卷 27, 编号 4 (2019)

目的：研究人工造成的心理情绪应激对躯体健康的青少年外周微循环血流动力学指标的影响。

材料与方法：本实验参与30名受试者（其中16名男生）。平均年龄为18.2±1.1岁。人工应力是由Stroop effect产生的。通过红细胞的动态光散射来评价微循环血流动力学特性。信号以三个血流动力学指标的形式进行整合：HI（Hemodynamic Indexes）。低频率指数（HI1）由缓慢的层间相互作用决定，高频率区域（HI3）表征层移动的快速过程。HI2占据中间位置（毛细血管前和毛细血管血流）。脉搏分量的心脏间隔变异性采用心率变异性（Heart Rate Variability，HRV）被评定。

结果：本研究表明了在测试阶段内心率（HR）加快，这表明心理压力度很高。在血流动力学中，血流在慢剪切速率方向上重新分布（血管壁血流）。在应力暴露终止后，血流动力学参数降低，恢复到原来的值。表征心率可变性的指标：LF（交感神经成分），HF（迷走神经活动），CVI（非线性副交感神经指数）出现呈上升趋势，而LF/HF的比率保持不变。

结论：因而进行的研究结果我们制定了多因素背景的微循环和植物调节心脏速率的指标，特定于诱导应激的适应性反应。所获得的移位的定量标准可以整合到应激指数中，并在临床中使用。由于mDLS的可移植性，该传感器加上特定的评估标准，可用于监测由压力情况引起的适应性反应，并在临床中做出早期诊断和预后决定，以及用于患者自我监测。

关键词：应力；血流动力学；心率变异性；适应；微循环

目的：研究代谢综合征（MS）患者的饮食和药物校正临床和实验室参数、内皮功能障碍和身体非特异性适应性储备的可能性。

材料与方法：为期3个月的治疗计划参与53名患MS的患者，分为两个可比较的组。对照组的患者遵循一定的低热量饮食和适量运动。研究组患者除上述生活方式校正方案外，服用了二甲双胍。所有的研究参与者都进行了两次人体测量、临床和实验室指标的评估，并分析了身体的复合成分、血管内皮的状态和身体的非特异性适应性储备。内皮功能障碍的程度由内皮素-1的水平和光电容积描记术检查的指标，以及非特异性适应储备由心率变异性的分析进行评估。

结果：二甲双胍联合饮食疗法和运动结合已被证明是一种校正MS成分和内皮功能障碍的安全药物。患MS的患者中，二甲双胍、饮食疗法和适量运动的结合与仅使用生活方式校正方案相比，会导致身体质量指数、腰围（女生）和总脂肪量的下降。在MS患者的复杂治疗方案中引入二甲双胍有助于一个更明显的不仅仅是生活方式的改变，并校正碳水化合物代谢，降低内皮素-1的值和主动脉壁的刚性的指数，增加调节自主神经系统的副交感神经回路的活动。

结论：与生活方式修饰程序相比，在代谢综合征复杂治疗中使用二甲双in有助于更显着地减少临床和实验室参数，内皮功能障碍和改善身体非特异性适应性储备。

目的：整合文献中的系统方法和个人的心理治疗援助的儿童与各种形式F40的实际经验，为了增加治疗的有效性，改善与F40患者的社会适应，并为儿童人口寻求组织形式的医疗保健。

材料与方法：该研究包括为8-17岁的61位儿童的患者, 由于结构包括F40的各种精神障碍2018年入了Sukhareva Scientific and Practical Center for Mental Health of Children and Adolescents 国家卫生保健事业单位。该研究中使用了医学历史分析和与家庭心理学家的课程记录。

结果：根据家庭功能的参数，确定了3个系统假设的焦虑恐惧症的表现组： 结构方面的障碍（范围、等级、联盟、三角形），交际环境或家族史。工作系统假设由十个临床实例说明。

结论：儿童恐惧性焦虑障碍的形成系统的假设允许制定旨在通过家庭条件的长期稳定缓解及改善患者的病情的治疗及康复战略。在治疗及康复计划中列入与家庭心理学家/心理治疗师的会话，允充许将儿童援助的重点转移到医院以外的方向。

Non-optimal long-term results of endovascular interventions using bare metal stents and their wide use in Russia in acute coronary syndrome (ACS) make it important to study the influence of the mentioned interventions on the results of coronary artery bypass graft surgery (CABG) performed after stenting of the obstructed artery in patients with ACS and multivessel disease.

Aim. To study the results of CABG performed at our department in early periods of ACS after stenting of an obstructed artery with bare metal stents versus  the results of use of drug coated stents of the 2^nd generation, on the basis of the data of NORSTENT study.

Materials and Methods. The work presents the results of a two-year observation of stepwise treatment of 97 patients with ACS and multivessel disease who were performed stenting of an obstructed artery for life-saving indications followed by CABG not later than in 90 days. Patients of the main group had three-vessel disease of coronary arteries with severity of damage 26.0±3.2 points on SYNTAX scale. The time from the moment of stenting to complete revascularization was 64±17 days. Clinico-demographic parameters of the main group were comparable with those of the comparison group (data of NORSTENT study).

Results. During observation time two cases of acute myocardial infarction occurred. Repeat revascularization was required in 14 patients (14.4%). The rate of MACCE was 0.1443. Odd ratio (OR) of the risk of MACCE occurrence was 1.61 (95% CI [1.14;2.78]).

Conclusion. Surgical revascularization of the coronary bed in early periods after stenting of the obstructed artery with bare metal stents in patients with ACS and multivessel disease has 1.6 times (95% CI 1.14;2.78) higher risk for initiation of adverse cardiovascular events, in comparison with endovascular revascularization with use of drug coated stents of the 2^nd generation.

Cardioesophageal carcinoid is a rare neuroendocrine neoplasm. Diagnosis and treatment are especially difficult in case of proximal localization of the gastric lesion (in the region of cardia) which requires a complex multidisciplinary approach. The clinical presentation of gastric  carcinoid is in most cases nonspecific, and the tumor is accidentally detected in endoscopic exa-mination for the pain syndrome, dyspepsia, anemia, etc. Thus, all said above makes tumors of cardioesophageal zone a rather actual problem. In this article, on an example of patient K., of 61 years of age, possibilities of a complex approach to diagnosis and treatment of a complicated case of cardioesophageal carcinoid are shown.

Conclusion. Diagnosis of carcinoid tumors is difficult and requires a multidisciplinary  approach. The algorithm of diagnostic search and treatment tactics should suggest an individual approach in each clinical case which permits to make a correct diagnosis and to successfully reali-ze a required complex of medical measures.

今时今日俄罗斯联邦有一个为享有特权的公民类别提供药品的有组织的制度。同时，法律法规也在不断完善中，通过制定新的法律性文件和修改现有的。本进程的基础是所有公民享有平等的机会和权利获得免费药品服务。然而，对人口中有一些优惠类别采取了额外的办法来组织药品供应。

目的：分析与相应的优惠人口类别有关的规范性法令。

结论：制定的规范性法令在联邦和区域两级对优待的公民类别的药物供应一个既定的管制框架，并允许患者接受必要的药物治疗，是至关重要的。应当指出，为了得到这种援助，公民必须有某种诊断或社会地位。公民的优先类别列表远远不包括所有的病人。因此，现行的医疗卫生法律法规还需要进一步完善。

In the world, a share of elderly and old individuals in the total population is constantly growing. This change in the demographic situation in the modern society certainly arouses a justified interest for the medico-social problems of this category of the population. A special role in this problem is assigned to the medium-grade medical personnel, since a statistically average patient ˃60 years of age suffers from a number of different chronic diseases, including cognitive disorders, senile dementia, syndrome of nutrition deficit, serious disorders in the musculo-skeletal system, etc. Salvation of these and other essential problems requires elaboration of complex targeted programs and special training of the nursing staff for work in hospitals, hospices, palliative beds, etc. In the ‘ageing’ society it is necessary to find appropriate rational forms of organization of medical assistance for aged group of patients and modern ways of interdepartmental interactions that would correspond to the principles of restructure of the healthcare systems. At present in Russia there exist several specialized geriatric and gerontological centers that render different kinds of medical care to the older generation. Integrated character, availability and effectiveness of medico-social assistance for individuals of older age groups is the aim of well-developed geriatric service. Development of such kind of support is also beneficial from the economical point of view in the sense that it permits to reduce duration of repeat stay in hospital, the number of ambulance calls, etc. The mentioned measures will help optimize treatment and diagnosis of age-related diseases and will permit to actualize the term ‘healthy ageing’. In the article, the problems of rendering medical assistance for the older age groups of population are considered with accentuation on the increased role of nursing personnel in realization of medical and social help to the elderly population within the three-level system on an example of the Voronezh region.

(to the 90th anniversary of A.F. Belov)