî¿ òêàíèíè. Äî ëåííÿì äâîõ ôàç ñíó ç'ÿâèëèñÿ ïðèïóùåííÿ ïðî îñíîâíèõ ôóíêö³é ôàçè øâèäêîãî ñíó â³äíîñÿòü çâ'ÿçîê â³äïîâ³äíî¿ ôóíêö³¿ ñíó ç ò³ºþ ÷è ³íøîþ ïåðåðîáêó ³íôîðìàö³¿, îòðèìàíî¿ â ïîïåðåä-

© Ì.ª. ×åðíåíêî, 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÍÅÂÐÎËÎÃ²ß 73

íüîìó ñòàí³, ³ ñòâîðåííÿ ïðîãðàìè ïîâåä³íêè çíèæóºòüñÿ ñò³éê³ñòü äî ñòðåñ³â, çìåíøóºòüñÿ íà ìàéáóòíº. ϳä ÷àñ øâèäêîãî ñíó êë³òèíè ïîòðåáà â ñï³ëêóâàíí³, ðîçâàãàõ. Ó ïåðåâàæí³é ìîçêó íàäçâè÷àéíî àêòèâí³, ïðîòå ³íôîðìàö³ÿ á³ëüøîñò³ âèïàäê³â ³íñîìí³ÿ º âòîðèííîþ, òîá- â³ä «âõîä³â» (îðãàí³â ïî÷óòò³â) äî íèõ íå íàä- òî âîíà ôîðìóºòüñÿ íà òë³ ðîçâèòêó çàõâîðþ- õîäèòü ³ íà «âèõîäè» (ì'ÿçîâó ñèñòåìó) íå ïî- âàíü ³/àáî íåñïðèÿòëèâèõ îáñòàâèí. äàºòüñÿ. Ó öüîìó ïîëÿãຠïàðàäîêñàëüíèé ijàãíîç «ðîçñ³ÿíèé ñêëåðîç» (ÐÑ), áåçó- õàðàêòåð öüîãî ñòàíó, â³äáèòèé â îäíîìó ç éîãî ìîâíî, º ñòðåñîâèì ÿâèùåì äëÿ ïàö³ºíòà. Øè- íàçâ [1, 2]. ðîêà ãàìà íåâðîëîã³÷íèõ, ñîìàòè÷íèõ ³ ïñèõ³- Ó ì³ðó ïîãëèáëåííÿ åëåêòðîåíöåôàëîãðà- ÷íèõ ïîðóøåíü ïðè öüîìó çàõâîðþâàíí³, à òà- ô³÷íî¿ êàðòèíè ïîâ³ëüíîãî ñíó ïåðâèíí³ íåéðî- êîæ øâèäêå íàðîñòàííÿ ³íâàë³äèçàö³¿ ïîðÿä íè çîðîâî¿ òà ñëóõîâî¿ êîðè, ïåðåñòàþ÷è ðåà- ç â³êîâèìè îñîáëèâîñòÿìè äåáþòó (ìîëîäèé ãóâàòè íà ìîäàëüíî-ñïåöèô³÷í³ ñòèìóëè, ïî- ïðàöåçäàòíèé ðåïðîäóêòèâíèé â³ê) ïîã³ðøóº ÷èíàþòü á³ëüøîþ ì³ðîþ â³äïîâ³äàòè íà ³íòðà- àäàïòàö³þ äî ñâîãî ä³àãíîçó. Äîñë³äíèêè â³ä- öåïòèâíó ³ìïóëüñàö³þ, ùî ïðèõîäèòü â êîðó çíà÷àþòü äîñèòü ÷àñòó çóñòð³÷àëüí³ñòü ïîðó- ç áîêó âíóòð³øí³õ îðãàí³â. Íà ìåìáðàí³ áàãà- øåíü ñíó ïðè äå쳺ë³í³çóþ÷èõ çàõâîðþâàííÿõ òüîõ ê³ðêîâèõ íåéðîí³â âèÿâëÿþòüñÿ îñîáëèâ³ öåíòðàëüíî¿ íåðâîâî¿ ñèñòåìè [8, 9]. Ç îãëÿäó êàëüö³ºâ³ êàíàëè, ùî â³äêðèâàþòüñÿ â óìîâàõ íà íàÿâí³ñòü íåéðîäåãåíåðàòèâíîãî óðàæåííÿ ã³ïåð-, à íå äåïîëÿðèçàö³¿, ùî ñâ³ä÷èòü ïðî òå, íåðâîâî¿ ñèñòåìè ïðè ÐÑ, ïîðóøåííÿ ñíó ïî- ùî â ñòàí³ ïîâ³ëüíîãî ñíó ïåðåðîáêà ³íôîð- ã³ðøóþòü ³ áåç òîãî ñêîìïðîìåòîâàí³ ïðîöåñè ìàö³¿ ìîçêîì íå ïðèïèíÿºòüñÿ [3, 4]. íåéðîïëàñòè÷íîñò³ ãîëîâíîãî ìîçêó. Íà æàëü, Íåñïàííÿ ³ í³÷íèé ñîí – ò³ñíî âçàºìîïîâ'ÿ- äîâîäèòüñÿ êîíñòàòóâàòè, ùî çàðàç ³íñîìí³÷- çàí³ ôóíêö³îíàëüí³ ñòàíè, ÿê³ â ð³âí³é ì³ð³ îïî- íèì ïîðóøåííÿì ïðè ðîçñ³ÿíîìó ñêëåðîç³ íå ñåðåäêîâóþòü ³ çàáåçïå÷óþòü àäàïòàö³éíó àê- ïðèä³ëÿºòüñÿ íàëåæíî¿ óâàãè. òèâí³ñòü ³íäèâ³äà. Á³îëîã³÷í³ ðèòìè ëþäèíè Ìåòà äîñë³äæåííÿ – ðîçðîáèòè êîìïëåêñ çíàõîäÿòüñÿ â ³ºðàðõ³÷í³é çàëåæíîñò³ â³ä îñ- åôåêòèâíèõ êîðåêö³éíî-ðåàá³ë³òàö³éíèõ çàõîä³â íîâíîãî âîä³ÿ ðèòìó, ðîçòàøîâàíîãî â ñóïðà- äëÿ õâîðèõ ç äå쳺ë³í³çóþ÷îþ ïàòîëî㳺þ òà õ³àçìàòè÷íèõ ÿäðàõ ã³ïîòàëàìóñà. Ðîëü ïîñå- ïîðóøåííÿìè ñíó äëÿ çàïîá³ãàííÿ ïîäàëüøîãî ðåäíèêà, ùî äîíîñèòü ðåãóëþþ÷³ ñèãíàëè äî íàðîñòàííÿ ïîðóøåííÿ íåéðîïëàñòè÷íîñò³. îðãàí³â, âèêîíóº ãîðìîí ìåëàòîí³í, ÿêèé ñèí- Ìàòåð³àë ³ ìåòîäè òåçóºòüñÿ êë³òèíàìè åï³ô³çà. Îäí³ºþ ç íàéâàæ- Ó äîñë³äæåíí³ áðàëè ó÷àñòü 30 ïàö³ºíò³â, ëèâ³øèõ ôóíêö³é ìåëàòîí³íó º éîãî ó÷àñòü ÿê³ ïåðåáóâàëè íà ë³êóâàíí³ â ÃÓ ²ÍÏÍ ÍÀÌÍ â ðåãóëÿö³¿ öèêëó «ñîí – íåñïàííÿ». Êîíöåíò- Óêðà¿íè (ì.Õàðê³â). ðàö³ÿ öüîãî ãîðìîíó â êðîâ³, ì³í³ìàëüíà ó ñâ³ò- Êðèòå𳿠âêëþ÷åííÿ: ëèé ÷àñ äîáè, ïî÷èíຠïîñòóïîâî çðîñòàòè çà – âñòàíîâëåíèé ä³àãíîç ðîçñ³ÿíîãî ñêëå- ê³ëüêà ãîäèí äî çâè÷íîãî ÷àñó â³äõîäó äî ñíó, ðîçó; äîñÿãàþ÷è ìàêñèìóìó ï³ñëÿ âèìèêàííÿ ñâ³òëà – â³äñóòí³ñòü çàãîñòðåííÿ äå쳺ë³í³çóþ÷îãî â ñïàëüí³. Ó ðàíí³ ðàíêîâ³ ãîäèíè ïðîäóêö³ÿ ïðîöåñó; ìåëàòîí³íó ïîñòóïîâî çíèæóºòüñÿ ³ ïðàêòè÷íî – êë³í³÷í³ ïðîÿâè ³íñîìí³¿; ïðèïèíÿºòüñÿ ï³ñëÿ ïðîáóäæåííÿ [5, 6]. – â³äñóòí³ñòü ïñèõîòè÷íî¿ ñèìïòîìàòèêè Òàêèì ÷èíîì, ìîæíà ñòâåðäæóâàòè, ùî (â ò. ÷. â àíàìíåç³). ïîðóøåííÿ ñíó íåãàòèâíî ïîçíà÷àþòüñÿ íà Êðèòåð³ÿìè âèêëþ÷åííÿ áóëè: ïðîöåñàõ íåéðîïëàñòè÷íîñò³ ãîëîâíîãî ìîçêó. – ïðèéîì ïàö³ºíòàìè ïðåïàðàò³â, ÿê³ âïëè- Ïðàêòè÷íî âñ³ äîñë³äíèêè ñõîäÿòüñÿ íà âàþòü íà ñîí; äóìö³, ùî íîðìàëüíèé ô³ç³îëîã³÷íèé ñîí âèêî- – çëîâæèâàííÿ ë³êàðñüêèìè òà ïñèõîàêòèâ- íóº íàéâàæëèâ³øó àíòèñòðåñîâó ôóíêö³þ, âè- íèìè ðå÷îâèíàìè â àíàìíåç³; çíà÷àþ÷è ïîâíîö³ííå ôóíêö³îíóâàííÿ îðãàí³ç- – ïåð³îä âàã³òíîñò³ òà ëàêòàö³¿; ìó â ïåð³îä íåñïàííÿ. Ïðè öüîìó ñòðåñ ðîç- – äåêîìïåíñàö³ÿ õðîí³÷íèõ çàõâîðþâàíü. ãëÿäàºòüñÿ ÿê íàéá³ëüø ÷àñòà ïðè÷èíà ïîðó- Ïàö³ºíòè áóëè ïîä³ëåí³ íà 2 ãðóïè ïî 15 îñ³á, øåííÿ ñíó. Áóëî ïîêàçàíî, ùî â óìîâàõ ñòðå- ãîìîãåíí³ çà ñòàòòþ, â³êîì, êë³í³÷íèìè ïðî- ñó ïîäîâæóºòüñÿ ÷àñ çàñèïàííÿ, çðîñòຠê³ëü- ÿâàìè ïîðóøåííÿ ñíó. Âñ³ ïàö³ºíòè îòðèìóâà- ê³ñòü ïðîáóäæåíü, çíèæóþòüñÿ ïðåäñòàâ- ëè òåðàï³þ ìåëàòîí³í-âì³ñíèì ïðåïàðàòîì ëåí³ñòü äåëüòà-ñíó òà åôåêòèâí³ñòü ñíó [7]. (äàë³ – ìåëàòîí³í) ó äîçóâàíí³ 3 ìã íà äîáó Ðîçëàäè ñíó ñåðéîçíî ïîçíà÷àþòüñÿ íà ÿêîñò³ ââå÷åð³ çà 0,5 ãîäèíè ïåðåä ñíîì â îäèí ³ òîé æå æèòòÿ ëþäèíè: íàðîñòàþòü åìîö³éíå íàïðó- ÷àñ. Ïåðøà ãðóïà (îñíîâíà ãðóïà, ÎÃ), íà æåííÿ, òðèâîãà, ðîçäðàòóâàííÿ ³, ÿê íàñë³äîê, â³äì³íó â³ä äðóãî¿ (êîíòðîëüíà ãðóïà, ÊÃ), îò-

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 74 ÍÅÂÐÎËÎòß

ðèìóâàëà òàêîæ ïñèõîêîðåêö³éíèé âïëèâ ó âè- ïàííÿ çàçíà÷àâñÿ ó 28 ïàö³ºíò³â, íåäîñòàòíÿ ê³ëü- ãëÿä³ êîãí³òèâíî-ïîâåä³íêîâî¿ òåðàﳿ (ÊÏÒ). ê³ñòü ÷àñó ñíó – ó 22, íàÿâí³ñòü í³÷íèõ ïðîáó- Òðèâàë³ñòü êîðåêö³éíîãî êóðñó ñòàíîâèëà äæåíü – ó 20, íàÿâí³ñòü ðàíêîâî¿ âòîìè – ó 30 ïà- 3 òèæí³. ö³ºíò³â. Òàêîæ âñ³ ïàö³ºíòè ñóá'ºêòèâíî â³äçíà- Ó êîãí³òèâíî-ïîâåä³íêîâó òåðàï³þ âõîäèëè ÷àëè ïîâ'ÿçàí³ ç ³íñîìí³ºþ åìîö³éí³ ïîðóøåí- êîìïîíåíòè, ñïðÿìîâàí³ íà ïîâåä³íêîâ³ ôàêòîðè íÿ, ëàá³ëüí³ñòü åìîö³é, çíèæåíèé ôîí íàñòðîþ. ï³äòðèìêè ³íñîìí³¿ (äåçàäàïòèâí³ çâè÷êè, íåðå- Ó ÊÃ, ùî îäåðæóâàëà òåðàï³þ ìåëàòîí³- ãóëÿðíèé ðåæèì ñíó, ïîãàíà ã³ã³ºíà ñíó ³ ò. ä.) ³ íîì, íà 14-é äåíü ë³êóâàííÿ ó 53,3 % ïàö³ºíò³â êîãí³òèâí³ ôàêòîðè ï³äòðèìêè ³íñîìí³¿ (íåðåàë³- â³äçíà÷àëàñÿ ïîâíà êë³í³÷íà ðåì³ñ³ÿ, ó 26,6 % – ñòè÷í³ î÷³êóâàííÿ, çàíåïîêîºííÿ, äåçàäàïòèâí³ çáåð³ãàëèñÿ ïåð³îäè÷í³ í³÷í³ ïðîáóäæåííÿ, 20,0 % ïåðåêîíàííÿ), à òàêîæ ðåëàêñàö³éí³ òåõí³êè. Ðå- õâîðèõ ñóá'ºêòèâíî îö³íþâàëè ê³ëüê³ñòü ÷àñó êîìåíäàö³¿ ùîäî ïîâåä³íêîâîãî êîìïîíåíòà í³÷íîãî ñíó ÿê íåäîñòàòíº. Ó 21-é äåíü ë³êó- òåðàﳿ áóëè íàñòóïíèìè: ëÿãàòè â ë³æêî ò³ëüêè âàííÿ ó 60,0 % ïàö³ºíò³â ö³º¿ ãðóïè â³äçíà÷àëà- ïðè íàñòàíí³ ñîíëèâîñò³, íå ïåðåáóâàòè â ë³æêó, ñÿ êë³í³÷íà ðåì³ñ³ÿ ç ðåäóêö³ºþ âñ³õ ñóá'ºêòèâ- ÿêùî ñîí íå íàñòóïàº; âèêîðèñòîâóâàòè ë³æêî íèõ ñêàðã ³ îá'ºêòèâíèõ îçíàê ³íñîìí³¿. ò³ëüêè äëÿ ñíó (óíèêàòè ÷èòàííÿ, òåëåáà÷åííÿ, гâåíü äåííîãî ìåëàòîí³íó ó ïàö³ºíò³â çðî- ðîçäóì³â òà ³í.), âñòàâàòè â îäèí ³ òîé æå ÷àñ ñòàâ óïðîäîâæ óñüîãî äîñë³äæåííÿ, òàêîæ ïðå- ùîðàíêó, óíèêàòè äåííîãî ñíó. Êîãí³òèâíèé êîì- ïàðàò íàäàâàâ ïîçèòèâíèé âïëèâ íà ï³äâèùåííÿ ïîíåíò ÊÏÒ áóâ ñïðÿìîâàíèé íà ïîëåãøåííÿ ð³âíÿ í³÷íî¿ åêñïðåñ³¿ ìåëàòîí³íó. Ðåçóëüòàòè çàíåïîêîºííÿ ³ ïîçáàâëåííÿ â³ä äåçàäàïòèâíèõ ëàáîðàòîðíîãî äîñë³äæåííÿ åêñïðåñ³¿ ìåëàòî- óÿâëåíü ïðî ñîí, ³íñîìí³þ òà ¿¿ íàñë³äêè. Êëþ- í³íó ó ïàö³ºíò³â, ÿê³ çàñòîñîâóâàëè ìîíîòåðà- ÷îâèìè ìîìåíòàìè äëÿ ðîáîòè áóëè íåðåàë³- ï³þ ìåëàòîí³íîì, ïðåäñòàâëåí³ â òàáëèö³. ñòè÷í³ î÷³êóâàííÿ, ñòðàõ íàñë³äê³â ³íñîìí³¿, õèáí³ Òàêîæ ó îáñòåæåíèõ ïàö³ºíò³â áóëî âèÿâ- óÿâëåííÿ ïðî ïðè÷èíè ïîðóøåíü ñíó. Ðåëàê- ëåíî çíèæåííÿ ð³âíÿ êîðòèçîëó (òàáëèöÿ). ñàö³éí³ ìåòîäèêè áóëè ñïðÿìîâàí³ íà çìåíøåí- Ïàö³ºíòè Îà êð³ì ìåëàòîí³íó îòðèìóâàëè íÿ ò³ëåñíî¿ íàïðóãè (ïðîãðåñèâíå ì'ÿçîâå ðîç- òàêîæ ïñèõîêîðåêö³þ êîãí³òèâíî-ïîâåä³íêîâîãî ñëàáëåííÿ, àóòîãåííå òðåíóâàííÿ, äèõàëüí³ òåõ- íàïðÿìêó. Ìåòîäèêà çä³éñíþâàëàñÿ 2 ðàçè íà í³êè òà ³í.), à òàêîæ íà ïîçáàâëåííÿ â³ä íàâ'ÿç- òèæäåíü ïðîòÿãîì óñüîãî ïåð³îäó äîñë³äæåííÿ ëèâèõ äóìîê, ÿê³ çàâàæàþòü íàñòàííþ ñíó. (3 òèæí³), âñüîãî áóëî ïðîâåäåíî 6 ñåàíñ³â. Äëÿ îáñòåæåííÿ ïàö³ºíò³â áóëè âèêîðèñòàí³ Ñåàíñè ïðîõîäèëè çà ñòàíäàðòíîþ ñõåìîþ êë³í³÷í³ òà ëàáîðàòîðí³ ìåòîäè: ïðîòÿãîì 50 õâèëèí ³ ì³ñòèëè â ñîá³ ðîáîòó – êë³í³÷íå îáñòåæåííÿ (îö³íþâàííÿ åìî- ç êîãí³ö³ÿìè, ïñ³õîåäóêàö³þ, ïîâåä³íêîâó àêòè- ö³éíî¿ ñôåðè, âèêëþ÷åííÿ ðîçëàä³â ïñèõîòè÷- âàö³þ ³ íàâ÷àííÿ ðåëàêñàö³éíèì ìåòîäèêàì. íîãî ðåã³ñòðó, çá³ð àíàìíåñòè÷íèõ äàíèõ, ðåº- Îñîáëèâà óâàãà ïðèä³ëÿëàñÿ òåõí³êàì äèõàí- ñòðàö³ÿ ñóá'ºêòèâíèõ ñêàðã); íÿ â ðàìêàõ ìàéíäôóëíåññ, ÿê³ ïàö³ºíòè ïî- – äîñë³äæåííÿ åêñïðåñ³¿ ìåëàòîí³íó âíî÷³ âèíí³ áóëè âèêîíóâàòè ùîäíÿ ïåðåä ñíîì. òà âäåíü, Ó ïàö³ºíò³â Îà íà 14-é äåíü ë³êóâàííÿ â³ä- – äîñë³äæåííÿ åêñïðåñ³¿ êîðòèçîëó. çíà÷àëàñÿ ïîçèòèâíà äèíàì³êà öèðêàäíîãî Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ. ðèòìó ñîí-íåñïàííÿ, çìåíøèëàñÿ ê³ëüê³ñòü ÷àñó Óñ³ õâîð³ ïðåä'ÿâëÿëè ñêàðãè íà ò³ ÷è ³íø³ çàñèíàííÿ, çíèçèëàñÿ ê³ëüê³ñòü í³÷íèõ ïðîáóä- ïîðóøåííÿ ñíó â ðàìêàõ ïîðóøåííÿ öèðêàä- æåíü, â³äçíà÷àëàñÿ ðåäóêö³ÿ ñèìïòîìàòèêè íîãî ðèòìó ñîí-íåñïàííÿ. Òðèâàëèé ÷àñ çàñè- ðàíêîâî¿ âòîìè, ï³äâèùåííÿ çàãàëüíîãî ôîíó Ïîêàçíèêè åêñïðåñ³¿ äåííîãî é í³÷íîãî ìåëàòîí³íó òà êîðòèçîëó â îáñòåæåíèõ ïàö³ºíò³â (n=15), ïã/ìë (m±M)

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÍÅÂÐÎËÎÃ²ß 75

íàñòðîþ ³ âèð³âíþâàííÿ åìîö³éíîãî ôîíó. Ó Ïðè çàñòîñóâàíí³ çàïðîïîíîâàíîãî ìåòîäó 60,0 % õâîðèõ â³äçíà÷àëàñÿ ïîâíà êë³í³÷íà êîðåêö³¿ ³íñîìí³¿ ó õâîðèõ ç ÐÑ ðåäóêö³ÿ êë³- ðåì³ñ³ÿ, ó 20,0 % çáåð³ãàëèñÿ ïåð³îäè÷í³ í³÷í³ í³÷íèõ ïðîÿâ³â, ïîðÿä ç ïîë³ïøåííÿìè ëàáîðà- ïðîáóäæåííÿ, 20,0 % ââàæàëè òðèâàë³ñòü ñâî- òîðíèõ ïîêàçíèê³â åêñïðåñ³¿ äåííîãî ³ í³÷íîãî ãî í³÷íîãî ñíó íåäîñòàòí³ì. Äî 21-ãî äíÿ ë³êó- ìåëàòîí³íó, à òàêîæ åêñïðåñ³¿ êîðòèçîëó, ñïî- âàííÿ ó 86,6 % ïàö³ºíò³â â³äçíà÷àëàñÿ êë³í³÷íà ñòåð³ãàëèñÿ âæå íà 14-é äåíü ë³êóâàííÿ, à íà ðåì³ñ³ÿ ç ðåäóêö³ºþ âñ³õ ñóá'ºêòèâíèõ ñêàðã ³ 21-é äåíü äîñë³äæåííÿ ö³ ïîêàçíèêè ïîë³ïøó- îá'ºêòèâíèõ îçíàê ³íñîìí³¿, îäíàê ó 13,4% ïà- âàëèñÿ çíà÷íîþ ì³ðîþ. Êë³í³÷íà åôåêòèâí³ñòü ö³ºíò³â çáåð³ãàëèñÿ ò³ ÷è ³íø³ ïîðóøåííÿ ñíó. â Îà äîñÿãíóòà â 86,6 % âèïàäê³â, â Êà – 60,0 % Ðåçóëüòàòè ëàáîðàòîðíîãî äîñë³äæåííÿ åêñ- âèïàäê³â. ïðåñ³¿ ìåëàòîí³íó ³ êîðòèçîëó ó ïàö³ºíò³â ÎÃ, Âèñíîâêè ÿê³ îòðèìóâàëè òåðàï³þ ìåëàòîí³íîì ³ ÊÏÒ, Ìåòîä êîðåêö³¿ ³íñîìí³¿ ó ïàö³ºíò³â ç ÐÑ â ïðåäñòàâëåí³ â òàáëèö³. ñòà䳿 êîìïåíñàö³¿, ùî ì³ñòèâ â ñîá³ êîìá³íà- Òàêèì ÷èíîì, ð³âåíü êîðòèçîëó ó ïàö³ºíò³â ö³þ ìåäèêàìåíòîçíèõ (ìåëàòîí³í-âì³ñí³ ïðå- ç ÐÑ, ÿê³ ñòðàæäàëè íà ³íñîìí³þ ³ îòðèìóâàëè ïàðàòè) ³ íåìåäèêàìåíòîçíèõ ìåòîä³â (ÊÏÒ), òåðàï³þ ìåëàòîí³íîì â êîìá³íàö³¿ ç ÊÏÒ, çíèæó- ïîêàçàâ äîñòàòíþ åôåêòèâí³ñòü ³ ãàðíó ïåðå- âàâñÿ ñèëüí³øå, í³æ ó ïàö³ºíò³â, ÿê³ íå îòðè- íîñèì³ñòü. Òàêèì ÷èíîì, ïëàíóºòüñÿ âèêîðè- ìóâàëè ÊÏÒ [(222±30,1) ïã/ìë ³ (377± 26,6) ïã/ìë ñòàííÿ äàíîãî ìåòîäó ïðè ðîçðîáö³ êîìïëåê- â³äïîâ³äíî ïðè ïðàêòè÷íî ïîä³áíèõ âèõ³äíèõ ñíî¿ ðåàá³ë³òàö³éíî¿ ïðîãðàìè ó ïàö³ºíò³â ç íåé- äàíèõ – (649±21,3) ³ (640±27,6) ïã/ìë â³äïîâ³äíî]. ðîäåãåíåðàö³ºþ.

˳òåðàòóðà 1. Ïóäèêîâ È. Â. Ðàññòðîéñòâà ñóòî÷íîãî ðèòìà ñíà – áîäðñòâîâàíèÿ / È. Â. Ïóäèêîâ // Ýôôåê- òèâíàÿ ôàðìàêîòåðàïèÿ. Íåâðîëîãèÿ. Ñïåöâûïóñê «Ñîí è åãî ðàññòðîéñòâà». – 2017. – ¹ 35. – Ñ. 58–66. 2. Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review / R. L. Sack, D. Auckley, R. R. Auger [et al.] // Sleep. – 2007. – Vol. 30, Issue 11. – Ð. 1484–1501. – DOI:10.1093/sleep/30.11.1484. 3. Ñîí òà éîãî ïîðóøåííÿ – ïðîáëåìà íåéðîïñèõ³àòðè÷íà?/ Â. È. Ïîíîìàðåâ, Â. È. Âîâê, Ì. Å. ×åð- íåíêî [è äð.] // Âðà÷åáíîå äåëî. – 2017. – ¹ 1. – 38–43. 4. A randomized controlled trial with bright light and melatonin for delayed sleep phase disorder: effects on subjective and objective sleep / I. W. Saxvig, A. Wilhelmsen-Langeland, S. Pallesen et al. – Chronobiol. Int. – 2014. – Vol. 31, Issue 1. – P. 172–186. – DOI:10.3109/07420528.2013.823200. 5. Ñåäàôèòîí Ôîðòå â ëå÷åíèè íàðóøåíèé öèðêàäíûõ ðèòìîâ / Í. Ï. Âîëîøèíà, Â. Â. Âàñèëîâ- ñêèé, Ì. Å. ×åðíåíêî [è äð.] // Ïðàêòèêóþ÷èé ë³êàð. – 2016. – ¹ 3 (5). Ñ. 45–48. 6. Ferracioli-Oda E. Meta-analysis: melatonin for the treatment of primary sleep disorders / E. Ferracioli-Oda, A. Qawasmi, M. H. Bloch // PloS One. – 2013. – ¹ 8 (5). – e63773. – DOI: 10.1371/ journal.pone.0063773. 7. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline / V. K. Kapur, D. H. Auckley, S. Chowdhuri [et al.] // J. Clin. Sleep Med. – 2017. – ¹ 13 (3). – P. 479–504. – DOI: 10.5664/jcsm.6506. 8. Êà÷åñòâî íî÷íîãî ñíà ó ïàöèåíòîâ ñ ðàññåÿííûì ñêëåðîçîì / Å. Þ. Çàõàðîâ, Å. Þ. Àôðîñèíà, Å. Â. Õèâèíöåâà [è äð.] // Æóðíàë íåâðîëîãèè è ïñèõèàòðèè. – 2016. – ¹ 116 (2). – Ð. 41–43. – DOI: 10.17116/jnevro20161162241-43. 9. Sleep disorders in patients with multiple sclerosis / S. D. Brass, P. Duquette, J. Proulx-Therrien [et al.] // Sleep Med Rev. – 2010. – Vol. 14 (2). – P. 121–129. – DOI:10.1016/j.smrv.2009.07.005. References 1. Pudikov I.V. (2017). Rasstroystva sutochnogo ritma sna – bodrstvovaniya [Disorders of the circadian rhythm of sleep – wakefulness]. Effektivnaya farmakoterapiya. Nevrologiya. Spetsvypusk «Son i yego rasstroystva» – Effective pharmacotherapy. Neurology. Special issue «Sleep and its disorders», vol. 35, pp. 58–66 [in Russian]. 2. Sack R.L., Auckley D., Auger R.R. et al. (2007). Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm.

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An American Academy of Sleep Medicine review. Sleep, vol. 30 (11), ðð. 1484–1501, DOI:10.1093/ sleep/30.11.1484. 3. Ponomarev V.I., Vovk V.I., Chernenko M.E., Ponomareva V.V. (2017). Son ta yoho porushennya – problema neyropsykhiatrychna? [Is sleep and its disorders a neuropsychiatric problem?]. Vrachebnoe delo – Medical business, vol. 1, pp. 38–43 [in Ukrainian]. 4. Saxvig I.W., Wilhelmsen-Langeland A., Pallesen S. et al. (2014). A randomized controlled trial with bright light and melatonin for delayed sleep phase disorder: effects on subjective and objective sleep. Chronobiol. Int., vol. 31, issue 1, pp. 172–186, DOI:10.3109/07420528.2013.823200. 5. Voloshina N.P., Vasilovsky V.V., Chernenko M.E., Vovk V.I. (2016). Sedafyton Forte v lechenyy narushenyy tsyrkadnykh rytmov [Sedafiton Forte in the treatment of circadian rhythm disorders]. Praktykuyuchyy likar – Practitioner, vol. 3 (5), pp. 45–48 [in Russian]. 6. Ferracioli-Oda E., Qawasmi A., Bloch M.H. (2013). Meta-analysis: melatonin for the treatment of primary sleep disorders. PloS One, ¹ 8 (5), e63773, DOI: 10.1371/journal.pone.0063773. 7. Kapur V.K., Auckley D.H., Chowdhuri S. et al. (2017). Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J. Clin. Sleep Med., ¹ 13 (3), pp. 479–504, DOI: 10.5664/jcsm.6506. 8. Zakharov E.Yu., Afrosina E.Yu., Khivintseva E.V., Antipov O.I. (2016). Kachestvo nochnogo sna u patsiyentov s rasseyannym sklerozom [The quality of night sleep in patients with multiple sclerosis]. Zhurnal nevrologii i psikhiatrii – Journal of Neurology and Psychiatry, ¹ 116 (2), pp. 41–43, DOI: 10.17116/jnevro20161162241-43[in Russian]. 9. Brass S.D., Duquette P., Proulx-Therrien J., Auerbach S. (2010). Sleep disorders in patients with multiple sclerosis. Sleep Med Rev., ¹ 14 (2), pp. 121–129, DOI:10.1016/j.smrv.2009.07.005. Ì.Å. ×åðíåíêî Ê ÂÎÏÐÎÑÓ Î ÍÅÎÁÕÎÄÈÌÎÑÒÈ ÐÀÇÐÀÁÎÒÊÈ ÊÎÌÏËÅÊÑÍÛÕ ÐÅÀÁÈËÈÒÀÖÈÎÍÍÛÕ ÌÅÐÎÏÐÈßÒÈÉ Ó ÏÀÖÈÅÍÒÎÂ Ñ ÍÅÉÐÎÄÅÃÅÍÅÐÀÖÈÅÉ Íàðóøåíèÿ ñíà íåãàòèâíî ñêàçûâàþòñÿ íà ïðîöåññàõ íåéðîïëàñòè÷íîñòè ãîëîâíîãî ìîçãà. Áîä- ðñòâîâàíèå è íî÷íîé ñîí – ôóíêöèîíàëüíûå ñîñòîÿíèÿ, êîòîðûå òåñíî âçàèìîñâÿçàííû è â ðàâíîé ñòåïåíè îïîñðåäñòâóþò è îáåñïå÷èâàþò àäàïòàöèîííóþ àêòèâíîñòü èíäèâèäà. Áèîëîãè÷åñêèå ðèòìû ÷åëîâåêà íàõîäÿòñÿ â èåðàðõè÷åñêîé çàâèñèìîñòè îò îñíîâíîãî âîäèòåëÿ ðèòìà, ðàñïîëîæåííîãî â ñóïðàõèàçìàòè÷åñêèõ ÿäðàõ ãèïîòàëàìóñà. Ðîëü ïîñðåäíèêà, äîñòàâëÿþùåãî ðåãóëèðóþùèå ñèã- íàëû â îðãàíû, âûïîëíÿåò ãîðìîí ìåëàòîíèí, êîòîðûé ñèíòåçèðóåòñÿ êëåòêàìè ýïèôèçà. Ðàññòðîé- ñòâà ñíà ñåðüåçíî ñêàçûâàþòñÿ íà êà÷åñòâå æèçíè ÷åëîâåêà: íàðàñòàþò ýìîöèîíàëüíîå íàïðÿæåíèå, òðåâîãà, ðàçäðàæåíèå è, êàê ñëåäñòâèå, ñíèæàåòñÿ óñòîé÷èâîñòü ê ñòðåññàì, óìåíüøàåòñÿ ïîòðåá- íîñòü â êîììóíèêàöèè, ðàçâëå÷åíèÿõ.  ïîäàâëÿþùåì áîëüøèíñòâå ñëó÷àåâ èíñîìíèÿ ÿâëÿåòñÿ âòîðè÷íîé, òî åñòü îíà ôîðìèðóåòñÿ íà ôîíå ðàçâèòèÿ çàáîëåâàíèé è/èëè íåáëàãîïðèÿòíûõ îáñòîÿ- òåëüñòâ. Äîñòàòî÷íî ÷àñòî íàðóøåíèÿ ñíà âñòðå÷àþòñÿ ïðè äåìèåëèíèçèðóþùèõ/íåéðîäåãåíåðàòèâ- íûõ çàáîëåâàíèÿõ öåíòðàëüíîé íåðâíîé ñèñòåìû. Áûëî îáñëåäîâàíî 30 ïàöèåíòîâ ñ äèàãíîçîì ðàñ- ñåÿííûé ñêëåðîç, êîòîðûå áûëè ðàçäåëåíû íà äâå ãðóïïû. Îñíîâíàÿ ãðóïïà ïîëó÷àëà òåðàïèþ ìå- ëàòîíèí-ñîäåðæàùèì ïðåïàðàòîì â êîìáèíàöèè ñ êîãíèòèâíî-ïîâåäåí÷åñêîé òåðàïèåé. Ïàöèåíòû êîíòðîëüíîé ãðóïïû ïîëó÷àëè òîëüêî òåðàïèþ ìåëàòîíèí-ñîäåðæàùèì ïðåïàðàòîì. Áûëî ïîêàçàíî, ÷òî óðîâåíü êîðòèçîëà ó ïàöèåíòîâ îñíîâíîé ãðóïïû ñíèæàëñÿ ñèëüíåå, ÷åì ó ïàöèåíòîâ, íå ïîëó- ÷àâøèõ ÊÏÒ. Ðåäóêöèÿ êëèíè÷åñêèõ ïðîÿâëåíèé, íàðÿäó ñ óëó÷øåíèÿìè ëàáîðàòîðíûõ ïîêàçàòåëåé ýêñïðåññèè äíåâíîãî è íî÷íîãî ìåëàòîíèíà, à òàêæå ýêñïðåññèè êîðòèçîëà, íàáëþäàëèñü óæå íà 14-é äåíü ëå÷åíèÿ, à íà 21-é äåíü èññëåäîâàíèÿ ýòè ïîêàçàòåëè óëó÷øàëèñü â çíà÷èòåëüíîé ñòåïåíè. Êëèíè÷åñêàÿ ýôôåêòèâíîñòü â îñíîâíîé ãðóïïå äîñòèãíóòà â 86,6 % ñëó÷àåâ, â êîíòðîëüíîé ãðóïïå – â 60,0 % ñëó÷àåâ. Ïëàíèðóåòñÿ èñïîëüçîâàíèå äàííîãî ìåòîäà ïðè ðàçðàáîòêå êîìïëåêñíîé ðåàáè- ëèòàöèîííîé ïðîãðàììû ó ïàöèåíòîâ ñ íåéðîäåãåíåðàöèåé. Êëþ÷åâûå ñëîâà: íåéðîäåãåíåðàöèÿ, äåìèåëèíèçàöèÿ, ðàññåÿííûé ñêëåðîç, íåéðîðåàáèëèòàöèÿ, êîãíèòèâíî-ïîâåäåí÷åñêàÿ òåðàïèÿ. M.E. Chernenko TO THE QUESTION OF THE NEED FOR THE DEVELOPMENT OF INTEGRATED REHABILITATION MEASURES IN PATIENTS WITH NEURODEGENERATION It is known that sleep disorders adversely affect the processes of brain neuroplasticity. Wakefulness and night sleep are functional states that are closely interrelated and equally mediate and provide the adaptive activity of the individual. Human biological rhythms are hierarchically dependent on the main pacemaker located in the suprachiasmatic nuclei of the hypothalamus. The role of a mediator that delivers

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÍÅÂÐÎËÎÃ²ß 77 regulatory signals to organs is played by the hormone melatonin, which is synthesized by pineal gland cells. Sleep disorders seriously affect a person's quality of life: emotional stress, anxiety, irritation increase and, as a result, stress resistance decreases, the need for communication, entertainment decreases. In the vast majority of cases, insomnia is secondary, that is, it is formed against the background of the development of diseases and/or adverse circumstances. Quite often, sleep disturbances occur in demyelinating/ neurodegenerative diseases of the central nervous system. We examined 30 patients with a diagnosis of multiple sclerosis, which were divided into two groups. The main group received therapy with a melatonin- containing drug in combination with cognitive-behavioral therapy. Patients in the control group received only therapy with melatonin-containing drug. It was shown that cortisol levels in patients of the main group decreased more than in patients who did not receive CBT. Reduction of clinical manifestations, along with improvements in laboratory indices of day and night melatonin expression, as well as cortisol expression, were already observed on the 14th day of treatment, and on the 21st day of the study, these indices improved significantly. Clinical efficacy in the main group was achieved in 86,6 % of cases, in the control group – in 60,0 % of cases. It is planned to use this method in the development of a comprehensive rehabilitation program in patients with neurodegeneration. Keywords: neurodegeneration, demyelination, multiple sclerosis, neurorehabilitation, cognitive- behavioral therapy.

Íàä³éøëà äî ðåäàêö³¿ 02.12.2019

Êîíòàêòíà ³íôîðìàö³ÿ ×åðíåíêî Ìàêñèì ªâãåíîâè÷ – êàíäèäàò ìåäè÷íèõ íàóê, ñò. íàóêîâèé ñï³âðîá³òíèê â³ää³ëó àóòî³ìóííèõ ³ äåãåíåðàòèâíèõ çàõâîðþâàíü íåðâîâî¿ ñèñòåìè ÄÓ «²íñòèòóò íåâðîëî㳿, ïñèõ³- àò𳿠òà íàðêîëî㳿 Íàö³îíàëüíî¿ àêàäå쳿 ìåäè÷íèõ íàóê Óêðà¿íè», ì. Õàðê³â; àñèñòåíò êàôåäðè êë³í³÷íî¿ íåâðîëî㳿, ïñèõ³àò𳿠òà íàðêîëî㳿 Õàðê³âñüêîãî íàö³îíàëüíîãî óí³âåðñèòåòó ³ìåí³ Â.Í. Êàðàç³íà. Àäðåñà: Óêðà¿íà, 61000, ì. Õàðê³â, ìàéäàí Ñâîáîäè, 4, ÕÍÓ ³ìåí³ Â.Í.Êàðàç³íà. Óêðà¿íà, 61000, ì. Õàðê³â, âóë. Àê.Ïàâëîâà, 46, ÄÓ «²íñòèòóò íåâðîëî㳿, ïñèõ³àò𳿠òà íàðêî- ëî㳿 ÍÀÌÍ Óêðà¿íè». Òåë.: +380577383141. Å-mail: [email protected]. ORCID: https://orcid.org/0000-0002-7810-792X.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 78 Õ²ÐÓÐòß

ХІРУРГІЯ https://doi.org/10.35339/ekm.2019.85.04.12 ÓÄÊ 616.133-007.271:616.831-005.1-036.65:616-005

².Ñ. Ïóëÿºâà, Â.Î. Ïðàñîë ÄÓ «²íñòèòóò çàãàëüíî¿ òà íåâ³äêëàäíî¿ õ³ðóð㳿 ³ì. Â.Ò. Çàéöåâà ÍÀÌÍÓ Óêðà¿íè», ì. Õàðê³â ÐÈÇÈÊÈ ÏÎÂÒÎÐÍÈÕ ²ÍÑÓËÜҲ ² ÐÅÏÅÐÔÓDzÉÍÎÃÎ ÑÈÍÄÐÎÌÓ Ó ÕÂÎÐÈÕ Ç ÊÐÈÒÈ×ÍÈÌ ÑÒÅÍÎÇÎÌ ÑÎÍÍÈÕ ÀÐÒÅÐ²É Ïðîàíàë³çîâàíî ðåçóëüòàòè êîìïëåêñíîãî îáñòåæåííÿ òà õ³ðóðã³÷íîãî ë³êóâàííÿ 230 ïà- ö³ºíò³â ç àòåðîñêëåðîòè÷íèì óðàæåííÿì ñîííèõ àðòåð³é. Ó äîñë³äæåííÿ âêëþ÷àëè ïà- ö³ºíò³â ç ñèìïòîìàòè÷íèì ñòåíîçîì âíóòð³øíüî¿ ñîííî¿ àðòå𳿠(ÂÑÀ) (ïîíàä 50 %), àñèìïòîìàòè÷íèì ñòåíîçîì ÂÑÀ (ïîíàä 70 %), íåñòàá³ëüíîþ áëÿøêîþ ÂÑÀ, ïîðóøåí- íÿì çîðó. Äëÿ îö³íêè âèðàæåíîñò³ íåâðîëîã³÷íîãî äåô³öèòó, ñòóïåíÿ â³äíîâëåííÿ íå- âðîëîã³÷íèõ ôóíêö³é ïðîâîäèëè ñèñòåìó áàëüíî¿ îö³íêè ð³çíèõ êë³í³êî-íåâðîëîã³÷íèõ ïàðàìåòð³â çà äîïîìîãîþ øêàëè òÿæêîñò³ ³íñóëüòó íàö³îíàëüíèõ ³íñòèòóò³â çäîðîâ'ÿ ÑØÀ (NIHSS) ³ç ðåêîìåíäàö³ÿìè îö³íþâàííÿ. Âñòàíîâëåíî, ùî ïàö³ºíòè ³ç ñèìïòîìàòè÷íèì óðàæåííÿì âíóòð³øíüî¿ ñîííî¿ àðòåð³¿, âåëèêèì âîãíèùåì ³íñóëüòó, á³ëàòåðàëüíèì óðà- æåííÿì ñîííèõ àðòåð³é º íàéá³ëüø âèñîêî ðèçèêîâîþ ãðóïîþ ùîäî ðîçâèòêó ïîâòîð- íîãî ³íñóëüòó òà ðåïåðôóç³éíîãî ñèíäðîìó. Ïðè âèáîð³ ìåòîäó ë³êóâàííÿ âàæëèâèì º ðîçì³ð ³øåì³÷íîãî âîãíèùà, ñîìàòè÷íèé ñòàí òà ð³âåíü íåâðîëîã³÷íîãî äåô³öèòó ó ïàö³ºíòà. Êëþ÷îâ³ ñëîâà: ñòåíîç ñîííèõ àðòåð³é, ðèçèêè ³íñóëüòó, ðåïåðôóç³éíèé ñèíäðîì.

Âñòóï ïðàöåçäàòíîñò³. Ëåòàëüí³ñòü óïðîäîâæ ïåð- Íà ñüîãîäí³ â Óêðà¿í³ ïîíàä 3 ìëí îñ³á õâî- øîãî ðîêó ï³ñëÿ ³íñóëüòó ñêëàäຠ35–38 %, à â ð³þòü íà öåðåáðîâàñêóëÿðí³ çàõâîðþâàííÿ ö³ëîìó, ïîðóøåííÿ ìîçêîâîãî êðîâîîá³ãó º ïðè- (ÖÂÇ) ð³çíîãî ñòóïåíÿ òÿæêîñò³. Íàéòÿæ÷îþ ÷èíîþ ÷âåðò³ óñ³õ ñìåðòåëüíèõ ðåçóëüòàò³â [5, ôîðìîþ º ìîçêîâ³ ³íñóëüòè, ÿêèõ â Óêðà¿í³ ðåº- 6]. Ïîðàçêà öåðåáðàëüíèõ àðòåð³é ó õâîðèõ ñòðóºòüñÿ áëèçüêî 110-130 ò. âèïàäê³â ùîð³÷- ç ³øåì³÷íîþ õâîðîáîþ ìîçêó ï³ñëÿ ïåðåíåñå- íî [1]. íîãî ãîñòðîãî ³íñóëüòó ìຠïîøèðåíèé õàðàê- Ñåðåä âñ³õ âèä³â ³íñóëüò³â äîì³íóþòü ³øå- òåð [7]. ÷í³ óðàæåííÿ ìîçêó, ÿê³ ñòàíîâëÿòü 70–85 %, Ìåòîþ äàíî¿ ðîáîòè º àíàë³ç ðèçèêó ïî- êðîâîâèëèâè â ìîçîê çóñòð³÷àþòüñÿ ó 20–25 % âòîðíèõ ³íñóëüò³â ³ ðåïåðôóç³éíîãî ñèíäðîìó âèïàäê³â, íåòðàâìàòè÷í³ ñóáàðàõíî¿äàëüí³ êðî- ó õâîðèõ ç êðèòè÷íèì ñòåíîçîì ñîííèõ àðòåð³é. âîâèëèâè ñòàíîâëÿòü 5 % [2]. Ìàòåð³àë ³ ìåòîäè Ùîð³÷íî ó ñâ³ò³ öåðåáðàëüíèé ³íñóëüò ïå- Ïðîàíàë³çîâàíî ðåçóëüòàòè êîìïëåêñíîãî ðåíîñÿòü ìàéæå 6 ìëí îñ³á. Çà äàíèìè ÂÎÎÇ, îáñòåæåííÿ òà õ³ðóðã³÷íîãî ë³êóâàííÿ 230 ïà- ó ðîçâèíóòèõ êðà¿íàõ ñâ³òó, ùîð³÷íî ðåºñòðó- ö³ºíò³â ç àòåðîñêëåðîòè÷íèì óðàæåííÿì ñîí- þòü â³ä 100 äî 300 ³íñóëüò³â íà êîæí³ 100 òèñ. íèõ àðòåð³é, ÿê³ çíàõîäèëèñü íà ë³êóâàíí³ ó â³ä- íàñåëåííÿ, à â Óêðà¿í³ – ïîíàä 125 òèñ. [3]. ä³ëåíí³ ãîñòðèõ çàõâîðþâàíü ñóäèí ÄÓ «²ÇÍÕ Ïðîô³ëàêòèêà ïîðóøåíü ìîçêîâîãî êðîâî- ³ì. Â.Ò. Çàéöåâà ÍÀÌÍ Óêðà¿íè» ç 2013 ïî îá³ãó çà ³øåì³÷íèì òèïîì º íàéá³ëüø àêòó- 2018 ð³ê. àëüíèì çàâäàííÿì êë³í³÷íî¿ àíã³îíåâðîëî㳿 [4]. ³êîâèé ³íòåðâàë ïàö³ºíò³â áóâ ó ìåæàõ 48– Öåðåáðîâàñêóëÿðíà ïàòîëîã³ÿ çíàõîäèòüñÿ íà 83 ðîêè. Ñåðåä íèõ áóëî 160 (69,5 %) ÷îëîâ³ê³â ïåðøîìó ì³ñö³ ñåðåä ïðè÷èí ñò³éêî¿ âòðàòè òà 70 (30,5 %) æ³íîê.

© ².Ñ. Ïóëÿºâà, Â.Î. Ïðàñîë, 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) Õ²ÐÓÐÃ²ß 79

Ó äîñë³äæåííÿ âêëþ÷àëè ïàö³ºíò³â ³ç ñèìï- íåîáõ³äí³ñòþ óñòàíîâêè òèì÷àñîâîãî øóíòà òîìàòè÷íèì ñòåíîçîì âíóòð³øíüî¿ ñîííî¿ àð- àáî ïðîòÿæíèì ñòåíîçîì. òå𳿠(ÂÑÀ) (ïîíàä 50 %), àñèìïòîìàòè÷íèì Óñ³ì ïàö³ºíòàì ïðîâîäèëèñü ñòàíäàðòí³ ñòåíîçîì ÂÑÀ (ïîíàä 70 %), íåñòàá³ëüíîþ ëàáîðàòîðí³ òà ³íñòðóìåíòàëüí³ ìåòîäè îáñòå- áëÿøêîþ ÂÑÀ. æåííÿ ³ âèêîíóâàëîñü îïåðàòèâíå ë³êóâàííÿ ï³ä Óñ³ õâîð³ áóëè ðîçä³ëåí³ íà äâ³ ãðóïè: ïðîâ³äíèêîâîþ àíåñòå糺þ, ÿêà äîçâîëÿº êîíò- ² ãðóïà – 64 (27,83 %) ñèìïòîìàòè÷íèõ ðîëþâàòè ñâ³äîì³ñòü ó ïåð³îä ïåðåòèñêàííÿ ïàö³ºíòè. Öå õâîð³ ç³ ñòåíîçîì ÂÑÀ ï³ñëÿ ïå- ñîííî¿ àðòåð³¿. Çà íàÿâíîñò³ íåâðîëîã³÷íîãî ðåíåñåíîãî ãîñòðîãî ïîðóøåííÿ ìîçêîâîãî äåô³öèòó âèêîíóâàëè åíäàðòåðåêòîì³þ ÂÑÀ êðîâîîá³ãó ïðîòÿãîì 6 ì³ñÿö³â òà õâîð³ ç ³çî- ç âèêîðèñòàííÿì òèì÷àñîâîãî øóíòà ³ âøè- ëüîâàíèì ïîðóøåííÿì çîðó. âàííÿì ñèíòåòè÷íî¿ ëàòêè. Ó ï³ñëÿîïåðàö³é- ²² ãðóïà – 166 (72,2 %) õâîðèõ ç âåðèô³êî- íîìó ïåð³îä³ ïàö³ºíòè îòðèìóâàëè àíòèáàêòåð- âàíèì àòåðîñêëåðîòè÷íèì óðàæåííÿì ñîííèõ ³àëüíó òåðàï³þ, äåçàãðåãàíòè òà ñòàò³íè. Ó ïåð- àðòåð³é áåç ïðîÿâ³â ãîñòðîãî ³øåì³÷íîãî ïî- øó ï³ñëÿîïåðàö³éíó äîáó ïàö³ºíòè çíàõîäèëèñü ðóøåííÿ ìîçêîâîãî êðîâîîá³ãó ïðîòÿãîì îñ- â ïàëàò³ ³íòåíñèâíî¿ òåðàﳿ äëÿ ìîí³òîðèíãó òàíí³õ 6 ì³ñÿö³â, ÿê³ ïîòðåáóâàëè õ³ðóðã³÷íîãî àðòåð³àëüíîãî òèñêó. Íà 3-òþ äîáó ïàö³ºíòè ë³êóâàííÿ äðóãèì åòàïîì íà ñåðö³, àîðò³ òà àð- áóëè âèïèñàí³. òåð³ÿõ íèæí³õ ê³íö³âîê, ³íøèõ îðãàí³â òà ñèñ- Îñîáëèâó óâàãó ïðèâåðòຠïèòàííÿ ïðî òåì ï³ä çàãàëüíèì çíåáîëåííÿì òà õâîð³ ç íå- íåîáõ³äí³ñòü äâîìîìåíòíèõ âòðó÷àíü ó ïà- ñòàá³ëüíîþ áëÿøêîþ. ö³ºíò³â, ùî ìàþòü êë³í³êó êðèòè÷íî¿ ³øå쳿 Ó ïàö³ºíò³â îáîõ ãðóï ñòåíîç ñîííèõ àðòåð³é íèæí³õ ê³íö³âîê ïðè àñèìïòîìíîìó óðàæåíí³ áóâ âèÿâëåíèé ïåðâèííî ïðè ñêðèí³íãó çà äà- ñîííèõ àðòåð³é. ²ñíóº òî÷êà çîðó, ùî ïðè àñèìï- íèìè óëüòðàçâóêîâîãî äîñë³äæåííÿ. Ïàö³ºíòàì, òîìíîìó êàðîòèäíîìó ñòåíîç³ îïåðàö³ÿ ÊÅ íå ó ÿêèõ áóâ âèÿâëåíèé ãåìîäèíàì³÷íî íåçíà÷- ïîêàçàíà, îñê³ëüêè íå äîâåäåíî çíèæåííÿ ðè- íèé ñòåíîç ñîííî¿ àðòå𳿠(äî 50 %) ç ãëàäêî- çèêó ðîçâèòêó ³íñóëüòó. Ïðîòå â³äîìî, ùî ñò³ííîþ ïîâåðõíåþ ïðè ÓÇÄ ïðèçíà÷àëè êîí- á³ëüø í³æ ó ïîëîâèí³ âèïàäê³â ïàö³ºíòè, ùî ñåðâàòèâíó òåðàï³þ ³ êîíòðîëü ÓÇÄ êîæí³ 6 ì³- ïåðåíåñëè ãîñòðå ïîðóøåííÿ ìîçêîâîãî êðî- ñÿö³â. Ïàö³ºíòàì, ó ÿêèõ ïðè ÓÇÄ âèçíà÷àâñÿ âîîá³ãó, íå ìàëè â àíàìíåç³ òðàíçèòîðíó ³øå- ñòåíîç á³ëüø í³æ 50 % áóëî âèêîíàíå äîäàò- ì³÷íó àòàêó. Öå ïîëîæåííÿ ï³äòâåðäæóþòü êîâå äîñë³äæåííÿ – ñï³ðàëüíà êîìï'þòåðíà òî- îòðèìàí³ íàìè ðåçóëüòàòè. Îñê³ëüêè ó 80 % ìîãðàô³ÿ ç êîíòðàñòóâàííÿì ýêñòðà- òà ³íòðà- õâîðèõ àñèìïòîìíèõ íåâðîëîã³÷íî, ïðè ïðîâå- êðàí³àëüíîãî â³ää³ëó ñîííèõ ³ öåðåáðàëüíèõ äåíí³ ïðîáè íàâàíòàæåííÿ ï³ä ÷àñ ïåðåòèñêàí- àðòåð³é. Ç íèõ, ó 5 õâîðèõ ä³àãíîñòîâàíî íå- íÿ ñîííèõ àðòåð³é óïðîäîâæ 7–40 õâ íå ñïî- ñòàá³ëüíó áëÿøêó â ãèðë³ ÂÑÀ (ðèñ. 1) ³ ó 6 õâî- ñòåð³ãàëîñÿ íåâðîëîã³÷íîãî äåô³öèòó, ³ ò³ëüêè ðèõ ñòåíîç á³ëüø í³æ 70 %. Ïåðåíåñåíå ðàííº ó 20 % ïàö³ºíò³â ïðè ïðîâåäåíí³ ïðîáè íàâàí- ãîñòðå ïîðóøåííÿ ìîçêîâîãî êðîâîîá³ãó çà òàæåííÿ ç ìîäåëüîâàíîþ ã³ïîêñ³ºþ ï³ä ÷àñ ïå- äàíèìè êîìï'þòåðíî¿ òîìîãðàô³¿ ï³äòâåðäæåíå ðåòèñêàííÿ ñîííèõ àðòåð³é áóâ âèÿâëåíèé ó 2 õâîðèõ.  îáîõ ãðóïàõ âèêîíàíà ýâåðñ³éíà íèçüêèé ðåçåðâ ïåðôó糿 ãîëîâíîãî ìîçêó. ÊÅ åíäàðòåðåêòîì³ÿ ó 165 âèïàäêàõ, ó 55 âèïàä- âèêîíóâàëàñÿ ² åòàïîì ó 91,9 % âèïàäê³â ó êàõ âèêîíàíà êàðîòèäíà åíäàðòåðåòîì³ÿ (ÊÅ) õâîðèõ ç êðèòè÷íîþ ³øå쳺þ íèæí³õ ê³íö³âîê ³ç âøèâàííÿì ñèíòåòè÷íî¿ ëàòêè, ó çâ'ÿçêó ç ïðè íåîáõ³äíîñò³ çàãàëüíî¿ àíåñòå糿. ²² åòàïîì ïàö³ºíòè áóëè îïåðîâàí³ ç ïðèâîäó îñíîâíîãî çàõâîðþâàííÿ ÷åðåç 5–7 ä³á. Ïàö³ºíòè ç ïîðóøåííÿì çîðó îòðèìóâàëè êîíñåðâàòèâíó òåðàï³þ ó îôòàëüìîëîãà òà âåñü ñïåêòð ä³àãíîñòè÷íèõ îáñòåæåíü. Ïðè íàÿâíîñò³ àòåðîñêëåðîçó ñîííî¿ àðòå𳿠² åòà- ïîì âèêîíóâàëè õ³ðóðã³÷íå ë³êóâàííÿ, à ²² – ë³êó- âàííÿ ïàòîëî㳿 çîðó, ó 32 % âèïàäê³â ó õâîðèõ ï³ñëÿ ÊÅ âèÿâëÿëè ïîêðàùåííÿ çîðó. Ïåðåä õ³ðóðã³÷íèì âòðó÷àííÿì âèêîíóâàëè êîìïëåê- ñíå îáñòåæåííÿ õâîðèõ ³ç çàëó÷åííÿì íåâðî- ëîãà, êàðä³îëîãà òà ³íøèõ ñóì³æíèõ ñïåö³à- Ðèñ. 1. Íåñòàá³ëüíà áëÿøêà ÂÑÀ ë³ñò³â. Âèêîðèñòîâóâàëè êëàñè÷í³ ìåòîäèêè ó õâîðîãî ç àìàâðîçîì êë³í³÷íîãî òà ëàáîðàòîðíîãî îáñòåæåííÿ, ïðî-

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 80 Õ²ÐÓÐòß

âîäèëè ñòàíäàðòíó îö³íêó íåâðîëîã³÷íîãî ñòà- êë³í³÷íîãî ñòàòóñó ³ íàÿâíîñò³ ï³ñëÿîïåðàö³é- òóñó òà âèêîíóâàëè ³íñòðóìåíòàëüí³ ìåòîäè íèõ óñêëàäíåíü. Ó ïàö³ºíò³â ² ãðóïè íà òë³ ïðè- îáñòåæåííÿ (ÓÇÄ, ÊÒ, ÌÐÒ, àíã³îãðàô³ÿ). çíà÷åíî¿ êîíñåðâàòèâíî¿ òåðàﳿ ñïîñòåð³ãàëî- Ó ïåðåäîïåðàö³éíîìó ïåð³îä³ ïðîâîäèëè ñÿ çáåðåæåííÿ â³äñîòêà ñòåíîçó, ïðè öüîìó, ó îö³íêó ôóíêö³îíàëüíîãî ñòàíó ñèñòåì òà 2 õâîðèõ â³äñîòîê ñòåíîçó ÂÑÀ çá³ëüøèâñÿ îðãàí³â õâîðîãî ç ìåòîþ âèÿâëåííÿ òà ïðîô³- íà 5–10 %. Ó 11 õâîðèõ ²² ãðóïè â ï³ñëÿîïå- ëàêòèêè ìîæëèâèõ ³íòðàîïåðàö³éíèõ òà ï³ñëÿ- ðàö³éíîìó ïåð³îä³ íå âèÿâëåíî óñêëàäíåíü ó âè- îïåðàö³éíèõ óñêëàäíåíü. ãëÿä³ ³íñóëüòó, êðîâîòå÷³, âòðàòè çîðó, ó 2 õâî- Âðàõîâóþ÷è åò³îëîã³þ àòåðîñêëåðîçó, âèñî- ðèõ âèçíà÷àâñÿ ðåïåðôóç³éíèé ñèíäðîì ó âè- êó éìîâ³ðí³ñòü óðàæåííÿ äâîõ ³ á³ëüøå àðòåð³- ãëÿä³ ãîëîâíîãî áîëþ íà òðåòþ äîáó, ÿêèé êóï³- àëüíèõ áàñåéí³â òà ëîêàë³çàö³þ àòåðîñêëåðî- ðóâàâñÿ ñàìîñò³éíî ïðîòÿãîì òèæíÿ. Óñ³ ïàö³- òè÷íèõ ñòåíîç³â ó ñîííèõ àðòåð³ÿõ â ïåðåäî- ºíòè ²² ãðóïè áóëè âèïèñàí³ â ñòàá³ëüíîìó ñòàí³. ïåðàö³éíîìó ïåð³îä³, îö³íþâàëè ñîìàòè÷íèé òà Òàêèì ÷èíîì, íàì âäàëîñÿ äîñÿãòè ïîë³ï- íåâðîëîã³÷íèé ñòàòóñ ïàö³ºíòà. øåííÿ â êë³í³÷íîìó ñòàòóñ³ õâîðîãî â 85 % âè- Âðàõîâóþ÷è òå, ùî ïîêàçàííÿ äî ÊÅÀ º ó ïàäê³â óïðîäîâæ 3 ì³ñÿö³â ï³ñëÿ îïåðàö³¿ ³ ñêî- ïàö³ºíò³â ÿê ³ç ñèìïòîìàòè÷íèì, òàê ³ ç àñèì- ðîòèòè ê³ëüê³ñòü ³øåì³÷íèõ ³íñóëüò³â. Ïðè îê- ïòîìàòè÷íèì ñòåíîçîì ÂÑÀ, îö³íêà íåâðîëî- ëþ糿 à. ophtalmica – õ³ðóðã³÷íå ë³êóâàííÿ äîç- ã³÷íîãî ñòàòóñó º íàäçâè÷àéíî âàæëèâîþ. Äëÿ âîëÿº ïîë³ïøèòè ãîñòðîòó ³ ïîëÿ çîðó. Ó ïåðø³ îö³íêè âèðàæåíîñò³ íåâðîëîã³÷íîãî äåô³öèòó, 24 ãîäèíè ïðÿìó îçíàêó ãîñòðîãî ³øåì³÷íîãî ñòóïåíÿ â³äíîâëåííÿ íåâðîëîã³÷íèõ ôóíêö³é, ïîðóøåííÿ ìîçêîâîãî êðîâîîá³ãó íå âäàâàëîñÿ ïðîâîäèëè ñèñòåìó áàëüíî¿ îö³íêè ð³çíèõ âèÿâèòè. Ïðè ïîâòîðíîìó ÊÒ-îáñòåæåíí³ ÷å- êë³í³êî-íåâðîëîã³÷íèõ ïàðàìåòð³â ³ âèêîðèñòî- ðåç 7–21 äí³â çîíà ³íôàðêòó äåùî çìåíøóâà- âóâàëè øêàëó òÿæêîñò³ ³íñóëüòó íàö³îíàëüíèõ ëàñü â ðîçì³ð³, ñòàâàëà á³ëüø ÷³òêî îêðåñëå- ³íñòèòóò³â çäîðîâ'ÿ ÑØÀ (NIHSS) ³ç ðåêîìåí- íîþ âíàñë³äîê àáñîðáö³¿ íåêðîòè÷íî¿ òêàíè- äàö³ÿìè îö³íþâàííÿ. íè. Íåâðîëîã³÷íèé äåô³öèò çà øêàëîþ çì³íþ- Âèçíà÷åííÿ òÿæêîñò³ ³íñóëüòó çà áàëàìè âàâñÿ íà 3–5 áàë³â ó õâîðèõ ñåðåäíüîãî ñòó- çã³äíî ç NIHSS: ïåíÿ (ðèñ. 2). –  5 áàë³â – ëåãêèé ³íñóëüò; – 6–13 áàë³â – ³íñóëüò ñåðåäíüî¿ òÿæêîñò³; – 14–20 áàë³â – òÿæêèé ³íñóëüò; – > 20 áàë³â – äóæå òÿæêèé ³íñóëüò. Ïîâòîðí³ îö³íêè íåâðîëîã³÷íîãî ñòàíó çà äîïîìîãîþ Øêàëè òÿæêîñò³ ³íñóëüòó (NIHSS) ïðîâîäÿòü ÷åðåç 3 òà 6 ãîä ç ìîìåíòó âèÿâ- ëåííÿ ³íñóëüòó òà â ï³ñëÿîïåðàö³éíîìó ïåð³îä³ Õ³ðóðã³÷íå ë³êóâàííÿ âèêîíóâàëè ïðè ëåã- êèõ ³íñóëüòàõ òà ³íñóëüòàõ ñåðåäíüî¿ òÿæêîñò³, òðàíçèòîðí³é ³øåì³÷í³é àòàö³, ïîðóøåíí³ çîðó. Íà åòàï³ ä³àãíîñòóâàííÿ âèÿâëåíî ð³çí³ òèïè ïîðóøåíü ìîçêîâîãî êðîâîîá³ãó: òðàíçè- òîðí³ ³øåì³÷í³ àòàêè, ³øåì³÷íèé ³íñóëüò, ñòàí ï³ñëÿ ³íñóëüòó òà ïîâòîðíèé ³íñóëüò. Õâîðèì Ðèñ. 2. ÊÒ äî êàðîòèäíî¿ åíäàðòåðåêòî쳿 òà ï³ñëÿ âèêîíóâàëè ÊÒ àáî ÌÐÒ ãîëîâíîãî ìîçêó. Âèñíîâêè Íàÿâí³ñòü ðîçì³ðó ³øåì³÷íîãî âîãíèùà º îäíèì 1. Ïàö³ºíòè ³ç ñèìïòîìàòè÷íèì óðàæåííÿì ³ç êëþ÷îâèõ êðèòåð³¿â âèáîðó òåðì³íó ÊÅÀ. ÂÑÀ, âåëèêèì âîãíèùåì ³íñóëüòó, á³ëàòåðàëü- Ïðè íàÿâíîñò³ ñâ³æîãî âîãíèùà ðîçì³ðîì äî íèì óðàæåííÿì ñîííèõ àðòåð³é º íàéá³ëüø âè- 23 ñì ÊÅÀ âèêîíóâàëè ïðîòÿãîì 2 ì³ñÿö³â ñîêî ðèçèêîâîþ ãðóïîþ ùîäî ðîçâèòêó ïîâòîð- ³ç ìîìåíòó ðîçâèòêó ÃÏÌÊ. Ó âèïàäêó âèÿâ- íîãî ³íñóëüòó òà ðåïåðôóç³éíîãî ñèíäðîìó. ëåííÿ ³øåì³÷íîãî âîãíèùà á³ëüøîãî ÿê 23 ñì, 2. Ïðè ãåìîäèíàì³÷íî çíà÷èìèõ ñòåíîçàõ ÊÅÀ âèêîíóâàëè ÷åðåç 5–6 òèæí³â â³ä ìîìåí- àáî íàÿâíîñò³ íåñòàá³ëüíî¿ áëÿøêè òà ï³äòâåð- òó ðîçâèòêó òÏÌÊ. Õâîðèì ç òÿæêèì ñîìà- äæåíèìè äàíèìè ÑÊÒ ç êîíòðàñòóâàííÿì íå- òè÷íèì ñòàíîì âèêîíóâàëè ñòåíòóâàííÿ. îáõ³äíî âèêîíóâàòè êàðîòèäíó åíäàðòåðåêòîì³þ, Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ ϳä ÷àñ âèáîðó ìåòîäó ë³êóâàííÿ âàæëèâèì º Áåçïîñåðåäí³ ðåçóëüòàòè îïåðàö³¿ ìè îö³- ðîçì³ð ³øåì³÷íîãî âîãíèùà, ñîìàòè÷íèé ñòàí íþâàëè êîìïëåêñíî íà ï³äñòàâ³ ì³ðè çì³íè òà ð³âåíü íåâðîëîã³÷íîãî äåô³öèòó ó ïàö³ºíòà.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) Õ²ÐÓÐÃ²ß 81

References 1. Clement D.L., Boccalon H., Dormandy J. et al. (2000). A clinical approach to the management of the patient with coronary (Co) and/or carotid (Ca) artery disease who presents with leg ischaemia (Lis). Int Angiol, vol. 19, pp. 97–125. 2. Nicolaides A.N., Kakkos S.K., Griffin M. et al. (2005). Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) Study Group. Effect of image normalization on carotid plaque classification and the risk of ipsilateral hemispheric ischemic events: results from the asymptomatic carotid stenosis and risk of stroke study. Vascular., vol. 13, pp. 211–221. 3. Sandercock P.A., Van den Belt A.G., Lindley R.I. et al. (1993). Antithrombotic therapy in acute ischaemic stroke: an overview of the completed randomised trials. J Neurol Neurosurg Psychiatry, vol. 56, pp. 17–25. 4. Thom T., Haase N., Rosamond W. et al. (2006). American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation., vol. 113, pp. 85–151. 5. Venkatachalam S. et al. (2011). Contemporary management of contaminant carotid and coronary artery disease. Heart., vol. 97 (3), pp. 175–180. 6. Kleindorfer D., Panagos P., Pancioli A. et al. (2005). Incidence and short-term prognosis of transient ischemic attack in a population-based study. Stroke., vol. 36, pp. 720–723. 7. Veith F.J., Amor M., Ohki T. et al. (2001). Current status of carotid bifurcation angioplasty and stenting based on a consensus of opinion leaders. J Vasc Surg., vol. 33, issue 2, pp. 111–116, doi: 10.1067/mva.2001.111665.

È.Ñ. Ïóëÿåâà, Â.À. Ïðàñîë ÐÈÑÊÈ ÏÎÂÒÎÐÍÛÕ ÈÍÑÓËÜÒÎÂ È ÐÅÏÅÐÔÓÇÈÎÍÍÎÃÎ ÑÈÍÄÐÎÌÀ Ó ÁÎËÜÍÛÕ Ñ ÊÐÈÒÈ×ÅÑÊÈÌ ÑÒÅÍÎÇÎÌ ÑÎÍÍÛÕ ÀÐÒÅÐÈÉ Ïðîàíàëèçèðîâàíû ðåçóëüòàòû êîìïëåêñíîãî îáñëåäîâàíèÿ è õèðóðãè÷åñêîãî ëå÷åíèÿ 230 ïàöèåí- òîâ ñ àòåðîñêëåðîòè÷åñêèì ïîðàæåíèåì ñîííûõ àðòåðèé.  èññëåäîâàíèå âêëþ÷àëè ïàöèåíòîâ ñ ñèìïòîìàòè÷åñêèì ñòåíîçîì âíóòðåííåé ñîííîé àðòåðèè (ÂÑÀ) (áîëåå 50 %), àñèìïòîìíûì ñòåíî- çîì ÂÑÀ (áîëåå 70 %), íåñòàáèëüíîé áëÿøêîé ÂÑÀ, íàðóøåíèåì çðåíèÿ. Äëÿ îöåíêè âûðàæåííîñòè íåâðîëîãè÷åñêîãî äåôèöèòà, ñòåïåíè âîññòàíîâëåíèÿ íåâðîëîãè÷åñêèõ ôóíêöèé ïðîâîäèëè ñèñòå- ìó áàëëüíîé îöåíêè ðàçëè÷íûõ êëèíèêî-íåâðîëîãè÷åñêèõ ïàðàìåòðîâ ñ ïîìîùüþ øêàëû òÿæåñòè èíñóëüòà íàöèîíàëüíûõ èíñòèòóòîâ çäîðîâüÿ ÑØÀ (NIHSS) ñ ðåêîìåíäàöèÿìè îöåíêè. Óñòàíîâëåíî, ÷òî ïàöèåíòû ñ ñèìïòîìàòè÷åñêèì ïîðàæåíèåì âíóòðåííåé ñîííîé àðòåðèè, áîëüøèì î÷àãîì èí- ñóëüòà, äâóñòîðîííèì ïîðàæåíèåì ñîííûõ àðòåðèé ÿâëÿþòñÿ íàèáîëåå âûñîêî ðèñêîâàííîé ãðóïïîé ïî ðàçâèòèþ ïîâòîðíîãî èíñóëüòà è ðåïåðôóçèîííîãî ñèíäðîìà. Ïðè âûáîðå ìåòîäà ëå÷åíèÿ âàæ- íûì ÿâëÿåòñÿ ðàçìåð èøåìè÷åñêîãî î÷àãà, ñîìàòè÷åñêîå ñîñòîÿíèå è óðîâåíü íåâðîëîãè÷åñêîãî äåôèöèòà ó ïàöèåíòà. Êëþ÷åâûå ñëîâà: ñòåíîç ñîííûõ àðòåðèé, ðèñêè èíñóëüòà, ðåïåðôóçèîííûé ñèíäðîì.

².S. Pulyaeva, V.O. Prasol THE RISCS OF REPEATED STROKES AND REPERFUSION SYNDROME IN PATIENTS WITH SEVERE STENOSIS OF CAROTID ARTERIES The results of a comprehensive examination and surgical treatment of 230 patients with atherosclerotic lesions of the carotid arteries were analyzed. The study included patients with symptomatic stenosis of the internal carotid artery (ICA) (more than 50 %), asymptomatic ICA stenosis (more than 70 %), unstable ICA plaque, visual impairment. To assess the severity of neurological deficits, the degree of recovery of neurological functions, a scoring system of various clinical and neurological parameters was performed using the scale of stroke severity of the National Institutes of Health (NIHSS) with evaluation recommendations. Patients with symptomatic internal carotid artery disease, large stroke, and bilateral carotid artery disease have been shown to be the highest risk group for recurrent stroke and reperfusion syndrome. When choosing a method of treatment, the size of the ischemic focus, somatic condition and the level of neurological deficit in the patient are important. Keywords: carotid artery stenosis, stroke risks, reperfusion syndrome.

Íàä³éøëà äî ðåäàêö³¿ 06.12.2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 82 Õ²ÐÓÐòß

Êîíòàêòíà ³íôîðìàö³ÿ: Ïóëÿºâà ²ííà Ñåð㳿âíà – êàíäèäàò ìåäè÷íèõ íàóê, ñòàðøèé íàóêîâèé ñï³âðîá³òíèê â³ää³ëåííÿ ãîñòðèõ çàõâîðþâàíü ñóäèí ÄÓ «²íñòèòóò çàãàëüíî¿ òà íåâ³äêëàäíî¿ õ³ðóð㳿 ³ì. Â.Ò. Çàéöåâà ÍÀÌÍÓêðà¿íè», ì. Õàðê³â. Àäðåñà: Óêðà¿íà, 61103, ì. Õàðê³â, â'¿çä Áàëàêèðºâà, 1. Òåë.: +380573494150. E- mail: [email protected] ORCID: https://orcid.org/0000-0002-6824-7232

Ïðàñîë ³òàë³é Îëåêñàíäðîâè÷ – äîêòîð ìåäè÷íèõ íàóê, çàâ³äóþ÷èé â³ää³ëåííÿì ãîñòðèõ çàõâîðþâàíü ñóäèí ÄÓ «²íñòèòóò çàãàëüíî¿ òà íåâ³äêëàäíî¿ õ³ðóð㳿 ³ì. Â. Ò. Çàéöåâà ÍÀÌÍ Óêðà¿íè», ì. Õàðê³â. Àäðåñà: Óêðà¿íà, 61103, ì. Õàðê³â, â'¿çä Áàëàêèðºâà, 1. Òåë.: +380573494187 E-mail: [email protected] ORCID: https://orcid.org/0000-0002-0556-6981

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) Õ²ÐÓÐÃ²ß 83

https://doi.org/10.35339/ekm.2019.85.04.13 ÓÄÊ 616.14-007.64-089.819

Å.Ã. ×åðêàøåíèíîâ1, À.Ñ. Êàëìûêîâà2 1Õàðüêîâñêèé íàöèîíàëüíûé ìåäèöèíñêèé óíèâåðñèòåò 2Ìåäèöèíñêèé öåíòð ÒΠ«ÏÐÈÂÀÒ ÊËÈÍÈÊ», ã. Õàðüêîâ ÐÅÇÓËÜÒÀÒÛ ÏÐÈÌÅÍÅÍÈß ÌÀËÎÈÍÂÀÇÈÂÍÛÕ ÌÅÒÎÄΠËÅ×ÅÍÈß ÂÀÐÈÊÎÇÍÎÉ ÁÎËÅÇÍÈ Ñ 2015 ïî 2019 ãîä íàìè áûëî ïðîâåäåíî îïåðàòèâíîå ëå÷åíèå 136 ïàöèåíòîâ ïî ïîâîäó âàðèêîçíîé áîëåçíè íèæíèõ êîíå÷íîñòåé, èç íèõ ìåòîäîì ýíäîâåíîçíîé ëàçåðíîé êîà- ãóëÿöèè áûëî ïðîîïåðèðîâàíî 74 ïàöèåíòà, ðàäèî÷àñòîòíîé àáëÿöèè – 62 ïàöèåíòà. Äëÿ ðàñïðåäåëåíèÿ áîëüíûõ ïî òÿæåñòè çàáîëåâàíèÿ èñïîëüçîâàëàñü ìåæäóíàðîäíàÿ êëàñ- ñèôèêàöèÿ õðîíè÷åñêîé âåíîçíîé íåäîñòàòî÷íîñòè (ÑÅÀÐ). Ïîêàçàíèåì ê âûïîëíåíèþ ìàëîèíâàçèâíûõ ìåòîäèê ÿâëÿëîñü íàëè÷èå âåðòèêàëüíîãî ðåôëþêñà ïî áîëüøîé èëè (è) ìàëîé ïîäêîæíîé âåíå â ñî÷åòàíèè ñ ãîðèçîíòàëüíûì âåíîçíûì ðåôëþêñîì â 95 % ñëó÷àåâ. Äëÿ âûïîëíåíèÿ ðàäèî÷àñòîòíîé àáëÿöèè èñïîëüçîâàëè ìåòîäèêó VNUS ClosureFast, à äëÿ âûïîëíåíèÿ ýíäîâàçàëüèîé ëàçåðíîé îáëèòåðàöèè àïïàðàò «Ë³êà-õ³ðóðã», ãåíåðèðóþùèé äëèíó âîëíû 1470 íì è ðàäèàëüíûå (êðóãîâûå) ñâåòîâîäû.). Äëÿ îöåíêè ðåçóëüòàòîâ è êà÷åñòâà ëå÷åíèÿ âñå áîëüíûå ïðîõîäèëè îñìîòð âðà÷à ñ ïðîâåäåíèåì ÓÇÄà îïåðèðîâàííîé íèæíåé êîíå÷íîñòè ñïóñòÿ 1, 6 è 12 ìåñÿöåâ, ïîñëå ïðîâåäåííîãî ëå÷åíèÿ. Ïàöèåíòû çàïîëíÿëè îïðîñíèê êà÷åñòâà æèçíè Chronic Venous Insufficiency Questionnaire (CIVIQ 20), ïåðåä îïåðàöèåé è ñïóñòÿ 6 ìåñÿöåâ ïîñëå ïðîâåäåííîãî ëå÷åíèÿ. Ó âñåõ 136 ïàöèåíòîâ ïàòîëîãè÷åñêèé âåíîçíûé ðåôëþêñ íå íàáëþäàëñÿ. Ó 2 ïàöèåíòîâ, ÷åðåç á ìåñÿöåâ ïîñëå ÝÂËÊ, ïðè âûïîëíåíèè ÓÇÄÃ-êîíòðîëÿ â ñòâîëàõ áîëüøîé ïîäêîæ- íîé âåíû îïðåäåëÿëàñü ñåãìåíòàðíàÿ ðåêàíàëèçàöèÿ áåç ïàòîëîãè÷åñêîãî ðåôëþêñà. Ïðèìåíåíèå ðàäèî÷àñòîòíîé àáëÿöèè è ýíäîâàçàëüíîé ëàçåðíîé êîàãóëÿöèè âåí ïðè ëå÷åíèè âàðèêîçíîé áîëåçíè ïîêàçûâàåò ïîëîæèòåëüíûå ðåçóëüòàòû, à â áîëüøèíñòâå ñëó÷àåâ ëó÷øå, ÷åì ïðè êëàññè÷åñêèõ õèðóðãè÷åñêèõ âìåøàòåëüñòâàõ, ÷òî îáóñëîâëåíî, â ïåðâóþ î÷åðåäü, ìàëîé òðàâìàòè÷íîñòüþ. Îäíèìè èç ôàêòîðîâ ÿâëÿþòñÿ ìàëûå ñðîêè ïðåáûâàíèÿ ïàöèåíòà â êëèíèêå è åãî àêòèâèçàöèÿ ñðàçó ïîñëå îïåðàöèè, ÷òî ïîçâîëÿåò ñîõðàíÿòü ðåæèì ïîâñåäíåâíîé æèçíè. Êëþ÷åâûå ñëîâà: ìèíèèíâàçèâíîå ëå÷åíèå, ðàäèî÷àñòîòíàÿ àáëÿöèÿ âåí, âåíîçíàÿ íåäî- ñòàòî÷íîñòü. Âñòóïëåíèå ðåííîñòè, ðàçâèòèè òðîôè÷åñêèõ è ãðîçíûõ Õðîíè÷åñêàÿ âåíîçíàÿ íåäîñòàòî÷íîñòü òðîìáîýìáîëè÷åñêèõ îñëîæíåíèé. Íåñìîòðÿ (ÕÂÍ) è åå îñëîæíåíèÿ ÿâëÿþòñÿ âàæíîé ìå- íà çíà÷èòåëüíûå óñïåõè, äîñòèãíóòûå â ëå- äèêî-ñîöèàëüíîé ïðîáëåìîé. Íàèáîëåå ÷àñ- ÷åíèè âàðèêîçíîé áîëåçíè âåí íèæíèõ êîíå÷- òî âñòðå÷àþùèìñÿ ñèìïòîìîì ÕÂÍ ÿâëÿåòñÿ íîñòåé è ðàçâèâàþùåéñÿ ïðè ýòîì õðîíè÷åñ- âàðèêîçíîå ðàñøèðåíèå ïîäêîæíûõ âåí íèæ- êîé âåíîçíîé íåäîñòàòî÷íîñòè, ïðîáëåìà äè- íèõ êîíå÷íîñòåé [1]. Âàðèêîçíàÿ áîëåçíü (ÂÁ) àãíîñòèêè è ëå÷åíèÿ ýòîãî çàáîëåâàíèÿ îñòà- íèæíèõ êîíå÷íîñòåé ÿâëÿåòñÿ ñàìîé ðàñïðî- åòñÿ àêòóàëüíîé. Ýòî îáóñëîâëåíî áîëüøîé ñòðàíåííîé ñîñóäèñòîé ïàòîëîãèåé, êîòîðàÿ ðàñïðîñòðàíåííîñòüþ è âûñîêèì ïðîöåíòîì âûðàæàåòñÿ â ñíèæåíèè òðóäîñïîñîáíîñòè, ðåöèäèâîâ, ðîñòîì åå ÷àñòîòû è íàëè÷èåì êà÷åñòâà æèçíè, ýñòåòè÷åñêîé íåóäîâëåòâî- îñëîæíåííûõ ôîðì çàáîëåâàíèÿ, ïðèâîäÿùèõ

© Å. Ã. ×åðêàøåíèíîâ, À.Ñ. Êàëìûêîâà, 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 84 Õ²ÐÓÐòß

ê äëèòåëüíîé íåòðóäîñïîñîáíîñòè [2, 3]. Âà- Ìàòåðèàë è ìåòîäû ðèêîçíàÿ áîëåçíü íèæíèõ êîíå÷íîñòåé è ïðî- Ñ 2015 ïî 2019 ãîä íàìè áûëî ïðîâåäåíî ãðåññèðóþùàÿ íà åå ôîíå õðîíè÷åñêàÿ âåíîç- îïåðàòèâíîå ëå÷åíèå 136 ïàöèåíòîâ ïî ïîâî- íàÿ íåäîñòàòî÷íîñòü, âñòðå÷àåòñÿ ïî÷òè ó 60 % äó âàðèêîçíîé áîëåçíè íèæíèõ êîíå÷íîñòåé, íàñåëåíèÿ çåìëè.  Óêðàèíå, òàê æå, êàê è â èç íèõ ìåòîäîì ýíäîâåíîçíîé ëàçåðíîé êîà- ñòðàíàõ Åâðîïû, äàííîé ïðîáëåìîé ñòðàäà- ãóëÿöèè áûëî ïðîîïåðèðîâàíî 74 ïàöèåíòà, ðà- þò îêîëî 25–30 % íàñåëåíèÿ, ïðè÷åì æåíùèíû äèî÷àñòîòíîé àáëÿöèè – 62 ïàöèåíòà. ñòðàäàþò â 2 ðàçà ÷àùå ìóæ÷èí.  2011 ãîäó Áîëüøèíñòâî ïàöèåíòîâ ñîñòàâëÿëè æåíùè- â Óêðàèíå âàðèêîçíàÿ áîëåçíü íèæíèõ êîíå÷- íû – 94 (69,1 %), à ìóæ÷èíû – 42 (30,9 %). Âîç- íîñòåé ÿâèëàñü ïðè÷èíîé èíâàëèäíîñòè ó 246 ðàñòíàÿ êàòåãîðèÿ ñîñòàâèëà îò 21 ãîäà äî 67 ëåò. ïàöèåíòîâ [4]. Òàêæå ñëåäóåò îòìåòèòü, ÷òî Äëÿ ðàñïðåäåëåíèÿ áîëüíûõ ïî òÿæåñòè çàáîëåâàåìîñòü âàðèêîçíîé áîëåçíüþ óâåëè- çàáîëåâàíèÿ èñïîëüçîâàëàñü ìåæäóíàðîäíàÿ ÷èâàåòñÿ ñ âîçðàñòîì, ïðèìåðíî êàæäîå äå- êëàññèôèêàöèÿ õðîíè÷åñêîé âåíîçíîé íåäî- ñÿòèëåòèå æèçíè óâåëè÷èâàåò ÷àñòîòó âûÿâ- ñòàòî÷íîñòè (ÑÅÀÐ).  òàáë. 1 ïîêàçàíî ðàñ- ëåíèÿ âàðèêîçíîé áîëåçíè íà 10 %. ïðåäåëåíèå ïàöèåíòîâ ïî ïîëîâîìó ïðèçíàêó Çà ïîñëåäíèå äâà äåñÿòèëåòèÿ â ïîâñåä- è òÿæåñòè çàáîëåâàíèÿ. íåâíóþ ëå÷åáíóþ ïðàêòèêó, àêòèâíî âíåäðÿ- Âñå áîëüíûå áûëè ãîñïèòàëèçèðîâàíû â þòñÿ ìàëîèíâàçèâíûå ìåòîäèêè ëå÷åíèÿ âà- ïëàíîâîì ïîðÿäêå çà ñóòêè äî îïåðàòèâíîãî ðèêîçíîé áîëåçíè. Äàííûå ìåòîäèêè èìåþò ëå÷åíèÿ äëÿ êëèíèêî-ëàáîðàòîðíîé äèàãíîñ- ðÿä ïðåèìóùåñòâ ïåðåä êëàññè÷åñêîé âåíýê- òèêè. Âñåì ïàöèåíòàì áûëî âûïîëíåíî ÓÇÄà Òàáëèöà 1. Ðàñïðåäåëåíèå îïåðèðîâàííûõ ïàöèåíòîâ â çàâèñèìîñòè îò ïîëà è ñòåïåíè òÿæåñòè õðîíè÷åñêîé âåíîçíîé íåäîñòàòî÷íîñòè

òîìèåé: ìàëàÿ òðàâìàòè÷íîñòü îïåðàöèè, êî- ñîñóäîâ íèæíèõ êîíå÷íîñòåé, ïî ðåçóëüòàòàì ðîòêèé ñðîê ðåàáèëèòàöèè ïàöèåíòà, âûñîêèé êîòîðîé îïðåäåëÿëè íàëè÷èå ðåôëþêñà ïî êîñìåòè÷åñêèé ýôôåêò [5]. Ñàìûìè ðàñïðî- áîëüøîé è ìàëîé ïîäêîæíûì âåíàì. Ïî äàí- ñòðàíåííûìè ÿâëÿþòñÿ ðàäèî÷àñòîòíàÿ àá- íûì èññëåäîâàíèÿ, ïîðàæåíèå òîëüêî áîëü- ëÿöèÿ (ÐFÀ), ýíäîâàçàëüíàÿ ëàçåðíàÿ êîàãó- øîé ïîäêîæíîé âåíû íàáëþäàëîñü ó 102 ïà- ëÿöèÿ (ÅVLT), àáëÿöèÿ ìèêðîèìïóëüñàìè ïàðà öèåíòîâ, èç íèõ 65 æåíùèí è 37 ìóæ÷èí, ìà- (SVS), áèîêëåé (Venaseal, Venablock), ìåõàíî- ëîé ïîäêîæíîé âåíû – ó 29 ïàöèåíòîâ, èç íèõ õèìè÷åñêàÿ àáëÿöèÿ âåí (Clarivein) è äð. Ê 24 æåíùèíû è 5 ìóæ÷èí, à êîìáèíèðîâàííîå ñîæàëåíèþ, â Óêðàèíå ñåðòèôèöèðîâàíû è ïîðàæåíèå áîëüøîé è ìàëîé ïîäêîæíûõ âåí äîñòóïíû ê ïðèìåíåíèþ, òîëüêî ðàäèî÷àñòîò- ó 5 ïàöèåíòîâ, è âñå îíè áûëè æåíùèíàìè. íàÿ àáëÿöèÿ (Ð×À) è ýíäîâàçàëüíàÿ ëàçåðíàÿ Ïîêàçàíèåì ê âûïîëíåíèþ ìàëîèíâàçèâ- êîàãóëÿöèÿ âåí (ÝÂËÊ). Îäíàêî, íåñìîòðÿ íà íûõ ìåòîäèê ÿâëÿëîñü íàëè÷èå âåðòèêàëüíî- ðÿä ïðåèìóùåñòâ ìàëîèíâàçèâíûõ ìåòîäîâ ãî ðåôëþêñà ïî áîëüøîé èëè (è) ìàëîé ïîä- íàä êëàññè÷åñêîé âåíýêòîìèåé, ñóùåñòâóåò êîæíîé âåíå â ñî÷åòàíèè ñ ãîðèçîíòàëüíûì ðÿä íåðåøåííûõ âîïðîñîâ â ýòîé îáëàñòè õè- âåíîçíûì ðåôëþêñîì â 95 % ñëó÷àåâ. ðóðãèè. Íà ñåãîäíÿøíèé äåíü îòñóòñòâóåò Äëÿ âûïîëíåíèÿ ðàäèî÷àñòîòíîé àáëÿöèè ñòàíäàðòèçèðîâàííàÿ ìåòîäèêà ïðîâåäåíèÿ èñïîëüçîâàëè ìåòîäèêó VNUS ClosureFast, à ÝÂËÊ è Ð×À, íåò ÷åòêèõ ïîêàçàíèé è ïðîòè- äëÿ âûïîëíåíèÿ ýíäîâàçàëüíîé ëàçåðíîé îá- âîïîêàçàíèé ê äàííûì âèäàì îïåðàòèâíîãî ëèòåðàöèè àïïàðàò «Ë³êà-õ³ðóðã» ãåíåðèðóþ- âìåøàòåëüñòâà [6].  ïîëíîé ìåðå íå èçó÷å- ùèé äëèíó âîëíû 1470 íì è ðàäèàëüíûå (êðó- íî âëèÿíèå íà ñèñòåìó ãåìîñòàçà è íåò ñòàí- ãîâûå) ñâåòîâîäû. äàðòîâ ïðîôèëàêòèêè âåíîçíûõ òðîìáîçîâ â Îïåðàòèâíîå ëå÷åíèå âûïîëíÿëè ñòàíäàð- ðàííåì ïîñëåîïåðàöèîííîì ïåðèîäå. Íå ïðî- òíî, ïîä ìåñòíîé àíåñòåçèåé 0,1 % ðàñòâî- ñëåæåíû îòäàëåííûå ðåçóëüòàòû ëå÷åíèÿ è ðîì Êëÿéíà. Ïóòåì ïóíêöèè ñòâîëà Áò èëè íå îïðåäåëåíî ìåñòî äàííûõ ìåòîäîâ â êîì- MÏB ïà ãðàíèöå ðåôëþêñà è ñîñòîÿòåëüíîãî ïëåêñíîì ëå÷åíèè áîëüíûõ ñ ÂÁÍÊ. ñòâîëà ïîä êîíòðîëåì ÓÇÄ ââîäèëè ýëåêòðîä/ Öåëü èññëåäîâàíèÿ – ïðîâåñòè àíàëèç ñâåòîâîä äî óñòüÿ v. åpigastrica, ïîñëå àáëÿ- ðåçóëüòàòîâ ëå÷åíèÿ áîëüíûõ âàðèêîçíîé áî- öèè ñòâîëà, ïðè íåîáõîäèìîñòè, è ïðèòîêîâ, ëåçíüþ ñ ïîìîùüþ ìàëîèíâàçèâíûõ ìåòîäîâ. âûïîëíÿëè ìèíèôëåáýêòîìèþ è ïåðåâÿçêó íå-

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) Õ²ÐÓÐÃ²ß 85

ñîñòîÿòåëüíûõ ïåðôîðàíòîâ. Óäàëåíèå âàðè- Ðåçóëüòàòû ëå÷åíèÿ áîëüíûõ ÷åðåç 6 ìå- êîçíî ðàñøèðåííûõ ïðèòîêîâ îñóùåñòâëÿëîñü ñÿöåâ ïîñëå îïåðàöèè ïðåäñòàâëåíû â òàáë. 3. ïî ìåòîäèêå Ìþëëåðà–Âàðàäè (ìèíèôëåáýê- Èç îñîáåííîñòåé îñëîæíåíèé, òàêèõ êàê ïà- òîìèÿ), ñ èñïîëüçîâàíèåì ñîîòâåòñòâóþùèõ ðåñòåçèè, íàëè÷èå ïîäêîæíîãî òÿæà, ãèïåðïèã- õèðóðãè÷åñêèõ èíñòðóìåíòîâ. Íåñîñòîÿòåëü- ìåíòàöèÿ êîæè, íàáëþäàëèñü â îáåèõ ãðóïïàõ. íûå ïåðôîðàíòû èëè ïðîæèãàëèñü èëè âûïîë- Àíàëèç êà÷åñòâà æèçíè ñïóñòÿ 6 ìåñÿöåâ íÿëàñü íàäôàñöèàëüíàÿ ïåðåâÿçêà. Chronic Venous Insufficiency Questionnaire  ðàííåì ïîñëåîïåðàöèîííîì ïåðèîäå (CIVIQ20) ïðåäñòàâëåí â òàáë. 4. áîëüíûå ïîëó÷àëè 3-õ äíåâíûé êóðñ àíòèáàê- Âûâîäû òåðèàëüíîé è àíòèêîàãóëÿïòíîé òåðàïèè, è â Çà ïîñëåäíèå äâà äåñÿòèëåòèÿ ëå÷åíèå âà- òå÷åíèå òðåõ íåäåëü ïðèìåíÿëè êîìïðåññè- ðèêîçíîé áîëåçíè çíà÷èòåëüíî ïðåòåðïåëî èç- îííûé òðèêîòàæ è ôëåáîòðîïíûå ïðåïàðàòû. ìåíåíèé. Íåñìîòðÿ íà ÷àñòî çàïóùåííîå çà- Äëÿ îöåíêè ðåçóëüòàòîâ è êà÷åñòâà ëå÷å- áîëåâàíèå, îäíèì èç ïðèîðèòåòíûõ òðåáîâà- íèÿ âñå áîëüíûå ïðîõîäèëè îñìîòð âðà÷à ñ íèé ê ëå÷åíèþ äàííîé ïàòîëîãèè ÿâëÿåòñÿ ìà- ïðîâåäåíèåì ÓÇÄà îïåðèðîâàííîé íèæíåé êî- ëîèíâàçèâíîñòü âìåøàòåëüñòâà, ìàêñèìàëü- íå÷íîñòè ñïóñòÿ 1, 6 è 12 ìåñÿöåâ, ïîñëå ïðî- íûé êîñìåòè÷åñêèé ýôôåêò è áûñòðîå âîññòà- âåäåííîãî ëå÷åíèÿ. Ïàöèåíòû çàïîëíÿëè îï- íîâëåíèå. ðîñíèê êà÷åñòâà æèçíè Chronic Venous Ïðèìåíåíèå ðàäèî÷àñòîòíîé àáëÿöèè è Insufficiency Questionnaire (CIVIQ 20) (7), ïå- ýíäîâàçàëüíîé ëàçåðíîé êîàãóëÿöèè âåí â ëå- ðåä îïåðàöèåé è ñïóñòÿ 6 ìåñÿöåâ ïîñëå ïðî- ÷åíèè âàðèêîçíîé áîëåçíè, ïîêàçûâàåò ïîëî- âåäåííîãî ëå÷åíèÿ. æèòåëüíûå ðåçóëüòàòû, à â áîëüøèíñòâå ñëó- Ðåçóëüòàòû è èõ îáñóæäåíèå ÷àåâ, ëó÷øå, ÷åì ïðè êëàññè÷åñêèõ õèðóðãè- Ó âñåõ 136 ïàöèåíòîâ ïàòîëîãè÷åñêèé âå- ÷åñêèõ âìåøàòåëüñòâàõ. Ýòî îáóñëîâëåíî, â íîçíûé ðåôëþêñ íå íàáëþäàëñÿ. Ó 2 ïàöèåí- ïåðâóþ î÷åðåäü, ìàëîé òðàâìàòè÷íîñòüþ. òîâ ÷åðåç á ìåñÿöåâ ïîñëå ÝÂËÊ â ñòâîëàõ Îäíèìè èç ôàêòîðîâ ÿâëÿþòñÿ ìàëûå ñðîêè áîëüøîé ïîäêîæíîé âåíû ïðè âûïîëíåíèè ïðåáûâàíèÿ ïàöèåíòà â êëèíèêå è åãî àêòèâè- ÓÇÄÃ-êîíòðîëÿ îïðåäåëÿëàñü ñåãìåíòàðíàÿ çàöèÿ ñðàçó ïîñëå îïåðàöèè, ÷òî ïîçâîëÿåò ðåêàíàëèçàöèÿ áåç ïàòîëîãè÷åñêîãî ðåôëþêñà. ñîõðàíÿòü ðåæèì ïîâñåäíåâíîé æèçíè. Èç ñóùåñòâåííûõ îñëîæíåíèé â ðàííåì Ïðè ñðàâíåíèè äâóõ ìåòîäîâ, íåëüçÿ ïîë- ïîñëåîïåðàöèîííîì ïåðèîäå ìîæíî âûäåëèòü íîöåííî âûäåëèòü, êàêîé èç íèõ ÿâëÿåòñÿ ëó÷- ñëåäóþùèå: òÿíóùèå áîëè ïî õîäó îáëèòåðè- øèì, êàæäûé ìåòîä èìååò ñâîè, íåçíà÷èòåëü- ðîâàííîé âåíû, ãåìàòîìû ïî õîäó îáëèòåðè- íûå, íà íàø âçãëÿä, ïðåèìóùåñòâà. Áîëåå âàæ- ðîâàííîé âåíû, òðîìáîç ìûøå÷íûõ ñèíóñîâ íî, ÷òîáû â àðñåíàëå ó âðà÷à áûëè äîñòóïíû (òàáë. 2). îáà ìåòîäà. Òàáëèöà 2. Ñòðóêòóðà è ÷àñòîòà ðàçâèòèÿ îñëîæíåíèé â ðàííåì ïîñëåîïåðàöèîííîì ïåðèîäå

Òàáëèöà 3. Ðåçóëüòàòû ëå÷åíèÿ áîëüíûõ âàðèêîçíîé áîëåçíüþ ÷åðåç 6 ìåñÿöåâ

'Òàáëèöà 4. Îöåíêà êà÷åñòâà æèçíè îïåðèðîâàííûõ ïàöèåíòîâ ÷åðåç 6 ìåñÿöåâ ïîñëå ìèíèèíâàçèâíîãî ëå÷åíèÿ

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Ëèòåðàòóðà 1. Ýíäîâàçàëüíàÿ îáëèòåðàöèÿ áîëüøîé ïîäêîæíîé âåíû ïðè âàðèêîçíîé áîëåçíè / Â. Þ. Áîãà- ÷åâ, À. È. Êèðèåíêî, È. À. Çîëîòóõèí [è äð.] // Àíãèîëîãèÿ è ñîñóäèñòàÿ õèðóðãèÿ. – 2004. – ¹ 10. – Ñ. 93–100. 2. Ñàâåëüåâ B. C. Ôëåáîëîãèÿ. Ðóêîâîäñòâî äëÿ âðà÷åé / Â. Ñ. Ñàâåëüåâ. – Ì.: Ìåäèöèíà, 2001. 3. Ôëåáîëîãèÿ: Ðóêîâîäñòâî äëÿ âðà÷åé / [Â. Ñ.Ñàâåëüåâ, Â. À. Ãîëîãîðñêèé, À. È. Êèðèåíêî è äð.] ; ïîä ðåä. Â. Ñ. Ñàâåëüåâà. – Ìîñêâà: Ìåäèöèíà, 2001. – 647 ñ. 4. Êîñèíñüêèé Î. Â. Õðîí³÷í³ çàõâîðþâàííÿ âåí íèæí³õ ê³íö³âîê: ñòðóêòóðà ³íâàë³äíîñò³ â Óê- ðà¿í³ çà 2011 ð³ê / Î. Â. Êîñèíñüêèé, Ä. Ë. Áóçìàêîâ // Êë³í³÷íà ôëåáîëîã³ÿ. – 2013. – Ò. 6 (1). – Ñ. 87–88. 5. Randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins / D. Caradice, I. Mekako, J. Hatfield, I. Chetter // Br J Surg. – 2011. – Vol. 98. – P. 501–510. 6. Comparable Effectiveness of Endovenous Laser Ablation and High Ligation with Stripping of the Great Saphenous Vein Two-Year Results of a Randomized Clinical Trial (RELACS Study) / K. Rass, N. Frings, P. Glowacki [et al.] // Arch Dermatol Published online September 19. – 2011. – DOI:10.1001/ 2011.272. 7. Øàéäàêîâ Å. Â. Êà÷åñòâî æèçíè, ñâÿçàííîå ñ õðîíè÷åñêèìè çàáîëåâàíèÿìè âåí / Å. Â. Øàé- äàêîâ, À. Â. Ïåòóõîâ, Å. À. Èëþõèí // Ôëåáîëîãèÿ. – 2011. – Òîì 5, ¹ 3. – Ñ. 64–68. References 1. Bogachev V.Yu., Kirienko A.I., Zolotuhin I.A. et al. (2004). Endovazalnaya obliteratsiya bolshoy podkozhnoy venyi pri varikoznoy bolezni [Endovasal obliteration of the great saphenous vein in varicose veins]. Angiologiya i sosudistaya hirurgiya – Angiology and vascular surgery, ¹ 10, ðð. 93–100 [in Russian]. 2. Savelev B.C. (2001). Flebologiya. Rukovodstvo dlya vrachey [Phlebology. A guide for doctors]. M.: Meditsina [in Russian]. 3. Savelev V.S., Gologorskiy V.A., Kirienko A.I. et al. (2001). Flebologiya: Rukovodstvo dlya vrachey [Phlebology: A Guide for Physicians]. V.S. Saveleva (Ed.). Moskva: Meditsina, 647 p. [in Russian]. 4. Kosinskiy O.V., Buzmakov D. L. (2013). Khronichni zakhvoryuvannya ven nyzhnikh kintsivok: struktura invalidnosti v Ukrayini za 2011 rik [Chronic diseases of the veins of the lower extremities: the structure of disability in Ukraine in 2011]. Klinichna flebolohiyavol – Clinical Phlebology, vol. 6 (1), pp. 87–88 [in Ukrainian]. 5. Caradice D., Mekako I., Hatfield J., Chetter I. (2011). Randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. Br J Surg, vol. 98, pp. 501–510. 6. Rass K., Frings N., Glowacki P. et al. (2011). Comparable Effectiveness of Endovenous Laser Ablation and High Ligation with Stripping of the Great Saphenous Vein Two-Year Results of a Randomized Clinical Trial (RELACS Study). Arch Dermatol Published online September 19, DOI:10.1001/ 2011.272. 7. Shaydakov E.V., Petuhov A.V., Ilyuhin E.A. (2011). Kachestvo zhizni, svyazannoe s hronicheskimi zabolevaniyami ven [Quality of life associated with chronic venous diseases]. Flebologiya – Phlebology, vol. 5, ¹ 3, pp. 64–68 [in Russian].

ª.Ã. ×åðêàøåíèíîâ, À.Ñ. Êàëìèêîâà ÐÅÇÓËÜÒÀÒÈ ÇÀÑÒÎÑÓÂÀÍÍß ÌÀËβÍÂÀÇÈÂÍÈÕ ÌÅÒÎIJ ˲ÊÓÂÀÍÍß ÂÀÐÈÊÎÇÍί ÕÂÎÐÎÁÈ Óïðîäîâæ 2015–2019 ðð. íàìè áóëî ïðîâåäåíî îïåðàòèâíå ë³êóâàííÿ 136 ïàö³ºíò³â ç ïðèâîäó âàðèêîçíî¿ õâîðîáè íèæí³õ ê³íö³âîê, ç íèõ ìåòîäîì åíäîâåíîçíî¿ ëàçåðíî¿ êîàãóëÿö³¿ áóëî ïðîîïåðî- âàíî 74 ïàö³ºíòè, ìåòîäîì ðàä³î÷àñòîòíî¿ àáëÿö³¿ – 62 ïàö³ºíòè. Äëÿ ðîçïîä³ëó õâîðèõ ïî òÿæêîñò³ çàõâîðþâàííÿ âèêîðèñòîâóâàëàñÿ ì³æíàðîäíà êëàñèô³êàö³ÿ õðîí³÷íî¿ âåíîçíî¿ íåäîñòàòíîñò³ (ÑÅÀÐ). Ñâ³ä÷åííÿì äî âèêîíàííÿ ìàëî³íâàçèâíèõ ìåòîäèê áóëà íàÿâí³ñòü âåðòèêàëüíîãî ðåôëþêñó ïî âå- ëèê³é àáî (òà) ìàë³é ï³äøê³ðí³é âåí³ ó ïîºäíàíí³ ç ãîðèçîíòàëüíèì âåíîçíèì ðåôëþêñîì ó 95 % âèïàäê³â. Äëÿ âèêîíàííÿ ðàä³î÷àñòîòíî¿ àáëÿö³¿ âèêîðèñòàëè ìåòîäèêó VNUS ClosureFast, à äëÿ âè- êîíàííÿ åíäîâàçàëüíî¿ ëàçåðíî¿ îáë³òåðàö³¿ – àïàðàò «Ë³êà-õ³ðóðã», ÿêèé ãåíåðóº äîâæèíó õâèë³ 1470 íì òà ðàä³àëüí³ (êðóãîâ³) ñâ³òëîïðîâîäè. Äëÿ îö³íêè ðåçóëüòàò³â ³ ÿêîñò³ ë³êóâàííÿ óñ³ õâîð³ ïðîõîäèëè îãëÿä ë³êàðÿ ç ïðîâåäåííÿì ÓÇÄà îïåðîâàíî¿ íèæíüî¿ ê³íö³âêè ÷åðåç 1, 6 ³ 12 ì³ñÿö³â ï³ñëÿ ïðîâåäå- íîãî ë³êóâàííÿ. Ïàö³ºíòè çàïîâíþâàëè îïèòóâà÷ ÿêîñò³ æèòòÿ Chronic Venous Insufficiency Questionnaire

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(CIVIQ 20) ïåðåä îïåðàö³ºþ ³ ÷åðåç 6 ì³ñÿö³â ï³ñëÿ ïðîâåäåíîãî ë³êóâàííÿ.  óñ³õ 136 ïàö³ºíò³â ïàòîëîã³÷íèé âåíîçíèé ðåôëþêñ íå ñïîñòåð³ãàâñÿ. Ó 2 ïàö³ºíò³â ÷åðåç 6 ì³ñÿö³â ï³ñëÿ ÝÂËÊ ó ñòâî- ëàõ âåëèêî¿ ï³äøê³ðíî¿ âåíè ïðè âèêîíàíí³ ÓÇÄÃ-êîíòðîëþ âèçíà÷àëàñÿ ñåãìåíòàðíà ðåêàíàë³çàö³ÿ áåç ïàòîëîã³÷íîãî ðåôëþêñó. Çàñòîñóâàííÿ ðàä³î÷àñòîòíî¿ àáëÿö³¿ òà åíäîâàçàëüíî¿ ëàçåðíî¿ êîàãó- ëÿö³¿ âåí ó ë³êóâàíí³ âàðèêîçíî¿ õâîðîáè ïîêàçóº ïîçèòèâí³ ðåçóëüòàòè, à ó á³ëüøîñò³ âèïàäê³â êðàù³, í³æ ïðè êëàñè÷íèõ õ³ðóðã³÷íèõ âòðó÷àííÿõ. Öå îáóìîâëåíî, ó ïåðøó ÷åðãó, ìàëîþ òðàâìàòè÷í³ñòþ. Îäíèìè ç ÷èííèê³â º ìàë³ òåðì³íè ïåðåáóâàííÿ ïàö³ºíòà â êë³í³ö³ òà éîãî àêòèâ³çàö³ÿ îäðàçó ï³ñëÿ îïåðàö³¿, ùî äîçâîëÿº çáåð³ãàòè ðåæèì ïîâñÿêäåííîãî æèòòÿ. Êëþ÷îâ³ ñëîâà: ìàëî³íâàçèâíå ë³êóâàííÿ, ðàä³î÷àñòîòíà àáëÿö³ÿ âåí, âåíîçíà íåäîñòàòí³ñòü.

E.G. Cherkasheninov, A.S. Kalmykova THE RESULTS OF THE APPLICATION OF LOW-INVASIVE METHODS FOR TREATMENT OF VARICOSE DISEASE From 2015 to 2019, we performed surgical treatment of 136 patients for varicose veins of the lower extremities, of whom 74 patients were operated on by endovenous laser coagulation, 62 patients were operated on by radiofrequency ablation. The international classification of chronic venous insufficiency (CEAP) was used to distribute patients according to the severity of the disease. The indication for minimally invasive techniques was the presence of vertical reflux along the major and/or minor saphenous vein in combination with horizontal venous reflux in 95 % of cases. To perform radiofrequency ablation, the VNUS ClosureFast technique was used, and to perform endovasal laser obliteration, the «Lika-Hirurg» apparatus generating a wavelength of 1470 nm and radial (circular) light guides. To assess the results and quality of treatment, all patients underwent examination by a doctor with USDG of the operated lower extremity 1, 6 and 12 months after the treatment. Patients completed the Chronic Venous Insufficiency Questionnaire (CIVIQ 20) before surgery and 6 months after treatment. In all 136 patients, pathological venous reflux was not observed. In 2 patients, 6 months after EVLK, when performing ultrasound control in the trunks of the great saphenous vein, segmental recanalization without pathological reflux was determined. The use of radiofrequency ablation and endovasal laser coagulation of veins in the treatment of varicose veins shows positive results, and in most cases better than in classical surgical interventions, which is primarily due to the low trauma. One of the factors is the short duration of the patient's stay in the clinic and its activation immediately after the operation, which allows maintaining the routine of daily life. Keywords: mini-invasive treatment, radiofrequency ablation of veins, venous insufficiency.

Íàä³éøëà äî ðåäàêö³¿ 20.11.2019

Êîíòàêòíà ³íôîðìàö³ÿ ×åðêàøåí³íîâ ªâãåí Ãåííàä³éîâè÷ – àñï³ðàíò Õàðê³âñüêîãî íàö³îíàëüíîãî ìåäè÷íîãî óí³- âåðñèòåòó. Àäðåñà: Óêðà¿íà, 61103, ì. Õàðê³â, â'¿çä Áàëàê³ðºâà, 1. Teë.: +380573494125. E-mail: [email protected] ORCID: https://orcid.org/0000-0002-9118-9704.

Êàëìèêîâà Àíàñòàñ³ÿ Ñåð㳿âíà – ë³êàð-õ³ðóðã ìåäè÷íîãî öåíòðó ÒΠ«ÏÐÈÂÀÒ Ê˲Ͳʻ, ì. Õàðê³â. Àäðåñà: Óêðà¿íà, 61002, ì. Õàðê³â, âóë. Äàðâ³íà, 8/10. Òåë.: +380934833648 E-mail: [email protected] ORCID: https://orcid.org/0000-0002-0725-093X.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 88 ÑÒÎÌÀÒÎËÎòß

СТОМАТОЛОГІЯ https://doi.org/10.35339/ekm.2019.85.04.14 ÓÄÊ 616.716.8+617.52]-089.844-76:615.46 DOI 10.31640/JVD.7-8.2019(0)

Î.Î. Àñòàïåíêî, Ò.Ì. Êîñòþê, Í.Ì. Ëèòîâ÷åíêî, Ò.Â. Òÿæêîðîá Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â ÄÎÑÂ²Ä ÂÈÊÎÐÈÑÒÀÍÍß ÐÅÇÎÐÁÒÈÂÍÈÕ ÌÀÒÅвÀË²Â Ó ÐÅÊÎÍÑÒÐÓÊÒÈÂÍÎ-²ÄÍÎÂÍ²É Õ²ÐÓÐò¯ Äîñë³äæóâàëè ï³äâèùåííÿ åôåêòèâíîñò³ õ³ðóðã³÷íîãî ë³êóâàííÿ õâîðèõ ³ç âðîäæåíîþ òà íàáóòîþ ê³ñòêîâîþ ïàòîëî㳺þ ùåëåïíî-ëèöüîâî¿ ä³ëÿíêè ç âèêîðèñòàííÿì ô³êñóþ- ÷èõ êîíñòðóêö³é çàäàíèõ âëàñòèâîñòåé ç á³îäåãðàäóþ÷îãî ìàòåð³àëó á³îàêòèâíî¿ ä³¿. Ïðè âèêîíàíí³ ðîáîòè íà åòàï³ êë³í³÷íî¿ ÷àñòèíè áóëè âèêîðèñòàí³ òàê³ ìåòîäè äîñë³äæåííÿ: êë³í³êî-ëàáîðàòîðí³, ðåíòãåíîëîã³÷í³ ìåòîäè (ðåíòãåíîãðàô³ÿ ê³ñòîê ëèöåâîãî ÷åðåïà â òðàäèö³éíèõ óêëàäêàõ, îðòîïàíòîìîãðàô³ÿ, ÊÒ 3D, ñòâîðåííÿ ³ àíàë³ç êîìï'þòåðíèõ 3-D ìîäåëåé, ðåíòãåíäåíñ³òîìåòð³ÿ, ðåíòãåíìîðôîìåòð³ÿ), ñòàòèñòè÷í³ ìåòîäè. Ðåçóëüòàòè äîñë³äæåííÿ ñòàëè îñíîâîþ äëÿ ïîøóêó ñïîñîá³â îòðèìàííÿ ìàòåð³àëó áåç ìåòàëåâîãî äåôåêòó, ç ÿêîãî ìîæíà áóëî á âèãîòîâèòè ô³êñàòîð ó âèãëÿä³ ïëàñòèí ³ ãâèíò³â äëÿ îñòåîñèíòåçó ùåëåïíî-ëèöåâî¿ ä³ëÿíêè. Ðîçðîáëåíî á³îðåçîðáòèâíèé ìàòåð³àë á³îàê- òèâíî¿ ä³¿ (ÅÏÏ-ÃÀÏ-ËÅÂ) íà îñíîâ³ ïîë³óðåòàíîâî¿ êîìïîçèö³¿, ùî ì³ñòèòü 20% ã³äðî- êñèàïàòèòó ³ 6 % ëåâàì³çîëà äëÿ îñòåîñèíòåçó. Äîâåäåíî åôåêòèâí³ñòü ô³êñàòîð³â ÅÏÓ- ÃÀÏ-ËÅ äëÿ îñòåîñèíòåçó ïðè ë³êóâàíí³ ïàö³ºíò³â ç ïåðåëîìàìè ³ äåôîðìàö³ÿìè ëèöå- âîãî ÷åðåïà. Ïîçèòèâí³ ðåçóëüòàòè âëàñíèõ êë³í³÷íèõ äîñë³äæåíü â ðàíí³ ³ â³ääàëåí³ òåðì³íè ñâ³ä÷èëè ïðî åôåêòèâí³ñòü ³ ïåðñïåêòèâí³ñòü âèêîðèñòàííÿ ïîë³ìåðíèõ (â òîìó ÷èñë³ ÅÏÓ-ÃÀÏ-ËÅÂ) ì³í³ïëàñòèí â õ³ðóðã³÷íîìó ë³êóâàíí³ ïåðåëîì³â ê³ñòîê ëèöåâîãî ÷åðåïà ç³ çì³ùåííÿì. Êëþ÷îâ³ ñëîâà: ïåðåëîìè, äåôîðìàö³ÿ, ùåëåïíî-ëèöåâà ä³ëÿíêà, îñòåîñèíòåç, á³î- ðåçîðáòèâí³ ïëàñòèíè, òèòàíîâ³ ïëàñòèíè. Âñòóï Ìåòà äîñë³äæåííÿ – ï³äâèùåííÿ åôåê- Ïðè âñ³õ ïîçèòèâíèõ âëàñòèâîñòÿõ òèòàíî- òèâíîñò³ õ³ðóðã³÷íîãî ë³êóâàííÿ õâîðèõ ³ç ïå- âèõ ô³êñàòîð³â îñòàíí³ìè ðîêàìè ç'ÿâèëàñÿ ðåëîìàìè òà äåôîðìàö³ÿìè ê³ñòîê ëèöåâîãî âåëèêà ê³ëüê³ñòü ïóáë³êàö³é ïðî çá³ëüøåííÿ ÷åðåïà øëÿõîì âèçíà÷åííÿ ïðè÷èííî-íàñë³äêî- ê³ëüêîñò³ óñêëàäíåíü ï³ñëÿ ìåòàëîîñòåîñèí- âèõ çâ'ÿçê³â óñêëàäíåíü ìåòàëîîñòåîñèíòåçó òåçó (ÌÎÑ) ç âèêîðèñòàííÿì òèòàíîâèõ íà- òà ðîçðîáêè, îá´ðóíòóâàííÿ, âèêîðèñòàííÿ, ê³ñòêîâèõ ïëàñòèí òà ãâèíò³â, ùî ñòàíîâèòü â³ä âïðîâàäæåííÿ ô³êñóþ÷èõ êîíñòðóêö³é äëÿ îñ- 5 äî 18 %, îòæå, âèíèêຠíåîáõ³äí³ñòü ¿õ âèäà- òåîñèíòåçó çàäàíèõ âëàñòèâîñòåé ³ç á³îäåãðà- ëåííÿ ï³ñëÿ êîíñîë³äàö³¿ ê³ñòêîâèõ ôðàãìåíò³â äóþ÷îãî ìàòåð³àëó á³îàêòèâíî¿ ä³¿. [1–5]. Ìàòåð³àë ³ ìåòîäè Çíà÷íå ïîøèðåííÿ òðàâìàòèçìó â ùåëåï- Äëÿ ðåàë³çàö³¿ ïîñòàâëåíèõ çàâäàíü ðîçðîá- íî-ëèöüîâ³é ä³ëÿíö³ (ÙËÄ) òà óñêëàäíåíü ï³ñëÿ ëåíî ïëàí íàóêîâèõ ïîñë³äîâíèõ äîñë³äæåíü, ÌÎÑ [6–8], íåäîñòàòíÿ åôåêòèâí³ñòü ìåòîä³â êîæíèé ç åòàï³â ÿêîãî ïåðåäáà÷àâ âèð³øåííÿ ô³êñàö³¿ ê³ñòêîâèõ ôðàãìåíò³â ç âèêîðèñòàííÿì çàâäàíü ïîïåðåäíüîãî. òèòàíîâèõ ô³êñàòîð³â, íåäîë³êè ³ñíóþ÷èõ á³î- Áóëî ñòâîðåíî á³îðåçîðáòèâíèé ìàòåð³àë ðåçîðáòèâíèõ ô³êñàòîð³â äëÿ îñòåîñèíòåçó á³îàêòèâíî¿ ä³¿ ç íåîáõ³äíèìè ô³çèêî-ìåõàí³÷- îáóìîâèëè àêòóàëüí³ñòü äîñë³äæåííÿ, âèçíà- íèìè âëàñòèâîñòÿìè, ðîçðîáëåíî ñïîñ³á éîãî ÷èëè éîãî ìåòó òà çàâäàííÿ. ñèíòåçó òà âèãîòîâëåííÿ ïðèñòðî¿â äëÿ îñòåî-

© Î.Î. Àñòàïåíêî, Ò.Ì. Êîñòþê, Í.Ì. Ëèòîâ÷åíêî, Ò.Â. Òÿæêîðîá, 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÑÒÎÌÀÒÎËÎÃ²ß 89

ñèíòåçó ê³ñòîê ëèöåâîãî â³ää³ëó ÷åðåïà, ïðî- âèâ³ëüíþþ÷èñü ç ïîë³ìåðíî¿ êîìïîçèö³¿, ïîâè- âåäåíî ðÿä åêñïåðèìåíòàëüíèõ äîñë³äæåíü. íåí ïîçèòèâíî âïëèâàòè íà çàãîºííÿ ê³ñòêîâî¿ Ó êë³í³ö³ äîñë³äæåíî 215 ïàö³ºíò³â ³ç ïåðå- ðàíè òà ì'ÿêèõ òêàíèí íà âñ³õ åòàïàõ ðåïàðà- ëîìàìè ê³ñòîê ëèöåâîãî â³ää³ëó ÷åðåïà ð³çíî¿ òèâíîãî ïðîöåñó. ëîêàë³çàö³¿ òà ð³çíî¿ äàâíîñò³, à òàêîæ ç äåôîð-  åêñïåðèìåíòàëüí³é ÷àñòèí³ äîñë³äæåí- ìàö³ÿìè ê³ñòîê ëèöåâîãî â³ää³ëó ÷åðåïà, ÿê³ íÿ âèâ÷èëè âëàñòèâîñò³ ÅÏÓ-ÃÀÏ-ËÅÂ-ïîë³- ïîòðåáóâàëè îïåðàòèâíîãî ë³êóâàííÿ; âèä³ëåí³ ìåðó, âèçíà÷èëè ìîæëèâ³ñòü éîãî çàñòîñóâàí- äâ³ ãðóïè. Äî îñíîâíî¿ ãðóïè (105 ïàö³ºíò³â) íÿ â ð³çíèõ ãàëóçÿõ ìåäèöèíè, ó òîìó ÷èñë³ óâ³éøëî 79 õâîðèõ ç³ 149 ïåðåëîìàìè ê³ñòîê ðåêîíñòðóêòèâíî-â³äíîâí³é õ³ðóð㳿 ÙËÄ. ëèöåâîãî â³ää³ëó ÷åðåïà, ÿêèì ïðîâåäåíî 143 Äàí³ åêñïåðèìåíòàëüíî¿ ÷àñòèíè äîñë³ä- îñòåîñèíòåçè ç âèêîðèñòàííÿì 152 ðåçîðáòèâ- æåííÿ ñòàëè ï³äñòàâîþ äëÿ ïðîâåäåííÿ êë³í³÷- íèõ ïîë³ìåðíèõ ïëàñòèí ç ãâèíòàìè, òà 26 õâî- íèõ äîñë³äæåíü. ðèõ ç äåôîðìàö³ÿìè ê³ñòîê ëèöåâîãî â³ää³ëó Îïåðàö³¿ îñòåîñèíòåçó ó 215 äîñë³äæóâà- ÷åðåïà, ÿêèì ïðîâåäåíî 36 îñòåîñèíòåç³â ç âè- íèõ õâîðèõ ïðîâîäèëè çà ïîêàçàííÿìè, ñåðåä êîðèñòàííÿì 41 ðåçîðáòèâíîãî ïîë³ìåðíîãî ÿêèõ äîì³íóâàëà íååôåêòèâí³ñòü êîíñåðâàòèâ- ô³êñàòîðà. Êîíòðîëüíó ãðóïó ñòàíîâèëè 110 ïà- íîãî ë³êóâàííÿ. Çàñòîñîâóâàëè îïåðàòèâí³ äî- ö³ºíò³â ç³ 175 ïåðåëîìàìè ê³ñòîê ëèöåâîãî ñòóïè, ÿê³ çàáåçïå÷óâàëè ðåïîçèö³þ òà ô³êñà- â³ää³ëó ÷åðåïà, ÿêèì ïðîâåäåíî 161 îïåðàö³þ ö³þ ê³ñòêîâèõ óëàìê³â ³ â³äïîâ³äàëè ïðèíöèïàì îñòåîñèíòåçó ç âèêîðèñòàííÿì 179 òèòàíîâèõ åñòåòèêè òà ôóíêö³îíàëüíîñò³ ó ùåëåïíî-ëè- ïëàñòèí òà ãâèíò³â çàðóá³æíèõ âèðîáíèê³â öåâ³é õ³ðóð㳿. Îïåðàö³¿ ïðîâîäèëè çã³äíî ç ðåã- (ô³ðìà «KLS Martin», ͳìå÷÷èíà). Óñ³ ïàö³ºíòè ëàìåíòîì ñó÷àñíèõ ïðîòîêîë³â õ³ðóðã³÷íîãî áóëè ïðàöåçäàòíîãî â³êó, ÷îëîâ³ê³â – 207 (96 %), ë³êóâàííÿ ïåðåëîì³â ³ ê³ñòêîâèõ äåôîðìàö³é æ³íîê – 8 (4 %). ÙËÄ, âèá³ð ô³êñàòîð³â, ¿õ ê³ëüêîñò³ òà ðîçòà- Ó ïåðåäîïåðàö³éíîìó ïåð³îä³ õâîðèõ îá- øóâàííÿ çä³éñíþâàëè, îð³ºíòóþ÷èñü íà ðåçóëü- ñòåæåíî çà êëàñè÷íèìè àëãîðèòìàìè äëÿ ö³º¿ òàòè òà ðåêîìåíäàö³¿ äîñë³äæåíü ç á³îìåõàí³- êàòåãîð³¿. Ïîêàçàííÿìè äî ïðîâåäåííÿ îñòåî- êè ïåðåëîì³â ÙËÄ. Äîäàòêîâó ì³æùåëåïíó ñèíòåçó áóëè: íååôåêòèâí³ñòü çàêðèòî¿ ðåïî- ³ììîá³ë³çàö³þ ùåëåï çä³éñíþâàëè ëèøå ïðè çèö³¿ ê³ñòêîâèõ óëàìê³â, íåìîæëèâ³ñòü çàáåç- ïåðåëîìàõ íèæíüî¿ ùåëåïè (ÍÙ) ó õâîðèõ ïå÷èòè ¿õ ñòàá³ëüí³ñòü ó ïðàâèëüíîìó ïîëî- îñíîâíî¿ òà êîíòðîëüíî¿ ãðóï, ïðè öüîìó ¿¿ òåð- æåíí³. Õ³ðóðã³÷íå ë³êóâàííÿ ïåðåäáà÷àëî ïðî- ì³íè ñòàíîâèëè (21±2) äîáè òà (18±2) äîáè âåäåííÿ â³äêðèòî¿ ðåïîçèö³¿ òà ô³êñàö³¿ óëàìê³â â³äïîâ³äíî. ç ïðèçíà÷åííÿì êóðñó àíòèáàêòåð³àëüíî¿, ïðîòè- Ñåðåäí³ òåðì³íè ãîñï³òàë³çàö³¿ õâîðèõ îñ- çàïàëüíî¿ òà ñèìïòîìàòè÷íî¿ òåðàﳿ â ï³ñëÿ- íîâíî¿ òà êîíòðîëüíî¿ ãðóï ç ïåðåëîìàìè ³ äå- îïåðàö³éíîìó ïåð³îä³. ôîðìàö³ÿìè âèëè÷íîãî êîìïëåêñó ñòàíîâèëè Åôåêòèâí³ñòü ë³êóâàííÿ âèçíà÷àëè òî÷í³- (7±2) äîáè òà (8±2) äîáè â³äïîâ³äíî, ç ïåðåëî- ñòþ â³äíîâëåííÿ àíàòîì³÷íî¿ ôîðìè ëèöåâîãî ìàìè òà äåôîðìàö³ÿìè ñåðåäíüî¿ ä³ëÿíêè îá- â³ää³ëó ÷åðåïà çà äàíèìè êîíòðîëüíî¿ ðåíòãå- ëè÷÷ÿ – (10±3) äîáè òà (11±3) äîáè, ÍÙ – íîãðàô³¿ àáî ÌÑÊÒ, çàãîºííÿì ï³ñëÿîïåðàö³é- (7±1) äîáà òà (6±1) äîáà â³äïîâ³äíî. íî¿ ðàíè, â³äñóòí³ñòþ çàïàëüíèõ óñêëàäíåíü, Ó õâîðèõ ³ç ïåðåëîìàìè òà äåôîðìàö³ÿìè ñêàðã ³ îñîáèñòèì çàäîâîëåííÿì ïàö³ºíò³â, ñòà- âèëè÷íîãî êîìïëåêñó ô³êñàö³þ ôðàãìåíò³â íîì ïðèêóñó, åñòåòè÷íèìè ïàðàìåòðàìè, ÷à- âèêîíóâàëè çà äîïîìîãîþ îäíî- (â ä³ëÿíö³ âè- ñòîòîþ ï³ñëÿîïåðàö³éíèõ óñêëàäíåíü òà àíà- ëè÷íî-ëîáíîãî øâà), äâî- (â ä³ëÿíö³ âèëè÷íî- ë³çîì ÿêîñò³ ê³íöåâîãî ðåçóëüòàòó. ëîáíîãî øâà òà âèëè÷íî-àëüâåîëÿðíîãî ãðåáíÿ) Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ àáî òðèëîêóñíî¿ (â ä³ëÿíö³ âèëè÷íî-ëîáíîãî Íàìè ñòâîðåíî á³îðåçîðáòèâíèé ìàòåð³àë øâà, âèëè÷íî-àëüâåîëÿðíîãî ãðåáíÿ, âèëè÷íî¿ á³îàêòèâíî¿ ä³¿, ÿêèé º åïîêñèïîë³óðåòàíîâîþ äóãè àáî íèæíüîîðá³òàëüíîãî êðàþ) ô³êñàö³¿. êîìïîçèö³ºþ, ùî ì³ñòèòü 20 % ã³äðîêñèàïàòè- Ó õâîðèõ ç ïåðåëîìàìè òà äåôîðìàö³ÿìè òó òà 6 % ëåâàì³çîëó (ÅÏÓ-ÃÀÏ-ËÅÂ), ç ÿêî¿ ñåðåäíüî¿ ä³ëÿíêè îáëè÷÷ÿ ô³êñàö³þ ê³ñòêîâèõ ìîæëèâî âèãîòîâèòè íàê³ñòêîâ³ ô³êñàòîðè äëÿ ôðàãìåíò³â çä³éñíþâàëè â ä³ëÿíêàõ âèëè÷íî- îñòåîñèíòåçó â ÙËÄ. óäðîêñèàïàòèò ó ñêëàä³ ëîáíîãî øâà, âèëè÷íî-àëüâåîëÿðíîãî ãðåáíÿ, ÅÏÓ-ÃÀÏ-ËÅ ïîçèòèâíî âïëèâຠíà ô³çèêî- íîñî-ëîáíîãî êîíòðôîðñó, âèëè÷íî¿ äóãè, íèæ- ìåõàí³÷í³ âëàñòèâîñò³ êîìïîçèö³¿, áåðå ó÷àñòü íüîîðá³òàëüíîãî êðàþ, âèëè÷íî-âåðõíüîùå- ó ïðîöåñ³ ðåãåíåðàö³¿ ê³ñòêîâî¿ òêàíèíè íà åòàï³ ëåïíîãî øâà ó ðàç³ ïîòðåáè. ì³íåðàë³çàö³¿ òà ðåìîäåëþâàííÿ. Ëåâàì³çîë, Ô³êñàòîð ïðè ïðîâåäåíí³ îñòåîñèíòåçó íà ô³êñîâàíèé íà ïîë³ìåðíîìó íîñ³¿, ïîñòóïîâî ÍÙ ï³äáèðàëè äèôåðåíö³éîâàíî, âðàõîâóþ÷è

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¿¿ àíàòîìî-òîïîãðàô³÷í³ òà ôóíêö³îíàëüí³ îñîá- ëèâîñò³, çàëåæíî â³ä á³îìåõàí³÷íèõ óìîâ ïå- ðåëîìó – â³ä ëîêàë³çàö³¿ òà òèïó. Ó âèïàäêàõ ïîîäèíîêîãî ïåðåëîìó â ä³ëÿíö³ ã³ëêè â îñ- íîâí³é ãðóï³ õâîðèõ âèêîðèñòîâóâàëè äâ³ íà- ê³ñòêîâ³ ïëàñòèíè ÅÏÓ-ÃÀÏ-ËÅ àáî îäíó òèòàíîâó ïëàñòèíó òà îäíó ÅÏÓ-ÃÀÏ-ËÅÂ- ïëàñòèíó ÿê äæåðåëî âèâ³ëüíåííÿ ëåâàì³çîëó äëÿ îïòèì³çàö³¿ óìîâ ðåãåíåðàö³¿ ê³ñòêîâî¿ òêà- íèíè òà ïðèñêîðåííÿ êîíñîë³äàö³¿ ê³ñòêîâèõ ôðàãìåíò³â, ó êîíòðîëüí³é ãðóï³ – îäíó òèòà- íîâó. Ïðè ïîäâ³éíèõ ïåðåëîìàõ ÍÙ â ä³ëÿíö³ ã³ëêè òà ï³äáîð³ääÿ, ó ïàö³ºíò³â îñíîâíî¿ ãðóïè â ä³ëÿíö³ ã³ëêè ÍÙ âèêîðèñòîâóâàëè äâ³ á³î- ðåçîðáòèâí³ ïëàñòèíè ÅÏÓ-ÃÀÏ-ËÅÂ, à â ä³- ëÿíö³ ï³äáîð³ääÿ – îäíó ÷è äâ³ òèòàíîâ³ ïëàñ- òèíè, îñê³ëüêè â ö³é ä³ëÿíö³ ô³êñàòîðè çàçíà- þòü çíà÷íîãî íàâàíòàæåííÿ é ðèçèê çì³ùåííÿ Ðèñ. 1. Õâîðèé Ï., 28 ðîê³â. ijàãíîç: ê³ñòêîâèõ óëàìê³â ó ï³ñëÿîïåðàö³éíîìó ïåð³îä³ òðàâìàòè÷íèé ïåðåëîì ïðàâî¿ âèëè÷íî¿ ê³ñòêè, âèñîêèé. ³äïîâ³äíî â êîíòðîëüí³é ãðóï³ õâî- ïîºäíàíèé ³ç äåôåêòîì äíà ïðàâî¿ îðá³òè. ðèõ ó öèõ ëîêóñàõ âñòàíîâëþâàëè òèòàíîâ³ Åòàï îïåðàö³¿ – ïîë³ìåðîñòåîñèíòåç ó ô³êñàòîðè (â ä³ëÿíö³ ã³ëêè – îäèí ô³êñàòîð, ä³ëÿíö³ ò³ëà âèëè÷íî¿ ê³ñòêè ïîáëèçó íèæíüî- îðá³òàëüíîãî êðàþ ó ä³ëÿíö³ ï³äáîð³ääÿ – äâà). Ó 97,4 % õâîðèõ îñíîâíî¿ ãðóïè ç ïåðåëî- ìàìè òà äåôîðìàö³ÿìè ñåðåäíüî¿ ä³ëÿíêè îá- ëè÷÷ÿ, âêëþ÷àþ÷è ä³ëÿíêó âèëè÷íîãî êîìï- ëåêñó, â ÿêèõ ô³êñàö³þ ê³ñòêîâèõ ôðàãìåíò³â çä³éñíþâàëè ç âèêîðèñòàííÿì ÅÏÓ-ÃÀÏ-ËÅÂ- ô³êñàòîð³â, îòðèìàíî çàäîâ³ëüí³ àíàòîì³÷í³ òà ôóíêö³îíàëüí³ ðåçóëüòàòè ë³êóâàííÿ. Ó 2 (2,6 %) ïàö³ºíò³â âíàñë³äîê ïîðóøåííÿ äðåíóâàííÿ ðàíè ñïîñòåð³ãàëè ¿¿ íàãíîºííÿ â ðàííüîìó ï³ñëÿîïåðàö³éíîìó ïåð³îä³. Çà äîïîìîãîþ êî- ðåêö³¿ äðåíóâàííÿ ðàíè òà àíòèá³îòèêîòåðàﳿ çàïàëüíèé ïðîöåñ áóëî óñóíåíî, ÅÏÓ-ÃÀÏ- ËÅÂ-ô³êñàòîð íå âèäàëÿëè. Ïðîòÿãîì ïåð³î- äó ñïîñòåðåæåííÿ (2 ðîêè) óñêëàäíåíü íå áóëî. Ðåàá³ë³òàö³ÿ ïàö³ºíò³â áóëà óñï³øíîþ. Ó 11 (91,7 %) ïàö³ºíò³â îñíîâíî¿ ãðóïè ç ïå- ðåëîìàìè òà äåôîðìàö³ÿìè ÍÙ îòðèìàíî çàäîâ³ëüíèé ðåçóëüòàò õ³ðóðã³÷íîãî ë³êóâàííÿ, ùî êë³í³÷íî ³ ðåíòãåíîëîã³÷íî ï³äòâåðäæåíî Ðèñ. 2. 3D çîáðàæåííÿ õâîðîãî Ï., 28 ðîê³â, ÷åðåç 1 ì³ñ ï³ñëÿ îïåðàö³¿. Óñêëàäíåíü çàïàëü- çà äàíèìè ÌÑÊÒ ÷åðåç òèæäåíü ï³ñëÿ îïåðàö³¿. íîãî õàðàêòåðó â ï³ñëÿîïåðàö³éíîìó ïåð³îä³ íå ijàãíîç: òðàâìàòè÷íèé ïåðåëîì ïðàâî¿ ñïîñòåð³ãàëè. Êîíñîë³äàö³ÿ ç'ºäíàíèõ ê³ñòêî- âèëè÷íî¿ ê³ñòêè, ïîºäíàíèé ³ç äåôåêòîì äíà ïðàâî¿ îðá³òè âèõ ôðàãìåíò³â â³äáóâàëàñÿ â÷àñíî.  1 (8,3 %) ïàö³ºíòà ç íåçðîùåíèì ïåðåëîìîì ó ä³ëÿíö³ Çàäîâ³ëüí³ ðåçóëüòàòè ë³êóâàííÿ îòðèìà- ï³äáîð³ääÿ â óìîâàõ íåô³êñîâàíîãî ïðèêóñó íî ó 93,8 % õâîðèõ êîíòðîëüíî¿ ãðóïè ç ïåðå- (áåç ³ììîá³ë³çàö³¿ ÍÙ) ïîë³ìåðîñòåîñèíòåç ëîìàìè òà äåôîðìàö³ÿìè ñåðåäíüî¿ ä³ëÿíêè äâîìà ÅÏÓ-ÃÀÏ-ËÅÂ-ïëàñòèíàìè é ãâèíòàìè îáëè÷÷ÿ.  ðàííüîìó ï³ñëÿîïåðàö³éíîìó ïå- áóâ íååôåêòèâíèì. Ó ï³ñëÿîïåðàö³éíîìó ïå- ð³îä³ óñêëàäíåíü íå ñïîñòåð³ãàëè. Ó 5 (6,17 %) ð³îä³ â³äáóëîñÿ çì³ùåííÿ ôðàãìåíò³â íà 4 ìì ïàö³ºíò³â òèòàíîâ³ ô³êñàòîðè âèäàëèëè ÷åðåç ïî âèñîò³, ùî ïîâ'ÿçàíî ç íåâ³äïîâ³äí³ñòþ ïà- 3-4 ì³ñ ï³ñëÿ îïåðàö³¿, îñê³ëüêè â ëîêóñàõ îñ- ðàìåòð³â ô³êñàòîðà óìîâàì ôóíêö³îíàëüíîãî òåîñèíòåçó â³äì³÷àëàñÿ â'ÿëà çàïàëüíà ðåàê- íàâàíòàæåííÿ (ðèñ. 1, 2). ö³ÿ íà ñòîðîííº ò³ëî ç óòâîðåííÿì íîðèöü òà

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÑÒÎÌÀÒÎËÎÃ²ß 91

ãðàíóëÿö³é, ÿêà ìàëà õðîí³÷íèé õàðàêòåð. Ñå- êèõ ñâ³æèõ ïåðåëîìàõ ã³ëêè òà âèðîñòêîâîãî ðåäíÿ òðèâàë³ñòü ñòàö³îíàðíîãî ë³êóâàííÿ â³äðîñòêà ùåëåïè. Ïèòàííÿ ïðî ðîçòàøóâàí- ïàö³ºíò³â îñíîâíî¿ ³ êîíòðîëüíî¿ ãðóï ñòàíîâè- íÿ á³îðåçîðáòèâíèõ ô³êñàòîð³â ó ä³ëÿíö³ øèé- ëà 7–8 (7±2) ä³á. êè âèðîñòêîâîãî â³äðîñòêà ³ â ä³ëÿíö³ âèð³çêè Ç óðàõóâàííÿì äàíèõ ë³òåðàòóðè, ðåçóëü- ÍÙ ïîòð³áíî âèð³øóâàòè ³íäèâ³äóàëüíî ç óðà- òàò³â âëàñíèõ äîñë³äæåíü ô³çèêî-ìåõàí³÷íèõ õóâàííÿì êîíêðåòíî¿ êë³í³÷íî¿ ñèòóàö³¿. âëàñòèâîñòåé ìàòåð³àëó ÅÏÓ-ÃÀÏ-ËÅÂ, ðå- Âñòàíîâëåííÿ ïîë³ìåðíèõ ô³êñàòîð³â ÅÏÓ- çóëüòàò³â äîñë³äæåíü ç á³îìåõàí³êè ïåðåëîì³â ÃÀÏ-ËÅ ó ä³ëÿíö³ çîâí³øíüî¿ êîñî¿ ë³í³¿ ïðè ÙËÄ ìè âèçíà÷èëè òà êîíêðåòèçóâàëè ïîêà- á³îìåõàí³÷íî ñïðèÿòëèâèõ ïîïåðå÷íèõ ïåðå- çàííÿ äî âèêîðèñòàííÿ ÅÏÓ-ÃÀÏ-ËÅÂ-ïðè- ëîìàõ êóòà ÍÙ âèÿâèëîñÿ åôåêòèâíèì ³ á³î- ñòðî¿â äëÿ îñòåîñèíòåçó ê³ñòîê ëèöåâîãî ìåõàí³÷íî îá´ðóíòîâàíèì. Ó ä³ëÿíö³ ò³ëà ÍÙ â³ää³ëó ÷åðåïà, à òàêîæ âèçíà÷èëè êë³í³÷í³ ñè- ³ ï³äáîð³ääÿ, ÿê³ çàçíàþòü çíà÷íèõ íàâàíòà- òóàö³¿, çà ÿêèõ çàñòîñîâóâàòè ¿õ íåäîö³ëüíî ³ æåíü òà ìàþòü ñêëàäíèé àíàòîì³÷íèé ðåëüºô, ìåòîäîì âèáîðó çàëèøàºòüñÿ ÌÎÑ. á³îðåçîðáòèâí³ ïëàñòèíè çàñòîñîâóâàëè ç îá- Òàê, âåðõíÿ ä³ëÿíêà îáëè÷÷ÿ âêëþ÷íî ç ä³- ìåæåííÿìè, ëèøå â êîìá³íàö³¿ ç øèíóâàííÿì ëÿíêîþ ïåðåí³ññÿ ³ íàäáð³âíèõ äóã çàçíຠíå- ùåëåïè àáî ïîºäíóâàëè ïîë³ìåð- òà ìåòàëîî- âåëèêèõ íàâàíòàæåíü, òîìó â ö³é ä³ëÿíö³ çà- ñòåîñèíòåç â îäíîìó ëîêóñ³. Ïðè öüîìó ïîë³- ñòîñóâàííÿ ô³êñàòîð³â ÅÏÓ-ÃÀÏ-ËÅ íàä³éíå ìåðíà ïëàñòèíà ÅÏÓ-ÃÀÏ-ËÅ â³ä³ãðàâàëà ³ äîö³ëüíå, îñê³ëüêè äîçâîëÿº óíèêíóòè äîäàò- ðîëü äîäàòêîâîãî ô³êñàòîðà ³ áóëà äæåðåëîì êîâîãî õ³ðóðã³÷íîãî âòðó÷àííÿ ç âèäàëåííÿ âèâ³ëüíåííÿ ëåâàì³çîëó, ÿêèé ïîçèòèâíî âïëè- ô³êñàòîðà. Ô³êñàòîðè ç á³îäåãðàäóþ÷èõ ìà- âàâ íà ðåïàðàö³þ òêàíèí â çîí³ îñòåîñèíòåçó. òåð³àë³â ðîçãëÿäàëè ÿê ìåòîä âèáîðó ïðè îñ- Òàêèì ÷èíîì, ðîçðîáëåíèé íàìè ë³êóâàëü- òåîñèíòåç³ â «ñòàòè÷íèõ» ä³ëÿíêàõ, ÿê³ â íîðì³ íèé ï³äõ³ä ³ç çàñòîñóâàííÿì çà ïîêàçàííÿìè çàçíàþòü íåçíà÷íèõ ôóíêö³îíàëüíèõ íàâàíòà- ïîë³ìåðíèõ ô³êñàòîð³â ÅÏÓ-ÃÀÏ-ËÅ ïîêà- æåíü (ëîáíà, ò³ì'ÿíà ê³ñòêè). Âèíÿòêîì çàëè- çàâ âèñîêó êë³í³÷íó åôåêòèâí³ñòü, ÿê ³ ïðè âè- øàþòüñÿ äð³áíî- òà áàãàòîóëàìêîâ³ ïåðåëî- êîðèñòàíí³ òèòàíîâèõ ô³êñàòîð³â äëÿ îñòåîñèí- ìè ïåðåäíüî¿ ñò³íêè ëîáíîãî ñèíóñà ³ ïåðå- òåçó. í³ññÿ, â ÿêèõ òèòàíîâ³ ñ³òêè ìàþòü ïåðåâàãè. Ðåçóëüòàòè ñòðóêòóðíî-ðåíòãåíîëîã³÷íîãî Ïðè ë³êóâàíí³ ïåðåëîì³â ñåðåäíüî¿ ä³ëÿíêè àíàë³çó çðîùåííÿ ê³ñòîê ó õâîðèõ ç ïåðåëîìà- îáëè÷÷ÿ íàéá³ëüø äîö³ëüíèìè ëîêóñàìè äëÿ ìè òà äåôîðìàö³ÿìè ê³ñòîê ëèöåâîãî â³ää³ëó ¿õ âñòàíîâëåííÿ áóëè âèëè÷íî-ëîáíèé òà íîñî- ÷åðåïà ïðè çàñòîñóâàíí³ ð³çíèõ ñïîñîá³â îñ- ëîáíèé êîíòðôîðñè. Ãîðèçîíòàëüí³ êîíòðôîð- òåîñèíòåçó â òåðì³í 6 ì³ñ ï³ñëÿ îïåðàö³¿ ó 83 ñè (ä³ëÿíêà íèæíüîãî êðàþ îðá³òè òà âèëè÷íî¿ (39 %) õâîðèõ (ç íèõ 38 ïàö³ºíò³â îñíîâíî¿ ãðóïè, äóãè) òàêîæ åôåêòèâíî â³äíîâëþâàëè ç âèêî- 45 – êîíòðîëüíî¿) ïîêàçàëè, ùî ðåãåíåðàö³ÿ ðèñòàííÿì á³îðåçîðáòèâíèõ ô³êñàòîð³â ïðè ê³ñòêîâî¿ òêàíèíè â ð³çíèõ ä³ëÿíêàõ ñåðåäíüî¿ àäåêâàòí³é ðåïîçèö³¿ ê³ñòêîâèõ ôðàãìåíò³â òà ä³ëÿíêè îáëè÷÷ÿ â³äáóâàëàñÿ ïî-ð³çíîìó. Òàê, ñòàá³ëüí³é ô³êñàö³¿ â ³íøèõ ëîêóñàõ ïåðåëîìó. â ä³ëÿíö³ âèëè÷íî-ëîáíîãî ç'ºäíàííÿ òà âèëè÷- Ìíîæèíí³ ïåðåëîìè âèëè÷íî¿ äóãè ñë³ä íî¿ äóãè ïðè òî÷í³é ðåïîçèö³¿ â òåðì³í 6 ì³ñÿö³â ô³êñóâàòè çà äîïîìîãîþ äåê³ëüêîõ ïîë³ìåð- ï³ñëÿ îïåðàö³¿ ù³ëèíà ïåðåëîìó ìàéæå íå ïðî- íèõ íàê³ñòêîâèõ ïëàñòèí (â³äïîâ³äíî äî ñë³äêîâóâàëàñÿ ³ â³ääèôåðåíö³þâàòè ä³ëÿíêó ê³ëüêîñò³ ë³í³é ïåðåëîìó), âèêîðèñòîâóþ÷è ðå- ê³ñòêîâîãî ðåãåíåðàòó â³ä ê³ñòêîâèõ øâ³â áóëî òåíö³éí³ âëàñòèâîñò³ ïîâåðõí³ ïåðåëîìó, äëÿ ïðàêòè÷íî íåìîæëèâî (ðèñ. 3). åôåêòèâíîãî ïåðåðîçïîä³ëó íàïðóæåííÿ. Àëå Ïåð³îñòàëüí³ ê³ñòêîâ³ íàøàðóâàííÿ áóëè ó âèïàäêàõ âèðàæåíî¿ íåñòàá³ëüíîñò³ äåÿêèõ â³äñóòí³ àáî ì³í³ìàëüíî âèðàæåí³ â ïåðåâàæí³é óëàìê³â ñë³ä â³äìîâèòèñÿ â³ä á³îðåçîðáòèâíèõ á³ëüøîñò³ âèïàäê³â. Íà åïþð³ ðåíòãåíîëîã³÷- ïëàñòèí íà êîðèñòü îäí³º¿ äîâãî¿ òèòàíîâî¿ íî¿ ù³ëüíîñò³ äàíèõ ëîêàë³çàö³é ïåðåëîìó íàê³ñòêîâî¿ ïëàñòèíè. Òèòàíîâèì ïëàñòèíàì â³äì³÷àëè ä³ëÿíêó ïëàâíîãî çíèæåííÿ ðåíòãå- íàäàâàëè ïåðåâàãó ïðè ïåðåëîìàõ ç äåôåêòîì íîëîã³÷íî¿ ù³ëüíîñò³, ÿêà áóëà íà 10–15 % ìåí- ê³ñòêè, çàñòàð³ëèõ, äð³áíî- òà áàãàòîóëàìêî- øå, í³æ íà íåóøêîäæåí³é ñèìåòðè÷í³é ä³ëÿíö³, âèõ ïåðåëîìàõ. ³ ïîøèðþâàëàñÿ íà â³äñòàíü 5–7 ìì â³ä ù³ëè- ÍÙ º ðóõîìîþ ê³ñòêîþ ëèöåâîãî â³ää³ëó íè ïåðåëîìó. Çíèæåííÿ ù³ëüíîñò³ ê³ñòêîâî¿ ÷åðåïà ³ òîìó çàçíຠíàéá³ëüøîãî íàâàíòàæåí- òêàíèíè áóëî ïëàâíèì, áåç ð³çêèõ ïåðåõîä³â ³ íÿ ï³ä ÷àñ æóâàííÿ. Îäíàê íàø äîñâ³ä ñâ³ä- ï³ê³â. ̳í³ìàëüíå çíà÷åííÿ ðåíòãåíîëîã³÷íî¿ ÷èòü, ùî çàñòîñóâàííÿ á³îðåçîðáòèâíèõ ô³êñà- ù³ëüíîñò³ ïðèáëèçíî â³äïîâ³äàëî ëîêàë³çàö³¿ òîð³â ó ä³ëÿíö³ ÍÙ äîñèòü åôåêòèâíå ïðè íèçü- ù³ëèíè ïåðåëîìó. Àëå â óñ³õ âèïàäêàõ ðåíò-

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 92 ÑÒÎÌÀÒÎËÎòß

Ðèñ. 3. Åïþðè ðåíòãåíîëîã³÷íî¿ ù³ëüíîñò³ ê³ñòêîâî¿ òêàíèíè, ïîáóäîâàí³ çà äàíèìè ÌÑÊÒ, õâîðî¿ Á., 25 ðîê³â, ÷åðåç 6 ì³ñ ï³ñëÿ îïåðàö³¿ – ðåôðàêòóðè, ðåïîçèö³¿, ïîë³ìåðîñòåîñèíòåçó (ÅÏÓ-ÃÀÏ-ËÅÂ) ë³âî¿ âèëè÷íî¿ ê³ñòêè ç ïðèâîäó ïîñòòðàâìàòè÷íî¿ äåôîðìàö³¿ ë³âîãî âèëè÷íî-îðá³òàëüíîãî êîìïëåêñó ãåíîëîã³÷íà ù³ëüí³ñòü ó öèõ ä³ëÿíêàõ áóëà Ïðè ïðîâåäåíí³ îñòåîñèíòåçó â êîíò- á³ëüøîþ çà 650 HU, ùî â³äïîâ³äàëî ù³ëüíîñò³ ðîëüí³é ãðóï³ ñïîñòåðåæåíü ìåòàëåâ³ ô³êñóþ÷³ ïîðîçíî¿ êîðòèêàëüíî¿ ê³ñòêè òà ñâ³ä÷èëî ïðî åëåìåíòè çà ðåíòãåíîëîã³÷íîþ ù³ëüí³ñòþ ñóò- óòâîðåííÿ êîìïàêòèçîâàíîãî ê³ñòêîâîãî ðåãå- òºâî ïåðåâèùóâàëè ðåíòãåíîëîã³÷íó ù³ëüí³ñòü íåðàòó â çîí³ çðîùåííÿ. Ñï³ââ³äíîøåííÿ ì³æ ê³ñòêè (â 1,5–2 ðàçè). Îçíàê îñòåîïîðîçó àáî ìàêñèìàëüíèì ³ ì³í³ìàëüíèì çíà÷åííÿì ðåíò- àòðîô³¿ ê³ñòêîâî¿ òêàíèíè ï³ä ïëàñòèíîþ â ä³- ãåíîëîã³÷íî¿ ù³ëüíîñò³ íà ãðàô³êó ¿¿ ðîçïîä³ëó ëÿíö³ ïðîâåäåííÿ âòðó÷àíü íå âèÿâëÿëè. Ðå- â çîí³ òðàâìè ñóòòºâî çìåíøóâàëîñÿ ïîð³âíÿíî çîðáö³þ ê³ñòêè íàâêîëî ô³êñóþ÷èõ ãâèíò³â ç ïåðåäîïåðàö³éíèìè ÌÑÊÒ ³ íàáëèæàëîñü äî â³äì³÷åíî ó 11 % ñïîñòåðåæåííÿõ, ùî íå ñó- ïîêàçíèêà ³íòàêòíî¿ ê³ñòêè, ÿêèé â ä³ëÿíö³ âè- ïðîâîäæóâàëîñÿ âòîðèííèì çì³ùåííÿì ôðàã- ëè÷íî-ëîáíîãî ç'ºäíàííÿ òà âèëè÷íî¿ äóãè ñòà- ìåíò³â ³ íå âïëèâàëî íà ïåðåá³ã ïðîöåñ³â ðåïà- íîâèâ 1,2–2,5. ðàòèâíî¿ ðåãåíåðàö³¿ ê³ñòêîâî¿ òêàíèíè. Ïðè Ó ä³ëÿíö³ âèëè÷íî-àëüâåîëÿðíîãî ãðåáíÿ öüîìó êë³í³÷í³ îçíàêè ðåàêö³¿ òêàíèí íà ñòî- òà â íèæí³õ â³ää³ëàõ íîñî-ëîáíîãî êîíòðôîðñó ðîííº ò³ëî, õîëîäîâó ðåàêö³þ, äèñêîìôîðò, à (41 õâîðèé) äèíàì³êà ðåïàðàòèâíèõ ïðîöåñ³â ³íîä³ á³ëü, ðîçõèòóâàííÿ òà âèïàä³ííÿ ãâèíò³â áóëà ³íøîþ ó çâ'ÿçêó ç ð³çíèì ðîçì³ðîì äåôåêò³â ó ä³ëÿíö³ ô³êñàòîð³â ìàëè ì³ñöå. Ó ðåøòè âè- ê³ñòêè. Ðåíòãåíîëîã³÷íà ù³ëüí³ñòü ó öèõ ä³ëÿí- ïàäê³â â³ääèôåðåíö³þâàòè îçíàêè îñòåîïîðî- êàõ ñòàíîâèëà â ñåðåäíüîìó (138±59) HU ³ áóëà çó ÷è ðåçîðáö³¿ ê³ñòêè â ä³ëÿíö³ øóðóïà é åôåêò â 5–16 ðàç³â íèæ÷îþ, í³æ íà çäîðîâ³é íåóø- «ðîçìèâàííÿ» ÌÑÊÒ çîáðàæåííÿ â ä³ëÿíêàõ êîäæåí³é ñòîðîí³. Ó 27 õâîðèõ áåçïåðåðâí³ñòü ð³çêîãî ïåðåõîäó â³ä âèñîêî¿ ðåíòãåíîëîã³÷íî¿ íîñî-ëîáíîãî òà âèëè÷íî-àëüâåîëÿðíîãî êîíòð- ù³ëüíîñò³ äî íèçüêî¿ áóëî ïðàêòè÷íî íåìîæ- ôîðñ³â áóëà â³äíîâëåíà ³ â ïåðåâàæí³é á³ëü- ëèâî. øîñò³ ñïîñòåðåæåíü (24 õâîðèõ) ìîæíà áóëî Ïîë³ìåðí³ ô³êñàòîðè íà ÌÑÊÒ íå â³çóàë³- ÷³òêî ëîêàë³çóâàòè ù³ëèíó ïåðåëîìó, àëå âîä- çóâàëèñÿ íàâ³òü ïðè çì³í³ ðåæèì³â êîíòðàñòó- íî÷àñ åïþðà ðåíòãåíîëîã³÷íî¿ ù³ëüíîñò³ çáå- âàííÿ. Îòâîðè äëÿ ô³êñóþ÷èõ ãâèíò³â íà äà- ð³ãàëà ð³âíîì³ðíèé õàðàêòåð âíàñë³äîê ñóòòº- íèé òåðì³í ñïîñòåðåæåííÿ íå çàì³ùóâàëèñÿ âîãî çíèæåííÿ ì³íåðàëüíî¿ íàñè÷åíîñò³ ïðè- ê³ñòêîâîþ òêàíèíîþ, ¿õ âì³ñò áóâ îäíîð³äíèì ëåãëèõ ä³ëÿíîê ê³ñòêè. Çàãàëîì ðåíòãåíîëîã³- ³ç ù³ëüí³ñòþ íà ð³âí³ (409±107) HU, ùî ìîæíà ÷íà ù³ëüí³ñòü ê³ñòêè â ä³ëÿíö³ çðîùåííÿ áóëà ïîÿñíèòè ïîÿâîþ ïåðøèõ ìîðôîëîã³÷íèõ îç- íà 20–30 % íèæ÷îþ, í³æ â ä³ëÿíö³ âèëè÷íî¿ íàê äåãðàäàö³¿ ïîë³ìåðó ÅÏÓ-ÃÀÏ-ËÅ ÷å- äóãè òà âèëè÷íî-ëîáíîãî ç'ºäíàííÿ. ðåç 6 ì³ñ ï³ñëÿ îñòåîñèíòåçó. Âèÿâëåí³ â ð³çíèõ çîíàõ ñåðåäíüî¿ ä³ëÿíêè ßê³ñíèõ ðîçá³æíîñòåé ó ôîðìóâàíí³ ê³ñòêî- îáëè÷÷ÿ â³äì³ííîñò³ ù³ëüíîñò³ ê³ñòêîâî¿ òêà- âîãî çðîùåííÿ óëàìê³â ñåðåäíüî¿ ä³ëÿíêè îá- íèíè âèçíà÷àëèñÿ òåõí³êîþ ïðîâåäåííÿ õ³ðóð- ëè÷÷ÿ ïðè çàñòîñóâàíí³ ð³çíèõ ñïîñîá³â ô³ê- ã³÷íèõ âòðó÷àíü, ð³çíèì ðåãåíåðàòîðíèì ïî- ñàö³¿, çà äàíèìè ÌÑÊÒ, äîñòîâ³ðíî¿ ð³çíèö³ òåíö³àëîì ð³çíèõ ê³ñòîê ëèöåâîãî â³ää³ëó ÷å- ó ïîêàçíèêàõ ðåíòãåíîëîã³÷íî¿ ù³ëüíîñò³ òà õà- ðåïà, îñîáëèâîñòÿìè àíàòî쳿 é ôóíêö³îíàëü- ðàêòåð³ ¿¿ ðîçïîä³ëó íà îäíîéìåííèõ àíàòîì³- íîãî íàâàíòàæåííÿ. ÷íèõ ä³ëÿíêàõ ïðè çàñòîñóâàíí³ îñòåîñèíòåçó

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÑÒÎÌÀÒÎËÎÃ²ß 93

àáî çàêðèò³é ðåïîçèö³¿ áåç âñòàíîâëåííÿ ô³êñà- ðàë³çàö³¿ ðåãåíåðàòó, íå ïîðóøóþ÷è ïðèðîäíèé òîðà íå âèÿâëåíî. Ñåðåäíº çíà÷åííÿ ðåíòãå- õ³ä ïðîöåñ³â çàãîºííÿ, à ÷àñòîòà çàì³ùåííÿ íîëîã³÷íî¿ ù³ëüíîñò³ ê³ñòêîâîãî çðîùåííÿ ïðè äåôåêò³â ðåãåíåðàòàìè, â ÿêèõ ïåðåâàæàëà çàñòîñóâàíí³ ïîë³ìåðîñòåîñèíòåçó áóëî âè- ê³ñòêîâà òêàíèíà, áóëà âèùîþ, í³æ ó ãðóï³, â ÿê³é ùèì, í³æ ïðè îñòåîñèíòåç³ òèòàíîâèìè ïëàñ- çàñòîñîâóâàëè òèòàíîâ³ ïëàñòèíè (íà 50 %, òèíàìè, – (896±121) HU ïðîòè (810±210) HU. ð<0,05). Çàïàëüíà ðåàêö³ÿ ó ô³áðîçí³é êàïñóë³ Îäíàê çà äàíî¿ ê³ëüêîñò³ ñïîñòåðåæåíü ö³ ðîç- íàâêîëî ³ìïëàíòàòó â³äïîâ³äàëà íåñïåöèô³÷- á³æíîñò³ áóëè íåäîñòîâ³ðíèìè. íîìó ïðîäóêòèâíîìó çàïàëåííþ íèçüêî¿ àêòèâ- Òàêèì ÷èíîì, ðåçóëüòàòè âèêîíàíî¿ ðîáîòè íîñò³ ÿê â ãðóï³, â ÿê³é çàñòîñîâóâàëè òèòàíîâ³ äîçâîëÿþòü çàïðîïîíóâàòè íîâ³ ï³äõîäè äî ïëàñòèíè, òàê ³ â ãðóï³, â ÿê³é çàñòîñîâóâàëè ë³êóâàííÿ ïàö³ºíò³â ç ïåðåëîìàìè òà äåôîð- ÅÏÓ-ÃÀÏ-ËÅÂ-ïëàñòèíè.  îòî÷óþ÷èõ ÅÏÓ- ìàö³ÿìè ê³ñòîê ëèöåâîãî â³ää³ëó ÷åðåïà. ÃÀÏ-ËÅÂ-ô³êñàòîð òêàíèíàõ íå âèÿâëåíî çì³í Âèñíîâêè òîêñè÷íîãî õàðàêòåðó. Îòðèìàíî á³îðåçîðáòèâíèé ìàòåð³àë á³î- Á³îäåãðàäóþ÷³ ïîë³ìåðí³ ô³êñàòîðè á³îàê- àêòèâíî¿ ä³¿ ÅÏÓ-ÃÀÏ-ËÅ äëÿ âèãîòîâëåííÿ òèâíî¿ ä³¿ ÅÏÓ-ÃÀÏ-ËÅ äîö³ëüíî âèêîðèñ- ô³êñóþ÷èõ êîíñòðóêö³é äëÿ îñòåîñèíòåçó â òîâóâàòè ïðè ïåðåëîìàõ (îñòåîòîì³ÿ) ê³ñòîê ÙËÄ, â ÿêîìó, ðåãóëþþ÷è ñï³ââ³äíîøåííÿ ëèöåâîãî â³ää³ëó ÷åðåïà â ä³ëÿíêàõ, ÿê³ íå çà- ïîë³óðåòàí-åïîêñèäíîãî îë³ãîìåðó, ã³äðîêñèà- çíàþòü çíà÷íîãî ôóíêö³îíàëüíîãî íàâàíòà- ïàòèòó ³ ëåâàì³çîëó, ìîæëèâî îòðèìóâàòè ìà- æåííÿ (âåðõíÿ òà ñåðåäíÿ òðåòèíè ëèöåâîãî òåð³àë ç íåîáõ³äíèìè ô³çèêî-ìåõàí³÷íèìè òà â³ää³ëó ÷åðåïà), ³ ïðè á³îìåõàí³÷íî ñïðèÿòëè- á³îëîã³÷íèìè âëàñòèâîñòÿìè. Îïòèìàëüíèì âèõ ïåðåëîìàõ ÍÙ ó ä³ëÿíêàõ, ùî çàçíàþòü âì³ñòîì ó ñêëàä³ öüîãî ìàòåð³àëó äëÿ âèãî- äåôîðìàö³é ðîçòÿãíåííÿ-ñòèñíåííÿ. Ïðè ôóíê- òîâëåííÿ íàê³ñòêîâèõ ïëàñòèí, ãâèíò³â äëÿ ö³îíàëüíî íåñòàá³ëüíèõ ïåðåëîìàõ ÍÙ ó ä³- îñòåîñèíòåçó º 20 % ã³äðîêñèàïàòèòó òà 6 % ëÿíêàõ ç³ çíà÷íèì á³îìåõàí³÷íèì íàâàíòàæåí- ëåâàì³çîëó. Âèêîðèñòàííÿ íàê³ñòêîâèõ ïëàñòèí íÿì íàê³ñòêîâ³ ô³êñàòîðè ç ÅÏÓ-ÃÀÏ-ËÅÂ- ç ÅÏÓ-ÃÀÏ-ËÅ ìàòåð³àëó çàáåçïå÷óâàëî ìàòåð³àëó ìîæíà ðåêîìåíäóâàòè ÿê äîäàòêî- àäåêâàòíå çàì³ùåííÿ ê³ñòêîâîãî äåôåêòó ÍÙ âó ô³êñàö³þ äî ìåòàëîîñòåîñèíòåçó â ä³ëÿíö³ íåçð³ëèìè ô³áðîçíî-ê³ñòêîâèìè ðåãåíåðàòàìè, ç ìåíøèì ôóíêö³îíàëüíèì íàâàíòàæåííÿì. ÿê³ çàïîâíþâàëè äåôåêò ç ïðèñêîðåííÿì ì³íå- Êîíôë³êòó ³íòåðåñ³â íåìàº.

˳òåðàòóðà 1. Âîçìîæíîñòè èñïîëüçîâàíèÿ óãëåðîäñîäåðæàùèõ ìàòåðèàëîâ â ÷åëþñòíî-ëèöåâîé õèðóðãèè / Â. Ì. Áåçðóêîâ, Ô. Õ. Íàáèåâ, À. Ñ. Ãðèãîðüÿí [è äð.] // Ñòîìàòîëîãèÿ ñåãîäíÿ è çàâòðà. – Ì., 2003. – Ñ. 77–83. 2. Áèîðåçîðáèðóåìûå ïîëèìåðû â îðòîïåäèèè è òðàâìàòîëîãèè / Â. Ðàä÷åíêî, Í. Äåäóõ, Ñ. Ìàëûøêèíà [è äð.] // Îðòîïåäèÿ, òðàâìàòîëîãèÿ è ïðîòåçèðîâàíèå. – 2006. – ¹ 3. – Ñ. 116–124. 3. Ðåçóëüòàòû õèðóðãè÷åñêîãî ëå÷åíèÿ ïåðåëîìîâ íèæíåé ÷åëþñòè ñ ïðèìåíåíèåì íàáîðà òèòà- íîâûõ ìèíèïëàñòèí è èíñòðóìåíòîâ äëÿ ÷åðåïíî- ÷åëþñòíî-ëèöåâîãî îñòåîñèíòåçà ôèðìû «Êîí- ìåò» / È. Í. Ìàòðîñ-Òàðàíåö, Ä. Ê. Êàëèíîâñêèé, Ò. Í. Õàõåëåâà [è äð.] // Ñîâðåìåííàÿ ñòîìàòîëî- ãèÿ. – 2004. – ¹ 1. – Ñ. 105–108. 4. Ðÿáîêîíü Å. Í. Âíóòðåííèé îñòåîñèíòåç ìèíèïëàñòèíàìè ïðè ëå÷åíèè áîëüíûõ ñ ïåðåëîìàìè ìûùåëêîâîãî îòðîñòêà íèæíåé ÷åëþñòè (îáçîð ëèòåðàòóðû) / Å. Í. Ðÿáîêîíü // Äåíòàëüíûå òåõíî- ëîãèè. – 2007. – ¹ 1. – Ñ. 59–62. 5. Osteosynthesis with biodegradable plates and screws of the free floating zygomatic arch. Results from the study / N. Andreopoulos, G. Stamatopoulos, A. Zavras [et al.] // J. Bone Joint Surg. Br. – 2004. – Vol. 86-B, Issue Supp II. – Ð. 157. – Ðåæèì äîñòóïó: http://www.bjjprocs.boneandjoint.org.uk/content/ 86-B/SUPP_II/157.4. 6. Husseiny M. Value of the resorbable biodegradable plates in fixation of mandibular fracture in children «2 years follow up» / M. Husseiny // J. Cranio-Maxillofac. Surg. – 2002. – Vol. 30, Suppl 1. – P. 38. 7. Äóäêî Î. Ã. Îñòåîñèíòåç ïåðåëîì³â ê³ñòîê ïîë³ìåðíèìè êîíñòðóêö³ÿìè, ùî ðîçñìîêòóþòüñÿ (îãëÿä ë³òåðàòóðè) / Î. Ã. Äóäêî // ³ñíèê îðòîïå䳿, òðàâìàòîëî㳿 òà ïðîòåçóâàííÿ. – 2011. – ¹ 1. – Ñ. 80–85. 8. Langford R. J. Tissue changes adjacent to titanium plates in patients / R. J. Langford, J. W. Frame // J. Cranio-Maxillofac. Surg. – 2002. – Vol. 30 (2). – P. 103–107.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 94 ÑÒÎÌÀÒÎËÎòß

Referenses 1. Bezrukov V.M., Nabyev F.X., Grygoryan A.S., Baryshnykov Y.V. (2003). Vozmozhnosty yspolzovaniya uglerodsoderzhashhyx materyalov v chelyustno-lycevoj hyrurgii [Possibilities of using carbon-containing materials in maxillofacial surge]. Stomatologiia segodnya i zavtra – Dentistry today and tomorrow, ðð. 77–83 [in Russian]. 2. Radchenko V., Dedux N., Malyshkina S., Bengus L. (2006). Biorezorbiruyemyye polimery v ortopediii i travmatologii [Bioresorbable polymers in orthopedics and traumatology]. Ortopediya, travmatologiya i protezirovaniye – Orthopedics, traumatology and prosthetics, ¹ 3, ðð. 116–124 [in Russian]. 3. Matros-Taranecz Y.N., Kalynovskyj D.K., Haheleva T.N. et. al. (2004). Rezultaty khirurgicheskogo lecheniya perelomov nizhney chelyusti s primeneniyem nabora titanovykh miniplastin i instrumentov dlya cherepno- chelyustno-litsevogo osteosinteza firmy «Konmet» [Results of surgical treatment of mandibular fractures using a set of titanium miniplates and instruments for craniomaxillofacial osteosynthesis by Konmet]. Sovremennaya stomatologyya – Modern dentistry, ðð. 105–108 [in Russian]. 4. Ryabokon E.N. (2007). Vnutrennyj osteosyntez mynyplastynamy pry lechenyy bolnyh s perelomamy myshhelkovogo otrostka nyzhnej chelyusty (obzor lyteratury) [Internal osteosynthesis with miniplates in the treatment of patients with fractures of the condylar process of the mandible (literature review)]. Dentalnye texnologyy – Dental technology, ¹ 1, ðð. 59–62 [in Russian]. 5. Andreopoulos N., Stamatopoulos G., Zavras A. et al. (2004). Osteosynthesis with biodegradable plates and screws of the free floating zygomatic arch. Results from the study. J. Bone Joint Surg. Br., vol. 86-B, issue suppl II, p. 157. Rtrieved from http://www.bjjprocs.boneandjoint.org.uk/content/86-B/ SUPP_II/157.4.N. 6. Husseiny M. (2002). Value of the resorbable biodegradable plates in fixation of mandibular fracture in children «2 years follow up». J. Cranio-Maxillofac. Surg., vol. 30, suppl 1, ð.38. 7. Dudko O.G. (2011). Osteosyntez perelomiv kistok polimernymy konstruktsiyamy, shcho rozsmoktuyutsya (ohlyad literatury) [Osteosynthesis of bone fractures by resorbable polymer structures (literature review)]. Visnyk ortopediyi, travmatologiyi ta protezuvannya – Bulletin of Orthopedics, Traumatology and Prosthetics, ¹ 1, ðð. 80–85 [in Ukrainian]. 8. Langford R.J., Frame J.W. (2002). Tissue changes adjacent to titanium plates in patients. J. Cranio-Maxillofac. Surg., vol. 30 (2), ðð.103–107.

Å.À. Àñòàïåíêî, Ò.Ì. Êîñòþê, Í.Ì. Ëèòîâ÷åíêî, Ò.Â. Òÿæêîðîá ÈÑÏÎËÜÇÎÂÀÍÈÅ ÊÎÍÑÒÐÓÊÖÈÉ ÈÇ ÁÈÎÄÅÃÐÀÄÈÐÓÞÙÅÃÎ ÌÀÒÅÐÈÀËÀ ÁÈÎÀÊÒÈÂÍÎÃÎ ÄÅÉÑÒÂÈß Â ÐÅÊÎÍÑÒÐÓÊÒÈÂÍÎ-ÂÎÑÑÒÀÍÎÂÈÒÅËÜÍÎÉ ÕÈÐÓÐÃÈÈ ×ÅËÞÑÒÍÎ-ËÈÖÅÂÎÉ ÎÁËÀÑÒÈ Èññëåäîâàëè ïîâûøåíèå ýôôåêòèâíîñòè õèðóðãè÷åñêîãî ëå÷åíèÿ áîëüíûõ ñ âðîæäåííîé è ïðè- îáðåòåííîé êîñòíîé ïàòîëîãèåé ÷åëþñòíî-ëèöåâîé îáëàñòè ñ èñïîëüçîâàíèåì ôèêñèðóþùèõ êîíñò- ðóêöèé çàäàííûõ ñâîéñòâ èç áèîðàçëàãàåìîãî ìàòåðèàëà áèîàêòèâíîãî äåéñòâèÿ. Ïðè âûïîëíåíèè ðàáîòû íà ýòàïå êëèíè÷åñêîé ÷àñòè áûëè èñïîëüçîâàíû ñëåäóþùèå ìåòîäû èññëåäîâàíèÿ: êëèíèêî- ëàáîðàòîðíûå, ðåíòãåíîëîãè÷åñêèå ìåòîäû (ðåíòãåíîãðàôèÿ êîñòåé ëèöåâîãî ÷åðåïà â òðàäèöèîí- íûõ óêëàäêàõ, îðòîïàíòîìîãðàôèè, ÊÒ 3D, ñîçäàíèå è àíàëèç êîìïüþòåðíûõ 3D ìîäåëåé, ðåíòãåí- äåíñèòîìåòðèÿ, ðåíòãåíìîðôîìåòðèÿ), ñòàòèñòè÷åñêèå ìåòîäû. Ðåçóëüòàòû èññëåäîâàíèÿ ÿâèëèñü îñíîâîé äëÿ ïîèñêà ñïîñîáîâ ïîëó÷åíèÿ ìàòåðèàëà áåç ìåòàëëè÷åñêîãî äåôåêòà, èç êîòîðîãî ìîæ- íî áûëî áû èçãîòîâèòü ôèêñàòîð â âèäå ïëàñòèí è âèíòîâ äëÿ îñòåîñèíòåçà â ÷åëþñòíî-ëèöåâîé îáëàñòè. Ðàçðàáîòàí áèîðàçëàãàåìûé ìàòåðèàë áèîàêòèâíîãî äåéñòâèÿ (ÝÏÓ-ÃÀÏ-ËÅÂ) íà îñíîâå ïîëèóðåòàíîâîé êîìïîçèöèè, ñîäåðæàùåé 20 % ãèäðîêñèàïàòèòà è 6 % ëåâàìèçîëà äëÿ ôèêñàöèè îñòåîñèíòåçà. Äîêàçàíà ýôôåêòèâíîñòü ôèêñàòîðîâ ÝÏÓ-ÃÀÏ-ËÅ äëÿ îñòåîñèíòåçà ïðè ëå÷åíèè ïàöèåíòîâ ñ ïåðåëîìàìè è äåôîðìàöèÿìè ëèöåâîãî ÷åðåïà. Ïîëîæèòåëüíûå ðåçóëüòàòû ñîáñòâåí- íûõ êëèíè÷åñêèõ èññëåäîâàíèé â ðàííèå è îòäàëåííûå ñðîêè ñâèäåòåëüñòâîâàëè îá ýôôåêòèâíîñòè è ïåðñïåêòèâíîñòè èñïîëüçîâàíèÿ ïîëèìåðíûõ (â òîì ÷èñëå ÝÏÓ-ÃÀÏ-ËÅÂ) ìèíèïëàñòèí â õèðóð- ãè÷åñêîì ëå÷åíèè ïåðåëîìîâ êîñòåé ëèöåâîãî ÷åðåïà ñî ñìåùåíèåì. Êëþ÷åâûå ñëîâà: ïåðåëîìû, äåôîðìàöèÿ, ÷åëþñòíî-ëèöåâàÿ îáëàñòü, îñòåîñèíòåç, áèîðåçîðá- òèâíûå ïëàñòèíû äëÿ îñòåîñèíòåçà, òèòàíîâûå ïëàñòèíû äëÿ îñòåîñèíòåçà.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÑÒÎÌÀÒÎËÎÃ²ß 95

O. Astapenko, T. Kostiuk, N. Lytovchenko, T. Tyazhkorob THE APPLICATION OF CONSTRUCTIONS MADE FROM BIODEGRADABLE MATERIAL WITH BIOACTIVE ACTION IN RECONSTRUCTIVE SURGERY OF MAXILLOFACIAL AREA Currently, titanium plates and screws are widely used to fix bone fragments in maxillofacial surgery. The need for a second operation to remove the metal structure increases the patient's incapacity for work, the economic costs of treatment and the psychoemotional load on the patient associated with anxiety and additional stress. All this has led to the emergence of an alternative method of osteosynthesis using biodegradable plates and screws, which do not have these disadvantages. With all the positive properties of titanium fixators in recent years there has been a large number of publications on the increase in complications after metal osteosynthesis (MOS) using titanium bone plates and screws, which is from 5 to 18 %, therefore, there is a need to remove them after consolidation of bone fragments. The results of the study were the basis for finding ways to obtain the material without metal defect, from which it would be possible to make fixator in the form of plates and screws for the osteosynthesis in maxillofacial region. It was developed biodegradable material of bioactive action (EPU-GAP-LEV) based on polyurethane composition which contains 20 % hydroxyapatite, and 6 % levamisole for osteosynthesis fixator. It was proved effectiveness of EPU-GAP-LEV fixators for osteosynthesis in the treatment of the patients with fractures and deformations of facial skull. Positive results of own clinical researches in early and long terms testified to efficiency and perspective of use of polymeric (including EPU-GAP-LEV) miniplasts in surgical treatment of fractures of facial skull with shift. Keywords: fractures, deformation, maxillo-facial area, osteosynthesis, biodegradable plates for osteosynthesis, titanium plates for osteosynthesis.

Íàä³ñëàíî äî ðåäàêö³¿ 02.12.2019

Êîíòàêòíà ³íôîðìàö³ÿ Àñòàïåíêî Îëåíà Îëåêñàíäð³âíà – äîêòîð ìåäè÷íèõ íàóê, äîöåíò êàôåäðè õ³ðóðã³÷íî¿ ñòîìàòîëî㳿 òà ùåëåïíî-ëèöåâî¿ õ³ðóð㳿 Íàö³îíàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó ³ìåí³ Î. Î. Áîãî- ìîëüöÿ, ì. Êè¿â. Àäðåñà: Óêðà¿íà, 01601, ì. Êè¿â, á-ð Øåâ÷åíêà,13, ÍÌÓ ³ìåí³ Î.Î. Áîãîìîëüöÿ. Òåë.: +380673270704. E-mail: [email protected]. ORCID: https://orcid.org/0000-0002-2168-9439.

Êîñòþê Òåòÿíà Ìèõàéë³âíà – êàíäèäàò ìåäè÷íèõ íàóê, äîöåíò êàôåäðè îðòîïåäè÷íî¿ ñòîìàòîëî㳿 Íàö³îíàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó ³ìåí³ Î. Î. Áîãîìîëüöÿ, ì. Êè¿â. Àäðåñà: Óêðà¿íà, 01601, ì. Êè¿â, á-ð Øåâ÷åíêà,13, ÍÌÓ ³ìåí³ Î.Î. Áîãîìîëüöÿ. Òåë.: +380683350403. E-mail: [email protected]. ORCID: https://orcid.org/0000-0001-6351-5181.

Ëèòîâ÷åíêî Íàòàë³ÿ Ìèõàéë³âíà – êàíäèäàò ìåäè÷íèõ íàóê, äîöåíò êàôåäðè õ³ðóðã³÷íî¿ ñòîìàòîëî㳿 òà ùåëåïíî-ëèöåâî¿ õ³ðóð㳿 Íàö³îíàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó ³ìåí³ Î. Î. Áî- ãîìîëüöÿ, ì. Êè¿â. Àäðåñà: Óêðà¿íà, 01601, ì. Êè¿â, á-ð Øåâ÷åíêà,13, ÍÌÓ ³ìåí³ Î.Î. Áîãîìîëüöÿ. Òåë.: +380978881912. E-mail: [email protected]. ORCID: https://orcid.org/0000-0001-6982-2764.

Òÿæêîðîá Òåòÿíà ³ëåí³âíà – êàíäèäàò ìåäè÷íèõ íàóê, àñèñòåíò êàôåäðè îðòîïåäè÷íî¿ ñòîìàòîëî㳿 Íàö³îíàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó ³ìåí³ Î. Î. Áîãîìîëüöÿ, ì. Êè¿â. Àäðåñà: Óêðà¿íà, 01601, ì. Êè¿â, á-ð Øåâ÷åíêà,13, ÍÌÓ ³ìåí³ Î.Î. Áîãîìîëüöÿ. Òåë.: +380663411767. E-mail: [email protected]. ORCID: https://orcid.org/0000-0001-9157-0866.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 96 ÑÒÎÌÀÒÎËÎòß

https://doi.org/10.35339/ekm.2019.85.04.15 ÓÄÊ 616.311.2-089.818.1

Ñ.Ñ. Òåðåõîâ, Í.Ñ. Õðîë Íàö³îíàëüíèé ìåäè÷íèé óí³âåðñèòåò ³ìåí³ Î.Î. Áîãîìîëüöÿ, ì. Êè¿â ÑÈÑÒÅÌÀ ÖÈÔÐÎÂÎÃÎ ÎÁ'ªÌÍÎÃÎ ÑÊÀÍÓÂÀÍÍß ÄËß Ï²ÄÂÈÙÅÍÍß ßÊÎÑÒ² ÐÅÒÐÀÊÖ²¯ ßÑÅÍÍÎÃÎ ÊÐÀÞ Ç ìåòîþ ï³äâèùåííÿ òî÷íîñò³ ãëèáèíè ïðåïàðóâàííÿ êóêñè äîñë³äæóâàíèõ çóá³â áóëî âèêîðèñòàíî òåõíîëîã³þ öèôðîâîãî îá'ºìíîãî ñêàíóâàííÿ ñèñòåìè CAD/CAM. Âèãî- òîâëÿëè ðîçá³ðí³ ã³ïñîâ³ ìîäåë³ äëÿ êîæíîãî êë³í³÷íîãî âèïàäêó òà ñêàíóâàëè ó ñèñòåì³ CAD – öèôðîâîìó îá'ºìíîìó ñêàíåð³. Çà äîïîìîãîþ âêàçàíî¿ òåõíîëî㳿 íà 3D ìîäåë³ âèçíà÷àëè òî÷íó ãëèáèíó ïðåïàðóâàííÿ êóêñè. Âñòàíîâèëè, ùî äîñë³äæåííÿ ìåòîäîì öèôðîâîãî îá'ºìíîãî ñêàíóâàííÿ ç ìåòîþ âèçíà÷åííÿ òà ïåðåâ³ðêè ãëèáèíè ïðåïàðó- âàííÿ äîñë³äæóâàíèõ çóá³â ë³êàðÿìè-îðòîïåäàìè, äຠçìîãó á³ëüø òî÷íî òà áåðåæíî ï³ä³éòè äî ïèòàííÿ ðàö³îíàëüíîñò³ ïðîâåäåííÿ ðåòðàêö³¿ ï³ä íåçí³ìí³ îðòîïåäè÷í³ êîíñò- ðóêö³¿. Êëþ÷îâ³ ñëîâà: öèôðîâèé â³äáèòîê, ðåòðàêö³ÿ ÿñåííîãî êðàþ, âíóòð³øíüîðîòîâèé ñêàíåð, âåëè÷èíà âåðòèêàëüíî¿ ðåòðàêö³¿, âåëè÷èíà ãîðèçîíòàëüíî¿ ðåòðàêö³¿.

Âñòóï ïîëåãøóº ïîäàëüøó ðîáîòó ³ ãàðàíòóº êðàùèé Ñèñòåìà öèôðîâîãî îá'ºìíîãî ñêàíóâàííÿ ðåçóëüòàò [5–6]. º îäíèì ç íàéá³ëüø ñó÷àñíèõ ìåòîä³â îòðè- ³äîáðàæåííÿ ïðîòåçíîãî ëîæà, îñîáëèâî ìàííÿ îïòè÷íèõ â³äáèòê³â, ÿê³ íàäàþòü ìîæ- ó ðàç³ ïðåïàðóâàííÿ ïðèÿñåííî¿ ä³ëÿíêè çóáà, ëèâ³ñòü ñòâîðþâàòè òðèâèì³ðí³ (3D) â³ðòóàëüí³ íåìîæëèâî áåç â³äòèñêóâàííÿ ÿñåííîãî êðàþ. çîáðàæåííÿ ïðåïàðîâàíèõ çóá³â, íà îñíîâ³ ÿêèõ Ìåòîþ ðåòðàêö³¿ º ðîçøèðåííÿ çóáîÿñåííî¿ âèãîòîâëÿþòüñÿ íåïðÿì³ ðåñòàâðàö³¿ (CAD/ áîðîçíè äëÿ îñòàòî÷íîãî ³ á³ëüø òî÷íîãî ïðå- CAM-ñèñòåìè) (ðèñóíîê). ïàðóâàííÿ òâåðäèõ òêàíèí çóáà â ïðèÿñåíí³é Çàñòîñóâàííÿ âíóòð³øíüîîðàëüíîãî ñêàíå- ä³ëÿíö³ áåç òðàâìóâàííÿ ÿñåí [7]. ðà ïîçáàâëÿº ïàö³ºíò³â íåïðèºìíèõ ïî÷óòò³â, Ìåòà äîñë³äæåííÿ – îö³íèòè âïëèâ öèô- ÿê³ âèêëèêàþòü òðàäèö³éí³ â³äáèòêîâ³ ìàòåð³à- ðîâîãî îá'ºìíîãî ñêàíóâàííÿ â òêàíèíàõ êðàéî- ëè. Áåçïîñåðåäíüî ïåðåä çàñòîñóâàííÿì ïî- âîãî ïàðîäîíòà ó ïàö³ºíò³â, ç ìåòîþ ï³äâèùåí- âåðõíÿ ³íòðàîðàëüíî¿ êàìåðè äåç³íô³êóºòüñÿ íÿ ÿêîñò³ ðåòðàêö³¿ ÿñåííîãî êðàþ. ñïåö³àëüíèìè çàñîáàìè àáî çàñòîñîâóºòüñÿ Ìàòåð³àë ³ ìåòîäè îäíîðàçîâèé ïëàñòèêîâèé ÷îõîë. Ñó÷àñí³ ñèñ- Íàìè áóëî îáñòåæåíî 39 ïàö³ºíò³â (28 æ³íîê òåìè íå ïîòðåáóþòü âèêîðèñòàííÿ ïîðîøêó òà 11 ÷îëîâ³ê³â). Îá'ºêòîì íàøîãî äîñë³äæåííÿ ç ä³îêñèäó òèòàíó [1–4]. áóâ ðåïðåçåíòàòèâíèé êîíòèíãåíò ïàö³ºíò³â Òàêîæ çá³ëüøóºòüñÿ øâèäê³ñòü îòðèìàí- ó ïåð³îä ïðîòåçóâàííÿ íåçí³ìíèìè êîíñòðóê- íÿ îïòè÷íèõ â³äáèòê³â çóá³â âíàñë³äîê òîãî, ùî ö³ÿìè ó ôðîíòàëüí³é ä³ëÿíö³. Êë³í³÷íå îáñòå- â³äïàëà íåîáõ³äí³ñòü ïðîâîäèòè ïðèì³ðêó â³ä- æåííÿ ïàö³ºíò³â ïðîâîäèëè ó â³êîâîìó ³íòåð- áèòêîâîþ ëîæêîþ, ðîçì³øóâàòè â³äáèòêîâ³ ìà- âàë³ â³ä 35 äî 55 ðîê³â. òåð³àëè òà ÷åêàòè ¿õ çàñòèãàííÿ. Äóæå øâèäêî Îêð³ì â³êîâîãî ä³àïàçîíó, îäíèì ç îñíîâ- ïðîâîäèòüñÿ àíàë³ç òðèâèì³ðíî¿ ìîäåë³, ÿêèé íèõ êðèòåð³¿â â³äáîðó ïàö³ºíò³â áóëà îáîâ'ÿç- äຠçìîãó îö³íèòè â³äïðåïàðîâàí³ çóáè òà ïðî- êîâà â³äñóòí³ñòü ñóá'ºêòèâíèõ ïðîÿâ³â òà êîíòðîëþâàòè øëÿõ âåäåííÿ ðåñòàâðàö³¿, à öå îðãàí³÷íèõ çì³í ó ñòðóêòóð³ ñêðîíåâî-íèæíü-

© Ñ.Ñ. Òåðåõîâ, Í.Ñ. Õðîë, 2019

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÑÒÎÌÀÒÎËÎÃ²ß 97

Öèôðîâ³ â³äáèòêè çàâàíòàæóâàëè ó ïðî- ãðàìíå çàáåçïå÷åííÿ CAD-KaVo multiCAD, â ÿêîìó çä³éñíþâàëè ïîºäíàííÿ â³ðòóàëüíèõ çîáðàæåíü, îòðèìàíèõ äî ðåòðàêö³¿, ç çîáðà- æåííÿìè, îòðèìàíèìè ï³ñëÿ ðåòðàêö³¿ ÿñåí. Ïîºäíàííÿ öèôðîâèõ â³äáèòê³â â ïðîãðàì- íîìó çàáåçïå÷åíí³ KaVo multiCAD çä³éñíþ- ºòüñÿ àâòîìàòè÷íî: ïðîãðàìà â òðèâèì³ðí³é ñèñòåì³ êîîðäèíàò ñàìîñò³éíî ðîçï³çíຠ³äåí- òè÷í³ òî÷êè íà äâîõ îá'ºêòàõ, çà ÿêèìè ³ â³äáó- âàºòüñÿ íàêëàäåííÿ äîñë³äæóâàíèõ îá'ºêò³â. Ñóì³ùåí³ òàêèì ÷èíîì â³ðòóàëüí³ çîáðà- æåííÿ åêñïîðòóâàëè â ïðîãðàì³ 3D PDF (Adobe Acrobat Document). Öåé äîäàòîê äîç- âîëÿº ïðîäèâëÿòèñü ñóì³ùåí³ öèôðîâ³ çîáðà- æåííÿ â ôîðìàò³ 3D, ïðîâîäèòè ë³í³éí³ òà îá'ºìí³ âèì³ðè, çä³éñíþâàòè ðîçòèí â³ðòóàëü- íîãî çîáðàæåííÿ â ð³çíèõ ïëîùèíàõ. Ó êîìï'þòåðíîìó ïðîãðàìíîìó çàáåçïå- Ñèñòåìà öèôðîâîãî îá'ºìíîãî ñêàíóâàííÿ. ÷åíí³ 3D PDF ïðîâîäèëè âèì³ðþâàííÿ âåëè- Ñêàíåð TRIOS Pod Color 3Shape ÷èíè ãîðèçîíòàëüíî¿ òà âåðòèêàëüíî¿ ðåòðàêö³¿ çóáîÿñåííî¿ áîðîçíè íà âåñòèáóëÿðí³é, îðàëüí³é îùåëåïíîãî ñóãëîáó, ùî ï³äòâåðäæóâàëîñÿ ³ êîíòàêòíèõ ïîâåðõíÿõ ÿñåííîãî êðàþ. ðåíòãåíîëîã³÷íî. Âèñíîâêè Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ ϳäñóìîâóþ÷è òà àíàë³çóþ÷è ðåçóëüòàòè Ïàö³ºíò³â, ïðè ñõîæèõ êë³í³÷íèõ ñèòóàö³ÿõ, äîñë³äæåíü, ìîæíà çðîáèòè âèñíîâîê, ùî äîñ- ðîçïîä³ëèëè íà äâ³ ãðóïè çà òèïîì ÿñåí. Äî ë³äæåííÿ ìåòîäîì öèôðîâîãî îá'ºìíîãî ñêà- ² ãðóïè óâ³éøëè ïàö³ºíòè ç òîâñòèì á³îòèïîì, íóâàííÿ ç ìåòîþ âèçíà÷åííÿ òà ïåðåâ³ðêè ãëè- äî ²² ãðóïè – ç òîíêèì á³îòèïîì. Ðåòðàêö³ÿ áèíè ïðåïàðóâàííÿ äîñë³äæóâàíèõ çóá³â ë³êà- ÿñåííîãî êðàþ ïðîâîäèëàñÿ çà äîïîìîãîþ ðÿìè-îðòîïåäàìè, äຠçìîãó á³ëüø òî÷íî òà íèòîê ç ïðîñî÷åííÿì òà ìåòîäèêè çàñòîñóâàí- áåðåæíî ï³ä³éòè äî ïèòàííÿ ðàö³îíàëüíîñò³ íÿ öèôðîâèõ â³äáèòê³â ç ìåòîþ âèâ÷åííÿ ÿêîñò³ ïðîâåäåííÿ ðåòðàêö³¿ ï³ä íåçí³ìí³ îðòîïåäè÷í³ ðåòðàêö³¿ ÿñåííîãî êðàþ. Ó êîæíîãî ïàö³ºíòà êîíñòðóêö³¿. Äàíèé ìåòîä º ñó÷àñíèì åòàïîì áóëè îòðèìàí³ äâà öèôðîâèõ â³äáèòêè çà äî- ä³àãíîñòèêè, ÿêèé ïîçáàâëÿº ïàö³ºíò³â íåïðèº- ïîìîãîþ âíóòð³øíüîðîòîâîãî ñêàíåðà iTERO, ìíèõ â³ä÷óòò³â, ÿê³ âèêëèêàþòü òðàäèö³éí³ ïåðøèé â³äáèòîê áóâ çðîáëåíèé äî ïðîâåäåí- â³äáèòêîâ³ ìàòåð³àëè, ñêàíóâàííÿ ïðîõîäèòü íÿ ðåòðàêö³¿ ÿñåííîãî êðàþ, äðóãèé – ï³ñëÿ. êîìôîðòíî, áåçáîë³ñíî òà åêîíîìèòü ÷àñ. ˳òåðàòóðà 1. Èáðàãèìîâ Ò. È. Àêòóàëüíûå âîïðîñû îðòîïåäè÷åñêîé ñòîìàòîëîãèè ñ óãëóáëåííûì èçó÷åíèåì ñîâðåìåííûõ ìåòîäîâ ëå÷åíèÿ / Ò. È. Èáðàãèìîâ, Í. À. Öàëèêîâà. – Ì.: Ïðàêòè÷åñêàÿ ìåäèöèíà. – 2006. – 255 ñ. 2. Æóëåâ Å. Í. Ìåòîäèêà ïðèìåíåíèÿ öèôðîâûõ îòòèñêîâ äëÿ èçó÷åíèÿ êà÷åñòâà ðåòðàêöèè äåñíå- âîãî êðàÿ / Å. Í. Æóëåâ // Êóáàíñêèé íàó÷íûé ìåäèöèíñêèé âåñòíèê. – 2017. – ¹ 1 (1). – Ñ. 46–48. 3. Ìåòîäû èçîëÿöèè ðàáî÷åãî ïîëÿ â ñòîìàòîëîãèè / [ïîä ðåä. ïðîô. È. Ì. Ìàêååâîé]. – Ì.: ÌÅÄïðåññ-èíôîðì, 2007. – 56 ñ. 4. Shillinburg H. Fundamentals of tooth preparation for cast metal and porcelain restorations / Shillinburg Í., Jacobi R., Brackett S. – Chicago – London – Berlin – St-Paulo – Tokyo and Hong Kong: Quintessence Publishing Co. – 1991. – 390 p. 5. Massironi D. Precision in dental esthetics. Clinical and laboratory procedures / D. Massironi, R. Pascetta, G. Romeo // Quintessence. – 2007. – 464 ð 6. Ðîçåíøòèëü Ñ. Ô. Îðòîïåäè÷åñêîå ëå÷åíèå íåñúåìíûìè ïðîòåçàìè / Ñ. Ô. Ðîçåíøòèëü. – Ì.: Ìåäïðåññ, 2010. – 940 ñ. 7. Áåëîâà Å. Þ. Êîìïëåêñíîå ëå÷åíèå çàáîëåâàíèé ïàðîäîíòà è ñëèçèñòîé îáîëî÷êè ïîëîñòè ðòà ñ ïðèìåíåíèåì ëàçåðíîãî õèðóðãè÷åñêîãî àïïàðàòà ñ êîìïüþòåðíûì óïðàâëåíèåì: àâòîðåô. äèñ. íà çäîáóòòÿ íàóê. ñòóïåíÿ êàíä. ìåä. íàóê / Å.Þ. Áåëîâà. – Ì., 1999. – 26 ñ.

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References 1. Ibragimov T.I., Tsalikova N.A. (2006). Aktualnyye voprosy ortopedicheskoy stomatologii s uglublennym izucheniyem sovremennykh metodov lecheniya [Topical issues of orthopedic dentistry with in-depth study of modern methods of treatment]. M.: Practical medicine, 255 p. [in Russian]. 2. Zhulev Ye.N. (2017). Metodika primeneniya tsifrovykh ottiskov dlya izucheniya kachestva retraktsii desnevogo kraya [Methodology of using digital impressions to study the quality of retraction of the gingival margin]. Kubanskiy nauchnyy meditsinskiy vestnik – Kuban Scientific Medical Bulletin, ¹ 1 (1), pp. 46–48 [in Russian]. 3. Makeeva I.M. (Eds.). (2007). Metody izolyatsii rabochego polya v stomatologii [Methods of isolation of the working field in dentistry]. M.: MEDpress-inform, 56 p. [in Russian]. 4. Shillinburg H., Jacobi R., Brackett S. (1991). Fundamentals of tooth preparation for cast metal and porcelain restorations. Chicago – London – Berlin – St-Paulo – Tokyo and Hong Kong: Quintessence Publishing Co, 390 p. 5. Massironi D., Pascetta R., Romeo G. (2007). Precision in dental esthetics. Clinical and laboratory procedures. Quintessence, 464 ð. 6. Rozenshtil S.F. (2010). Ortopedicheskoye lecheniye nes"yemnymi protezami [Orthopedic treatment with fixed prostheses]. M.: Medpress, 940 p. [in Russian]. 7. Belova E.Yu. (1999). Kompleksnoye lecheniye zabolevaniy parodonta i slizistoy obolochki polosti rta s primeneniyem lazernogo khirurgicheskogo apparata s komp'yuternym upravleniyem [Complex treatment of periodontal and oral mucosa diseases using a computer-controlled laser surgical device]. Extended abstracts of candidate's thesis [in Russian].

Ñ.Ñ. Òåðåõîâ, Í.Ñ. Õðîë ÑÈÑÒÅÌÀ ÖÈÔÐÎÂÎÃÎ ÎÁÚÅÌÍÎÃÎ ÑÊÀÍÈÐÎÂÀÍÈß ÄËß ÏÎÂÛØÅÍÈß ÊÀ×ÅÑÒÂÀ ÐÅÒÐÀÊÖÈÈ ÄÅÑÍÅÂÎÃÎ ÊÐÀß Ñ öåëüþ ïîâûøåíèÿ òî÷íîñòè ãëóáèíû ïðåïàðèðîâàíèÿ êóëüòè èññëåäóåìûõ çóáîâ áûëà èñïîëü- çîâàíà òåõíîëîãèÿ öèôðîâîãî îáúåìíîãî ñêàíèðîâàíèÿ ñèñòåìû CAD/CAM. Èçãîòàâëèâàëè ðàçáîð- íûå ãèïñîâûå ìîäåëè äëÿ êàæäîãî êëèíè÷åñêîãî ñëó÷àÿ è ñêàíèðîâàëè â ñèñòåìå CAD – öèôðîâîì îáúåìíîì ñêàíåðå. Ñ ïîìîùüþ óêàçàííîé òåõíîëîãèè íà 3D ìîäåëè îïðåäåëÿëè òî÷íóþ ãëóáèíó ïðåïàðèðîâàíèÿ êóëüòè. Óñòàíîâèëè, ÷òî èññëåäîâàíèÿ ìåòîäîì öèôðîâîãî îáúåìíîãî ñêàíèðîâà- íèÿ ñ öåëüþ îïðåäåëåíèÿ è ïðîâåðêè ãëóáèíû ïðåïàðèðîâàíèÿ èññëåäóåìûõ çóáîâ âðà÷àìè-îðòîïå- äàìè, ïîçâîëÿåò áîëåå òî÷íî è áåðåæíî ïîäîéòè ê âîïðîñó ðàöèîíàëüíîñòè ïðîâåäåíèÿ ðåòðàêöèè ïîä íåñúåìíûå îðòîïåäè÷åñêèå êîíñòðóêöèè. Êëþ÷åâûå ñëîâà: öèôðîâîé îòòèñê, ðåòðàêöèÿ äåñíåâîãî êðàÿ, âíóòðèðîòîâîé ñêàíåð, âåëè- ÷èíà âåðòèêàëüíîé ðåòðàêöèè, âåëè÷èíà ãîðèçîíòàëüíîé ðåòðàêöèè.

S.S. Terekhov, N.S. Khrol DIGITAL VOLUME SCANNING SYSTEM FOR IMPROVING THE QUALITY OF GARDEN RETRACTION Digital 3D scanning technology of the CAD / CAM system was used to increase the accuracy of the stump depth of the examined teeth. Collapsible plaster models were made for each clinical case and scanned in the CAD system - digital volume scanner. Using this technology on a 3D model to determine the exact depth of preparation of the stump. It was found that the study by digital volume scanning to determine and verify the depth of preparation of the examined teeth by orthopaedists, allows a more accurate and careful approach to the rationality of retraction for fixed orthopaedic structures. Keywords: digital imprint, gingival margin retraction, intraoral scanner, vertical retraction value, horizontal retraction value.

Íàä³éøëà äî ðåäàêö³¿ 25.09.2019

Êîíòàêòíà ³íôîðìàö³ÿ Òåðåõîâ Ñåðã³é Ñåðã³éîâè÷ – àñï³ðàíò êàôåäðè îðòîïåäè÷íî¿ ñòîìàòîëî㳿 Íàö³îíàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó ³ì. Î.Î. Áîãîìîëüöÿ, ì. Êè¿â. Àäðåñà: Óêðà¿íà, 03680, ì. Êè¿â, âóë. Çîîëîã³÷íà, 1, ê.322 Òåë.: +380633373505. E-mail: [email protected]. ORCID: https://orcid.org/0000-0002-4313-9497.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) ÑÒÎÌÀÒÎËÎÃ²ß 99

Õðîë ͳíà Ñåð㳿âíà – êàíäèäàò ìåäè÷íèõ íàóê, äîöåíò êàôåäðè îðòîïåäè÷íî¿ ñòîìàòî- ëî㳿 Íàö³îíàëüíîãî ìåäè÷íîãî óí³âåðñèòåòó ³ì. Î.Î. Áîãîìîëüöÿ, ì. Êè¿â. Àäðåñà: Óêðà¿íà, 03680, ì. Êè¿â, âóë. Çîîëîã³÷íà, 1, ê.322. Òåë.: +380672203768. E-mail: [email protected]. ORCID: https://orcid.org/0000-0003-3208-9057.

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85) 100

Âèìîãè äî îôîðìëåííÿ ñòàòåé äëÿ ïóáë³êàö³¿ â æóðíàë³

1. Æóðíàë ïðèéìຠäî ïóáë³êàö³¿ îðèã³íàëüí³ é îãëÿäîâ³ ñòàòò³ ïî ð³çíèõ ïðîáëåìàõ êë³í³÷íî¿ é åêñïåðèìåíòàëüíî¿ ìåäèöèíè. 2. Îá’ºì îðèã³íàëüíî¿ ñòàòò³ – 5–12 ñòîð³íîê òåêñòó, îãëÿäîâî¿ – äî 18, êîðîòêèõ ïîâ³äîìëåíü – äî 3 ñòîð³íîê. 3. Ñòàòòÿ ïîäàºòüñÿ â ðåäàêö³þ ó äâîõ äðóêîâàíèõ åêçåìïëÿðàõ òà â åëåêòðîííîìó âàð³àíò³ (íà äèñêó, ôëåøö³, åëåêòðîííîþ ïîøòîþ). 4. Òåêñòîâèé ôàéë íà äèñêó ïîâèíåí ìàòè ôîðìàò ðåäàêòîðà Word àáî .rtf òà ì³ñòèòèñÿ â îäíîìó ôàéë³. ²ì’ÿ ôàéëà (ëàòèíñüêèìè ë³òåðàìè) ïîâèííî â³äïîâ³äàòè ïð³çâèùó ïåðøîãî àâòîðà. 5. Òåêñò ñòàòò³ ìຠáóòè íàäðóêîâàíèé øðèôòîì Times New Roman, êåãëü 14, ì³æðÿäêîâèé ³íòåðâàë – ïîëóòîð- íèé. Îäíà ñòîð³íêà äðóêîâàíîãî òåêñòó ïîâèííà âì³ùàòè 60–65 çíàê³â ó ðÿäêó, 28–30 ðÿäê³â íà ñòîð³íö³. 6. Ðóêîïèñ ï³äïèñóºòüñÿ âñ³ìà àâòîðàìè. 7. Íà òèòóëüíîìó ëèñò³ ðîáîòè ïîâèííà çíàõîäèòèñÿ ïîçíà÷êà êåð³âíèêà óñòàíîâè, â ÿê³é âèêîíàíà ðîáîòà, ïðî äîçâ³ë íà ïóáë³êàö³þ (çàñâ³ä÷óºòüñÿ ïå÷àòêîþ). Äî ñòàòò³ äîäàþòüñÿ îô³ö³éíå íàïðàâëåííÿ â³ä êåð³âíèêà óñòàíîâè (àáî ³íøî¿ óïîâíîâàæåíî¿ îñîáè) òà äîâ³äêà ïðî ïåðåâ³ðêó íà ïëàã³àò. 8. Îðèã³íàëüí³ ñòàòò³ ïèøóòüñÿ çà òàêîþ ñõåìîþ: ÓÄÊ; Àâòîðè (³ì’ÿ, ïî áàòüêîâ³ òà ïð³çâèùå, ïîñàäà, çâàííÿ); Óñòàíîâà; Íàçâà ñòàòò³; Âñòóï (îïèñ ïðîáëåìè, ÿêà âèð³øóºòüñÿ ó ñòàòò³); Àíàë³ç ë³òåðàòóðíèõ äàíèõ (ïîñèëàííÿ íå ò³ëüêè íà ðîáîòè, ÿê³ ï³äêð³ïëþþòü ðåçóëüòàòè äîñë³äæåííÿ, à é íà ò³, ÿê³ ìàþòü ïðîòèð³÷÷ÿ; ðîáîòè, ÿê³ ï³äêðåñëþþòü íàóêîâó íîâèçíó ïðîáëåìè); Ìåòà ³ çàâäàííÿ äîñë³äæåííÿ; Ìàòåð³àë ³ ìåòîäè äîñë³äæåííÿ (ìຠáóòè ÷³òêî îïèñàíà ñèñòåìà äîñë³äæåííÿ òà øëÿõè îòðèìàííÿ ðåçóëüòàò³â); Ðåçóëüòàòè òà ¿õ îáãîâîðåííÿ (îïèñóºòüñÿ ðåçóëüòàò äîñë³äæåííÿ àáî åêñïåðèìåíòó; ðåçóëüòàòè ìîæóòü áóòè ïîäàí³ çà äîïîìîãîþ òàáëèöü, ä³àãðàì, ðèñóíê³â ³ îáîâ’ÿçêîâî ì³ñòèòè ïîÿñíþâàëüíó ÷àñòèíó); Âèñíîâêè (ïîð³âíþþòüñÿ ðåçóëüòàòè âëàñíîãî äîñë³äæåííÿ ç ðåçóëüòàòàìè ïîïåðåäíèê³â, ðîç’ÿñíþºòüñÿ, ÷èì ðåçóëüòàòè äîñë³äæåííÿ ìîæóòü áóòè êîðèñíèìè ó äàí³é ãàëóç³; ÿê ìîæíà çàñòîñîâóâàòè îòðèìàí³ ðåçóëüòàòè â ïîäàëüøîìó ÿê ó äàí³é ãàëóç³, òàê ³ â ³íøèõ; ÿê îòðèìàí³ ðåçóëüòàòè óçàãàëüíþþòü ðåçóëüòàòè ïîïåðåäí³õ äîñë³äæåíü); Ïåðñïåêòèâí³ñòü ïîäàëüøèõ äîñë³äæåíü; Ñïèñîê ë³òåðàòóðè (íå ìåíøå 7 äæåðåë ó ïîðÿäêó çãàäóâàííÿ â òåêñò³; ÿêùî àâòîð³â á³ëüøå ÷îòèðüîõ, âêàçóþòüñÿ òðè ïð³çâèùà, à ïîò³ì «òà ³í.», ÿêùî ÷îòèðè – âñ³ ÷îòèðè ïð³çâèùà; îáîâ’ÿçêîâî äàºòüñÿ íàçâà æóðíàëüíî¿ ñòàòò³). Îôîðìëþºòüñÿ â³äïîâ³äíî äî ÄÑÒÓ ÃÎÑÒ 7.1:2006. ̳í³ìóì 50% ïîñèëàíü ìàþòü áóòè íà ë³òåðàòóðí³ äæåðåëà, ÿê³ áóëè îïóáë³êîâàí³ íå ï³çí³øå 10 ðîê³â òîìó; Ñïèñîê ë³òåðàòóðè, òðàíñë³òåðîâàíèé àíãë³éñüêèìè ë³òåðàìè. Îôîðìëþºòüñÿ â³äïîâ³äíî äî ì³æíàðîäíîãî ñòàíäàðòó; Ðåçþìå ³ç íàçâîþ ³ ïð³çâèùåì àâòîðà, à òàêîæ êëþ÷îâ³ ñëîâà îáîâ’ÿçêîâî òðüîìà ìîâàìè – óêðà¿íñüêîþ, ðîñ³éñüêîþ, àíãë³éñüêîþ. Êëþ÷îâ³ ñëîâà ìàþòü áóòè ÿêîìîãà á³ëüø ³íôîðìàòèâíèìè. 9. Ñòàòòÿ ìîæå áóòè íàïèñàíà óêðà¿íñüêîþ, ðîñ³éñüêîþ àáî àíãë³éñüêîþ ìîâàìè. 10. Òåêñò ñòàòò³ ìîæå áóòè ³ëþñòðîâàíèé òàáëèöÿìè, ãðàô³êàìè, ñõåìàìè, ä³àãðàìàìè áóäü-ÿêîãî ñòóïåíÿ ñêëàäíîñò³, ôîòîãðàô³ÿìè ì³êðîïðåïàðàò³â. Òàáëèö³ ïîâèíí³ ìàòè âåðòèêàëüíó îð³ºíòàö³þ é ñòâîðþâàòèñÿ çà äîïîìîãîþ ìàéñòðà òàáëèöü (îïö³ÿ «Òàáëèöÿ – âñòàâèòè òàáëèöþ» ðåäàêòîðà Word). Ôîðìóëè ñòâîðþþòüñÿ çà äîïîìîãîþ ðåäàêòîðà ôîðìóë MS Equation (Âñòàâêà–Îá’ºêò–Equation), ãðàô³êè é ä³àãðàìè – çà äîïîìîãîþ MS Graph, MS Excel). Ôîòîãðàô³¿ é ³íø³ ðàñòðîâ³ çîáðàæåííÿ ñë³ä ïîäàâàòè â îðèã³íàë³ é îáîâ’ÿçêîâî îêðåìèìè ôàéëàìè TIFF, Photoshop PSD ç ðîçä³ëüíîþ çäàòí³ñòþ íå ìåíø í³æ 300 dpi. 11. Òåêñò ñòàòò³ é ìàòåð³àëè äî íå¿ ïîâèíí³ áóòè ðåòåëüíî âèâ³ðåí³; öèòàòè, òàáëèö³, ³ëþñòðàö³¿, ôîðìóëè, â³äîìîñò³ ïðî äîçóâàííÿ ïîâèíí³ áóòè çàâ³çîâàí³ àâòîðàìè íà ïîëÿõ. 12. Àâòîðàì íåîáõ³äíî ïîâ³äîìèòè òàê³ äàí³: ïð³çâèùå, ³ì’ÿ, ïî áàòüêîâ³, ì³ñöå ðîáîòè, ïîñàäó, íàóêîâèé ñòóï³íü, ó÷åíå çâàííÿ, òåìó âèêîíàíî¿ (âèêîíóâàíî¿) íàóêîâî¿ ïðàö³, äîìàøíþ àäðåñó, êîíòàêòí³ òåëåôîíè òà e-mail, ðåºñòðàö³éíèé íîìåð ORCID. Óñ³ ñòàòò³, ïîäàí³ â ðåäàêö³þ, ïðîõîäÿòü ðåäàãóâàííÿ é ðåöåíçóâàííÿ. Ðåäàêö³ÿ çàëèøຠçà ñîáîþ ïðàâî ñêîðî÷óâàòè é êîðèãóâàòè òåêñò ñòàòò³ â ÷àñòèí³, ùî íå ñòîñóºòüñÿ çì³ñòó ðîáîòè. Æóðíàë íå ïðèéìຠìàòåð³àëè, ðàí³øå îïóáë³êîâàí³ àáî ïîäàí³ äëÿ ïóáë³êàö³¿ â ³íø³ äðóêîâàí³ âèäàííÿ.

Òåë. +38 (057) 707-73-00 e-mail: [email protected]

ÅÊÑÏÅÐÈÌÅÍÒÀËÜÍÀ ² Ê˲Ͳ×ÍÀ ÌÅÄÈÖÈÍÀ. 2019. ¹ 4 (85)