эффект обучения лапароскопической хирургии в виртуальной

ɗɎɎȿɄɌ ɈȻɍɑȿɇɂə ɅȺɉȺɊɈɋɄɈɉɂɑȿɋɄɈɃ ɏɂɊɍɊȽɂɂ ȼ ȼɂɊɌɍȺɅɖɇɈɃ
ɊȿȺɅɖɇɈɋɌɂ: ɊȺɇȾɈɆɂɁɂɊɈȼȺɇɇɈȿ ɄɈɇɌɊɈɅɂɊɍȿɆɈȿ ɂɋɋɅȿȾɈȼȺɇɂȿ
Ʉɪɢɫɬɢɚɧ Ɋ. Ʌɚɪɫɟɧ ɢ ɫɨɚɜ.
ɍɧɢɜɟɪɫɢɬɟɬɫɤɚɹ Ʉɥɢɧɢɤɚ Ɋɢɝɯɫɯɨɫɩɢɬɚɥɢɬɟɬ, ɨɬɞ. ɝɢɧɟɤɨɥɨɝɢɢ. Ʉɨɩɟɧɝɚɝɟɧ, Ⱦɚɧɢɹ
(ɫɨɤɪɚɳɟɧɧɵɣ ɩɟɪɟɜɨɞ, Ƚɨɪɲɤɨɜ Ɇ.Ⱦ.)
Ɉɪɢɝɢɧɚɥ ɫɬɚɬɶɢ ɨɩɭɛɥɢɤɨɜɚɧ ɜ 2009 ɝ. ɜ «Ȼɪɢɬɚɧɫɤɨɦ Ɇɟɞɢɰɢɧɫɤɨɦ ɀɭɪɧɚɥɟ» (BMJ 2009;338:b1802)
Effect of virtual reality training on laparoscopic
surgery: randomised controlled trial
1
Christian R Larsen, clinical research fellow, Jette L Soerensen,
2
assistant professor and consultant, Teodor P Grantcharov, assistant
3
professor and consultant, Torur Dalsgaard, consultant,4 Lars
4
Schouenborg, consultant, Christian Ottosen, consultant,4 Torben V
5
Schroeder, professor and consultant, Bent S Ottesen, managing
6
director and professor at the Juliane Marie Centre
1
Department of Gynecology, Juliane Marie Centre for Children, Women and
Reproduction, Copenhagen University Hospital Rigshospitalet, Blegdamsvej
9, DK-2100 OE, Copenhagen, Denmark
2
Department of Obstetrics, Juliane Marie Centre, Copenhagen
3Division of General Surgery, St Michael’s Hospital, Toronto, ON, Canada
4Department of Gynecology, Juliane Marie Centre, Copenhagen
5Department of Vascular Surgery, Abdominal Centre, Copenhagen. University
Hospital Rigshospitalet, Copenhagen
6Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
Correspondence to: C R Larsen crl@dadlner.dk
Summary
Seven gynaecological departments in the Zeeland
region of Denmark participated in prospective
randomized controlled and blinded trial. 24 first and
second year residents specializing in gynecology and
ɊȿɁɘɆȿ
ɐɟɥɶɸ
ɧɚɫɬɨɹɳɟɝɨ
ɪɚɧɞɨɦɢɡɢɪɨɜɚɧɧɨɝɨ
ɤɨɧɬɪɨɥɢɪɭɟɦɨɝɨ ɫɥɟɩɨɝɨ ɢɫɫɥɟɞɨɜɚɧɢɹ ɛɵɥɨ
ɨɩɪɟɞɟɥɢɬɶ
ɷɮɮɟɤɬɢɜɧɨɫɬɶ
ɨɛɭɱɟɧɢɹ
ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɨɣ ɯɢɪɭɪɝɢɢ ɜ ɜɢɪɬɭɚɥɶɧɨɣ
ɪɟɚɥɶɧɨɫɬɢ. ȼ ɢɫɫɥɟɞɨɜɚɧɢɢ ɩɪɢɧɹɥɨ ɭɱɚɫɬɢɟ
24
ɪɟɡɢɞɟɧɬɚ-ɝɢɧɟɤɨɥɨɝɚ
ɢɡ
ɫɟɦɢ
ɝɢɧɟɤɨɥɨɝɢɱɟɫɤɢɯ
ɨɬɞɟɥɟɧɢɣ
ɪɚɡɥɢɱɧɵɯ
ɪɟɝɢɨɧɨɜ Ⱦɚɧɢɢ. ɍɱɚɫɬɧɢɤɢ ɨɫɧɨɜɧɨɣ ɝɪɭɩɩɵ
ɨɬɪɚɛɚɬɵɜɚɥɢ ɧɚ ɜɢɪɬɭɚɥɶɧɨɦ ɫɢɦɭɥɹɬɨɪɟ
ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɭɸ
ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɸ,
ɤɨɧɬɪɨɥɶɧɚɹ ɝɪɭɩɩɚ ɩɪɨɯɨɞɢɥɚ ɫɬɚɧɞɚɪɬɧɨɟ
ɤɥɢɧɢɱɟɫɤɨɟ ɨɛɭɱɟɧɢɟ. Ⱦɨ ɢ ɩɨɫɥɟ ɬɪɟɧɢɧɝɚ
ɫɚɦɨɫɬɨɹɬɟɥɶɧɨ
ɪɟɡɢɞɟɧɬɵ
ɨɛɟɢɯ
ɝɪɭɩɩ
ɜɵɩɨɥɧɹɥɢ
ɪɟɚɥɶɧɭɸ
ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɭɸ
ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɸ. Ⱦɜɚ ɧɟɡɚɜɢɫɢɦɵɯ ɷɤɫɩɟɪɬɚ,
ɧɟɨɫɜɟɞɨɦɥɟɧɧɵɟ
ɨ
ɫɬɚɬɭɫɟ
ɨɩɟɪɚɬɨɪɚ,
4
obstetrics participate in the trial. Proficiency based virtual
reality simulator training in laparoscopic salpingectomy
and standard clinical education (controls). The simulator
trained group (n=11) reached a median total score of 33
points with interquartile range of 32-36 points (technical
performance assessed by two independent observers
blinded to trainee and training status using a previously
validated general and task specific rating scale),
equivalent to the experience gained after 20-50
laparoscopic procedures, whereas the control group
(n=10) reached a median total score of 23 (22-27)
points, equivalent to the experience gained from fewer
than five procedures (P<0.001). The median total
operation time in the simulator trained group was 12
minutes (interquartile range 10-14 minutes) and in the
control group was 24 (20-29) minutes (P<0.001). The
observers’ inter-rater agreement was 0.79. Skills in
laparoscopic surgery can be increased in a clinically
relevant manner using proficiency based virtual reality
simulator training. The performance level of novices was
increased to that of intermediately experienced
laparoscopists and operation time was halved. Simulator
training should be considered before trainees carry out
laparoscopic procedures. Trial registration:
ClinicalTrials.gov NCT00311792.
ɨɰɟɧɢɜɚɥɢ ɭɪɨɜɟɧɶ ɩɪɚɤɬɢɱɟɫɤɨɝɨ ɧɚɜɵɤɚ
ɜɵɩɨɥɧɟɧɧɨɣ
ɨɩɟɪɚɰɢɢ.
Ʉɪɨɦɟ
ɬɨɝɨ,
ɫɪɚɜɧɢɜɚɥɨɫɶ
ɜɪɟɦɹ,
ɡɚɬɪɚɱɟɧɧɨɟ
ɧɚ
ɜɦɟɲɚɬɟɥɶɫɬɜɨ.
Ƚɪɭɩɩɚ
ɤɭɪɫɚɧɬɨɜ,
ɨɬɪɚɛɨɬɚɜɲɢɯ ɜɦɟɲɚɬɟɥɶɫɬɜɨ ɜ ɜɢɪɬɭɚɥɶɧɨɣ
ɪɟɚɥɶɧɨɫɬɢ
(n=11),
ɞɨɫɬɢɝɥɚ
ɫɪɟɞɧɟɝɨ
ɩɨɤɚɡɚɬɟɥɹ ɜ 33 ɛɚɥɥɚ (ɪɚɡɛɪɨɫ 32-36), ɱɬɨ
ɷɤɜɢɜɚɥɟɧɬɧɨ ɭɪɨɜɧɸ ɦɚɫɬɟɪɫɬɜɚ ɯɢɪɭɪɝɚ ɫɨ
ɫɪɟɞɧɢɦ
ɨɩɵɬɨɦ
ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɢɯ
ɜɦɟɲɚɬɟɥɶɫɬɜ
(20-50
ɫɚɦɨɫɬɨɹɬɟɥɶɧɵɯ
Ʉɭɪɫɚɧɬɵ ɠɟ ɤɨɧɬɪɨɥɶɧɨɣ
ɥɚɩɚɪɨɫɤɨɩɢɣ).
ɝɪɭɩɩɵ (n=10) ɩɨɤɚɡɚɥɢ ɫɪɟɞɧɢɣ ɪɟɡɭɥɶɬɚɬ ɜ 23
ɛɚɥɥɚ (22-27), ɫɪɚɜɧɢɦɵɣ ɫ ɨɩɵɬɨɦ ɜɵɩɨɥɧɟɧɢɹ
ɦɟɧɟɟ ɩɹɬɢ ɜɦɟɲɚɬɟɥɶɫɬɜ (P<0.001). ɋɪɟɞɧɹɹ
ɩɪɨɞɨɥɠɢɬɟɥɶɧɨɫɬɶ ɨɩɟɪɚɰɢɢ ɜ ɨɫɧɨɜɧɨɣ
ɝɪɭɩɩɟ ɫɨɫɬɚɜɢɥɚ 12 ɦɢɧɭɬ (ɨɬ 10 ɞɨ 14 ɦɢɧɭɬ),
ɚ ɜ ɤɨɧɬɪɨɥɶɧɨɣ 24 ɦɢɧɭɬɵ (20-29) (P<0.001).
Ʉɨɪɪɟɥɹɰɢɹ ɨɰɟɧɨɤ ɷɤɫɩɟɪɬɨɜ ɫɨɫɬɚɜɢɥɚ 0.79.
2(2) 2009
Ɍɚɤɢɦ ɨɛɪɚɡɨɦ, ɧɚɜɵɤɢ ɜ ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɨɣ
ɯɢɪɭɪɝɢɢ ɦɨɝɭɬ ɛɵɬɶ ɪɟɚɥɢɫɬɢɱɧɨ ɭɥɭɱɲɟɧɵ ɜ
ɯɨɞɟ ɬɪɟɧɢɧɝɚ ɧɚ ɜɢɪɬɭɚɥɶɧɨɦ ɫɢɦɭɥɹɬɨɪɟ.
ɍɪɨɜɟɧɶ ɩɪɚɤɬɢɱɟɫɤɨɝɨ ɦɚɫɬɟɪɫɬɜɚ ɧɚɱɢɧɚɸɳɢɯ
ɯɢɪɭɪɝɨɜ ɩɨɜɵɫɢɥɫɹ ɞɨ ɭɪɨɜɧɹ ɯɢɪɭɪɝɨɜ ɫɨ
ɫɪɟɞɧɢɦ ɩɪɚɤɬɢɱɟɫɤɢɦ ɨɩɵɬɨɦ, ɚ ɨɩɟɪɚɰɢɨɧɧɨɟ
ɜɪɟɦɹ ɫɨɤɪɚɬɢɥɨɫɶ ɜɞɜɨɟ.
Ⱦɨ ɧɚɱɚɥɚ
ɫɚɦɨɫɬɨɹɬɟɥɶɧɵɯ
ɜɦɟɲɚɬɟɥɶɫɬɜ
ɯɢɪɭɪɝɚɦ
ɫɥɟɞɭɟɬ ɩɪɨɯɨɞɢɬɶ ɜɢɪɬɭɚɥɶɧɵɣ ɬɪɟɧɢɧɝ.
ɇɨɦɟɪ
ɤɥɢɧɢɱɟɫɤɨɝɨ
ClinicalTrials.gov NCT00311792.
ɢɫɫɥɟɞɨɜɚɧɢɹ:
ȼȼȿȾȿɇɂȿ
Ʌɚɩɚɪɨɫɤɨɩɢɹ
ɫɬɚɥɚ
ɨɛɵɱɧɵɦ
ɦɟɬɨɞɨɦ,
ɩɪɢɦɟɧɹɟɦɵɦ ɜ ɛɨɥɶɲɢɧɫɬɜɟ ɯɢɪɭɪɝɢɱɟɫɤɢɯ
ɨɛɥɚɫɬɟɣ.1-3 ɗɬɨɬ ɦɟɬɨɞ ɩɨɹɜɢɥɫɹ ɛɥɚɝɨɞɚɪɹ
ɫɬɪɟɦɥɟɧɢɸ ɫɧɢɡɢɬɶ ɯɢɪɭɪɝɢɱɟɫɤɭɸ ɬɪɚɜɦɭ,
ɭɫɤɨɪɢɬɶ ɩɨɫɥɟɨɩɟɪɚɰɢɨɧɧɭɸ ɪɟɚɛɢɥɢɬɚɰɢɸ,
ɫɨɤɪɚɬɢɬɶ ɫɪɨɤ ɩɪɟɛɵɜɚɧɢɹ ɜ ɛɨɥɶɧɢɰɟ,
ɭɥɭɱɲɢɬɶ ɤɨɫɦɟɬɢɱɟɫɤɢɟ ɪɟɡɭɥɶɬɚɬɵ ɨɩɟɪɚɰɢɢ.4
ɉɪɢ ɷɬɨɦ ɥɚɩɚɪɨɫɤɨɩɢɹ ɚɫɫɨɰɢɢɪɭɟɬɫɹ ɫ
ɛɨɥɶɲɟɣ ɞɥɢɬɟɥɶɧɨɫɬɶɸ ɜɦɟɲɚɬɟɥɶɫɬɜɚ ɢ
ɛɨɥɟɟ ɜɵɫɨɤɢɦ ɩɨɤɚɡɚɬɟɥɟɦ ɯɢɪɭɪɝɢɱɟɫɤɢɯ
ɨɫɥɨɠɧɟɧɢɣ ɩɨ ɯɨɞɭ ɩɪɢɨɛɪɟɬɟɧɢɹ ɯɢɪɭɪɝɨɦ
ɩɪɚɤɬɢɱɟɫɤɨɝɨ ɨɩɵɬɚ. ɗɬɨ ɛɵɥɨ ɩɨɞɬɜɟɪɠɞɟɧɨ
ɜ ɪɚɡɥɢɱɧɵɯ ɫɩɟɰɢɚɥɢɡɚɰɢɹɯ, ɜɤɥɸɱɚɹ ɨɛɳɭɸ
ɯɢɪɭɪɝɢɸ,56 ɭɪɨɥɨɝɢɸ,78 ɞɟɬɫɤɭɸ ɯɢɪɭɪɝɢɸ,9 ɢ
ɝɢɧɟɤɨɥɨɝɢɸ.10
Ɍɟɯɧɢɱɟɫɤɢɟ
ɧɚɜɵɤɢ,
ɧɟɨɛɯɨɞɢɦɵɟ ɜ ɥɚɩɚɪɨɫɤɨɩɢɢ, ɪɚɞɢɤɚɥɶɧɨ
ɨɬɥɢɱɚɸɬɫɹ ɨɬ ɧɚɜɵɤɨɜ ɬɪɚɞɢɰɢɨɧɧɨɣ ɨɬɤɪɵɬɨɣ
ɯɢɪɭɪɝɢɢ
ɢ
ɯɚɪɚɤɬɟɪɢɡɭɸɬɫɹ
ɛɨɥɟɟ
ɩɪɨɞɨɥɠɢɬɟɥɶɧɨɣ
ɤɪɢɜɨɣ
ɨɛɭɱɟɧɢɹ.
ɍɧɢɤɚɥɶɧɚɹ ɬɟɯɧɢɤɚ ɷɧɞɨɯɢɪɭɪɝɢɢ ɜ ɫɨɱɟɬɚɧɢɢ
ɫ ɜɨɡɪɚɫɬɚɸɳɢɦ ɜɧɢɦɚɧɢɟɦ ɤ ɛɟɡɨɩɚɫɧɨɫɬɢ ɢ
ɩɪɚɜɚɦ ɩɚɰɢɟɧɬɚ, ɫɨɤɪɚɳɟɧɢɟ ɪɚɛɨɱɢɯ ɱɚɫɨɜ ɢ
ɫɬɨɢɦɨɫɬɶ
ɜɪɟɦɟɧɢ,
ɩɪɨɜɟɞɟɧɧɨɝɨ
ɜ
ɨɩɟɪɚɰɢɨɧɧɨɣ, – ɜɨɬ ɮɚɤɬɨɪɵ, ɨɫɩɚɪɢɜɚɸɳɢɟ
ɥɢɞɟɪɫɬɜɨ
ɬɪɚɞɢɰɢɨɧɧɨɣ
ɯɢɪɭɪɝɢɢ
ɢ
ɫɩɨɫɨɛɫɬɜɭɸɳɢɟ ɪɚɡɜɢɬɢɸ ɧɨɜɵɯ ɦɟɬɨɞɨɜ,
ɩɪɢɦɟɧɹɟɦɵɯ ɩɪɢ ɨɛɭɱɟɧɢɢ ɥɚɩɚɪɨɫɤɨɩɢɢ.12
ɏɨɬɹ ɦɨɞɟɥɢɪɨɜɚɧɢɟ ɜ ɜɢɪɬɭɚɥɶɧɨɣ ɪɟɚɥɶɧɨɫɬɢ
ɞɚɟɬ ɜɚɠɧɵɟ ɩɪɟɢɦɭɳɟɫɬɜɚ ɩɪɢ ɨɫɜɨɟɧɢɢ
ɧɨɜɵɯ ɧɚɜɵɤɨɜ ɢ ɩɪɨɰɟɞɭɪ, ɦɵ ɜɫɟ ɠɟ
ɪɚɫɩɨɥɚɝɚɟɦ
ɨɝɪɚɧɢɱɟɧɧɵɦ
ɤɨɥɢɱɟɫɬɜɨɦ
ɫɜɢɞɟɬɟɥɶɫɬɜ ɜɨɡɦɨɠɧɨɫɬɢ ɩɪɢɦɟɧɟɧɢɹ ɧɚ
ɩɪɚɤɬɢɤɟ
ɧɚɜɵɤɨɜ,
ɢɫɩɨɥɶɡɨɜɚɧɧɵɯ
ɜ
13 14
ɦɨɞɟɥɢɪɨɜɚɧɧɨɣ ɧɚ ɤɨɦɩɶɸɬɟɪɟ ɫɪɟɞɟ.
Ɇɵ
ɢɡɭɱɢɥɢ ɷɮɮɟɤɬ ɜɢɪɬɭɚɥɶɧɨɝɨ ɬɪɟɧɢɧɝɚ ɧɚ
ɤɚɱɟɫɬɜɨ
ɧɚɜɵɤɨɜ,
ɩɪɢɨɛɪɟɬɟɧɧɵɯ
ɞɥɹ
ɤɥɸɱɟɜɨɣ
ɝɢɧɟɤɨɥɨɝɢɱɟɫɤɨɣ
ɩɪɨɰɟɞɭɪɵ.
ɂɫɫɥɟɞɨɜɚɧɢɟ
ɩɪɨɜɨɞɢɥɨɫɶ
ɤɚɤ
ɫɥɟɩɨɟ
ɢɫɫɥɟɞɨɜɚɧɢɟ ɦɟɬɨɞɨɦ ɫɥɭɱɚɣɧɨɣ ɜɵɛɨɪɤɢ ɜ
ɫɨɨɬɜɟɬɫɬɜɢɢ ɫ ɪɟɤɨɦɟɧɞɚɰɢɹɦɢ ɩɨ ɨɬɱɟɬɧɨɫɬɢ
ɨ ɩɪɨɜɟɞɟɧɧɵɯ ɢɫɩɵɬɚɧɢɹɯ (www.consortstatement.org).
ɆȿɌɈȾɕ
ɋ ɫɟɧɬɹɛɪɹ 2006 ɝ. ɩɨ ɢɸɧɶ 2007 ɝ. ɜ
ɢɫɫɥɟɞɨɜɚɧɢɢ ɩɪɢɧɹɥɢ ɭɱɚɫɬɢɟ 32 ɪɟɡɢɞɟɧɬɚ ɩɨ
ɝɢɧɟɤɨɥɨɝɢɢ, 1 ɢ 2 ɝɨɞɚ ɫɩɟɰɢɚɥɢɡɚɰɢɢ (3-8
ɝɨɞɵ ɩɨɫɬɞɢɩɥɨɦɧɨɝɨ ɨɛɭɱɟɧɢɹ; ɫɦ. ɫɯɟɦɭ), ɧɟ
ɢɦɟɸɳɢɟ ɨɩɵɬɚ ɜ ɩɪɨɞɜɢɧɭɬɨɣ ɥɚɩɚɪɨɫɤɨɩɢɢ
(ɜɵɩɨɥɧɹɟɦɨɣ
ɫ
ɤɨɨɪɞɢɧɢɪɨɜɚɧɧɵɦ
ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɛɨɥɟɟ ɨɞɧɨɝɨ ɢɧɫɬɪɭɦɟɧɬɚ).
ɂɡ ɝɪɭɩɩɵ ɜ 42 ɪɟɡɢɞɟɧɬɚ (38 ɠɟɧɳɢɧ ɢ 4
ɦɭɠɱɢɧ) ɜɨɫɶɦɟɪɵɦ ɛɵɥɨ ɨɬɤɚɡɚɧɨ ɜ ɩɪɚɜɟ
ɩɪɢɧɢɦɚɬɶ ɭɱɚɫɬɢɟ, ɬɚɤ ɤɚɤ ɭ ɧɢɯ ɭɠɟ ɛɵɥ ɨɩɵɬ
ɜ ɷɬɨɣ ɫɮɟɪɟ, ɟɳɟ ɱɟɬɵɪɟ ɤɚɧɞɢɞɚɬɚ
ɩɪɟɞɫɬɚɜɥɹɥɢ ɛɨɥɶɧɢɰɵ, ɧɟ ɭɱɚɫɬɜɨɜɚɜɲɢɟ ɜ
ɢɫɫɥɟɞɨɜɚɧɢɢ. ɂɡ ɨɫɬɚɜɲɢɯɫɹ 30 ɤɚɧɞɢɞɚɬɨɜ
ɛɵɥɢ ɡɚɱɢɫɥɟɧɵ ɩɟɪɜɵɯ 24 ɭɱɚɫɬɧɢɤɚ,
ɢɡɴɹɜɢɜɲɢɯ ɠɟɥɚɧɢɟ ɩɪɨɞɨɥɠɢɬɶ.
Ɉɧɢ
ɩɪɟɞɫɬɚɜɥɹɥɢ ɫɟɦɶ ɢɡ ɞɟɜɹɬɢ ɝɢɧɟɤɨɥɨɝɢɱɟɫɤɢɯ
ɨɬɞɟɥɟɧɢɣ ɨɛɥɚɫɬɢ Ɂɟɥɚɧɞɢɹ ɜ Ⱦɚɧɢɢ
(ɧɚɫɟɥɟɧɢɟ 2,3 ɦɢɥɥɢɨɧɚ ɱɟɥɨɜɟɤ): Ƚɟɧɬɨɮɬ
(ɩɹɬɶ ɪɟɡɢɞɟɧɬɨɜ), ɏɟɪɥɟɜ (n=4), Ɋɨɫɤɢɥɶɞ
(n=4), ɏɢɥɥɟɪɨɟɞ (n=1), ɏɨɥɶɛɚɟɤ (n=1),
ɏɜɢɞɨɜɪɟ (n=2) ɢ Ɋɢɝɫɯɨɫɩɢɬɚɥɢɬɟɬ (n=7).
ȼɵɛɨɪɤɚ ɢ ɛɟɫɩɪɢɫɬɪɚɫɬɧɨɫɬɶ
ɑɬɨɛɵ ɨɫɧɨɜɧɵɟ ɯɚɪɚɤɬɟɪɢɫɬɢɤɢ ɪɟɡɢɞɟɧɬɨɜ
ɛɵɥɢ ɩɨɯɨɠɢɦɢ ɜ ɩɪɟɞɟɥɚɯ ɝɪɭɩɩɵ ɢ ɦɟɠɞɭ
ɝɪɭɩɩɚɦɢ,
ɦɵ
ɜɨɫɩɨɥɶɡɨɜɚɥɢɫɶ
ɦɟɬɨɞɨɦ
ɪɚɫɫɥɨɟɧɧɨɣ
ɜɵɛɨɪɤɢ,
ɨɫɧɨɜɚɧɧɨɣ
ɧɚ
ɢɦɟɜɲɟɦɫɹ ɨɩɵɬɟ ɩɨ ɩɪɨɫɬɨɣ ɥɚɩɚɪɨɫɤɨɩɢɢ
(ɨɩɪɟɞɟɥɹɟɦɨɣ
ɤɚɤ
ɫɨɜɨɤɭɩɧɨɫɬɶ
ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɢɯ ɩɪɨɰɟɞɭɪ, ɜɵɩɨɥɧɹɟɦɵɯ ɫ
ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɨɞɧɨɝɨ ɢɧɫɬɪɭɦɟɧɬɚ, ɬɚɤɢɯ ɤɚɤ
ɞɢɚɝɧɨɫɬɢɱɟɫɤɚɹ
ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɚɹ
ɫɬɟɪɢɥɢɡɚɰɢɹ
ɢɥɢ
ɞɢɚɝɧɨɫɬɢɱɟɫɤɚɹ
ȼ Ɉɬɞɟɥɟɧɢɢ ɤɥɢɧɢɱɟɫɤɢɯ
ɥɚɩɚɪɨɫɤɨɩɢɹ).
ɢɫɩɵɬɚɧɢɣ ɍɧɢɜɟɪɫɢɬɟɬɚ Ʉɨɩɟɧɝɚɝɟɧɚ ɩɪɨɜɟɥɢ
ɤɨɦɩɶɸɬɟɪɧɭɸ ɜɵɛɨɪɤɭ ɭɱɚɫɬɧɢɤɨɜ ɢ ɪɚɡɞɟɥɢɥɢ
ɢɯ ɧɚ ɝɪɭɩɩɵ ɜɦɟɲɚɬɟɥɶɫɬɜɚ ɢ ɤɨɧɬɪɨɥɹ.
Ɋɟɡɭɥɶɬɚɬɵ ɜɵɛɨɪɤɢ ɛɵɥɢ ɫɨɯɪɚɧɟɧɵ ɫ
ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɥɢɱɧɵɯ ɢɞɟɧɬɢɮɢɤɚɰɢɨɧɧɵɯ
2 (2) 2009
5
ɧɨɦɟɪɨɜ ɪɟɡɢɞɟɧɬɨɜ (ɥɢɱɧɵɣ
ɪɟɝɢɫɬɪɚɰɢɨɧɧɵɣ ɧɨɦɟɪ).
ɰɟɧɬɪɚɥɶɧɵɣ
Ɋɟɡɢɞɟɧɬɨɜ ɢɡ ɝɪɭɩɩɵ ɜɦɟɲɚɬɟɥɶɫɬɜɚ ɭɫɬɧɨ
ɩɪɨɢɧɫɬɪɭɤɬɢɪɨɜɚɥɢ ɨ ɪɚɛɨɬɟ ɢɦɢɬɚɬɨɪɚ ɢ
ɲɤɚɥɟ ɛɚɥɥɨɜ, ɢɫɩɨɥɶɡɭɟɦɨɣ ɞɥɹ ɨɰɟɧɢɜɚɧɢɹ
ɪɟɡɭɥɶɬɚɬɨɜ. Ɉɩɟɪɚɰɢɢ, ɩɪɨɜɨɞɢɦɵɟ ɜɨ ɜɪɟɦɹ
ɢɫɩɵɬɚɧɢɹ, ɡɚɩɢɫɵɜɚɥɢɫɶ. ȼ ɫɢɥɭ ɩɪɢɪɨɞɵ
ɩɪɨɜɨɞɢɦɨɝɨ ɢɫɩɵɬɚɧɢɹ ɪɟɡɢɞɟɧɬɵ ɛɵɥɢ
ɨɫɜɟɞɨɦɥɟɧɵ ɨ ɫɜɨɟɣ ɩɪɢɧɚɞɥɟɠɧɨɫɬɢ ɤ
ɨɫɧɨɜɧɨɣ ɢɥɢ ɤɨɧɬɪɨɥɶɧɨɣ ɝɪɭɩɩɚɦ, ɧɨ ɜɫɟ
ɡɚɞɟɣɫɬɜɨɜɚɧɧɵɟ ɨɬɞɟɥɟɧɢɹ, ɪɭɤɨɜɨɞɢɬɟɥɢ ɢ
ɩɟɪɫɨɧɚɥ ɨɩɟɪɚɰɢɨɧɧɵɯ ɧɟ ɨɛɳɚɥɢɫɶ ɫ ɝɪɭɩɩɨɣ
ɪɟɡɢɞɟɧɬɚ, ɚ ɥɢɰɚ, ɨɰɟɧɢɜɚɜɲɢɟ ɪɟɡɭɥɶɬɚɬɵ,
ɧɟ ɦɨɝɥɢ ɨɛɳɚɬɶɫɹ ɧɢ ɫ ɪɟɡɢɞɟɧɬɨɦ, ɧɢ ɫ ɟɝɨ
ɝɪɭɩɩɨɣ. Ɋɭɤɨɜɨɞɢɬɟɥɶ ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɨɥɭɱɢɥ
ɞɚɧɧɵɟ ɬɨɥɶɤɨ ɩɨɫɥɟ ɩɪɨɜɟɞɟɧɢɹ ɜɫɟɯ ɨɰɟɧɨɤ,
ɢ ɩɨɫɥɟ ɡɚɝɪɭɡɤɢ ɢɧɮɨɪɦɚɰɢɢ ɜ ɛɚɡɭ ɞɚɧɧɵɯ.
Ƚɪɭɩɩɚ ɤɨɧɬɪɨɥɹ ɩɪɨɯɨɞɢɥɚ ɫɬɚɧɞɚɪɬɧɨɟ
ɤɥɢɧɢɱɟɫɤɨɟ ɨɛɭɱɟɧɢɟ. ȼɨ ɜɪɟɦɹ ɩɪɨɜɟɞɟɧɢɹ
ɢɫɫɥɟɞɨɜɚɧɢɹ ɧɢ ɨɞɧɨɦɭ ɢɡ ɪɟɡɢɞɟɧɬɨɜ ɨɛɟɢɯ
ɝɪɭɩɩ
ɧɟ
ɛɵɥɨ
ɪɚɡɪɟɲɟɧɨ
ɜɵɩɨɥɧɹɬɶ
ɩɪɨɞɜɢɧɭɬɭɸ ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɭɸ ɯɢɪɭɪɝɢɸ –
ɬɨɥɶɤɨ
ɩɪɨɫɬɭɸ
ɥɚɩɚɪɨɫɤɨɩɢɸ
(ɨɞɧɢɦ
ɢɧɫɬɪɭɦɟɧɬɨɦ) ɢɥɢ ɚɫɫɢɫɬɢɪɨɜɚɬɶ ɫɬɚɪɲɢɦ
ɤɨɥɥɟɝɚɦ. ɑɬɨɛɵ ɩɪɨɜɟɪɢɬɶ, ɱɬɨ ɜɵɛɨɪɤɚ ɛɵɥɚ
ɩɪɨɜɟɞɟɧɚ ɭɫɩɟɲɧɨ, ɝɪɭɩɩɚ ɤɨɧɬɪɨɥɹ ɩɨɫɥɟ
ɩɪɨɜɟɞɟɧɢɹ ɢɫɫɥɟɞɨɜɚɧɢɹ ɬɚɤɠɟ ɩɪɨɯɨɞɢɥɚ
ɩɪɚɤɬɢɤɭɦ ɧɚ ɜɢɪɬɭɚɥɶɧɨɦ ɫɢɦɭɥɹɬɨɪɟ.
ɂɯ
ɧɚɱɚɥɶɧɵɟ ɪɟɡɭɥɶɬɚɬɵ ɪɚɡɢɬɟɥɶɧɵɦ ɨɛɪɚɡɨɦ
ɨɬɥɢɱɚɥɢɫɶ ɨɬ ɪɟɡɭɥɶɬɚɬɨɜ ɨɫɧɨɜɧɨɣ ɝɪɭɩɩɵ
ɜɦɟɲɚɬɟɥɶɫɬɜɚ.
Ɉɛɨɪɭɞɨɜɚɧɢɟ
ɦɨɞɟɥɢɪɨɜɚɧɢɹ
ɜɢɪɬɭɚɥɶɧɨɣ
ɉɪɨɝɪɚɦɦɚ
ɪɟɚɥɶɧɨɫɬɢ ɥɚɩɚɪɨɫɤɨɩɢɢ (LapSim Gyn 3.0.1;
Surgical
Science,
Ƚɺɬɟɛɨɪɝ,
ɒɜɟɰɢɹ)
ɡɚɩɭɫɤɚɥɚɫɶ
ɧɚ
ɤɨɦɩɶɸɬɟɪɟ
IBM
T42
ɭɫɬɚɧɨɜɨɱɧɨɣ ɫɬɚɧɰɢɢ (PentiumM1.8 GHz/512
MB RAM; IBM, Ⱥɪɦɨɧɤ, ɲɬɚɬ ɇɶɸ-Ƀɨɪɤ, ɋɒȺ) ɫ
ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ ɢɧɬɟɪɮɟɣɫɚ ɫ ɞɢɚɬɟɪɦɢɱɟɫɤɨɣ
ɩɟɞɚɥɶɸ (Virtual Laparoscopic Interface; ɋɚɧɏɨɫɟ, ɲɬɚɬ Ʉɚɥɢɮɨɪɧɢɹ, ɋɒȺ).
Ɉɩɟɪɚɰɢɢ
ɩɪɨɜɨɞɢɥɢɫɶ ɜ ɨɩɟɪɚɰɢɨɧɧɵɯ ɩɪɢɧɢɦɚɸɳɢɯ
ɭɱɚɫɬɢɟ ɨɬɞɟɥɟɧɢɣ ɢ ɡɚɩɢɫɵɜɚɥɢɫɶ ɧɚ DVD ɫ
ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ
ɷɧɞɨɜɢɞɟɨɤɚɦɟɪɵ,
ɩɪɢɤɪɟɩɥɟɧɧɨɣ
ɤ
ɥɚɩɚɪɨɫɤɨɩɭ
ɞɥɹ
ɩɨɫɥɟɞɭɸɳɟɣ ɛɟɫɩɪɢɫɬɪɚɫɬɧɨɣ ɨɰɟɧɤɢ.
ȼɨ
ɜɪɟɦɹ ɨɩɟɪɚɰɢɢ ɨɞɢɧ ɢɡ ɚɜɬɨɪɨɜ ɧɚɛɥɸɞɚɥ ɡɚ
6
ɪɚɛɨɬɨɣ ɫ ɯɢɪɭɪɝɢɱɟɫɤɢɦɢ ɢɧɫɬɪɭɦɟɧɬɚɦɢ, ɫ
ɩɪɢɜɥɟɱɟɧɢɟɦ ɪɭɤɨɜɨɞɢɬɟɥɹ, ɫɨɛɥɸɞɟɧɢɟɦ
ɫɬɚɧɞɚɪɬɧɨɣ ɩɪɨɰɟɞɭɪɵ ɨɩɟɪɚɰɢɢ, ɚ ɬɚɤɠɟ
ɫɥɟɞɢɥ ɡɚ ɬɟɦ, ɱɬɨɛɵ ɡɚɩɢɫɶ ɛɵɥɚ ɫɞɟɥɚɧɚ
ɬɨɱɧɨ ɢ ɜɟɪɧɨ, ɡɚɜɟɪɲɟɧɚ ɢ ɨɰɟɧɟɧɚ.
Ɉɛɭɱɟɧɢɟ ɧɚ ɫɢɦɭɥɹɬɨɪɟ
Ƚɪɭɩɩɚ
ɜɦɟɲɚɬɟɥɶɫɬɜɚ
ɪɚɛɨɬɚɥɚ
ɫɨ
ɫɩɟɰɢɚɥɶɧɨɣ ɨɛɭɱɚɸɳɟɣ ɩɪɨɝɪɚɦɦɨɣ ɧɚ
ɜɢɪɬɭɚɥɶɧɨɦ ɫɢɦɭɥɹɬɨɪɟ. ɉɪɨɝɪɚɦɦɚ ɫɨɫɬɨɹɥɚ
ɢɡ ɞɜɭɯ ɱɚɫɬɟɣ: ɩɟɪɜɨɣ – ɨɬɪɚɛɨɬɤɢ ɞɜɭɯ
ɨɫɧɨɜɧɵɯ ɧɚɜɵɤɨɜ «ɩɨɞɴɟɦɚ ɢ ɡɚɯɜɚɬɚ» ɢ
«ɪɚɡɪɟɡɚ», ɜ ɬɟɱɟɧɢɟ ɤɨɬɨɪɨɣ ɭɱɚɫɬɧɢɤɢ
ɨɡɧɚɤɨɦɢɥɢɫɶ
ɫɨ
ɫɪɟɞɨɣ
ɢɦɢɬɚɬɨɪɚ
ɢ
ɪɚɡɥɢɱɧɵɦɢ
ɢɧɫɬɪɭɦɟɧɬɚɦɢ;
ɜɬɨɪɨɣ
–
ɜɵɩɨɥɧɟɧɢɹ ɨɞɧɨɝɨ ɩɪɨɰɟɞɭɪɧɨɝɨ ɡɚɞɚɧɢɹ, ɜɨ
ɜɪɟɦɹ
ɤɨɬɨɪɨɝɨ
ɭɱɚɫɬɧɢɤ
ɞɨɥɠɟɧ
ɛɵɥ
ɜɵɩɨɥɧɢɬɶ
ɩɨɥɧɭɸ
ɩɪɚɜɨɫɬɨɪɨɧɧɸɸ
ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɸ ɫ ɫɨɯɪɚɧɟɧɢɟɦ ɹɢɱɧɢɤɚ.
Ɍɪɟɧɢɪɨɜɤɚ ɨɫɧɨɜɧɵɯ ɧɚɜɵɤɨɜ ɩɪɨɜɨɞɢɥɚɫɶ
ɨɞɢɧ ɪɚɡ ɜ ɬɟɱɟɧɢɟ ɤɚɠɞɨɝɨ ɬɪɟɧɢɪɨɜɨɱɧɨɝɨ
ɰɢɤɥɚ
ɞɥɢɬɟɥɶɧɨɫɬɶɸ
45-60
ɦɢɧɭɬ.
ɋɚɥɶɩɢɧɝɷɤɬɨɦɢɹ ɩɨɫɬɨɹɧɧɨ ɨɬɪɚɛɚɬɵɜɚɥɚɫɶ ɜ
ɬɟɱɟɧɢɟ ɰɢɤɥɚ.
Ȼɥɚɝɨɞɚɪɹ ɜɢɪɬɭɚɥɶɧɨɦɭ
ɫɢɦɭɥɹɬɨɪɭ ɭ ɪɟɡɢɞɟɧɬɨɜ ɛɵɥɚ ɦɝɧɨɜɟɧɧɚɹ
ɨɛɪɚɬɧɚɹ ɫɜɹɡɶ, ɨɧɢ ɦɨɝɥɢ ɭɡɧɚɬɶ ɞɥɢɧɭ ɩɭɬɢ ɢ
ɭɝɥɨɜɨɣ ɩɭɬɶ ɞɜɢɠɟɧɢɹ ɢɧɫɬɪɭɦɟɧɬɨɜ, ɨ
ɤɪɨɜɨɬɟɱɟɧɢɢ,
ɪɚɡɪɟɡɟ
ɧɟɤɨɚɝɭɥɢɪɜɚɧɧɵɯ
ɚɪɬɟɪɢɣ
ɢ
ɩɪɢɦɟɧɟɧɢɢ
ɞɢɚɬɟɪɦɢɢ
ɧɚ
ɧɟɰɟɥɟɜɵɯ ɬɤɚɧɹɯ. Ɍɪɟɧɢɧɝɢ ɩɨɜɬɨɪɹɥɢɫɶ ɞɨ
ɬɟɯ ɩɨɪ, ɩɨɤɚ ɭɪɨɜɟɧɶ ɷɤɫɩɟɪɬɚ ɧɟ ɛɵɥ
ɞɨɫɬɢɝɧɭɬ ɩɪɢ ɞɜɭɯ ɩɨɫɥɟɞɨɜɚɬɟɥɶɧɵɯ ɢ
ɧɟɡɚɜɢɫɢɦɵɯ ɦɨɞɟɥɢɪɨɜɚɧɢɹɯ.
Ʉɪɢɬɟɪɢɣ
ɩɪɨɮɟɫɫɢɨɧɚɥɢɡɦɚ ɛɵɥ ɭɫɬɚɧɨɜɥɟɧ ɷɤɫɩɟɪɬɚɦɢ
ɜ
ɩɪɟɞɵɞɭɳɢɯ
ɢɫɫɥɟɞɨɜɚɧɢɹɯ
ɩɨ
ɤɨɧɫɬɪɭɤɬɢɜɧɨɣ
ɞɨɫɬɨɜɟɪɧɨɫɬɢ
ɢ
ɤɪɢɜɨɣ
ɩɪɢɨɛɪɟɬɟɧɢɹ ɧɚɜɵɤɚ. 15 16 ɋ ɬɪɟɛɨɜɚɧɢɹɦɢ ɢ
ɧɚɫɬɪɨɣɤɚɦɢ ɢɦɢɬɚɬɨɪɚ ɦɨɠɧɨ ɨɡɧɚɤɨɦɢɬɶɫɹ ɧɚ
www.skopisimulator.rh.dk
ɏɢɪɭɪɝɢɱɟɫɤɨɟ ɜɦɟɲɚɬɟɥɶɫɬɜɨ
Ɋɟɡɢɞɟɧɬɵ
ɜɵɩɨɥɧɢɥɢ
ɩɟɪɜɭɸ
ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɸ
ɜ
ɫɜɨɟɦ
ɦɟɫɬɧɨɦ
ɝɢɧɟɤɨɥɨɝɢɱɟɫɤɨɦ ɨɬɞɟɥɟɧɢɢ ɩɨɞ ɪɭɤɨɜɨɞɫɬɜɨɦ
ɫɬɚɪɲɟɝɨ ɤɨɥɥɟɝɢ, ɤɨɬɨɪɨɦɭ ɛɵɥɨ ɢɡɜɟɫɬɧɨ ɨ
ɰɟɥɢ ɢɫɫɥɟɞɨɜɚɧɢɹ. Ⱦɥɹ ɨɛɥɟɝɱɟɧɢɹ ɫɪɚɜɧɟɧɢɹ
ɜɵɩɨɥɧɟɧɧɨɣ
ɩɪɨɰɟɞɭɪɵ
ɜɫɟ
ɪɟɡɢɞɟɧɬɵ
2(2) 2009
ɜɵɩɨɥɧɹɥɢ ɩɪɚɜɨɫɬɨɪɨɧɧɸɸ ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɸ.
ɉɚɰɢɟɧɬɤɢ ɩɨɫɬɭɩɚɥɢ ɧɚ ɝɨɫɩɢɬɚɥɢɡɚɰɢɸ ɞɥɹ
ɜɵɩɨɥɧɟɧɢɹ ɷɥɟɤɬɢɜɧɨɣ ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɢ ɢɥɢ
ɞɥɹ ɩɪɨɮɢɥɚɤɬɢɱɟɫɤɨɝɨ ɭɞɚɥɟɧɢɹ ɦɚɬɨɱɧɵɯ
ɬɪɭɛ ɢ ɹɢɱɧɢɤɨɜ ɢɡ-ɡɚ ɩɨɥɨɠɢɬɟɥɶɧɨɝɨ
ɪɟɡɭɥɶɬɚɬɚ ɬɟɫɬɚ ɧɚ ɪɚɤ ɦɨɥɨɱɧɨɣ ɠɟɥɟɡɵ ɝɟɧ 1
(BRCA1).
Ɋɟɡɢɞɟɧɬɚɦ
ɧɟ
ɩɪɟɞɥɚɝɚɥɢ
ɨɩɟɪɢɪɨɜɚɬɶ ɩɚɰɢɟɧɬɨɤ, ɩɨɞɜɟɪɝɚɜɲɢɯɫɹ ɞɨ
ɷɬɨɝɨ
ɨɬɤɪɵɬɨɣ
ɢɥɢ
ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɨɣ
ɯɢɪɭɪɝɢɢ
ɧɢɠɟ
ɩɭɩɤɚ,
ɭ
ɤɨɬɨɪɵɯ
ɩɪɟɞɩɨɥɨɠɢɬɟɥɶɧɨ
ɛɵɥɢ
ɡɥɨɤɚɱɟɫɬɜɟɧɧɵɟ
ɡɚɛɨɥɟɜɚɧɢɹ ɛɪɸɲɧɨɣ ɩɨɥɨɫɬɢ, ɱɟɣ ɩɨɤɚɡɚɬɟɥɶ
ɜ ɫɨɨɬɜɟɬɫɬɜɢɢ ɫ Ⱥɦɟɪɢɤɚɧɫɤɨɣ ɯɢɪɭɪɝɢɱɟɫɤɨɣ
ɚɫɫɨɰɢɚɰɢɟɣ ɛɵɥ •3 (ɩɚɰɢɟɧɬɤɢ ɫ ɫɟɪɶɟɡɧɵɦɢ
ɫɢɫɬɟɦɧɵɦɢ ɡɚɛɨɥɟɜɚɧɢɹɦɢ), ɭ ɤɨɬɨɪɵɯ ɢɧɞɟɤɫ
ɦɚɫɫɵ ɬɟɥɚ ɛɵɥ ɦɟɧɟɟ 18 ɢɥɢ ɩɪɟɜɵɲɚɥ 27,
ɩɚɰɢɟɧɬɨɤ ɫ ɝɟɦɨɮɢɥɢɟɣ ɢɥɢ ɭ ɤɨɬɨɪɵɯ ɛɵɥɢ
ɢɧɵɟ
ɩɪɨɛɥɟɦɵ,
ɩɪɟɩɹɬɫɬɜɨɜɚɜɲɢɟ
ɩɪɨɜɟɞɟɧɢɸ
ɯɢɪɭɪɝɢɱɟɫɤɨɣ
ɩɪɨɰɟɞɭɪɵ.
Ɉɩɟɪɚɰɢɢ
ɩɪɨɜɨɞɢɥɢɫɶ
ɩɨ
ɫɬɚɧɞɚɪɬɧɨɣ
ɦɟɬɨɞɢɤɟ ɜ ɫɨɨɬɜɟɬɫɬɜɢɢ ɫ ɤɨɧɫɟɧɫɭɫɨɦ
ɷɤɫɩɟɪɬɨɜ. 17 18
Ɋɭɤɨɜɨɞɢɬɟɥɹɦ ɛɵɥɨ
ɪɚɡɪɟɲɟɧɨ ɞɚɜɚɬɶ ɬɨɥɶɤɨ ɭɫɬɧɵɟ ɭɤɚɡɚɧɢɹ,
ɨɞɢɧ ɢɫɫɥɟɞɨɜɚɬɟɥɶ ɩɪɢɫɭɬɫɬɜɨɜɚɥ, ɱɬɨɛɵ
ɜɟɫɬɢ ɧɚɛɥɸɞɟɧɢɟ ɡɚ ɯɨɞɨɦ ɩɪɨɰɟɞɭɪɵ ɢ
ɨɬɦɟɱɚɬɶ,
ɜ
ɱɶɢɯ
ɪɭɤɚɯ
ɧɚɯɨɞɢɥɢɫɶ
ɢɧɫɬɪɭɦɟɧɬɵ.
Ɍɚɛɥ. Ʉɨɥɢɱɟɫɬɜɟɧɧɨɟ ɪɚɫɩɪɟɞɟɥɟɧɢɟ ɪɟɡɢɞɟɧɬɨɜ ɜ ɩɪɨɰɟɫɫɟ ɢɫɫɥɟɞɨɜɚɧɢɹ
Ɋɟɡɢɞɟɧɬɵ ɢ ɩɚɰɢɟɧɬɵ (n=24)
ɋɤɪɵɬɚɹ ɜɵɛɨɪɤɚ (n=24)
ȼɢɪɬɭɚɥɶɧɵɣ ɬɪɟɧɢɧɝ, ɩɪɨɜɨɞɢɜɲɢɣɫɹ
ɞɨ ɞɨɫɬɢɠɟɧɢɹ ɷɤɫɩɟɪɬɧɨɝɨ ɭɪɨɜɧɹ
(ɞɜɚ ɪɟɡɭɥɶɬɚɬɚ ɩɨɞɪɹɞ)
Ɇɚɤɫɢɦɚɥɶɧɵɣ ɫɪɨɤ 60 ɞɧɟɣ (n=13)
Ʌɚɩɚɪɨɫɤɨɩɢɱɟɫɤɚɹ ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɹ
ɇɟɨɬɪɟɞɚɤɬɢɪɨɜɚɧɧɚɹ ɡɚɩɢɫɶ ɧɚ DVD (n=13)
ȼɵɛɵɜɲɢɟ (n=2):
ɧɟ ɫɩɪɚɜɢɥɢɫɶ ɫ
ɩɪɨɝɪɚɦɦɨɣ ɬɪɟɧɢɧɝɚ
(n=1)
ɧɟɩɨɞɯɨɞɹɳɢɣ ɩɚɰɢɟɧɬ
(n=1)
, ,
.
(n=11)
Ɉɛɵɱɧɨɟ ɦɟɞɢɰɢɧɫɤɨɟ ɨɛɭɱɟɧɢɟ
Ⱥɫɫɢɫɬɟɧɰɢɹ ɜ ɨɩɟɪɚɰɢɨɧɧɨɣ
Ɇɚɤɫɢɦɚɥɶɧɵɣ ɫɪɨɤ 60 ɞɧɟɣ (n=11)
Ʌɚɩɚɪɨɫɤɨɩɢɱɟɫɤɚɹ ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɹ
ɇɟɨɬɪɟɞɚɤɬɢɪɨɜɚɧɧɚɹ ɡɚɩɢɫɶ ɧɚ DVD (n=11)
ȼɵɛɵɜɲɢɟ (n=1):
ɧɟ ɫɩɪɚɜɢɥɢɫɶ ɫ
ɜɢɞɟɨɡɚɩɢɫɶɸ (n=1)
, ,
.
(n=11)
Ƚɪɭɩɩɚ ɤɨɧɬɪɨɥɹ ɩɪɨɯɨɞɢɥɚ ɜɢɪɬɭɚɥɶɧɵɣ ɬɪɟɧɢɧɝ (ɩɨɫɥɟ ɨɩɟɪɚɰɢɢ ɢɥɢ ɞɨɛɪɨɜɨɥɶɧɨ) (n=9)
ɉɨɥɭɱɟɧɧɵɟ ɪɟɡɭɥɶɬɚɬɵ
Ɉɫɧɨɜɧɵɦ ɩɨɤɚɡɚɬɟɥɟɦ ɪɟɡɭɥɶɬɚɬɚ ɛɵɥɨ
ɬɟɯɧɢɱɟɫɤɨɟ ɜɵɩɨɥɧɟɧɢɟ, ɪɚɫɫɦɚɬɪɢɜɚɟɦɨɟ ɤɚɤ
ɢɬɨɝɨɜɵɣ
ɩɨɤɚɡɚɬɟɥɶ
(10-50
ɛɚɥɥɨɜ)
ɫ
ɢɫɩɨɥɶɡɨɜɚɧɢɟɦ
ɨɛɴɟɤɬɢɜɧɨɣ
ɫɬɪɭɤɬɭɪɧɨɣ
ɨɰɟɧɤɢ ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɨɣ ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɢ,
ɤɨɬɨɪɚɹ ɜɤɥɸɱɚɟɬ ɩɹɬɶ ɟɞɢɧɢɰ ɨɛɳɟɣ ɲɤɚɥɵ
ɨɰɟɧɤɢ ɢ ɩɹɬɶ ɟɞɢɧɢɰ ɲɤɚɥɵ ɨɰɟɧɤɢ ɡɚɞɚɧɢɣ.19
Ⱦɜɚ ɧɟɡɚɜɢɫɢɦɵɯ ɷɤɫɩɟɪɬɚ, ɧɟ ɨɫɜɟɞɨɦɥɟɧɧɵɯ
ɨ ɫɬɚɬɭɫɟ ɬɪɟɧɢɧɝɚ ɢ ɢɦɟɧɢ ɤɭɪɫɚɧɬɚ,
ɜɵɩɨɥɧɹɜɲɟɝɨ
ɜɦɟɲɚɬɟɥɶɫɬɜɨ,
ɨɰɟɧɢɜɚɥɢ
ɡɚɩɢɫɚɧɧɵɟ ɨɩɟɪɚɰɢɢ. ȼɬɨɪɵɦ ɩɨɤɚɡɚɬɟɥɟɦ
ɪɟɡɭɥɶɬɚɬɚ
ɹɜɥɹɟɬɫɹ
ɜɪɟɦɹ
ɩɪɨɜɟɞɟɧɢɹ
ɨɩɟɪɚɰɢɢ ɜ ɦɢɧɭɬɚɯ.
ɇɚɞɟɠɧɨɫɬɶ ɨɰɟɧɤɢ
ɨɩɪɟɞɟɥɹɥɚɫɶ ɩɨɞɫɱɟɬɨɦ ɤɨɪɪɟɥɹɰɢɣ ɩɨ ɞɜɭɦ
ɲɤɚɥɚɦ (ɤɨɥɢɱɟɫɬɜɨ ɤɨɪɪɟɥɹɰɢɣ ɩɨ ɤɚɠɞɨɦɭ ɢɡ
ɨɰɟɧɢɜɚɟɦɵɯ ɩɭɧɤɬɨɜ, ɪɚɡɞɟɥɟɧɧɨɟ ɧɚ ɨɛɳɟɟ
ɤɨɥɢɱɟɫɬɜɨ
ɨɰɟɧɢɜɚɟɦɵɯ
ɩɭɧɤɬɨɜ)
ɢ
ɤɨɷɮɮɢɰɢɟɧɬɨɦ Ȗ.
2 (2) 2009
7
Ɋɚɫɱɟɬ ɫɢɥɵ
ɊȿɁɍɅɖɌȺɌɕ
Ɋɚɫɱɟɬ ɫɢɥɵ ɨɫɧɨɜɵɜɚɥɫɹ ɩɨ ɫɩɟɰɢɮɢɱɧɨɣ
ɜɦɟɲɚɬɟɥɶɫɬɜɭ ɲɤɚɥɟ ɨɛɴɟɤɬɢɜɧɨɣ ɫɬɪɭɤɬɭɪɧɨɣ
ɨɰɟɧɤɢ ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɨɣ ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɢ ,
ɨɩɪɟɞɟɥɟɧɧɨɣ ɜ ɩɪɟɞɵɞɭɳɟɦ ɢɫɫɥɟɞɨɜɚɧɢɢ19.
ɇɚɫɬɨɹɳɟɟ ɢɫɫɥɟɞɨɜɚɧɢɟ ɩɪɨɞɟɦɨɧɫɬɪɢɪɨɜɚɥɨ
ɪɚɡɧɢɰɭ ɜ ɲɟɫɬɶ ɛɚɥɥɨɜ ɦɟɠɞɭ ɧɨɜɢɱɤɚɦɢ ɜ
ɥɚɩɚɪɨɫɤɨɩɢɢ (0-5 ɜɵɩɨɥɧɟɧɧɵɯ ɩɪɨɰɟɞɭɪ) ɢ
ɷɧɞɨɯɢɪɭɪɝɚɦɢ, ɢɦɟɸɳɢɦɢ ɨɩɵɬ ɫɪɟɞɧɟɝɨ
ɭɪɨɜɧɹ (30-50 ɜɵɩɨɥɧɟɧɧɵɯ ɥɚɩɚɪɨɫɤɨɩɢɣ).
ɉɪɢɟɦɥɟɦɵɦ ɫɱɢɬɚɥɨɫɶ ɭɥɭɱɲɟɧɢɟ ɧɚɜɵɤɨɜ,
ɞɨɫɬɢɝɚɜɲɟɟ 30 ɢ ɛɨɥɟɟ ɛɚɥɥɨɜ.
ȼɨɫɟɦɶ ɪɟɡɢɞɟɧɬɨɜ ɢɡ ɝɪɭɩɩɵ ɜ 42 ɱɟɥɨɜɟɤɚ (38
ɠɟɧɳɢɧ, ɱɟɬɵɪɟ ɦɭɠɱɢɧɵ) ɛɵɥɢ ɢɫɤɥɸɱɟɧɵ ɢɡ
ɢɫɫɥɟɞɨɜɚɧɢɹ, ɬɚɤ ɤɚɤ ɨɧɢ ɛɵɥɢ ɫɥɢɲɤɨɦ
ɨɩɵɬɧɵɦɢ, ɚ ɱɟɬɵɪɟ ɪɟɡɢɞɟɧɬɚ ɩɪɟɞɫɬɚɜɥɹɥɢ
ɨɬɞɟɥɟɧɢɹ, ɧɟ ɩɪɢɧɢɦɚɜɲɢɟ ɭɱɚɫɬɢɟ ɜ
ɢɫɫɥɟɞɨɜɚɧɢɢ.
Ɉɫɬɚɜɲɢɟɫɹ 30 ɪɟɡɢɞɟɧɬɨɜ
ɫɨɝɥɚɫɢɥɢɫɶ ɭɱɚɫɬɜɨɜɚɬɶ, ɢɡ ɤɨɬɨɪɵɯ ɤ
ɢɫɫɥɟɞɨɜɚɧɢɸ ɛɵɥɨ ɩɪɢɜɥɟɱɟɧɨ 24 ɱɟɥɨɜɟɤ.
ɂɡ ɧɢɯ 22 (90%) ɛɵɥɢ ɠɟɧɳɢɧɵ, ɱɬɨ ɨɬɪɚɠɚɟɬ
ɬɟɤɭɳɟɟ ɪɚɫɩɪɟɞɟɥɟɧɢɟ ɩɨ ɩɨɥɭ ɫɪɟɞɢ
ɪɟɡɢɞɟɧɬɨɜ ɩɨ ɫɩɟɰɢɚɥɶɧɨɫɬɢ «Ⱥɤɭɲɟɪɫɬɜɨ ɢ
ɝɢɧɟɤɨɥɨɝɢɹ» ɜ Ⱦɚɧɢɢ.
ɋɪɟɞɧɢɣ ɜɨɡɪɚɫɬ
ɪɟɡɢɞɟɧɬɨɜ ɫɨɫɬɚɜɥɹɥ 32,8 ɥɟɬ (ɨɬ 26 ɞɨ 42
ɥɟɬ), 23 ɛɵɥɢ ɩɪɚɜɨɪɭɤɢɦɢ.
Ɉɞɢɧɧɚɞɰɚɬɶ
ɫɥɭɱɚɣɧɨɣ
ɪɟɡɢɞɟɧɬɨɜ
ɛɵɥɢ
ɨɬɨɛɪɚɧɵ
ɜɵɛɨɪɤɨɣ ɞɥɹ ɭɱɚɫɬɢɹ ɜ ɜɢɪɬɭɚɥɶɧɨɦ ɬɪɟɧɢɧɝɟ
ɩɨ ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɨɣ ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɢ, ɚ 10
ɛɵɥɢ ɨɬɨɛɪɚɧɵ ɞɥɹ ɫɬɚɧɞɚɪɬɧɨɝɨ ɤɥɢɧɢɱɟɫɤɨɝɨ
ɨɛɭɱɟɧɢɹ (ɤɨɧɬɪɨɥɶ). ȼ Ɍɚɛɥɢɰɟ 1 ɩɨɤɚɡɚɧɵ
ɨɫɧɨɜɧɵɟ
ɯɚɪɚɤɬɟɪɢɫɬɢɤɢ
ɪɟɡɢɞɟɧɬɨɜ.
ȼɩɨɫɥɟɞɫɬɜɢɢ ɞɜɚ ɭɱɚɫɬɧɢɤɚ ɛɵɥɢ ɢɫɤɥɸɱɟɧɵ
ɢɡ ɝɪɭɩɩɵ, ɪɚɛɨɬɚɜɲɟɣ ɫ ɫɢɦɭɥɹɬɨɪɨɦ, ɬɚɤ ɤɚɤ
ɨɞɢɧ ɧɟ ɫɦɨɝ ɡɚɜɟɪɲɢɬɶ ɨɛɭɱɚɸɳɭɸ ɩɪɨɝɪɚɦɦɭ,
ɚ ɞɪɭɝɨɣ ɞɨɥɠɟɧ ɛɵɥ ɩɪɢɧɢɦɚɬɶ ɭɱɚɫɬɢɟ ɜ
ɨɩɟɪɚɰɢɢ, ɤɨɬɨɪɚɹ ɛɵɥɚ ɨɬɦɟɧɟɧɚ ɢɡ-ɡɚ
ɚɧɚɬɨɦɢɱɟɫɤɨɣ ɩɚɬɨɥɨɝɢɢ ɢ ɩɨɞɨɡɪɟɧɢɟ ɧɚ
ɧɚɥɢɱɢɟ ɡɥɨɤɚɱɟɫɬɜɟɧɧɨɝɨ ɡɚɛɨɥɟɜɚɧɢɹ ɭ
ɩɚɰɢɟɧɬɚ. Ɉɞɢɧ ɭɱɚɫɬɧɢɤ ɛɵɥ ɢɫɤɥɸɱɟɧ ɢɡ
ɝɪɭɩɩɵ ɤɨɧɬɪɨɥɹ ɢɡ-ɡɚ ɧɟɢɫɩɪɚɜɧɨɫɬɢ DVD,
ɢɫɩɨɥɶɡɨɜɚɜɲɟɝɨɫɹ ɞɥɹ ɡɚɩɢɫɢ ɨɩɟɪɚɰɢɢ.
ɋɬɚɬɢɫɬɢɱɟɫɤɢɣ ɚɧɚɥɢɡ
ɋɨɜɨɤɭɩɧɵɣ ɩɨɤɚɡɚɬɟɥɶ ɩɪɢɧɹɬ ɤɚɤ ɫɪɟɞɧɢɦ
ɡɧɚɱɟɧɢɟɦ (ɞɜɭɯ ɧɚɛɥɸɞɚɬɟɥɟɣ) ɜ ɫɪɚɜɧɟɧɢɢ ɫ
ɧɟɩɚɪɚɦɟɬɪɢɱɟɫɤɢɦ
ɚɧɚɥɢɡɨɦ
(U-ɤɪɢɬɟɪɢɣ
Ɇɚɧɧɚ-ɍɢɬɧɢ).
Ɇɵ
ɪɚɫɫɦɚɬɪɢɜɚɥɢ
ɞɜɭɯɫɬɨɪɨɧɧɟɟ ɡɧɚɱɟɧɢɟ Ɋ ɪɚɜɧɵɦ 0,05 ɢɥɢ
ɦɟɧɶɲɟ, ɱɬɨɛɵ ɨɧɨ ɛɵɥɨ ɫɬɚɬɢɫɬɢɱɟɫɤɢ
ɡɧɚɱɢɦɵɦ, ɢ ɤɨɪɪɟɥɹɰɢɸ ɩɨ ɲɤɚɥɚɦ ɢ
ɤɨɷɮɮɢɰɢɟɧɬ Ȗ ɪɚɜɧɵɦɢ 0,8 (ɤɚɠɞɚɹ ɜɟɥɢɱɢɧɚ),
ɱɬɨɛɵ ɨɧɢ ɛɵɥɢ ɞɨɩɭɫɬɢɦɵɦɢ.
. , .
8
2(2) 2009
Ɍɚɛɥɢɰɚ 1.
Ɉɫɧɨɜɧɵɟ ɯɚɪɚɤɬɟɪɢɫɬɢɤɢ ɪɟɡɢɞɟɧɬɨɜ ɩɨ ɝɢɧɟɤɨɥɨɝɢɢ, ɨɬɨɛɪɚɧɧɵɯ ɞɥɹ ɬɪɟɧɢɧɝɚ ɜ ɜɢɪɬɭɚɥɶɧɨɣ
ɪɟɚɥɶɧɨɫɬɢ ɩɨ ɦɨɞɟɥɢɪɨɜɚɧɢɸ ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɨɣ ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɢ ɢɥɢ ɫɬɚɧɞɚɪɬɧɨɟ ɦɟɞɢɰɢɧɫɤɨɟ
ɨɛɭɱɟɧɢɟ. ɐɢɮɪɵ ɫɨɨɬɜɟɬɫɬɜɭɸɬ ɤɨɥɢɱɟɫɬɜɭ ɪɟɡɢɞɟɧɬɨɜ, ɟɫɥɢ ɢɧɨɟ ɧɟ ɭɤɚɡɚɧɨ
Ɉɫɧɨɜɧɵɟ ɯɚɪɚɤɬɟɪɢɫɬɢɤɢ ɪɟɡɢɞɟɧɬɨɜ ɩɨ ɝɢɧɟɤɨɥɨɝɢɢ
ɏɚɪɚɤɬɟɪɢɫɬɢɤɢ
Ƚɪɭɩɩɚ ɜɢɪɬɭɚɥɶɧɨɝɨ ɬɪɟɧɢɧɝɚ
(n=13)
Ƚɪɭɩɩɚ ɤɨɧɬɪɨɥɹ (n=11)
Ɇɭɠɱɢɧɵ
1
1
ɀɟɧɳɢɧɵ
12
10
ɋɪɟɞɧɢɣ ɜɨɡɪɚɫɬ (ɞɢɚɩɚɡɨɧ)
33,3 (30-42)
32,4 (26-38)
Ɉɩɵɬ ɩɪɨɫɬɨɣ ɥɚɩɚɪɨɫɤɨɩɢɢ
6
5
ɇɟɬ
ɨɩɵɬɚ
ɥɚɩɚɪɨɫɤɨɩɢɢ
7
6
ɩɪɨɫɬɨɣ
ɋɪɟɞɧɢɣ ɪɟɡɭɥɶɬɚɬ ɨɛɳɟɣ ɲɤɚɥɵ ɨɰɟɧɤɢ ɢ
ɲɤɚɥɵ ɨɰɟɧɤɢ ɡɚɞɚɧɢɣ ɪɚɜɧɹɥɫɹ 33 ɛɚɥɥɚɦ
(ɦɟɠɤɜɚɪɬɢɥɶɧɵɣ ɪɚɡɦɚɯ ɫɨɫɬɚɜɥɹɥ 32-36
ɛɚɥɥɨɜ) ɜ ɝɪɭɩɩɟ, ɪɚɛɨɬɚɜɲɟɣ ɫ ɢɦɢɬɚɬɨɪɨɦ ɢ
23 (22-27 ɛɚɥɥɨɜ) ɜ ɝɪɭɩɩɟ ɤɨɧɬɪɨɥɹ (Ɋ<0,001,
Ɍɚɛɥɢɰɚ 2).
ɂɬɨɝɨɜɨɟ ɫɪɟɞɧɟɟ ɜɪɟɦɹ,
ɧɟɨɛɯɨɞɢɦɨɟ ɞɥɹ ɜɵɩɨɥɧɟɧɢɹ ɩɪɨɰɟɞɭɪɵ,
ɫɨɫɬɚɜɥɹɥɨ 12 ɦɢɧɭɬ (ɦɟɠɤɜɚɪɬɢɥɶɧɵɣ ɪɚɡɦɚɯ
10-14 ɦɢɧɭɬ) ɜ ɝɪɭɩɩɟ, ɪɚɛɨɬɚɜɲɟɣ ɫ
ɢɦɢɬɚɬɨɪɨɦ, ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ 24 (20-29 ɦɢɧɭɬ) ɜ
ɝɪɭɩɩɟ ɤɨɧɬɪɨɥɹ (Ɋ<0,001, Ɍɚɛɥɢɰɚ 2).
ȼɫɟɝɨ ɛɵɥɚ ɨɰɟɧɟɧɚ ɞɜɚɞɰɚɬɶ ɨɞɧɚ ɨɩɟɪɚɰɢɹ.
ɋɪɟɞɧɟɟ ɱɢɫɥɨ ɫɦɨɞɟɥɢɪɨɜɚɧɧɵɯ ɨɩɟɪɚɰɢɣ ɩɨ
ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɢ, ɧɟɨɛɯɨɞɢɦɨɟ ɞɥɹ ɞɨɫɬɢɠɟɧɢɹ
ɭɪɨɜɧɹ
ɩɪɨɮɟɫɫɢɨɧɚɥɢɡɦɚ,
ɜ
ɝɪɭɩɩɟ,
ɪɚɛɨɬɚɜɲɟɣ ɫ ɢɦɢɬɚɬɨɪɨɦ, ɪɚɜɧɹɥɨɫɶ 28 (24-32
ɨɩɟɪɚɰɢɢ ɩɨ ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɢ).
Ƚɪɭɩɩɟ
ɤɨɧɬɪɨɥɹ ɩɪɟɞɥɨɠɢɥɢ ɬɪɟɧɢɧɝ ɫ ɢɦɢɬɚɬɨɪɨɦ
ɩɨɫɥɟ ɨɩɟɪɚɰɢɢ. Ⱦɟɜɹɬɶ ɢɡ 11 ɪɟɡɢɞɟɧɬɨɜ ɷɬɨɣ
ɝɪɭɩɩɵ ɫɨɝɥɚɫɢɥɢɫɶ, ɢ ɜ ɫɪɟɞɧɟɦ ɛɵɥɨ
ɧɟɨɛɯɨɞɢɦɨ 26 (23-32) ɫɦɨɞɟɥɢɪɨɜɚɧɧɵɯ
ɨɩɟɪɚɰɢɣ ɩɨ ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɢ ɞɥɹ ɞɨɫɬɢɠɟɧɢɹ
ɭɪɨɜɧɹ ɩɪɨɮɟɫɫɢɨɧɚɥɢɡɦɚ (Ɋ=0,70). ɋɪɟɞɧɟɟ
ɜɪɟɦɹ, ɡɚɬɪɚɱɟɧɧɨɟ ɧɚ ɨɛɭɱɟɧɢɟ ɫ ɢɦɢɬɚɬɨɪɨɦ,
ɫɨɫɬɚɜɢɥɨ 7 ɱɚɫɨɜ 15 ɦɢɧɭɬ (5ɱ 30ɦɢɧ – 8ɱ
0ɦɢɧ) ɜ ɝɪɭɩɩɟ ɜɦɟɲɚɬɟɥɶɫɬɜɚ ɢ 7 ɱɚɫɨɜ 0
ɦɢɧɭɬ (5ɱ 15ɦɢɧ – 7ɱ 45 ɦɢɧ) ɜ ɝɪɭɩɩɟ ɤɨɧɬɪɨɥɹ
(Ɋ=0,65; Ɍɚɛɥɢɰɚ 3). Ȼɚɡɨɜɵɣ ɛɚɥɥ (ɩɟɪɜɚɹ
ɩɨɩɵɬɤɚ) ɜ ɝɪɭɩɩɟ, ɪɚɛɨɬɚɜɲɟɣ ɫ ɢɦɢɬɚɬɨɪɨɦ,
ɛɵɥɨ 8 (5-15), ɚ ɜ ɝɪɭɩɩɟ ɤɨɧɬɪɨɥɹ ɩɨɫɥɟ
ɬɪɟɧɢɧɝɚ ɨɧɨ ɫɨɫɬɚɜɢɥɨ 9 (7-19) (Ɋ=0,070;
Ɍɚɛɥɢɰɚ 3).
ȼɫɟ ɪɚɡɥɢɱɢɹ ɢ ɬɟɧɞɟɧɰɢɢ ɜ
ɨɫɧɨɜɧɵɯ ɯɚɪɚɤɬɟɪɢɫɬɢɤɚɯ ɧɟ ɨɱɟɧɶ ɫɢɥɶɧɨ
ɨɬɥɢɱɚɥɢɫɶ.
ȼɪɟɦɹ, ɡɚɧɟɫɟɧɧɨɟ ɨɰɟɧɢɜɚɸɳɢɦɢ ɥɢɰɚɦɢ ɜ
ɬɚɛɥɢɰɭ, ɛɵɥɨ ɫɪɟɞɧɢɦ ɢɬɨɝɨɜɵɦ ɜɪɟɦɟɧɟɦ
ɩɪɨɜɟɞɟɧɢɹ ɨɩɟɪɚɰɢɢ ɩɥɸɫ ɩɹɬɶ ɦɢɧɭɬ,
ɡɚɬɪɚɱɟɧɧɵɟ
ɧɚ
ɤɚɠɞɭɸ
DVD-ɡɚɩɢɫɶ.
Ʉɨɪɪɟɥɹɰɢɹ ɨɰɟɧɨɤ ɩɨ ɲɤɚɥɚɦ ɫɨɫɬɚɜɢɥɚ 0,79
(166/210). ɂɫɩɨɥɶɡɨɜɚɧɧɵɣ ɞɥɹ ɢɡɭɱɟɧɢɹ ɫɢɥɵ
ɧɚɛɥɸɞɚɬɟɥɹɦɢ
Ȗ
ɤɨɪɪɟɥɹɰɢɢ
ɦɟɠɞɭ
ɤɨɷɮɮɢɰɢɟɧɬ ɧɚ ɨɞɢɧɨɱɧɨɦ ɩɪɟɞɦɟɬɧɨɦ
ɭɪɨɜɧɟ ɫɨɫɬɚɜɢɥ 0,83% (95%, ɞɨɜɟɪɢɬɟɥɶɧɵɣ
ɢɧɬɟɪɜɚɥ ɨɬ 0,69 ɞɨ 0,99).
2 (2) 2009
9
ɈȻɋɍɀȾȿɇɂȿ
ɍɪɨɜɟɧɶ
ɩɪɚɤɬɢɱɟɫɤɨɝɨ
ɦɚɫɬɟɪɫɬɜɚ,
ɩɪɢɨɛɪɟɬɟɧɧɵɣ ɜ ɯɨɞɟ ɜɢɪɬɭɚɥɶɧɨɝɨ ɬɪɟɧɢɧɝɚ
ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɨɣ
ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɢ,
ɫɪɚɜɧɢɜɚɥɫɹ ɫɨ ɫɬɚɧɞɚɪɬɧɨɣ ɤɥɢɧɢɱɟɫɤɨɣ
ɩɪɚɤɬɢɱɟɫɤɨɣ ɩɨɞɝɨɬɨɜɤɨɣ, ɢ ɫɜɹɡɵɜɚɥɫɹ ɫ
ɤɥɢɧɢɱɟɫɤɢ ɜɚɠɧɵɦ ɭɥɭɱɲɟɧɢɟɦ ɨɩɟɪɚɰɢɨɧɧɵɯ
ɧɚɜɵɤɨɜ
ɜɨ
ɜɪɟɦɹ
ɩɪɨɜɟɞɟɧɢɹ
ɫɚɦɨɣ
ɩɪɨɰɟɞɭɪɵ. Ʉɪɢɜɚɹ ɨɛɭɱɟɧɢɹ ɜ ɨɩɟɪɚɰɢɨɧɧɨɣ
ɛɵɥɚ ɬɚɤɠɟ ɤɨɪɨɱɟ.
ȼ ɞɚɧɧɨɣ ɪɚɛɨɬɟ
ɢɫɩɨɥɶɡɨɜɚɥɚɫɶ ɲɤɚɥɚ ɛɚɥɥɨɜ, ɤɨɬɨɪɚɹ ɛɵɥɚ
ɩɪɟɞɜɚɪɢɬɟɥɶɧɨ ɨɬɪɚɛɨɬɚɧɚ ɜ ɨɬɞɟɥɶɧɨɦ
ɢɫɫɥɟɞɨɜɚɧɢɢ. ɉɨ ɷɬɨɣ ɲɤɚɥɟ ɧɚɱɢɧɚɸɳɢɟ
ɷɧɞɨɯɢɪɭɪɝɢ
(ɦɟɧɟɟ
ɩɹɬɢ
ɜɵɩɨɥɧɟɧɧɵɯ
ɩɪɨɰɟɞɭɪ) ɧɚɛɪɚɥɢ ɜ ɫɪɟɞɧɟɦ 24 ɛɚɥɥɚ, ɚ
ɷɧɞɨɯɢɪɭɪɝɢ ɫɨ ɫɪɟɞɧɢɦ ɭɪɨɜɧɟɦ ɩɪɚɤɬɢɱɟɫɤɨɝɨ
ɦɚɫɬɟɪɫɬɜɚ (20-25 ɜɵɩɨɥɧɟɧɧɵɯ ɩɪɨɰɟɞɭɪ)
ɧɚɛɪɚɥɢ ɜ ɫɪɟɞɧɟɦ 33 ɛɚɥɥɚ – ɩɨ ɫɪɚɜɧɟɧɢɸ ɫ
30 ɛɚɥɥɚɦɢ ɜ ɫɪɟɞɧɟɦ ɞɥɹ ɷɤɫɩɟɪɬɨɜ.19
Ɋɟɡɭɥɶɬɚɬɵ ɧɚɫɬɨɹɳɟɝɨ ɢɫɫɥɟɞɨɜɚɧɢɹ ɦɨɝɭɬ
ɢɦɟɬɶ ɨɛɲɢɪɧɨɟ ɤɥɢɧɢɱɟɫɤɨɟ ɩɪɢɦɟɧɟɧɢɟ.
ɉɨɫɥɟ
ɨɬɪɚɛɨɬɤɢ
ɫɨɨɬɜɟɬɫɬɜɭɸɳɟɝɨ
ɜɦɟɲɚɬɟɥɶɫɬɜɚ
ɞɨ
ɞɨɫɬɢɠɟɧɢɹ
ɡɚɪɚɧɟɟ
ɭɫɬɚɧɨɜɥɟɧɧɨɝɨ
ɭɪɨɜɧɹ
ɩɪɚɤɬɢɱɟɫɤɨɝɨ
ɦɚɫɬɟɪɫɬɜɚ ɧɟɨɩɵɬɧɵɟ ɯɢɪɭɪɝɢ ɩɪɢ ɜɵɩɨɥɧɟɧɢɢ
ɫɜɨɟɣ
ɩɟɪɜɨɣ
ɫɚɦɨɫɬɨɹɬɟɥɶɧɨɣ
ɫɥɨɠɧɨɣ
ɥɚɩɚɪɨɫɤɨɩɢɢ
ɩɨɤɚɡɵɜɚɥɢ
ɪɟɡɭɥɶɬɚɬɵ
ɫɨɩɨɫɬɚɜɢɦɵɣ
ɫ
ɭɪɨɜɧɟɦ,
ɩɨɤɚɡɚɧɧɵɦ
ɝɢɧɟɤɨɥɨɝɚɦɢ
ɫɨ
ɫɪɟɞɧɢɦ
ɫɬɚɠɟɦ
ɥɚɩɚɪɨɫɤɨɩɢɣ.
ɋ ɩɨɦɨɳɶɸ ɜɢɪɬɭɚɥɶɧɨɝɨ ɬɪɟɧɢɧɝɚ ɦɨɠɧɨ
ɢɡɛɟɠɚɬɶ ɩɪɟɠɞɟɜɪɟɦɟɧɧɭɸ (ɤɪɭɬɭɸ) ɤɪɢɜɭɸ
ɨɛɭɱɟɧɢɹ, ɤɨɬɨɪɚɹ ɱɚɫɬɨ ɫɜɹɡɵɜɚɟɬɫɹ ɫ ɛɨɥɟɟ
ɜɵɫɨɤɢɦ
ɭɪɨɜɧɟɦ
ɨɫɥɨɠɧɟɧɢɣ.20
ɐɟɥɶɸ
ɧɚɫɬɨɹɳɟɝɨ ɢɫɫɥɟɞɨɜɚɧɢɹ ɧɟ ɛɵɥɨ ɢɡɭɱɟɧɢɟ
ɭɪɨɜɧɹ ɨɫɥɨɠɧɟɧɢɣ, ɩɨɷɬɨɦɭ ɜɵɜɨɞɵ ɩɨ ɷɬɨɦɭ
ɜɨɩɪɨɫɭ ɧɭɠɧɨ ɞɟɥɚɬɶ ɨɫɬɨɪɨɠɧɨ. ȼ ɰɟɥɨɦ,
ɫɥɨɠɧɨ ɢɫɩɨɥɶɡɨɜɚɬɶ ɪɟɡɭɥɶɬɚɬɵ ɩɚɰɢɟɧɬɨɜ
ɞɥɹ ɨɰɟɧɤɢ ɤɭɪɫɚ ɤɥɢɧɢɱɟɫɤɨɝɨ ɬɪɟɧɢɧɝɚ. ȼɨɩɟɪɜɵɯ, ɜ ɨɬɥɢɱɢɟ ɨɬ ɢɫɫɥɟɞɨɜɚɧɢɣ ɩɨ
ɨɞɢɧɨɱɧɨɦɭ
ɜɦɟɲɚɬɟɥɶɫɬɜɭ
(ɧɚɩɪɢɦɟɪ,
ɢɫɫɥɟɞɨɜɚɧɢɟ ɧɨɜɨɝɨ ɥɟɤɚɪɫɬɜɚ) ɦɟɞɢɰɢɧɫɤɨɟ
ɨɛɪɚɡɨɜɚɧɢɟ
ɹɜɥɹɟɬɫɹ
ɫɥɨɠɧɵɦ
ɦɧɨɝɨɮɚɤɬɨɪɧɵɦ ɩɪɨɰɟɫɫɨɦ, ɡɚɬɪɚɝɢɜɚɸɳɟɟ
ɦɧɨɝɨ ɜɡɚɢɦɨɫɜɹɡɚɧɧɵɯ ɱɚɫɬɟɣ ɢ ɭɪɨɜɧɟɣ.21 ȼɨɜɬɨɪɵɯ, ɨɰɟɧɤɚ ɬɟɯɧɢɱɟɫɤɢɯ ɯɢɪɭɪɝɢɱɟɫɤɢɯ
ɧɚɜɵɤɨɜ ɨɬɞɟɥɶɧɵɯ ɪɟɡɢɞɟɧɬɨɜ ɞɨɥɠɧɚ ɛɵɬɶ
ɨɫɧɨɜɚɧɚ
ɧɚ
ɡɚɦɟɳɚɸɳɢɯ
ɤɨɧɟɱɧɵɯ
ɪɟɡɭɥɶɬɚɬɚɯ, ɚ ɧɟ ɧɚ ɬɚɤɢɯ ɪɟɡɭɥɶɬɚɬɚɯ, ɤɚɤ
ɡɚɛɨɥɟɜɚɟɦɨɫɬɶ ɢɥɢ ɫɦɟɪɬɧɨɫɬɶ, ɬɚɤ ɤɚɤ, ɜ
ɫɨɨɬɜɟɬɫɬɜɢɢ
ɫ
ɷɬɢɱɟɫɤɢɦ
ɢɦɩɟɪɚɬɢɜɨɦ,
ɪɟɡɭɥɶɬɚɬ ɨɩɟɪɚɰɢɢ, ɩɪɨɜɟɞɟɧɧɨɣ ɧɨɜɢɱɤɨɦ,
ɞɨɥɠɟɧ ɛɵɬɶ ɬɚɤɨɣ ɠɟ, ɤɚɤ ɭ ɨɩɟɪɚɰɢɢ,
ɜɵɩɨɥɧɟɧɧɨɣ ɨɩɵɬɧɵɦ ɯɢɪɭɪɝɨɦ.
Ɉɛɭɱɟɧɢɟ
ɦɨɠɟɬ ɨɬɧɹɬɶ ɜɪɟɦɹ ɢ ɩɪɢɱɢɧɢɬɶ ɧɟɭɞɨɛɫɬɜɨ
ɩɚɰɢɟɧɬɭ, ɧɨ ɨɧɨ ɧɢɤɨɝɞɚ ɧɟ ɞɨɥɠɧɨ ɭɝɪɨɠɚɬɶ
ɛɟɡɨɩɚɫɧɨɫɬɢ ɢɥɢ ɪɟɡɭɥɶɬɚɬɭ ɥɟɱɟɧɢɹ.
ȼɬɪɟɬɶɢɯ, ɱɬɨɛɵ ɩɪɨɞɟɦɨɧɫɬɪɢɪɨɜɚɬɶ ɪɚɡɥɢɱɢɹ ɜ
ɪɟɡɭɥɶɬɚɬɚɯ, ɨɫɧɨɜɚɧɧɵɟ ɧɚ ɤɭɪɫɟ ɬɪɟɧɢɧɝɚ,
ɤɨɥɢɱɟɫɬɜɨ
ɪɟɡɢɞɟɧɬɨɜ,
ɩɪɢɧɢɦɚɸɳɢɯ
ɧɟɩɨɫɪɟɞɫɬɜɟɧɧɨɟ
ɭɱɚɫɬɢɟ,
ɞɨɥɠɧɨ
ɡɧɚɱɢɬɟɥɶɧɨ ɩɪɟɜɨɫɯɨɞɢɬɶ ɤɨɥɢɱɟɫɬɜɨ ɜɫɟɯ
ɪɟɡɢɞɟɧɬɨɜ, ɱɬɨ ɞɟɥɚɟɬ ɩɨɞɨɛɧɨɟ ɢɫɫɥɟɞɨɜɚɧɢɟ
ɧɟɜɨɡɦɨɠɧɵɦ.
ɉɟɪɟɦɟɧɧɚɹ
Ƚɪɭɩɩɚ, ɪɚɛɨɬɚɜɲɚɹ ɧɚ
ɫɢɦɭɥɹɬɨɪɟ (n=11)
Ƚɪɭɩɩɚ ɤɨɧɬɪɨɥɹ
(n=9)*
Ɂɧɚɱɟɧɢɟ Ɋ†
Ʉɨɥ-ɜɨ (ɞɢɚɩɚɡɨɧ) ɭɱɟɛɧɵɯ ɫɟɫɫɢɣ
28 (16-39)
26 (19-43)
0,76
Ⱦɥɢɬɟɥɶɧɨɫɬɶ (ɞɢɚɩɚɡɨɧ) ɨɛɭɱɟɧɢɹ
7ɱ 15ɦɢɧ
(4ɱ 15 ɦɢɧ – 9ɱ 30 ɦɢɧ)
7ɱ 0ɦɢɧ
(4ɱ 0 ɦɢɧ – 9ɱ 15ɦɢɧ)
0,70
ɋɪɟɞɧɢɣ ɪɟɡɭɥɶɬɚɬ (ɞɢɚɩɚɡɨɧ) ɩɟɪɜɨɣ
ɩɨɩɵɬɤɢ (%), ɛɚɥɥɵ
8 (5-15)
9 (7-19)
í
* Ⱦɨɛɪɨɜɨɥɶɧɵɣ ɬɪɟɧɢɧɝ ɧɚ ɫɢɦɭɥɹɬɨɪɟ ɩɨɫɥɟ ɯɢɪɭɪɝɢɱɟɫɤɨɣ ɩɪɨɰɟɞɭɪɵ.
† U-ɤɪɢɬɟɪɢɣ Ɇɚɧɧɚ-ɍɢɬɧɢ.
10
2(2) 2009
Ɉɩɟɪɚɰɢɨɧɧɨɟ ɜɪɟɦɹ
Ʉɭɪɫɚɧɬɵ, ɩɪɨɲɟɞɲɢɟ ɜɢɪɬɭɚɥɶɧɵɣ ɬɪɟɧɢɧɝ
ɜɵɩɨɥɧɹɥɢ ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɸ ɜ ɫɪɟɞɧɟɦ ɡɚ 12
ɦɢɧɭɬ, ɬɨɝɞɚ ɤɚɤ ɝɪɭɩɩɚ ɤɨɧɬɪɨɥɹ ɫɩɪɚɜɥɹɥɚɫɶ
ɫ ɷɬɨɣ ɡɚɞɚɱɟɣ ɡɚ 24 ɦɢɧɭɬɵ.
[]
ȼɪɟɦɹ,
ɧɟɨɛɯɨɞɢɦɨɟ
ɞɥɹ
ɜɵɩɨɥɧɟɧɢɹ
ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɨɣ ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɢ, ɛɵɥɨ
ɫɨɤɪɚɳɟɧɨ ɜɞɜɨɟ. ɇɟɫɦɨɬɪɹ ɧɚ ɬɨ, ɱɬɨ ɜɪɟɦɹ,
ɡɚɬɪɚɱɟɧɧɨɟ ɥɸɛɵɦ ɧɚɱɢɧɚɸɳɢɦ ɯɢɪɭɪɝɨɦ ɧɚ
ɩɪɨɜɟɞɟɧɢɟ ɨɩɟɪɚɰɢɢ, ɦɨɠɟɬ ɛɵɬɶ ɛɨɥɶɲɟ,
ɪɟɡɭɥɶɬɚɬ ɞɨɥɠɟɧ ɛɵɬɶ ɨɞɢɧɚɤɨɜɵɦ. Ɍɚɤ ɤɚɤ
ɨɩɟɪɚɰɢɨɧɧɚɹ ɬɪɟɛɭɟɬɫɹ ɢ ɞɥɹ ɩɪɨɜɟɞɟɧɢɹ
ɨɩɟɪɚɰɢɣ, ɢ ɞɥɹ ɨɛɪɚɡɨɜɚɬɟɥɶɧɵɯ ɰɟɥɟɣ, ɬɨ
ɞɚɧɧɨɟ ɫɨɤɪɚɳɟɧɢɟ ɨɩɟɪɚɬɢɜɧɨɝɨ ɜɪɟɦɟɧɢ
ɹɜɥɹɟɬɫɹ ɤɥɢɧɢɱɟɫɤɢ ɰɟɧɧɵɦ.
ɇɚɫɬɨɹɳɢɟ
ɪɟɡɭɥɶɬɚɬɵ ɩɨɞɱɟɪɤɢɜɚɸɬ, ɱɬɨ ɫ ɩɨɦɨɳɶɸ
ɬɪɟɧɢɧɝɚ
ɧɚ
ɢɦɢɬɚɬɨɪɟ
ɜɢɪɬɭɚɥɶɧɨɣ
ɪɟɚɥɶɧɨɫɬɢ
ɯɢɪɭɪɝɢ
ɦɨɝɭɬ
ɨɫɜɨɢɬɶ
ɩɪɚɤɬɢɱɟɫɤɢɟ ɧɚɜɵɤɢ ɥɚɩɚɪɨɫɤɨɩɢɢ.
ɗɬɢ
ɪɟɡɭɥɶɬɚɬɵ
ɬɚɤɠɟ
ɩɨɤɚɡɵɜɚɸɬ,
ɱɬɨ
ɨɫɧɨɜɚɧɧɚɹ
ɧɚ
ɨɛɴɟɤɬɢɜɧɵɯ
ɤɪɢɬɟɪɢɹɯ
ɨɬɪɚɛɨɬɤɚ ɜɦɟɲɚɬɟɥɶɫɬɜɚ ɧɚ ɜɢɪɬɭɚɥɶɧɨɦ
ɫɢɦɭɥɹɬɨɪɟ ɦɨɠɟɬ ɫɷɤɨɧɨɦɢɬɶ ɪɚɛɨɱɟɟ ɜɪɟɦɹ,
ɩɨɦɨɝɚɹ ɧɚɱɢɧɚɸɳɢɦ ɯɢɪɭɪɝɚɦ ɛɵɫɬɪɟɟ
ɞɨɫɬɢɱɶ ɜɵɫɨɤɨɝɨ ɭɪɨɜɧɹ ɩɪɨɮɟɫɫɢɨɧɚɥɢɡɦɚ.
Ɍɪɚɞɢɰɢɨɧɧɨɟ ɨɛɭɱɟɧɢɟ ɡɚɜɢɫɢɬ ɨɬ ɧɚɥɢɱɢɹ
ɛɨɥɶɧɵɯ, ɞɨɫɬɭɩɧɵɯ ɧɚ ɞɚɧɧɵɣ ɦɨɦɟɧɬ, ɬɨɝɞɚ
ɤɚɤ ɬɪɟɧɢɧɝ ɫ ɜɢɪɬɭɚɥɶɧɵɦ ɢɦɢɬɚɬɨɪɨɦ
ɩɪɨɜɨɞɢɬɫɹ
ɜ
ɥɸɛɨɣ
ɦɨɦɟɧɬ
«ɩɨ
ɩɨɬɪɟɛɧɨɫɬɢ».
ɑɬɨɛɵ
ɫɚɦɨɫɬɨɹɬɟɥɶɧɨ
ɜɵɩɨɥɧɢɬɶ 28 ɨɩɟɪɚɰɢɣ ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɢ
ɦɨɠɟɬ ɩɨɬɪɟɛɨɜɚɬɶɫɹ ɝɨɞ ɢ ɛɨɥɟɟ ɤɥɢɧɢɱɟɫɤɨɣ
ɩɪɚɤɬɢɤɢ, ɬɨɝɞɚ ɤɚɤ ɧɚ ɢɦɢɬɚɬɨɪɟ ɷɬɨ ɡɚɣɦɟɬ
ɜɫɟɝɨ ɜɨɫɟɦɶ ɱɚɫɨɜ.
ɇɚɤɨɧɟɰ,
ɧɟɥɶɡɹ
ɩɨɞɜɟɪɝɚɬɶ
ɫɨɦɧɟɧɢɸ
ɜɚɠɧɨɫɬɶ ɫɨɤɪɚɳɟɧɢɹ ɨɩɟɪɚɰɢɨɧɧɨɝɨ ɜɪɟɦɟɧɢ
ɜɞɜɨɟ, ɨɬ 24 ɦɢɧɭɬ ɜ ɝɪɭɩɩɟ ɤɨɧɬɪɨɥɹ ɞɨ 12
ɦɢɧɭɬ ɜ ɝɪɭɩɩɟ ɜɢɪɬɭɚɥɶɧɨɝɨ ɬɪɟɧɢɧɝɚ. Ɍɚɤ,
ɛɨɥɟɟ ɞɟɫɹɬɢ ɥɟɬ ɧɚɡɚɞ (1997) ɛɵɥɨ
ɩɨɞɫɱɢɬɚɧɨ, ɱɬɨ ɜɨ ɜɪɟɦɹ ɩɨɞɝɨɬɨɜɤɢ ɜɪɚɱɟɣɫɩɟɰɢɚɥɢɫɬɨɜ ɫɜɟɪɯɧɨɪɦɚɬɢɜɧɵɟ ɡɚɬɪɚɬɵ ɧɚ
ɭɜɟɥɢɱɟɧɢɟ
ɩɪɨɞɨɥɠɢɬɟɥɶɧɨɫɬɢ
ɪɚɛɨɬɵ
ɨɩɟɪɚɰɢɨɧɧɨɣ ɜɪɟɦɟɧɢ ɫɨɫɬɚɜɢɥɢ ɩɪɢɦɟɪɧɨ
$48 000 (£31 841,00; €35 907,00) ɧɚ
ɱɟɥɨɜɟɤɚ.22
ȼ ɫɥɭɱɚɟ ɛɨɥɟɟ ɫɥɨɠɧɵɯ
ɜɦɟɲɚɬɟɥɶɫɬɜ
ɢɥɢ
ɞɚɠɟ
ɩɪɨɫɬɨ
ɩɪɢ
ɜɵɩɨɥɧɟɧɢɢ ɞɜɭɫɬɨɪɨɧɧɟɣ ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɢ
ɛɨɥɶɲɟɟ
ɢɫɩɨɥɶɡɨɜɚɧɢɟ
ɜɢɪɬɭɚɥɶɧɨɝɨ
ɬɪɟɧɢɧɝɚ ɦɨɠɟɬ ɡɧɚɱɢɬɟɥɶɧɨ ɫɨɤɪɚɬɢɬɶ
ɨɩɟɪɚɰɢɨɧɧɨɟ
ɜɪɟɦɹ,
ɡɚɬɪɚɱɟɧɧɨɟ
ɧɚ
ɨɛɭɱɟɧɢɟ ɧɚɱɢɧɚɸɳɢɯ ɫɩɟɰɢɚɥɢɫɬɨɜ, ɫɧɢɠɚɹ
ɧɚɝɪɭɡɤɭ ɧɚ ɨɩɟɪɚɰɢɨɧɧɭɸ.
x Ɉɛɪɚɬɧɚɹ ɬɚɤɬɢɥɶɧɚɹ ɫɜɹɡɶ.
x ɇɚɫɬɪɨɣɤɚ ɫɥɨɠɧɨɫɬɢ
x ɂɧɞɢɤɚɬɨɪɵ ɦɚɫɬɟɪɫɬɜɚ
ɍɱɟɛɧɵɟ ɦɨɞɭɥɢ
x
x
x
x
Ⱥɪɬɪɨɫɤɨɩɢɱɟɫɤɚɹ ɚɧɚɬɨɦɢɹ
Ȼɚɡɨɜɵɟ ɭɩɪɚɠɧɟɧɢɹ (ɷɪɝɨɧɨɦɢɤɚ,
ɧɚɜɢɝɚɰɢɹ, ɜɡɚɢɦɨɞɟɣɫɬɜɢɟ)
Ⱥɪɬɪɨɫɤɨɩɢɹ ɤɨɥɟɧɧɨɝɨ ɫɭɫɬɚɜɚ
Ⱥɪɬɪɨɫɤɨɩɢɹ ɩɥɟɱɟɜɨɝɨ ɫɭɫɬɚɜɚ
Ⱥɥɶɬɚ Ɇɟɞɢɤɚ
/ +7 (495) 796 45 47
!."
: office@altamedica.ru,
www.altamedica.ru
Camera training*
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: office@intermedica.nnov.ru
12
ɉɟɪɟɧɨɫ ɧɚɜɵɤɨɜ
ɇɟɫɦɨɬɪɹ ɧɚ ɬɨ, ɱɬɨ ɢɦɢɬɚɬɨɪɵ ɜɢɪɬɭɚɥɶɧɨɣ
ɪɟɚɥɶɧɨɫɬɢ ɩɨɹɜɢɥɢɫɶ ɛɨɥɟɟ ɞɟɫɹɬɢ ɥɟɬ ɧɚɡɚɞ,
ɦɚɥɨ ɞɨɤɚɡɚɬɟɥɶɫɬɜ ɢɯ ɷɮɮɟɤɬɢɜɧɨɫɬɢ ɜ
ɨɩɟɪɚɰɢɨɧɧɨɣ.13 ɇɚ ɫɟɝɨɞɧɹɲɧɢɣ ɞɟɧɶ ɧɟ
ɨɩɭɛɥɢɤɨɜɚɧɨ
ɦɚɬɟɪɢɚɥɨɜ
ɨ
ɩɟɪɟɧɨɫɟ
ɬɟɯɧɢɱɟɫɤɢɯ ɧɚɜɵɤɨɜ ɫ ɢɦɢɬɚɬɨɪɚ ɧɚ ɪɟɚɥɶɧɵɟ
ɨɩɟɪɚɰɢɢ, ɞɨɤɚɡɚɬɟɥɶɧɨɫɬɶ ɤɨɬɨɪɵɯ ɩɪɟɜɵɫɢɥɚ
ɛɵ ɫɬɟɩɟɧɶ 2ɚ; ɧɚɲɟ ɢɫɫɥɟɞɨɜɚɧɢɟ ɢɦɟɟɬ
ɫɬɟɩɟɧɶ 1b.
ɗɬɢ ɜɵɜɨɞɵ ɩɨɞɬɜɟɪɠɞɟɧɵ
ɫɢɫɬɟɦɚɬɢɱɟɫɤɢɦ ɨɛɡɨɪɨɦ,14 ɱɬɨ ɢɫɫɥɟɞɨɜɚɧɢɹ
ɫɨ ɫɥɭɱɚɣɧɨɣ ɜɵɛɨɪɤɨɣ ɩɨ ɷɮɮɟɤɬɭ ɨɬ ɬɪɟɧɢɧɝɚ
ɧɚ ɢɦɢɬɚɬɨɪɟ ɛɵɥɢ, ɤɚɤ ɩɪɚɜɢɥɨ, ɧɢɡɤɨɝɨ
ɧɚɭɱɧɨɝɨ ɤɚɱɟɫɬɜɚ.
Ƚɥɚɜɧɵɦɢ ɩɪɨɛɥɟɦɚɦɢ
ɢɫɫɥɟɞɨɜɚɧɢɣ ɛɵɥɢ ɜɵɛɨɪɤɚ ɫ ɧɟɞɨɫɬɚɬɨɱɧɵɦ
ɫɨɤɪɵɬɢɟɦ
ɪɚɫɩɪɟɞɟɥɟɧɢɹ
ɭɱɚɫɬɧɢɤɨɜ
ɢɫɫɥɟɞɨɜɚɧɢɹ ɩɨ ɝɪɭɩɩɚɦ, ɧɟɞɨɫɬɚɬɤɢ ɪɚɫɱɟɬɨɜ
ɢɥɢ
ɧɟɞɨɫɬɚɬɨɱɧɵɟ
ɪɚɡɦɟɪɵ
ɜɵɛɨɪɨɤ,
ɧɟɞɨɫɬɚɬɨɱɧɚɹ ɛɟɫɩɪɢɫɬɪɚɫɬɧɨɫɬɶ ɧɚɛɥɸɞɚɬɟɥɟɣ
(ɨɫɜɟɞɨɦɥɟɧɧɨɫɬɶ ɷɤɫɩɟɪɬɨɜ ɨ ɬɢɩɟ ɬɪɟɧɢɧɝɚ),
ɧɟɞɨɫɬɚɬɨɱɧɨɟ ɜɪɟɦɹ ɞɥɹ ɬɪɟɧɢɧɝɚ ɢɥɢ
ɞɨɫɬɢɠɟɧɢɹ ɩɨɫɬɚɜɥɟɧɧɨɣ ɰɟɥɢ, ɧɟɫɬɚɧɞɚɪɬɧɵɟ
ɤɪɢɬɟɪɢɢ
ɫɪɚɜɧɟɧɢɹ
ɦɟɠɞɭ
ɝɪɭɩɩɚɦɢ
ɢ
ɧɟɫɨɢɡɦɟɪɢɦɵɟ ɜɦɟɲɚɬɟɥɶɫɬɜɚ ɜ ɨɫɧɨɜɧɵɯ
ɝɪɭɩɩɚɯ. ȼ ɛɨɥɶɲɢɧɫɬɜɟ ɢɫɫɥɟɞɨɜɚɧɢɣ ɬɚɤɠɟ
ɢɫɩɨɥɶɡɨɜɚɥɢɫɶ ɫɭɪɪɨɝɚɬɧɵɟ ɤɨɧɱɟɧɵɟ ɰɟɥɢ –
ɜɦɟɫɬɨ ɨɰɟɧɤɢ ɩɨɥɭɱɟɧɧɨɝɨ ɧɚɜɵɤɚ ɜ ɯɨɞɟ
ɪɟɚɥɶɧɨɣ
ɨɩɟɪɚɰɢɢ,
ɨɰɟɧɤɚ
ɪɟɡɭɥɶɬɚɬɨɜ
ɩɪɨɢɡɜɨɞɢɥɚɫɶ ɧɚ ɨɬɤɪɵɬɵɯ ɬɪɟɧɚɠɟɪɚɯ ɢɥɢ ɜ
ɯɨɞɟ ɬɟɫɬɨɜ ɧɚ ɫɚɦɢɯ ɜɢɪɬɭɚɥɶɧɵɯ ɫɢɦɭɥɹɬɨɪɚɯ.
ȼɵɜɨɞ
ɦɟɬɚ-ɚɧɚɥɢɡɚ
ɭɩɨɦɹɧɭɬɨɝɨ
ɫɢɫɬɟɦɚɬɢɱɟɫɤɨɝɨ ɨɛɡɨɪɚ ɫɨɫɬɨɹɥ ɜ ɬɨɦ, ɱɬɨ
ɬɨɥɶɤɨ
ɧɟɫɤɨɥɶɤɨ
ɢɫɫɥɟɞɨɜɚɧɢɣ
ɛɵɥɢ
ɧɟɨɛɯɨɞɢɦɨɝɨ ɤɚɱɟɫɬɜɚ, ɞɜɚ ɢɫɫɥɟɞɨɜɚɧɢɹ
ɩɨɤɚɡɚɥɢ ɩɨɥɨɠɢɬɟɥɶɧɵɟ ɪɟɡɭɥɶɬɚɬɵ 23 24
(ɧɚɫɬɨɹɳɚɹ ɨɩɟɪɚɰɢɹ), ɢ ɨɞɧɨ ɢɫɫɥɟɞɨɜɚɧɢɟ ɧɟ
ɩɨɤɚɡɚɥɨ
ɧɢɤɚɤɢɯ
ɪɟɡɭɥɶɬɚɬɨɜ
25
(ɫɦɨɞɟɥɢɪɨɜɚɧɧɚɹ ɨɩɟɪɚɰɢɹ) ɩɨ ɜɢɪɬɭɚɥɶɧɨɦɭ
ɬɪɟɧɢɧɝɭ. ȿɳɟ ɨɞɧɚ ɨɛɳɚɹ ɱɟɪɬɚ ɩɪɟɞɵɞɭɳɢɯ
ɢɫɫɥɟɞɨɜɚɧɢɣ
ɡɚɤɥɸɱɚɟɬɫɹ
ɜ
ɬɨɦ,
ɱɬɨ
ɩɪɨɜɟɞɟɧɧɨɟ ɜ ɧɢɯ ɦɨɞɟɥɢɪɨɜɚɧɢɟ ɛɵɥɨ
ɧɚɰɟɥɟɧɨ ɧɚ ɛɚɡɨɜɵɟ ɧɚɜɵɤɢ, ɚ ɧɟ ɧɚ
ɫɩɟɰɢɮɢɱɟɫɤɢɟ ɩɪɨɰɟɞɭɪɧɵɟ ɧɚɜɵɤɢ.
ȼɨɡɦɨɠɧɨ, ɜ ɧɚɲɟɦ ɢɫɫɥɟɞɨɜɚɧɢɢ ɟɫɬɶ ɧɟɫɤɨɥɶɤɨ
ɩɪɢɱɢɧ ɡɧɚɱɢɬɟɥɶɧɨɝɨ ɜɨɡɞɟɣɫɬɜɢɹ ɜɢɪɬɭɚɥɶɧɨɝɨ
ɬɪɟɧɢɧɝɚ ɤɚɤ ɧɚ ɭɪɨɜɟɧɶ ɩɪɚɤɬɢɱɟɫɤɨɝɨ ɧɚɜɵɤɚ
ɩɪɢ ɜɵɩɨɥɧɟɧɢɟ ɨɩɟɪɚɰɢɢ, ɬɚɤ ɢ ɧɚ ɜɪɟɦɹ ɩɨ
ɫɪɚɜɧɟɧɢɸ ɫ ɪɚɧɟɟ ɨɩɭɛɥɢɤɨɜɚɧɧɵɦɢ ɪɚɛɨɬɚɦɢ.
ȼɨ-ɩɟɪɜɵɯ,
ɫɢɦɭɥɹɬɨɪ
ɞɚɟɬ
ɪɟɚɥɢɫɬɢɱɧɨɟ
ɝɪɚɮɢɱɟɫɤɨɟ ɩɪɟɞɫɬɚɜɥɟɧɢɟ ɚɧɚɬɨɦɢɢ ɫ ɬɨɱɤɢ
ɡɪɟɧɢɹ ɯɢɪɭɪɝɢɢ ɢ ɯɨɪɨɲɭɸ ɫɢɫɬɟɦɭ ɨɛɪɚɬɧɨɣ
ɫɜɹɡɢ, ɩɨɡɜɨɥɹɸɳɭɸ ɪɟɡɢɞɟɧɬɚɦ ɤɨɪɪɟɤɬɢɪɨɜɚɬɶ
ɫɜɨɢ ɧɚɜɵɤɢ. ȼɨ-ɜɬɨɪɵɯ, ɢɫɩɨɥɶɡɨɜɚɧɢɟ ɡɚɪɚɧɟɟ
ɩɨɫɬɚɜɥɟɧɧɵɯ ɰɟɥɟɣ ɬɪɟɧɢɧɝɚ (ɭɪɨɜɟɧɶ ɷɤɫɩɟɪɬɚɩɪɨɮɟɫɫɢɨɧɚɥɚ) ɜɦɟɫɬɨ ɮɢɤɫɢɪɨɜɚɧɧɨɝɨ
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ɜɪɟɦɟɧɢ ɢɥɢ ɡɧɚɱɟɧɢɣ ɫɩɨɫɨɛɫɬɜɨɜɚɥɨ ɬɨɦɭ, ɱɬɨ
ɪɟɡɢɞɟɧɬɵ ɨɬɪɚɛɚɬɵɜɚɥɢ ɧɚɜɵɤɢ ɧɚ ɢɦɢɬɚɬɨɪɟ
ɞɨ ɞɨɫɬɢɠɟɧɢɹ ɦɚɤɫɢɦɚɥɶɧɨɝɨ ɷɮɮɟɤɬɚ. ȼɬɪɟɬɶɢɯ, ɜɦɟɫɬɨ ɨɬɛɨɪɚ ɫɬɭɞɟɧɬɨɜ-ɦɟɞɢɤɨɜ,
ɤɨɬɨɪɵɟ ɦɨɝɭɬ ɧɟ ɜɵɛɪɚɬɶ ɫɩɟɰɢɚɥɶɧɨɫɬɶ
ɯɢɪɭɪɝɚ, ɦɵ ɪɚɛɨɬɚɥɢ ɫ ɪɟɡɢɞɟɧɬɚɦɢ ɫ ɜɵɫɨɤɨɣ
ɦɨɬɢɜɚɰɢɟɣ, ɤɨɬɨɪɵɦ ɧɭɠɧɨ ɛɵɥɨ ɢɡɭɱɢɬɶ
ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɢɟ ɧɚɜɵɤɢ ɞɥɹ ɛɭɞɭɳɟɣ ɪɚɛɨɬɵ.
Ɇɵ ɨɰɟɧɢɥɢ ɜɥɢɹɧɢɟ ɜɢɪɬɭɚɥɶɧɨɝɨ ɬɪɟɧɢɧɝɚ ɧɚ
ɫɚɥɶɩɢɧɝɷɤɬɨɦɢɸ, ɤɨɬɨɪɚɹ ɹɜɥɹɟɬɫɹ ɜɚɠɧɨɣ
ɝɢɧɟɤɨɥɨɝɢɱɟɫɤɨɣ ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɨɣ ɩɪɨɰɟɞɭɪɨɣ
ɢ ɦɨɠɟɬ ɪɚɫɫɦɚɬɪɢɜɚɬɶɫɹ ɤɚɤ ɤɥɸɱɟɜɚɹ
ɨɩɟɪɚɰɢɹ,
ɨɛɥɚɞɚɸɳɚɹ
ɜɫɟɦɢ
ɨɫɧɨɜɧɵɦɢ
ɧɚɜɵɤɚɦɢ, ɧɟɨɛɯɨɞɢɦɵɦɢ ɞɥɹ ɩɪɨɜɟɞɟɧɢɹ
ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɢɯ ɩɪɨɰɟɞɭɪ.
Ɇɵ ɩɪɨɜɨɞɢɥɢ
ɬɟɫɬɢɪɨɜɚɧɢɟ ɬɨɥɶɤɨ ɜ ɝɢɧɟɤɨɥɨɝɢɢ.
Ɉɞɧɚɤɨ
ɭɥɭɱɲɟɧɧɵɟ ɜ ɩɪɨɰɟɫɫɟ ɬɟɫɬɢɪɨɜɚɧɢɹ ɧɚɜɵɤɢ
ɹɜɥɹɸɬɫɹ ɨɫɧɨɜɧɵɦɢ ɢ ɩɪɢɝɨɞɹɬɫɹ ɜɨ ɜɫɟɯ
ɯɢɪɭɪɝɢɱɟɫɤɢɯ ɫɩɟɰɢɚɥɶɧɨɫɬɹɯ. ɏɨɞ ɨɩɟɪɚɰɢɢ
ɨɫɧɨɜɚɧ ɤɚɤ ɧɚ ɬɟɯɧɢɱɟɫɤɢɯ ɧɚɜɵɤɚɯ, ɬɚɤ ɢ ɧɚ
ɡɧɚɧɢɢ ɩɪɨɰɟɞɭɪɵ. ɉɨɷɬɨɦɭ ɦɵ ɧɚɞɟɟɦɫɹ, ɱɬɨ
ɧɚɜɵɤɢ, ɩɪɢɨɛɪɟɬɟɧɧɵɟ ɜɨ ɜɪɟɦɹ ɬɪɟɧɢɧɝɚ ɧɚ
ɜɢɪɬɭɚɥɶɧɨɦ ɢɦɢɬɚɬɨɪɟ, ɦɨɝɭɬ ɛɵɬɶ ɩɨɥɟɡɧɵ ɞɥɹ
ɞɪɭɝɢɯ
ɥɚɩɚɪɨɫɤɨɩɢɱɟɫɤɢɯ
ɩɪɨɰɟɞɭɪ,
ɯɨɬɹ
ɪɟɡɭɥɶɬɚɬ ɛɭɞɟɬ ɛɨɥɟɟ ɡɚɦɟɬɟɧ ɜ ɬɟɯɧɢɱɟɫɤɢɯ
ɧɚɜɵɤɚɯ, ɱɟɦ ɜ ɡɧɚɧɢɢ ɩɪɨɰɟɞɭɪ.
ɗɬɢ
ɩɪɟɞɩɨɥɨɠɟɧɢɹ
ɩɨɞɬɜɟɪɠɞɚɸɬɫɹ
ɧɟɞɚɜɧɢɦ
ɲɜɟɞɫɤɢɦ
ɢɫɫɥɟɞɨɜɚɧɢɟɦ
ɬɪɟɧɢɧɝɚ
ɜ
ɜɢɪɬɭɚɥɶɧɨɣ ɪɟɚɥɶɧɨɫɬɢ ɩɨ ɯɨɥɟɰɢɫɬɷɤɬɨɦɢɢ,
ɜɵɜɨɞɵ ɤɨɬɨɪɨɝɨ ɫɯɨɠɢ ɫ ɜɵɜɨɞɚɦɢ ɧɚɫɬɨɹɳɟɣ
ɪɚɛɨɬɵ.26
ȼɕȼɈȾɕ
ɇɚɜɵɤɢ, ɩɪɢɨɛɪɟɬɟɧɧɵɟ ɜɨ ɜɪɟɦɹ ɬɪɟɧɢɧɝɚ ɧɚ
ɜɢɪɬɭɚɥɶɧɨɦ ɫɢɦɭɥɹɬɨɪɟ, ɦɨɠɧɨ ɩɟɪɟɧɟɫɬɢ ɜ
ɪɟɚɥɶɧɭɸ ɨɩɟɪɚɰɢɸ.
ɉɨɞɨɛɧɵɣ ɬɪɟɧɢɧɝ ɩɨ
ɨɫɧɨɜɧɵɦ ɩɪɨɮɟɫɫɢɨɧɚɥɶɧɵɦ ɧɚɜɵɤɚɦ ɞɨɥɠɟɧ
ɫɬɚɬɶ ɧɟɨɬɴɟɦɥɟɦɨɣ ɱɚɫɬɶɸ ɤɭɪɫɚ ɯɢɪɭɪɝɢɢ ɞɥɹ
ɜɫɟɯ ɜɪɚɱɟɣ-ɨɪɞɢɧɚɬɨɪɨɜ ɞɨ ɩɪɨɜɟɞɟɧɢɹ ɢɦɢ
ɨɩɟɪɚɰɢɣ ɧɚ ɩɚɰɢɟɧɬɚɯ-ɥɸɞɹɯ.
ɗɬɨ ɦɨɠɟɬ
ɩɨɜɵɫɢɬɶ ɛɟɡɨɩɚɫɧɨɫɬɶ ɩɚɰɢɟɧɬɨɜ ɢ ɭɥɭɱɲɢɬɶ
ɪɚɛɨɬɭ ɜ ɨɩɟɪɚɰɢɨɧɧɨɣ.
Ɇɵ ɜɵɪɚɠɚɟɦ ɩɪɢɡɧɚɬɟɥɶɧɨɫɬɶ Ƀɨɪɧɭ ȼɟɬɬɟɪɫɥɟɜɭ
ɢɡ
Ɉɬɞɟɥɟɧɢɹ
ɤɥɢɧɢɱɟɫɤɢɯ
ɢɫɩɵɬɚɧɢɣ
ɍɧɢɜɟɪɫɢɬɟɬɚ
Ʉɨɩɟɧɝɚɝɟɧɚ
ɡɚ
ɤɪɢɬɢɱɟɫɤɢɟ
ɡɚɦɟɱɚɧɢɹ ɩɨ ɧɚɫɬɨɹɳɟɦɭ ɢɫɫɥɟɞɨɜɚɧɢɸ.
14
Ⱥɜɬɨɪɵ: CRL (ɝɥɚɜɧɵɣ ɢɫɫɥɟɞɨɜɚɬɟɥɶ) ɩɨɥɭɱɚɥ
ɢɧɮɨɪɦɚɰɢɸ, ɧɚɩɢɫɚɥ ɱɟɪɧɨɜɨɣ ɜɚɪɢɚɧɬ ɧɚɫɬɨɹɳɟɣ
ɪɚɛɨɬɵ, ɜɵɩɨɥɧɢɥ ɫɬɚɬɢɫɬɢɱɟɫɤɢɣ ɚɧɚɥɢɡ ɢ
ɩɨɥɭɱɢɥ ɮɢɧɚɧɫɢɪɨɜɚɧɢɟ.
TPG ɢ JLS ɨɤɚɡɵɜɚɥɢ
ɚɞɦɢɧɢɫɬɪɚɬɢɜɧɭɸ ɩɨɞɞɟɪɠɤɭ ɢ ɨɮɢɰɢɚɥɶɧɨɟ
ɨɬɪɟɞɚɤɬɢɪɨɜɚɥɢ ɪɭɤɨɩɢɫɶ.
JLS ɢɦɟɥ ɩɨɥɧɵɣ
ɞɨɫɬɭɩ ɤɨ ɜɫɟɣ ɢɧɮɨɪɦɚɰɢɢ ɢ ɛɟɪɟɬ ɧɚ ɫɟɛɹ
ɨɬɜɟɬɫɬɜɟɧɧɨɫɬɶ ɡɚ ɰɟɥɨɫɬɧɨɫɬɶ ɞɚɧɧɵɯ ɢ
ɬɨɱɧɨɫɬɶ ɚɧɚɥɢɡɚ.
TD ɩɨɥɭɱɚɥ ɢɧɮɨɪɦɚɰɢɸ,
ɨɤɚɡɵɜɚɥ ɬɟɯɧɢɱɟɫɤɭɸ ɩɨɞɞɟɪɠɤɭ ɢ ɤɪɢɬɢɱɧɨ
ɨɬɪɟɞɚɤɬɢɪɨɜɚɥ ɪɭɤɨɩɢɫɶ.
LS ɢ CO ɩɨɥɭɱɚɥɢ
ɢɧɮɨɪɦɚɰɢɸ,
ɨɤɚɡɵɜɚɥɢ
ɚɞɦɢɧɢɫɬɪɚɬɢɜɧɭɸ
ɩɨɞɞɟɪɠɤɭ ɢ ɤɪɢɬɢɱɧɨ ɨɬɪɟɞɚɤɬɢɪɨɜɚɥɢ ɪɭɤɨɩɢɫɶ.
TVS ɢ BSO ɨɤɚɡɵɜɚɥɢ ɚɞɦɢɧɢɫɬɪɚɬɢɜɧɭɸ ɩɨɞɞɟɪɠɤɭ,
ɪɭɤɨɜɨɞɢɥɢ
ɢɫɫɥɟɞɨɜɚɧɢɟɦ,
ɤɪɢɬɢɱɧɨ
ɨɬɪɟɞɚɤɬɢɪɨɜɚɥɢ
ɪɭɤɨɩɢɫɶ
ɢ
ɩɨɥɭɱɚɥɢ
ɮɢɧɚɧɫɢɪɨɜɚɧɢɟ.
ȼɫɟ ɚɜɬɨɪɵ ɭɱɚɫɬɜɨɜɚɥɢ ɜ
ɪɚɡɪɚɛɨɬɤɟ
ɢɫɫɥɟɞɨɜɚɧɢɹ,
ɚɧɚɥɢɡɢɪɨɜɚɥɢ
ɢ
ɢɧɬɟɪɩɪɟɬɢɪɨɜɚɥɢ ɢɧɮɨɪɦɚɰɢɸ.
Ɏɢɧɚɧɫɢɪɨɜɚɧɢɟ: ɇɚɫɬɨɹɳɢɣ ɩɪɨɟɤɬ ɛɵɥ ɩɨɞɞɟɪɠɚɧ
ɏɨɫɩɢɬɚɥ Ɋɢɝɫɯɨɫɩɢɬɚɥɢɬɟɬ ɩɪɢ ɍɧɢɜɟɪɫɢɬɟɬɟ
Ʉɨɩɟɧɝɚɝɟɧɚ. Ɍɪɢɝɮɨɧɞɟɬ ɩɪɟɞɨɫɬɚɜɢɥ ɪɚɡɥɢɱɧɵɟ
ɦɚɬɟɪɢɚɥɵ, ɜɤɥɸɱɚɹ ɚɩɩɚɪɚɬɧɨɟ ɨɛɟɫɩɟɱɟɧɢɟ. Ⱦɟɬ
Ʉɚɥɫɫɟɧɫɤɟ Ɏɢɞɟɤɨɦɦɢɫ Ƀɸɛɢɥɚɟɭɦɡɮɨɧɞ ɨɩɥɚɬɢɥ
ɞɨɪɨɠɧɵɟ ɪɚɫɯɨɞɵ.
Ⱥɚɡɟ ɢ ɗɣɧɟɪ Ⱦɚɧɢɷɥɶɫɟɧɡ
Ɏɚɭɧɞɟɣɲɧ ɩɪɟɞɨɫɬɚɜɢɥ ɩɪɨɝɪɚɦɦɧɨɟ ɨɛɟɫɩɟɱɟɧɢɟ ɢ
ɨɛɧɨɜɥɟɧɢɹ, ɡɚɩɢɫɵɜɚɸɳɢɟ ɭɫɬɪɨɣɫɬɜɚ DVD ɢ
ɜɢɞɟɨɦɨɧɢɬɨɪ.
Ⱦɚɬɫɤɨɟ ɨɛɳɟɫɬɜɨ ɡɚɳɢɬɵ
ɥɚɛɨɪɚɬɨɪɧɵɯ ɠɢɜɨɬɧɵɯ ɩɪɟɞɨɫɬɚɜɢɥɨ ɚɩɩɚɪɚɬɧɨɟ
ɢ ɤɨɦɩɶɸɬɟɪɧɨɟ ɨɛɟɫɩɟɱɟɧɢɟ.
ȼɫɟ ɷɬɚɩɵ
ɢ
ɧɚɫɬɨɹɳɟɣ
ɪɚɛɨɬɵ,
ɜɤɥɸɱɚɹ
ɪɚɡɪɚɛɨɬɤɭ
ɩɪɨɜɟɞɟɧɢɟ
ɢɫɫɥɟɞɨɜɚɧɢɹ;
ɫɛɨɪ,
ɚɧɚɥɢɡ
ɢ
ɢɧɬɟɪɩɪɟɬɚɰɢɸ
ɞɚɧɧɵɯ;
ɩɨɞɝɨɬɨɜɤɚ,
ɪɟɞɚɤɬɢɪɨɜɚɧɢɟ
ɢ
ɨɞɨɛɪɟɧɢɟ
ɨɤɨɧɱɚɬɟɥɶɧɨɝɨ
ɜɚɪɢɚɧɬɚ ɪɭɤɨɩɢɫɢ ɛɵɥɢ ɜɵɩɨɥɧɟɧɵ ɧɟɡɚɜɢɫɢɦɨ ɨɬ
ɮɢɧɚɧɫɢɪɭɸɳɢɯ ɨɪɝɚɧɢɡɚɰɢɣ.
Ʉɨɧɤɭɪɟɧɬɵ: ɇɟ ɡɚɹɜɥɟɧɨ.
ɗɬɢɱɟɫɤɨɟ ɨɞɨɛɪɟɧɢɟ: ɂɫɫɥɟɞɨɜɚɧɢɟ ɩɨɥɧɨɫɬɶɸ
ɫɨɨɬɜɟɬɫɬɜɭɟɬ
ɬɪɟɛɨɜɚɧɢɹɦ
ɏɟɥɶɫɢɧɤɫɤɨɣ
ɞɟɤɥɚɪɚɰɢɢ II ɩɨ ɛɢɨɦɟɞɢɰɢɧɫɤɢɦ ɢɫɫɥɟɞɨɜɚɧɢɹɦ.
ɂɫɫɥɟɞɨɜɚɧɢɟ ɛɵɥɨ ɨɞɨɛɪɟɧɨ Ⱦɚɬɫɤɢɦ ɤɨɦɢɬɟɬɨɦ
ɩɨ ɷɬɢɤɟ ɛɢɨɯɢɦɢɱɟɫɤɢɯ ɢɫɫɥɟɞɨɜɚɧɢɣ (ɤɨɞ ɨɞɨɛɪɟɧɢɹ
(KF) 01 28 37 56).
ȼɫɟ ɭɱɚɫɬɧɢɤɢ ɢ ɩɚɰɢɟɧɬɵ
ɢɫɫɥɟɞɨɜɚɧɢɹ
ɨɡɧɚɤɨɦɢɥɢɫɶ
ɫ
ɩɢɫɶɦɟɧɧɨɣ
ɞɨɤɭɦɟɧɬɚɰɢɟɣ ɩɨ ɧɚɫɬɨɹɳɟɦɭ ɢɫɫɥɟɞɨɜɚɧɢɸ ɢ ɛɵɥɢ
ɡɚɧɟɫɟɧɵ ɜ ɧɟɝɨ ɩɨɫɥɟ ɫɨɝɥɚɫɢɹ, ɩɨɥɭɱɟɧɧɨɝɨ ɧɚ
ɨɫɧɨɜɟ ɩɪɟɞɨɫɬɚɜɥɟɧɧɨɣ ɢɧɮɨɪɦɚɰɢɢ.
Ⱦɚɬɫɤɨɟ
ɚɝɟɧɬɫɬɜɨ ɩɨ ɡɚɳɢɬɟ ɢɧɮɨɪɦɚɰɢɢ ɨɞɨɛɪɢɥɨ ɫɛɨɪ,
ɚɧɚɥɢɡ ɢ ɯɪɚɧɟɧɢɟ DVD-ɡɚɩɢɫɟɣ (ɤɨɞ ɨɞɨɛɪɟɧɢɹ: 200541-5817).
2(2) 2009
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