6 курс / Скорая помощь / АЛГОРИТМЫ_ОКАЗАНИЯ_СКОРОЙ_И_НЕОТЛОЖНОЙ_МЕДИЦИНСКОЙ_ПОМОЩИ_БОЛЬНЫМ

ɉɪɢ ɨɬɫɭɬɫɬɜɢɢ ɷɮɮɟɤɬɚ

- Ⱥɦɢɨɞɚɪɨɧ ɦɝ ɤɝ ɜ ɜɟɧɧɨ ɤɚɩɟɥɶɧɨ ɜ ɬɟɱɟɧɢɟ ɧɟ

ɦɟɧɟɟ ɦɢɧɭɬ ɜɨ ɜɪɟɦɹ ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ

ɫɦ «ɉɪɢɥɨɠɟɧɢɟ 40» ɫɬɪ 91)

ɉɚɪɨɤɫɢɡɦɚɥɶɧɚɹ

• Ɉɤɫɢɝɟɧɨɬɟɪɚɩɢɹ ɩɪɢ SpO2 - FiO2 0.5

ɬɚɯɢɤɚɪɞɢɹ ɫ ɲɢɪɨɤɢɦ

• Ʉɚɬɟɬɟɪɢɡɚɰɢɹ ɜɟɧɵ ɢɥɢ ɜɧɭɬɪɢɤɨɫɬɧɵɣ ɞɨɫɬɭɩ

QRS ɦɨɧɨɦɨɪɮɧɚɹ

ȼɜɨɞɧɚɹ ɚɧɟɫɬɟɡɢɹ ɤɨɦɛɢɧɚɰɢɟɣ ɩɪɟɩɚɪɚɬɨɜ

ɋɨɫɬɨɹɧɢɟ ɬɹɠɟɥɨɟ

- Ɇɢɞɚɡɨɥɚɦ ɦɝ ɤɝ ɜ ɜɟɧɧɨ ɞɥɹ ɛɪɢɝɚɞ ȺɢɊ ɢ

ɝɟɦɨɞɢɧɚɦɢɤɚ

Ɏɟɧɬɚɧɢɥ - ɦɤɝ ɤɝ ɜ ɜɟɧɧɨ

ɧɟɫɬɚɛɢɥɶɧɚɹ - ɩɪɢ

ɢɥɢ - Ⱦɢɚɡɟɩɚɦ - ɦɝ ɤɝ ɜ ɜɟɧɧɨ ɢ Ɏɟɧɬɚɧɢɥ - 4

ɫɧɢɠɟɧɢɢ ɋȺȾ

ɦɤɝ ɤɝ ɜ ɜɟɧɧɨ

ɨɬ ɜɨɡɪɚɫɬɧɨɣ

ɢɥɢ - ɉɪɨɩɨɮɨɥ - ɦɝ ɤɝ ɞɥɹ ɛɪɢɝɚɞ ȺɢɊ

ɧɨɪɦɵ

ɋɢɧɯɪɨɧɢɡɢɪɨɜɚɧɧɚɹ ɷɥɟɤɬɪɨɤɚɪɞɢɨɜɟɪɫɢɹ - 2

Ⱦɠ ɤɝ

ɉɪɢ ɨɬɫɭɬɫɬɜɢɢ ɷɮɮɟɤɬɚ

ɋɢɧɯɪɨɧɢɡɢɪɨɜɚɧɧɚɹ ɷɥɟɤɬɪɨɤɚɪɞɢɨɜɟɪɫɢɹ Ⱦɠ ɤɝ

ɉɪɢ ɨɬɫɭɬɫɬɜɢɢ ɷɮɮɟɤɬɚ

- Ⱥɦɢɨɞɚɪɨɧ ɦɝ ɤɝ ɜ ɜɟɧɧɨ ɤɚɩɟɥɶɧɨ ɜ ɬɟɱɟɧɢɟ ɧɟ

ɦɟɧɟɟ ɦɢɧɭɬ ɜɨ ɜɪɟɦɹ ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ

ɫɦ «ɉɪɢɥɨɠɟɧɢɟ 40» ɫɬɪ 91)

ɀɟɥɭɞɨɱɤɨɜɚɹ ɬɚɯɢɤɚɪɞɢɹ

• Ɉɤɫɢɝɟɧɨɬɟɪɚɩɢɹ ɩɪɢ SpO2 - FiO2 0.5

ɩɨɥɢɦɨɪɮɧɚɹ

• Ʉɚɬɟɬɟɪɢɡɚɰɢɹ ɜɟɧɵ ɢɥɢ ɜɧɭɬɪɢɤɨɫɬɧɵɣ ɞɨɫɬɭɩ

ɋɨɫɬɨɹɧɢɟ ɫɪɟɞɧɟɣ

- Ⱦɢɚɡɟɩɚɦ - ɦɝ ɤɝ ɜ ɜɟɧɧɨ ɢɥɢ ɜ ɦɵɲɟɱɧɨ

ɬɹɠɟɫɬɢ ɝɟɦɨɞɢɧɚɦɢɤɚ

- Ɇɚɝɧɢɹ ɫɭɥɶɮɚɬ ɦɝ ɦɥ - ɦɥ ɜ ɪɚɡɜɟɞɟɧɢɢ

ɫɬɚɛɢɥɶɧɚɹ

ɇɚɬɪɢɹ ɯɥɨɪɢɞɚ - ɦɥ ɜ ɜɟɧɧɨ ɤɚɩɟɥɶɧɨ - 3

ɤɚɩ ɤɝ ɜ ɦɢɧ ɦɝ ɤɝ - ɫɬɪɨɝɨ ɦɢɧɭɬ ɜɨ ɜɪɟɦɹ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ

230

ɀɟɥɭɞɨɱɤɨɜɚɹ ɬɚɯɢɤɚɪɞɢɹ

• Ɉɤɫɢɝɟɧɨɬɟɪɚɩɢɹ ɩɪɢ SpO2 - FiO2 0.5

ɩɨɥɢɦɨɪɮɧɚɹ ɬɢɩɚ

• Ʉɚɬɟɬɟɪɢɡɚɰɢɹ ɜɟɧɵ ɢɥɢ ɜɧɭɬɪɢɤɨɫɬɧɵɣ ɞɨɫɬɭɩ

ɩɢɪɭɷɬ

ȼɜɨɞɧɚɹ ɚɧɟɫɬɟɡɢɹ ɤɨɦɛɢɧɚɰɢɟɣ ɩɪɟɩɚɪɚɬɨɜ

ɋɨɫɬɨɹɧɢɟ ɬɹɠɟɥɨɟ

- Ɇɢɞɚɡɨɥɚɦ ɦɝ ɤɝ ɜ ɜɟɧɧɨ ɞɥɹ ɛɪɢɝɚɞ ȺɢɊ ɢ

ɝɟɦɨɞɢɧɚɦɢɤɚ

Ɏɟɧɬɚɧɢɥ - ɦɤɝ ɤɝ ɜ ɜɟɧɧɨ

ɧɟɫɬɚɛɢɥɶɧɚɹ - ɩɪɢ

ɢɥɢ - Ⱦɢɚɡɟɩɚɦ - ɦɝ ɤɝ ɜ ɜɟɧɧɨ ɢ Ɏɟɧɬɚɧɢɥ - 4

ɫɧɢɠɟɧɢɢ ɋȺȾ

ɦɤɝ ɤɝ ɜ ɜɟɧɧɨ

ɨɬ ɜɨɡɪɚɫɬɧɨɣ

ɢɥɢ - ɉɪɨɩɨɮɨɥ - ɦɝ ɤɝ ɞɥɹ ɛɪɢɝɚɞ ȺɢɊ

ɧɨɪɦɵ

ɋɢɧɯɪɨɧɢɡɢɪɨɜɚɧɧɚɹ ɷɥɟɤɬɪɨɤɚɪɞɢɨɜɟɪɫɢɹ 1 - 2

Ⱦɠ ɤɝ

ɉɪɢ ɨɬɫɭɬɫɬɜɢɢ ɷɮɮɟɤɬɚ

ɋɢɧɯɪɨɧɢɡɢɪɨɜɚɧɧɚɹ ɷɥɟɤɬɪɨɤɚɪɞɢɨɜɟɪɫɢɹ Ⱦɠ ɤɝ

I49

Ȼɪɚɞɢɫɢɫɬɨɥɢɱɟɫɤɢɟ

ɗɄȽ

1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

ɧɚɪɭɲɟɧɢɹ ɫɟɪɞɟɱɧɨɝɨ

ɉɭɥɶɫɨɤɫɢɦɟɬɪɢɹ

ɛɨɥɶɧɢɰɭ Ɍɪɚɧɫɩɨɪɬɢɪɨɜɤɚ

ɪɢɬɦɚ

• Ɉɤɫɢɝɟɧɨɬɟɪɚɩɢɹ ɩɪɢ SpO2 - FiO2 0.5 - 1.0

ɧɚ ɧɨɫɢɥɤɚɯ

Ⱦɥɹ ɨɛɳɟɩɪɨɮɢɥɶɧɵɯ

ɋɢɧɞɪɨɦ ɫɥɚɛɨɫɬɢ

• Ʉɚɬɟɬɟɪɢɡɚɰɢɹ ɜɟɧɵ ɢɥɢ ɜɧɭɬɪɢɤɨɫɬɧɵɣ ɞɨɫɬɭɩ

ɛɪɢɝɚɞ – ɜɵɡɨɜ ɛɪɢɝɚɞ ȺɢɊ

ɫɢɧɭɫɨɜɨɝɨ ɭɡɥɚ ɫ

- Ⱥɬɪɨɩɢɧ - ɦɝ ɤɝ ɜ ɜɟɧɧɨ

3. ɉɪɢ ɨɬɤɚɡɟ ɨɬ

ɩɪɢɫɬɭɩɨɦ Ɇɗɋ

ɉɪɢ ɫɨɯɪɚɧɹɸɳɟɣɫɹ ɛɪɚɞɢɤɚɪɞɢɢ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ –

- ɗɩɢɧɟɮɪɢɧ ɦɝ ɤɝ ɤɚɠɞɵɟ - ɦɢɧɭɬ

ɚɤɬɢɜ ɧɚ «103» ɱɟɪɟɡ ɱɚɫɚ

ɦɚɤɫɢɦɚɥɶɧɚɹ ɫɭɦɦɚɪɧɚɹ ɞɨɡɚ - ɞɨ ɦɝ ɜ ɜɟɧɧɨ

ɉɪɢ ɩɨɜɬɨɪɧɨɦ ɨɬɤɚɡɟ –

ɫɦ ©ɉɪɢɥɨɠɟɧɢɟ 38» ɫɬɪ 289)

ɚɤɬɢɜ ɜ ɈɇɆɉȼɢȾɇ

ɉɪɢ ɫɨɯɪɚɧɹɸɳɟɣɫɹ Ɇɗɋ:

• Ʉɨɦɩɪɟɫɫɢɹ ɝɪɭɞɧɨɣ ɤɥɟɬɤɢ

ȼɪɟɦɟɧɧɚɹ ɤɚɪɞɢɨɫɬɢɦɭɥɹɰɢɹ ɞɥɹ ɛɪɢɝɚɞ ȺɢɊ

I44

Ⱥȼ ɛɥɨɤɚɞɵ I - II ɫɬ ɢ

ɇɟ ɬɪɟɛɭɟɬ ɥɟɱɟɧɢɹ ɧɚ ɷɬɚɩɟ ɨɤɚɡɚɧɢɹ ɫɤɨɪɨɣ

1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

Ⱥȼ ɛɥɨɤɚɞɚ III ɫɬ

ɦɟɞɢɰɢɧɫɤɨɣ ɩɨɦɨɳɢ

ɛɨɥɶɧɢɰɭ Ɍɪɚɧɫɩɨɪɬɢɪɨɜɤɚ

ɜɪɨɠɞɟɧɧɚɹ ɢɥɢ

ɧɚ ɧɨɫɢɥɤɚɯ

ɩɪɢɨɛɪɟɬɟɧɧɚɹ

ɉɪɢ ɨɬɤɚɡɟ ɨɬ

ɋɨɫɬɨɹɧɢɟ ɫɪɟɞɧɟɣ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ –

231

ɫɬɟɩɟɧɢ ɬɹɠɟɫɬɢ ɛɟɡ

ɚɤɬɢɜ ɧɚ © ª ɱɟɪɟɡ ɱɚɫɚ

ɧɚɪɭɲɟɧɢɣ ɫɨɡɧɚɧɢɹ

ɉɪɢ ɩɨɜɬɨɪɧɨɦ ɨɬɤɚɡɟ –

ɚɤɬɢɜ ɜ ɩɨɥɢɤɥɢɧɢɤɭ

Ⱥȼ ɛɥɨɤɚɞɚ III ɫɬ

• Ʉɨɦɩɪɟɫɫɢɹ ɝɪɭɞɧɨɣ ɤɥɟɬɤɢ

1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

ɋɨɫɬɨɹɧɢɟ ɬɹɠɟɥɨɟ ɫ

• Ʉɚɬɟɬɟɪɢɡɚɰɢɹ ɜɟɧɵ ɢɥɢ ɜɧɭɬɪɢɤɨɫɬɧɵɣ ɞɨɫɬɭɩ

ɛɨɥɶɧɢɰɭ Ɍɪɚɧɫɩɨɪɬɢɪɨɜɤɚ

ɩɪɢɫɬɭɩɨɦ Ɇɗɋ

- Ⱥɬɪɨɩɢɧ - ɦɝ ɤɝ ɜ ɜɟɧɧɨ

ɧɚ ɧɨɫɢɥɤɚɯ

ɉɪɢ ɫɨɯɪɚɧɹɸɳɟɣɫɹ Ɇɗɋ

Ⱦɥɹ ɨɛɳɟɩɪɨɮɢɥɶɧɵɯ

ȼɪɟɦɟɧɧɚɹ ɤɚɪɞɢɨɫɬɢɦɭɥɹɰɢɹ ɞɥɹ ɛɪɢɝɚɞ ȺɢɊ

ɛɪɢɝɚɞ - ɜɵɡɨɜ ɛɪɢɝɚɞ ȺɢɊ

3. ɉɪɢ ɨɬɤɚɡɟ ɨɬ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ –

ɚɤɬɢɜ ɧɚ «103» ɱɟɪɟɡ ɱɚɫɚ

ɉɪɢ ɩɨɜɬɨɪɧɨɦ ɨɬɤɚɡɟ –

ɚɤɬɢɜ ɜ ɈɇɆɉȼɢȾɇ

ɂɧɮɟɤɰɢɨɧɧɵɟ ɡɚɛɨɥɟɜɚɧɢɹ ɭ ɞɟɬɟɣ

J05.0

Ɉɫɬɪɵɣ ɨɛɫɬɪɭɤɬɢɜɧɵɣ

ɉɪɢɦɟɧɟɧɢɟ ɧɟɛɭɥɚɣɡɟɪɚ

1. Ⱥɤɬɢɜ ɜ ɈɇɆɉȼɢȾɇ

ɥɚɪɢɧɝɢɬ ɤɪɭɩ

- Ȼɭɞɟɫɨɧɢɞ 0,5 ɦɝ ɜ ɪɚɡɜɟɞɟɧɢɢ ɇɚɬɪɢɹ ɯɥɨɪɢɞɚ

I ɫɬɟɩɟɧɶ

ɞɨ 3 ɦɥɢɧɝɚɥɹɰɢɹ ɱɟɪɟɡ ɧɟɛɭɥɚɣɡɟɪ

ɉɭɥɶɫɨɤɫɢɦɟɬɪɢɹ

• Ɉɤɫɢɝɟɧɨɬɟɪɚɩɢɹ ɩɪɢ SpO2 - FiO2 0.5

II ɫɬɟɩɟɧɶ

ɉɪɢɦɟɧɟɧɢɟ ɧɟɛɭɥɚɣɡɟɪɚ

1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

- Ȼɭɞɟɫɨɧɢɞ ɦɝ ɜ ɪɚɡɜɟɞɟɧɢɢ ɇɚɬɪɢɹ ɯɥɨɪɢɞɚ -

ɛɨɥɶɧɢɰɭ

2 ɦɥɢ ɗɩɢɧɟɮɪɢɧ ɦɝ ɤɝ ɧɟ ɛɨɥɟɟ 3 ɦɝ -

ɉɪɢ ɨɬɤɚɡɟ ɨɬ

ɨɞɧɨɜɪɟɦɟɧɧɨ ɫ ɛɭɞɟɫɨɧɢɞɨɦ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ –

• ɉɭɥɶɫɨɤɫɢɦɟɬɪɢɹ

ɚɤɬɢɜ ɜ ɈɇɆɉȼɢȾɇ

• Ɉɤɫɢɝɟɧɨɬɟɪɚɩɢɹ ɩɪɢ SpO2 - FiO2 0.5 - 1.0

ɉɪɢ ɨɬɫɭɬɫɬɜɢɢ ɷɮɮɟɤɬɚ ɨɬ ɧɟɛɭɥɚɣɡɟɪɧɨɣ ɬɟɪɚɩɢɢ

- ɉɪɟɞɧɢɡɨɥɨɧ - ɦɝ ɤɝ ɢɥɢ Ⱦɟɤɫɚɦɟɬɚɡɨɧ 0,2 -

ɦɝ ɤɝ ɜ ɦɵɲɟɱɧɨ ɢɥɢ ɜ ɜɟɧɧɨ

232

III ɫɬɟɩɟɧɶ

• Ʉɚɬɟɬɟɪɢɡɚɰɢɹ ɜɟɧɵ ɢɥɢ ɜɧɭɬɪɢɤɨɫɬɧɵɣ ɞɨɫɬɭɩ

1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

- ɉɪɟɞɧɢɡɨɥɨɧ ɦɝ ɤɝ ɢɥɢ Ⱦɟɤɫɚɦɟɬɚɡɨɧ ɦɝ ɤɝ

ɛɨɥɶɧɢɰɭ

ɜ ɜɟɧɧɨ

ɉɪɢ ɨɬɤɚɡɟ ɨɬ

- Ȼɭɞɟɫɨɧɢɞ ɦɝ ɜ ɪɚɡɜɟɞɟɧɢɢ ɇɚɬɪɢɹ ɯɥɨɪɢɞɚ -

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ –

2 ɦɥɢ ɗɩɢɧɟɮɪɢɧ ɦɝ ɤɝ ɧɟ ɛɨɥɟɟ 3 ɦɝ -

ɚɤɬɢɜ ɧɚ © ª ɱɟɪɟɡ ɱɚɫɚ

ɨɞɧɨɜɪɟɦɟɧɧɨ ɫ ɛɭɞɟɫɨɧɢɞɨɦ

ɉɪɢ ɩɨɜɬɨɪɧɨɦ ɨɬɤɚɡɟ –

• Ɉɤɫɢɝɟɧɨɬɟɪɚɩɢɹ ɩɪɢ SpO2 - FiO2 0.5 - 1.0

ɚɤɬɢɜ ɜ ɈɇɆɉȼɢȾɇ

ɉɭɥɶɫɨɤɫɢɦɟɬɪɢɹ

IV ɫɬɟɩɟɧɶ

Ʉɚɬɟɬɟɪɢɡɚɰɢɹ ɜɟɧɵ ɢɥɢ ɜɧɭɬɪɢɤɨɫɬɧɵɣ ɞɨɫɬɭɩ

- ɇɚɬɪɢɹ ɯɥɨɪɢɞ - 10 - ɦɥ ɤɝ ɜ ɜɟɧɧɨ ɤɚɩɟɥɶɧɨ

- ɉɪɟɞɧɢɡɨɥɨɧ - 10 ɦɝ ɤɝ ɢɥɢ Ⱦɟɤɫɚɦɟɬɚɡɨɧ - 1,2

ɦɝ ɤɝ ɜ ɜɟɧɧɨ

ɉɟɪɟɞ ɢɧɬɭɛɚɰɢɟɣ

- Ⱥɬɪɨɩɢɧ - ɦɝ ɤɝ ɜ ɜɟɧɧɨ ɩɨ ɩɨɤɚɡɚɧɢɹɦ

ȼɜɨɞɧɚɹ ɚɧɟɫɬɟɡɢɹ ɤɨɦɛɢɧɚɰɢɟɣ ɩɪɟɩɚɪɚɬɨɜ

ɩɪɨɢɡɜɨɞɢɬɫɹ ɩɪɢ ɭɪɨɜɧɟ ɫɨɡɧɚɧɢɹ ! ɛɚɥɥɨɜ ɩɨ

ɲɤɚɥɟ ɤɨɦɵ ȽɅȺɁȽɈ

- Ɇɢɞɚɡɨɥɚɦ ɦɝ ɤɝ ɞɥɹ ɛɪɢɝɚɞ ȺɢɊ ɢ Ʉɟɬɚɦɢɧ -

ɦɝ ɤɝ ɜ ɜɟɧɧɨ

ɢɥɢ - Ⱦɢɚɡɟɩɚɦ - ɦɝ ɤɝ ɜ ɜɟɧɧɨ ɢ Ʉɟɬɚɦɢɧ - 2

ɦɝ ɤɝ ɜ ɜɟɧɧɨ

ɢɥɢ - ɉɪɨɩɨɮɨɥ 2 - ɦɝ ɤɝ ɜ ɜɟɧɧɨ ɞɥɹ ɛɪɢɝɚɞ ȺɢɊ

ɂɧɬɭɛɚɰɢɹ ɬɪɚɯɟɢ ɬɪɭɛɤɚ ɞɢɚɦɟɬɪɨɦ ɧɚ ɨɞɢɧ

ɪɚɡɦɟɪ ɦɟɧɶɲɟ ɜɨɡɪɚɫɬɧɨɣ ɧɨɪɦɵ ɢɥɢ

ɤɨɧɢɤɨɬɨɦɢɹ

• ɂȼɅ ȼȼɅ ɫ FiO2 1.0

ɉɨɩɵɬɤɚ ɢɧɬɭɛɚɰɢɢ ɞɨɥɠɧɚ ɛɵɬɶ ɨɞɧɨɤɪɚɬɧɨɣ

ɉɪɢɦɟɧɟɧɢɟ ɥɚɪɢɧɝɟɚɥɶɧɨɣ ɬɪɭɛɤɢ

ɩɪɨɬɢɜɨɩɨɤɚɡɚɧɨ

J20

Ɉɫɬɪɵɣ ɛɪɨɧɯɢɬ,

Ⱥɤɬɢɜ ɜ ɩɨɥɢɤɥɢɧɢɤɭ

J21.9

ɛɪɨɧɯɢɨɥɢɬ

2. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

- ɩɪɢ ɬɟɦɩɟɪɚɬɭɪɟ ɬɟɥɚ

- ɉɚɪɚɰɟɬɚɦɨɥ - ɦɝ ɤɝ ɜɧɭɬɪɶ ɢɥɢ ɫɜɟɱɢ ɪɟɤɬɚɥɶɧɨ

ɛɨɥɶɧɢɰɭ:

! ɋ

ɢɥɢ Ɇɟɬɚɦɢɡɨɥ ɧɚɬɪɢɹ ɦɝ ɤɝ ɜ ɦɵɲɟɱɧɨ

- ɞɟɬɢ ɞɨ ɥɟɬ

- ɫ ɹɜɥɟɧɢɹɦɢ

• ɉɪɢɦɟɧɟɧɢɟ ɧɟɛɭɥɚɣɡɟɪɚ

- ɩɪɢ ɧɟɤɭɩɢɪɭɸɳɟɦɫɹ

ɛɪɨɧɯɨɨɛɫɬɪɭɤɰɢɢ

- ɂɩɪɚɬɪɨɩɢɹɛɪɨɦɢɞ+ ɮɟɧɨɬɟɪɨɥ - ɞɨ ɥɟɬ - ɤɚɩ ɧɚ

ɩɪɢɫɬɭɩɟ ɛɪɨɧɯɨɨɛɫɬɪɭɤɰɢɢ

1 ɤɝ ɦɚɫɫɵ ɬɟɥɚ ɫɬɚɪɲɟ ɥɟɬ - ɞɨ ɤɚɩ ɢɥɢ

3. ɉɪɢ ɨɬɤɚɡɟ ɨɬ

ɋɚɥɶɛɭɬɚɦɨɥ , ɦɝ ɜɪɚɡɜɟɞɟɧɢɢ ɇɚɬɪɢɹɯɥɨɪɢɞɚ 0,9%

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ –

ɞɨ 3 ɦɥ

ɚɤɬɢɜ ɜ ɩɨɥɢɤɥɢɧɢɤɭ

- Ȼɭɞɟɫɨɧɢɞ 0,5 - 1 ɦɝɱɟɪɟɡ ɦɢɧ ɩɨɫɥɟ ɢɧɝɚɥɹɰɢɢ

ɛɪɨɧɯɨɥɢɬɢɤɚɞɨɛɚɜɢɬɶɜɧɟɛɭɥɚɣɡɟɪ

• Ɉɤɫɢɝɟɧɨɬɟɪɚɩɢɹ ɩɪɢ SpO2 - FiO2 0.5

ɉɭɥɶɫɨɤɫɢɦɟɬɪɢɹ

ɉɪɢ ɧɟɞɨɫɬɚɬɨɱɧɨɦ ɷɮɮɟɤɬɟ

ɉɨɜɬɨɪɢɬɶ ɚɧɚɥɨɝɢɱɧɭɸ ɢɧɝɚɥɹɰɢɸ ɱɟɪɟɡ 15 - 20

ɦɢɧɭɬ

ɉɪɢ ɧɟɞɨɫɬɚɬɨɱɧɨɦ ɷɮɮɟɤɬɟ

- Ⱦɟɤɫɚɦɟɬɚɡɨɧ 0,2 - ɦɝ ɤɝ ɢɥɢ ɉɪɟɞɧɢɡɨɥɨɧ - 5

ɦɝ ɤɝ ɜ ɜɟɧɧɨ

ɉɪɢ ɧɟɞɨɫɬɚɬɨɱɧɨɦ ɷɮɮɟɤɬɟ

- Ⱥɦɢɧɨɮɢɥɥɢɧ - 5 ɦɝ ɤɝ ɜ ɜɟɧɧɨ ɦɟɞɥɟɧɧɨ ɫ

ɨɫɬɨɪɨɠɧɨɫɬɶɸ

J05

ɗɩɢɝɥɨɬɬɢɬ

ɇɟ ɭɤɥɚɞɵɜɚɬɶ ɧɚ ɫɩɢɧɭ ɇɟ ɨɫɦɚɬɪɢɜɚɬɶ ɡɟɜ

1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

ɲɩɚɬɟɥɟɦ

ɛɨɥɶɧɢɰɭ. Ɍɪɚɧɫɩɨɪɬɢɪɨɜɤɚ

Ɉɛɟɫɩɟɱɢɬɶ ɩɨɥɨɠɟɧɢɟ ɫɢɞɹ ɫ ɧɚɤɥɨɧɨɦ ɬɭɥɨɜɢɳɚ

ɫɬɪɨɝɨ ɜ ɩɨɥɨɠɟɧɢɢ ɫɢɞɹ

ɜɩɟɪɟɞ

2. ɉɪɢ ɨɬɤɚɡɟ ɨɬ

ɉɭɥɶɫɨɤɫɢɦɟɬɪɢɹ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ –

• Ɉɤɫɢɝɟɧɨɬɟɪɚɩɢɹ ɩɪɢ SpO2 - FiO2 0.5

ɚɤɬɢɜ ɧɚ «103» ɱɟɪɟɡ ɱɚɫɚ

- ɩɪɢ ɧɚɪɭɲɟɧɢɢ ɞɵɯɚɧɢɹ

ɉɟɪɟɞ ɢɧɬɭɛɚɰɢɟɣ

ɉɪɢ ɩɨɜɬɨɪɧɨɦ ɨɬɤɚɡɟ –

• Ʉɚɬɟɬɟɪɢɡɚɰɢɹ ɜɟɧɵ ɢɥɢ ɜɧɭɬɪɢɤɨɫɬɧɵɣ ɞɨɫɬɭɩ

ɚɤɬɢɜ ɜ ɈɇɆɉȼɢȾɇ

- Ⱥɬɪɨɩɢɧ - ɦɝ ɤɝ ɜ ɜɟɧɧɨ ɩɨ ɩɨɤɚɡɚɧɢɹɦ

234

ɉɨɜɪɟɠɞɚɸɳɟɟ

ɜɨɡɞɟɣɫɬɜɢɟ ɮɚɤɬɨɪɨɜ ɫɪɟɞɵ ɢ ɧɟɫɱɚɫɬɧɵɟ ɫɥɭɱɚɢ

T48.5

Ɉɬɪɚɜɥɟɧɢɟ ɩɪɟɩɚɪɚɬɚɦɢ

ɗɄȽ - ɦɨɧɢɬɨɪɢɧɝ

1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

ɧɚɮɚɡɨɥɢɧɚ ɢɥɢ

- Ⱥɬɪɨɩɢɧ - ɦɝ ɤɝ ɜ ɦɵɲɟɱɧɨ ɢɥɢ ɜ ɜɟɧɧɨ

ɛɨɥɶɧɢɰɭ.

ɤɫɢɥɨɦɟɬɚɡɨɥɢɧɚ

- ɉɪɟɞɧɢɡɨɥɨɧ - ɦɝ ɤɝ ɢɥɢ Ⱦɟɤɫɚɦɟɬɚɡɨɧ ɦɝ ɤɝ

2. ɉɪɢ ɨɬɤɚɡɟ ɨɬ

ɜ ɦɵɲɟɱɧɨ ɢɥɢ ɜ ɜɟɧɧɨ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ

ɉɪɢ ɫɨɯɪɚɧɹɸɳɟɣɫɹ ɛɪɚɞɢɤɚɪɞɢɢ ɱɟɪɟɡ ɦɢɧɭɬ

– ɤɨɧɫɭɥɶɬɚɰɢɹ ɬɨɤɫɢɤɨɥɨɝɚ

- Ⱥɬɪɨɩɢɧ - ɦɝ ɤɝ ɜ ɦɵɲɟɱɧɨ ɢɥɢ ɜ ɜɟɧɧɨ

– ɚɤɬɢɜ ɧɚ ©1 ª ɱɟɪɟɡ

- ɩɪɢ ɫɧɢɠɟɧɢɢ ɋȺȾ

• Ʉɚɬɟɬɟɪɢɡɚɰɢɹ ɜɟɧɵ ɢɥɢ ɜɧɭɬɪɢɤɨɫɬɧɵɣ ɞɨɫɬɭɩ

ɱɚɫɚ

! ɨɬ ɜɨɡɪɚɫɬɧɨɣ

- ɇɚɬɪɢɹ ɯɥɨɪɢɞ - 10 - ɦɥ ɤɝ ɜ ɜɟɧɧɨ ɤɚɩɟɥɶɧɨ

ɉɪɢ ɩɨɜɬɨɪɧɨɦ ɨɬɤɚɡɟ –

ɧɨɪɦɵ

ɚɤɬɢɜ ɜ ɩɨɥɢɤɥɢɧɢɤɭ

Ɍ

Ɉɬɪɚɜɥɟɧɢɟ ɤɚɥɢɟɦ

- Ɍɪɚɦɚɞɨɥ 1 - ɦɝ ɤɝ ɢɥɢ Ɏɟɧɬɚɧɢɥ - ɦɤɝ ɤɝ

1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

ɩɟɪɦɚɧɝɚɧɚɬɨɦ

ɜ ɜɟɧɧɨ ɢɥɢ ɜ ɦɵɲɟɱɧɨ

ɛɨɥɶɧɢɰɭ

- ɉɪɟɞɧɢɡɨɥɨɧ - ɦɝ ɤɝ ɢɥɢ Ⱦɟɤɫɚɦɟɬɚɡɨɧ ɦɝ ɤɝ

2. ɉɪɢ ɨɬɤɚɡɟ ɨɬ

ɜ ɦɵɲɟɱɧɨ ɢɥɢ ɜ ɜɟɧɧɨ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ

- Ⱥɫɤɨɪɛɢɧɨɜɚɹ ɤɢɫɥɨɬɚ ɦɝ ɦɥ ɜ ɪɚɡɜɟɞɟɧɢɢ -

– ɤɨɧɫɭɥɶɬɚɰɢɹ ɬɨɤɫɢɤɨɥɨɝɚ

235

ɨɛɪɚɛɨɬɤɚ ɫɥɢɡɢɫɬɨɣ ɪɨɬɨɝɥɨɬɤɢ ɫɚɥɮɟɬɤɨɣ ɫɦɨɱɟɧɧɨɣ – ɚɤɬɢɜ ɧɚ © ª ɱɟɪɟɡ

ɪɚɫɬɜɨɪɨɦ

ɱɚɫɚ

ɉɪɨɦɵɜɚɧɢɟ ɠɟɥɭɞɤɚ ɱɟɪɟɡ ɡɨɧɞ

ɉɪɢ ɩɨɜɬɨɪɧɨɦ ɨɬɤɚɡɟ -

ɫɦ ©ɉɪɢɥɨɠɟɧɢɟ 10» ɫɬɪ 54)

ɚɤɬɢɜ ɜ ɩɨɥɢɤɥɢɧɢɤɭ

ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ

ɯɢɦɢɱɟɫɤɢɟ ɨɠɨɝɢª ɫɬɪ. 237

Ɍ -

Ɍɟɪɦɢɱɟɫɤɢɟ ɢ

Ɉɩɪɟɞɟɥɟɧɢɟ ɩɥɨɳɚɞɢ ɨɠɨɝɨɜ ɫɦ ©ɉɪɢɥɨɠɟɧɢɟ ª 1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

Ɍ

ɯɢɦɢɱɟɫɤɢɟ ɨɠɨɝɢ

ɫɬɪ 55)

ɛɨɥɶɧɢɰɭ:

Ɍ

ɏɢɦɢɱɟɫɤɢɟ ɨɠɨɝɢ ɩɪɨɦɵɜɚɬɶ ɩɪɨɬɨɱɧɨɣ ɜɨɞɨɣ

- ɞɟɬɢ ɞɨ ɝɨɞɚ -

Ɍ

ɤɪɨɦɟ ɨɠɨɝɚ ɧɟɝɚɲɟɧɨɣ ɢɡɜɟɫɬɶɸ

ɧɟɡɚɜɢɫɢɦɨ ɨɬ ɫɬɟɩɟɧɢ,

Ɍ

• Ɉɛɪɚɛɨɬɤɚ ɨɠɨɝɨɜ - ɚɩɩɥɢɤɚɰɢɹ ɫɩɟɰɢɚɥɶɧɵɦɢ

ɩɥɨɳɚɞɢ ɢ ɥɨɤɚɥɢɡɚɰɢɢ

ɫɚɥɮɟɬɤɚɦɢ (ɬɨɥɶɤɨ ɩɪɢ I ɫɬɟɩɟɧɢ ɨɠɨɝɨɜ

ɨɠɨɝɚ;

ɩɥɨɳɚɞɶɸ ɦɟɧɟɟ )

- ɞɟɬɢ ɫɬɚɪɲɟ 1 ɝɨɞɚ - III ɫɬ

• Ⱥɫɟɩɬɢɱɟɫɤɚɹ ɩɨɜɹɡɤɚ ɢ ɢɥɢ ɨɛɟɪɬɵɜɚɧɢɟ ɫɬɟɪɢɥɶɧɨɣ ɧɟɡɚɜɢɫɢɦɨ ɨɬ ɩɥɨɳɚɞɢ

ɩɪɨɫɬɵɧɟɣ

I ɫɬ 5 %, II ɫɬ 3 %

- ɞɟɬɢ ɝɨɞɚ ɩɪɢ ɨɠɨɝɚɯ

ɥɢɰɚ ɝɥɚɡ ɭɲɟɣ ɧɨɫɚ

- ɩɪɢ ɨɠɨɝɚɯ I ɫɬɟɩɟɧɢ

- Ɇɟɬɚɦɢɡɨɥ ɧɚɬɪɢɹ ɦɝ ɤɝ ɢɥɢ Ɍɪɚɦɚɞɨɥ - ɦɝ ɤɝ

10 %

ɜ ɦɵɲɟɱɧɨ ɢɥɢ ɜ ɜɟɧɧɨ

ɤɢɫɬɟɣ ɫɬɨɩɵ

ɩɪɨɦɟɠɧɨɫɬɢ

- ɏɥɨɪɨɩɢɪɚɦɢɧ ɦɥ ɝɨɞ ɠɢɡɧɢ ɜ ɜɟɧɧɨ

ɩɨɥɨɜɵɯ ɨɪɝɚɧɨɜ ɤɪɭɩɧɵɯ

ɫɭɫɬɚɜɨɜ

2. ɉɪɢ ɨɬɤɚɡɟ ɨɬ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ –

236

- ɩɪɢ ɨɠɨɝɚɯ II, III ɫɬɟɩɟɧɢ Ʉɚɬɟɬɟɪɢɡɚɰɢɹ ɜɟɧɵ ɢɥɢ ɜɧɭɬɪɢɤɨɫɬɧɵɣ ɞɨɫɬɭɩ

ɚɤɬɢɜ ɧɚ «103» ɱɟɪɟɡ ɱɚɫɚ

ɩɨɜɟɪɯɧɨɫɬɢ ɬɟɥɚ

- Ɇɟɬɚɦɢɡɨɥ ɧɚɬɪɢɹ ɦɝ ɤɝ ɢɥɢ Ɍɪɚɦɚɞɨɥ - ɦɝ ɤɝ

3. ɉɪɢ ɩɨɜɬɨɪɧɨɦ ɨɬɤɚɡɟ –

ɜ ɦɵɲɟɱɧɨ ɢɥɢ ɜ ɜɟɧɧɨ

ɚɤɬɢɜ ɜ ɩɨɥɢɤɥɢɧɢɤɭ

- ɏɥɨɪɨɩɢɪɚɦɢɧ ɦɥ ɝɨɞ ɠɢɡɧɢ ɜ ɜɟɧɧɨ

Ⱦɨɫɬɚɜɤɚ ɜ

ɉɪɢ ɧɟɞɨɫɬɚɬɨɱɧɨɦ ɷɮɮɟɤɬɟ

ɬɪɚɜɦɚɬɨɥɨɝɢɱɟɫɤɢɣ ɩɭɧɤɬ

- Ɏɟɧɬɚɧɢɥ - ɦɤɝ ɤɝ ɜ ɜɟɧɧɨ ɢɥɢ ɜ ɦɵɲɟɱɧɨ

- ɞɟɬɢ ɫɬɚɪɲɟ 1 ɝɨɞɚ

- ɇɚɬɪɢɹ ɯɥɨɪɢɞ - 10 - ɦɥ ɤɝ ɜ ɜɟɧɧɨ ɤɚɩɟɥɶɧɨ

I ɫɬ 5 %

ɢɥɢ Ʉɚɥɢɹ ɯɥɨɪɢɞ ɤɚɥɶɰɢɹ ɯɥɨɪɢɞ ɧɚɬɪɢɹ ɯɥɨɪɢɞ ɉɪɢ ɨɬɤɚɡɟ - ɚɤɬɢɜ

10 - ɦɥ ɤɝ ɜ ɜɟɧɧɨ ɤɚɩɟɥɶɧɨ

ɜ ɩɨɥɢɤɥɢɧɢɤɭ

- ɩɪɢ ɨɠɨɝɚɯ I ɫɬɟɩɟɧɢ

• Ʉɚɬɟɬɟɪɢɡɚɰɢɹ ɜɟɧɵ ɢɥɢ ɜɧɭɬɪɢɤɨɫɬɧɵɣ ɞɨɫɬɭɩ

10 %,

- Ɏɟɧɬɚɧɢɥ - ɦɤɝ ɤɝ ɜ ɜɟɧɧɨ

II, III ɫɬɟɩɟɧɢ

ɉɪɢ ɧɟɞɨɫɬɚɬɨɱɧɨɦ ɷɮɮɟɤɬɟ:

ɩɨɜɟɪɯɧɨɫɬɢ ɬɟɥɚ

- Ʉɟɬɚɦɢɧ - ɦɝ ɤɝ ɜ ɜɟɧɧɨ

- ɇɚɬɪɢɹ ɯɥɨɪɢɞ - 10 - ɦɥ ɤɝ ɜ ɜɟɧɧɨ ɤɚɩɟɥɶɧɨ

ɢɥɢ Ʉɚɥɢɹ ɯɥɨɪɢɞ ɤɚɥɶɰɢɹ ɯɥɨɪɢɞ ɧɚɬɪɢɹ ɯɥɨɪɢɞ

10 - ɦɥ ɤɝ ɜ ɜɟɧɧɨ ɤɚɩɟɥɶɧɨ

- ɉɪɟɞɧɢɡɨɥɨɧ - ɦɝ ɤɝ ɜ ɜɟɧɧɨ

- ɩɪɢ ɨɠɨɝɟ ɜɟɪɯɧɢɯ

ɉɭɥɶɫɨɤɫɢɦɟɬɪɢɹ

1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

ɞɵɯɚɬɟɥɶɧɵɯ ɩɭɬɟɣ

• Ɉɤɫɢɝɟɧɨɬɟɪɚɩɢɹ ɩɪɢ SpO2 - FiO2 0.5 - 1.0

ɛɨɥɶɧɢɰɭ

• Ʉɚɬɟɬɟɪɢɡɚɰɢɹ ɜɟɧɵ ɢɥɢ ɜɧɭɬɪɢɤɨɫɬɧɵɣ ɞɨɫɬɭɩ

2. ɉɪɢ ɨɬɤɚɡɟ ɨɬ

- Ɏɟɧɬɚɧɢɥ - ɦɤɝ ɤɝ ɜ ɜɟɧɧɨ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ

ɉɪɢ ɧɟɞɨɫɬɚɬɨɱɧɨɦ ɷɮɮɟɤɬɟ

- ɤɨɧɫɭɥɶɬɚɰɢɹ ɬɨɤɫɢɤɨɥɨɝɚ

- Ʉɟɬɚɦɢɧ - ɦɝ ɤɝ ɜ ɜɟɧɧɨ

- ɚɤɬɢɜ ɧɚ © ª ɱɟɪɟɡ ɱɚɫɚ

237

R59.9

Ʌɢɯɨɪɚɞɤɚ ɧɟɭɬɨɱɧɟɧɧɚɹ

ɉɭɥɶɫɨɤɫɢɦɟɬɪɢɹ

1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

- ɩɪɢ ɩɨɜɵɲɟɧɢɢ

- ɉɚɪɚɰɟɬɚɦɨɥ - ɦɝ ɤɝ ɜɧɭɬɪɶ ɢɥɢ ɫɜɟɱɢ ɪɟɤɬɚɥɶɧɨ

ɛɨɥɶɧɢɰɭ

ɬɟɦɩɟɪɚɬɭɪɵ ɬɟɥɚ ! °ɋ

ɢɥɢ Ɇɟɬɚɦɢɡɨɥ ɧɚɬɪɢɹ ɦɝ ɤɝ ɜ ɦɵɲɟɱɧɨ

ɉɪɢ ɨɬɤɚɡɟ ɨɬ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ –

ɚɤɬɢɜ ɜ ɈɇɆɉȼɢȾɇ

Ɉɬɞɟɥɶɧɵɟ ɫɨɫɬɨɹɧɢɹ, ɜɨɡɧɢɤɚɸɳɢɟ ɜ ɩɟɪɢɧɚɬɚɥɶɧɨɦ ɩɟɪɢɨɞɟ

Ɋ

Ɉɦɮɚɥɢɬ

Ɉɛɪɚɛɨɬɤɚ ɩɭɩɨɱɧɨɣ ɪɚɧɤɢ ɚɧɬɢɫɟɩɬɢɤɨɦ

1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

- ɩɪɢ ɤɪɨɜɨɬɟɱɟɧɢɢ ɢɡ

• Ⱥɫɟɩɬɢɱɟɫɤɚɹ ɩɨɜɹɡɤɚ

ɛɨɥɶɧɢɰɭ

ɩɭɩɨɱɧɨɣ ɪɚɧɤɢ

ɉɪɢ ɨɬɤɚɡɟ ɨɬ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ –

ɚɤɬɢɜ ɜ ɈɇɆɉȼɢȾɇ

Ɋ

Ɇɚɫɬɢɬ ɧɨɜɨɪɨɠɞɟɧɧɨɝɨ

Ⱥɤɬɢɜ ɜ ɈɇɆɉȼɢȾɇ

- ɩɪɢ ɬɟɦɩɟɪɚɬɭɪɟ ɬɟɥɚ

- ɉɚɪɚɰɟɬɚɦɨɥ - ɦɝ ɤɝ ɜɧɭɬɪɶ ɢɥɢ ɫɜɟɱɢ ɪɟɤɬɚɥɶɧɨ

1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

ɋ

ɛɨɥɶɧɢɰɭ

ɉɪɢ ɨɬɤɚɡɟ ɨɬ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ –

ɚɤɬɢɜ ɜ ɈɇɆɉȼɢȾɇ

Ɋ .4

ɉɢɨɞɟɪɦɢɹ

ɇɟ ɬɪɟɛɭɟɬ ɥɟɱɟɧɢɹ ɧɚ ɷɬɚɩɟ ɨɤɚɡɚɧɢɹ ɫɤɨɪɨɣ

1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

ɦɟɞɢɰɢɧɫɤɨɣ ɩɨɦɨɳɢ

ɛɨɥɶɧɢɰɭ

ɉɪɢ ɨɬɤɚɡɟ ɨɬ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ –

ɚɤɬɢɜ ɜ ɈɇɆɉȼɢȾɇ

Ƚɟɦɨɥɢɬɢɱɟɫɤɚɹ ɛɨɥɟɡɧɶ

ɇɟ ɬɪɟɛɭɟɬ ɥɟɱɟɧɢɹ ɧɚ ɷɬɚɩɟ ɨɤɚɡɚɧɢɹ ɫɤɨɪɨɣ

1. Ɇɟɞɢɰɢɧɫɤɚɹ ɷɜɚɤɭɚɰɢɹ ɜ

Ɋ

ɧɨɜɨɪɨɠɞɟɧɧɨɝɨ

ɦɟɞɢɰɢɧɫɤɨɣ ɩɨɦɨɳɢ

ɛɨɥɶɧɢɰɭ

Ɋ

ɉɪɢ ɨɬɤɚɡɟ ɨɬ

ɦɟɞɢɰɢɧɫɤɨɣ ɷɜɚɤɭɚɰɢɢ –

ɚɤɬɢɜ ɜ ɈɇɆɉȼɢȾɇ

239