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Проблемні питання амбулаторного ведення дітей з гострими респіраторними вірусними інфекціями

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Порівняльне дослідження включення противірусного препарату "Еребра" у терапію гострих респіраторних інфекцій у дітей https://erebra.com/wp-content/uploads/Kryuchko-problemi.pdf
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3 rocTpur||'-u pecnipaTopHuMm BipycHHMyt inQexqiqnrn
BIHSV "VrpaincbKa Me[hqHa crovaronoriqsa aragevin",
rvr.
flonraea
SOVREI\4ENNAYA PEDIATRIYA. 201 4.8(64):65-69
Mema:nopialtaLLuledocnidlcewne(letcmtleTncTLiBKn'10,4e7nur'npo7n,LL61'pL|C1tozonpen'()p(]'mt1<.Epe6pa,>um'epu?.II7O
pe cnip
amopuux aipu cr'tux inQ ext4ir)
Ilat4ieumu i nemodu.
nixyeauua
<Epe6pa'>.
t
IIil
Lt
dimeil.
utocmepe.trceuuan nepe.6tleato 74 dumurru eixon aid 3 do 12 poxia, up ttpoxo}tnu ntw14ttamoptLe
Ocnoeny zpyny crnanu 50 \imci, axi iodamxoso do cmaudaprnuoi me.panii omplrwlatlt n])et'tapam
npueody IPBI.
nopiauaHHa cKnaru
lpyny
24 dumuuu, arci ompunycatu Jtuwe sazanruonputiuanry mepanin.
Ou,htneanuca
mpuea'ticmu ma cupnsuianb ocHolHLLr cuttntnonio 3n.xsopn6nHH,n, cmau nic4eeozo i,ttyttimemg, uac.momo ycxanfiueut, ntn
saxaoprcaauicmb npomazoil nieporcy nicta nircg aartua.
Pesgntmamu, Ha @oui ilrcyeauua Epe6porc acmanolttello )ocmoeipue 3JweHueHHa eupatuocmi rcLtini,auux cu,unmouia
pecnipamopuol iuQtercu,ii, ei.)u.oetteuust norcaeutrcie illJKo3tLttbtlozo iuyuimemy, 3uuJ{eHna pwLtKA (topuyeanrn smoputlttl$.
6arcmepianuuut ycxtnluena potno?.lomKLt ma uocmomu petcypeumuux f PBI e \uuauiu,i.
<,Epe6pn.r> e e(tercmuertu-u ma 6eene,ultru saco6ou trircueauua |PBI y dimeil..
Karc4oei cnosa: z.ocmpa pecnipamopua eiptlan iu(:etctEia, dimu, Lttyuonoitiuui noxasuuxtt, Epe6pa
Bucuoercu. flpenapam
Bcryu
riue
focrpi
a
,,).
pecnil-raroprri nrpycrri irrfrcxrrii
(fPBI)
e o,'rrriero
I 3 IIaUOIJIbIII nO[]IpeHIIX IIpUIMII BlSr,rTlB AO neAlaTpa
ra rocnira.ni:auii. 3a .4arrrarrlu {epNaetroi caHiraprro-enr4er.rio"toriqnoi cayx6n, B 2013 poqi nnrova eara ripycuux
iu$erqifi 1' crpyrrypi in@exqiirHoi
e Vnpaiui craHoBr.rra
xBoproBarrb cepea
3axBoproBaHocri airerl
99,95'% uunaitxin iritlerqirlnux saairerl. B VrpaiHi clreprnicrl niA rla-
inQexqii, 3oKpeMa sia cnpr4.l,.rueHlrx nrreBMoKoKoM,
craHoBrrb 300*350 4irefi rqopiuno, cepeA Hlix 00- 120 nirerl
cu\tHl4x
'1
nixorur 4o porcy
(C.O. Kpar,rapen, 2013).
Peur,iAusHi pecniparopHi iH$ercqii Br,rMararorh niAsurueHoi
ynaru lixrpr 4o LrtTutru: B ahrffrror\ry sirti,tacrora pccniparopnux inrbexuii.;i y 1,5-3 paar.i ruqa, irix y.{opocJrl4x. Oco6.nueoi
yraru norpe6yrorr Airr.r MoJroAuroro niry, y lrzx IPBI crarroetxrl' 6576 eia ycix 3zrxgoproBaHb, aaNe si.4or4o, 1qo uacriure
xnopix-rru carre ajrrr, xxi nilni4yroru oprauironaui Aurs.ri
KofleKfl.rBu i, :asslFrarl, r ocinnro-:rlltonufi nepioa [3,5].
flepeaaxHa 6i.nr,ruicrr, airert : rocrplrruru pecuiparopHam.i
iaxBoproBaHHsMpr He Marorb ceprloenoi irilyHo.norivuoi rraro;rorii, i 5i"'mlicrr anropie po:Jrn{Aaxrrb np}.lqr.{H)r pequ4zein
vepea $isio"nori.rHe craHosreuHa neepi.rroi irr,ryHHoi cHcreMrr.
Tar, y 4ireri eiKor\,i 1*5 porin uacrora |PBI rr.roxe Koilr4Barr4-
ct
enisolis sa ociHrrso-arrN4oazl.i rrcpio4;
y 6imu craprrr4x 4ireii (nirorrr 6-12 poxin) - sia oArioro
BiA ilJecrr,r Ao BocbMr.r
Ao rrorr4pbox erriao4in.
Ilpore uaeirr
pecniparopnux iHQerqifi
y
<<AorrycruMa> qac.Tora
rr4'rr4H14 BlrnJrr4Kae 3aHerroKo€HHff
cnprz.rrautrorb ypa)r(errtr.q c;rusonoi o6o"rtolmu poror"norrn pzHonipycu, PC-uipycrr, a4erronipycu, nipl'cu naparpl4ny ra rpilny, are [pr.rq]4rroro anrnrauii xpotri'urux Eorur.lu
iurfexuii e 6arrepii (reuolirnvnurl crpenroKoK, eororasr.ul
cratpirorox, uoparceaa), a raKo)n rpu6u Candida. flo 80%
slrnaArie $apurrririn y airerl eirol,r ao 3 poxie nipyuroi erio"rorirc, nic-rrs 5 poxin oco6aunoi arryalurocri rra6ynarcrl 6axrepia:rr,rri rfoprvrN ypaxennx [3,5].
Cepea ycxla4HeHr,, qxi uacro rfopuyrorr,ca y 4ireii, nepeRaxno l)arrHboro nircy,
orr4T, ct4Hyct4T, rrrrilra. C-rri4 :aarrarraru, rqo u ocrroei 6anrepi:lirtnoi cynepirrrfreitqii Jrexr4Tb
un.trun nipvcrroi irr$exuii ria rrccnequrpi'.rri nexarrieuu aaxr.i('r'y: ropy rx(' lru rrlyxoqn,'r r irp u of u Tpar rcr ropTy T,l y r oei.n unenna <:erpeuii AtlxaJtbHhx ui,,r, xi s, 3HI4xoHItt{ xcrn rlenrpaqii
-
r
auruuixpo6uux Irenttr4is n cexperi, a raxox
llepB].rHHa
3aIraJIbHa peaKqix. Bce qe crnopxre cnpu.auuei yMoBr4 aJ'trr
a4resii rrrinpoSJropfi Ea c.rrusoelfi o6o"rronrli i nepeAyuonu no
BlrHr.rKHeHHr uonoro iu@erqirlnoro npoqecy 6arrepia.nr,noi
eriolorii. qiei rrprvr,rHr4 BaxJrr Brrr\,rn 3axoxaM'.r nonepeAlr(eHHr 6arrepialr,unx ycKnalHeHl, e ni4rpnvaHua npr.r-
3
pollHux lrexanigvir necnerqudli.*roro 3ax14cr)r: :a6cane,renns
uopNlanbHoro l,tyxoqu.niapuoro rpalrcnopry, crlavy,laqil llccncqr.rSivnoi iruyrtroi pe3r4crcHrtrocri, npr'rrni.rcrrna 3arrairer{ur, a rar{o)K arrunaqir ccr<peqii urruvinpcl6nnx rrporeinie.
OcraHsiv qacotl yBary nayxoerlie ece 6i./rbrue rrpuBeprarurr ;letfren:uura aurulrixpo6ni nerrruar.r, erfenropu cucreMI{ Bpo4xeHoro ilryuirery, .grci eiluocgrb 4o nepannuoi
-
6arr,xis. Bax,runo, rlo Jlrlrrre y 9,5% ni'reil paHHboro nlxy rrpurrriHoro qacrr'rx 3axBoproBaHb ua pecniparopni iHQexqii e nepntauni i nropuirui ilrynoaeQiuuru, n 50%' erana4rin
alepriuHi saxnopnnaHnz. i y 40,5% 4irefi naara.ni He BliqBreKlrrrcs
i uynoaorivui 3pyrrreHHr ( JI.I. 9epnrauroea, 20 1 0).
Rptcora rracrora 3axBoproBanb pecniparopnoro rpaxTy
IorcHroerbcr piauouanirrau erioJrori.rH].tx $arropin (punoRipycr.I, a4euonipycz, nipvca rpr..rny, naparpany, peotipycr.l,
JIaHKU
per:niparopHo-cunqzriallnui.i nipyr;, xnaiui4ii, Nrixon.nasMu,
6axrepia"nlui areHrn rorqo), a raxox aerricrrc nepe4aui s6yaHzxa i eficoxoro niu.nunicrro nipycin [7]. Eilnuicrr, nipycin
pieuy 84) [4]. Bnac.tiaox eK3ouuro3y ana,rrri rcosueurpauii
4eSeirsr.ruin Moxyrb Harrortur{yBarac.a y noruurqi 3ana"rreHH.s.
-
HaJIexarb Ao PFIK-sNricHax (nlruarox craHoBr.rrb aTleuonipyc,
ni6pion rxoro npe.4crasreur4rz {I{K). Cepea aipycia Haftuac-
ISSN 1992-5913 Conpeueunax neAuarpr{r 8(64)/2014
rf
3axrrcry uig narorenin [1,4,6]. fieQen:unlr e 5araroyHxtliona;rr'nulrz irrtynoperyJrroHtqr4Mli areHTaMr4, rrlo BlAt -
fpaloTb Ba)(nnBy poJrrr y rrrexaHi:lurax rfarorlrarosy Ta 3aflareHH.s rJepe3 iHri6ynauua Mera6ori.rlrlrx nporlecin a6o nopyrlemra
qincuocri n-lirunuoi ueu6paulr. flenrr'rAu a4arni cnpauonyBarlr Ao BofrrlrilIa 3arraJrerlrr uarpo$aru, nci,irporpiaa,
B-aivtbourrrrr, npfi3Boaa,rn 4.o rruni,rr,rrt'rrrrl vc4iaropin
3ana.rreHnrr
(iureplerixinie
6, B, 10, iurepQepouin ra.nerixor-
Cepe4 vexanievin Aii nenraaie - iu4yrcqit anonroay i npr.rrni.Jelins cr4HTe3y Qaxropy HeKpo3y nyxJrr4tr, luo BaxJrr4Bo Ha
3aK"'rrcr{Hux eranax 3aflarbHoro nporlecy [ 1 ,5,8].
b)
\u-r*iltr# Flfr* un *ariil*: http.llnr*ci**xp*rt.**m.iln
itlx
i"i"tii),liiitjrrl'1:,i:.f lllrl,l{i
t1 i-ifl;iil:i11I;!hlx;\'iii;'r.LI
flenrrzAra ;roraaisyromca y noBepxHeBlrx ilapax KriTr4H
r'ticqrx npoHuKHeHH.fl naTofeuin, uqo cui4unrr npo crparerivHy poJrb qllx 6ianin y saxucri oprauiavy. baxrepiocraruvnuri,
nporunipycHufi ra anru$ynra"nrHr,rrt uexani:lru 4ii pea.'ri:y5'
rorsc.n nHyrpimHron"niraHno ra notar.nirzuuo. Bi4orrao, qo
ilopymefiHt ercnpecii 4e$eusnnir e npu.u'rnoro uacrux in$er<uii,innx, y r.v. pecniparopnr.rx, nipycnr.rx eaxnopronanr [1r].
Ha croroAui i4cHrrlrfrironano noual 2000 4e(renaluin r
6ararrox rKaHilH i pianux rurrie x,/rirnH 6eaxpe6erHrzx, xpe6erHtax, pocJrtiH rpra6ie. TaK, .tucaeHHur\{u pe3yJrbraraMu
Aoc.niAxeul pocJrr{H BcraHoBJreHa 4erl-reu:uu-o6yruoB,'reHa
nporzrr.rirpo6Ha I nporlrnipycHa arruenicrL y cocnx, nepc\4Ka, pocJu'.tH pollrHr4 xpecroqnirHux, Br4norpaAy, o6.ninuxrz ra
i
iH. [4]. BaNarawrrrr $axrort raxr.rx Aoc.niANeHb craro BcraHoBneHHt repaneBTrrqHr4x g:ractusocrei y pocnrlH 3a paxyHoK
Ixel)cJla er(rorcr-rll,tx lerfrerrrr'tt.tin, r raKox ix rvrox,nunicrn
inllrrynarra cr4lrre3 enroferrnux pe$enannin [61.
An I 6i.n r'nrocri cr4r rrcrr gn r'r x n porrr o ipvcHl..rx npcn apari n,
rqo Br4KopprcroByrorl,c.s n uauil,i rpaini, ni4r:yrr'rr .{oi(a3oBa
uiHi.rHa 6aea; BzuK,'rr,rBe 3saqenuq, oco6arrao Arx te.liarptr.mux
naqieHrie, nae ri4cyrnicrb roxclr.{Hocri ra 4o6pa nepeHocrlrr,ticm. Totvty n ne4iarpravHirt
nparrvqi oco6ansoi
aKTyaJIbHo-
cri
na6ynarorl "ninapcr,xi saco6n npr.rpoAHoro rroxoAxteHH.s
3 BncoxrrM npo$i.nerv e@exrnnuocri ra 6eane.{uocri. O71surur
B raKrix
(3AT
<,cDaprr,nteHrp
e airapcnrnii
eaci6 <.Epe6pa>
BIJIAP>, Il A/ 1 2485 / 01 /0 1 ), npe4cra-
npenaparin
nneuuh 6io:roriqrro aKTI4Blrr.rMrr Korlrnor{cr{TaMr4, nz,4i.nenavu
3
Jrrlcrn o6ainnxu xpvnrnrrono.{i6rroi: raroelarorauilrauri
(ue nerrure 60%), x;urporerroBoro, eoxJroporerroBoro, nyN{apoeoro, acrop6irroBoro KrrcJloral{lr, KarexlHoM, enrxarexiHov,
pyrI4rroM, KBeprlerr4noM, isopauuerrruoM, eJlearl{o3r,tAoru,
xaporzroirauu,
e(,ripnr,u'ar.r
M
acJr aM 14
roLuo [2].
Oeno.nlni cno JryKr4 npo,a B Jr.srorrr iuri6yrouni.i e@ exr nilr{ocHo [n4poxoro cneKTpa 6arrepiri, rpz6nin i nipycin: rpuny,
repnecy, napalrirconipycin, aaenonipycin roqo. Y qzc.nenr r Hx eKcnepriMeHTaJ'l rrlr4x ra n"ri u i qruax Aoc:ri,lxes u g x etbexrunrrocri rinolranrirrl' BcrarroRJ'rerro yrrincpca"nurry nporzni-
pycny airo na PI-IK
i Al-Ilt-suicrri
nipycr,r
:
6.iroxynarrrr.rin
sipvcr{oi rrcr,ipoauirri4aara (cia.nilaaa) ra irr4ynqiro cr4r'rre3y
cr{Aole}rrr?rx a- i 1-iulepdrcpouir [2,7,10].
Ilperrapar <.Epe6pa> uae rupasrufi inri6yrovlrr? erfterr na
axrusHicrb eipycnoi HerlpauiHigasra (66% y xonqeHrpaqii
100 uxr,/r'l.rt), llo icrorno siApianse fioro siA ei4ouux nporarplrno3H?rx npenaparie a,\tauralrlriy i per.ranra4lrny, rri ne Bnr?rBarors Ha aKrfisHicrt, rlroro rlrep,rteury [10]. BHac.ni,{or npu*nveuux uefiparlrini4a3u ilopymyerbca a6ipra ei6piony, rqo aano5irae
perrpo4yrqii nipycie. Iurep{reponinlyryloqa 4ix npenapary
<,Epe6pu uae vicqe nptr aacrocynaHtri uininamtu.rx ao3 npe[apary
10, 20, 50 ur<r/u.t, npu s6i,rruretuti ro:r.t.[o 100 rvmr/rrr.r
cnocrrepiraemt:l 3Hr4ncnur npoaynuii iurepQcpouin [2].
IIpone4eHr,rr,i aHalig AaHr,rx cucreruarntrH14x or.nsAie
pecypcy PabMed cBi4qvlo rrpo Brrcoxy :aqinaureHicrr uaynonr{ie qoAo B}4BqeHHr (riHi.{Hr4x er!exrie peqoBrlH, sr,r4ire-
-
nux ie nucrs
o6rinr.rxra rpyuuuono4i6uoi (Hippophae
Rhamnoides L.) - 6,rnerro 20 Aoc,niAxeHr,, axi ni4rnep4xynrr, nelaxurT TepaneBTlrrrHr,rfi noreHrlia"n a iMynono4ylroro-
qfJn, npoTfi3anaJrbHorot rrpoTeKTuBHoro, ilpoTI4nyxJIHHHolo,
aHTuor{cr4Aarrrrroro, rap4io- Ta renaronporer{Tr4BHOIo, nporr4uirpo6noro i nporunipycuoro anrunuicrro [ 1 zr, 1 6, 1 Bl. fl oc,'rilHr4KaMr4 AoBeAeHo nporlrnip5rcny arcrrznuicrr ulo.(o pient.tx
rlrraMis nipycin rpr.rny A i B, aaeHor:ipycin, napauirccbeipycin,
eipycin npocroro reprrecy, Varic e lla zo ster, uuroM e.ra;roripycy, pecniparopHo-cuHunriarruoro nipycy [9,10,12].
I.LIupoxr.riii cneKrp auru6axtepia;rr'noi aiT eKcrpaKry
i: .nlrcrs o6.ninnxu rpyurunono4i6noi : axrilsnicrlo nporl,I
KI,iUIKOBOI ITa"II4qKI4, CaJIbMOHeJItr, lJlr4f eJrl,l, npOTeIO, eHTepO-
oo
f
irll{
fl!-iili4
KoKy, cl,rHbonrifiHoi na.nn.rKu, nHeBMoKoKy, 3oJroraBofo
crat!i.roxory, KaHAr4 Atr, rr,rirco6anrepii ry6epnyatoay BcraHoereHr4i.i 3a pciynbrarartrra 5arrcpio.nori.JHux ra rcrirriqnux
,{oc.rriAxeur, [2,12,19,20].
B. Jayashankar, K.P Mishra (2012r) niareepnxer{o Brrar:rnsicrr, eKcrpaKTy nvcts, o6nirtuxr,r 3Hr4lryBarr,r [potBr4
enAoresnoi iuroxcnraqii npN iHrlercqirlHrlx 3axBoploBaHHrrx,
6yrra rroreuqiarbHr.rM TeparreBTr{trHtitvl areHToM a,la,linyraHH.s eH,4ororcr4ro:y. BcrauoueHo, rqo arrunHufi KoMrroHeHT
- i:opavneruH npurHivye .tinono.nicaxapi4rz in4yxoeauoi
eHAorcrrcelrii, iHri6ye npolyKlliro IL-6, TNF-cx ra excnpecim
CI)40. flporrlsanarr'Hi Rlac'runocri xapaxrepu3vBanr4ct
3HLrxeHHtM encnpecii IIOf-2 i INOS-6irrin (inducible macrophage-type nitric oxide synthase) [131.
, Cril rarotrr 3a3Haqr.rrra, uo 6ioloriquo
cnoJryKr4 KBeprlerr,iH, relan$epo,r
axrusui $eno;rlni
ra ieopauuelrn, ilIo
BXoATITb
rrpenapaw ..Epe6pa,r, MatoTb BJracTnBicrs nprrruivynaru peamlii ei,rruopa4uranbHoro oKr4cJreHHr qepe3 Bcranosaeni MoleKyJrspHo-6ioxirrai.{Hi uexaui:l,rrr aHTtrorcr4AaHruoi aii (6eanocepe{Hr anrupaarrr{aJbHa axrnnHicrr ra Henprni aurraorcz4anrni sracrfieocri rrloAo aKTr,rBHt4x Qoplr xlrcHn
:i :nuxennqr\,{ nvicry niltHlzx iouin 4noxnaleHrnoro :a.niea)
[9, I 2,1 9]. 3a:na.{eHa slacrrzsicrl Epe6pra qo71o xolrn.nexoroi
AO CKrany
perylxqii nporlecin nilr,uopa4r,malbrroro
3 ocHoBrrr4x rr.rexaui:vin
ort4cJrerrlrr € oAHuM
iioro $apnrarolori.ruoi aii, rqo ryuo-
BJno€ po3rll4perrru iioro repaneBTl4rlnoro norerrqia,ry
- npoSilanruxa ra xopexqir niaunopaAlrralrHoi naro.lorii [1 1].
llpueepratorr yBary pesyJtbraru nonepe4nix KJrlHlrHr.rx
floc,riAxeur eKcrparTy iz nucl+t o6ninr.rxr.i rpyruzuono4i6Hoi
(I ra I1 Saea), rpoBeAeuax y 9 uepu.mr.rx qenrpax, e orliHxoro
eQerrunnocri .nixynauur 3araroM v 625 crauionapHlrx xBoplrx
Aopocrroro i gr,irx.roro nixy (ni4 2-x rrlicquin), e ni4rnep4xeuH.qru rloro 6e:nevnocri, go6poi nepeuocnr',rocri :ra nacoroi repanenta.rtoi e$errzrnocri rqo4o nipycnzx 3axBollroBar'rh, y r.rt.
vcKJIa,(IreHI,rx 6arrepia.ntnnvu iu$exqiairlra (rocrpr.ri.i ronelrair), :i cxopouourM repMit{iB oAyxarfirr xBopux [10]
Me morc AocJriAxerlu cra,ro nopintuuua e(;exrr.rnrrocri
repanii rocrpux pecrrlparopuux eipycHr.rx iHrlexuiri y Airefi
B BKJIrcqeHHril,i nporunip\rcHoro ilperrapary <.Epe6pa>.
Marepial i vero4n 4oc.li4xeHwt
IIi4
crrocrepexeuHxru nepe6ysalro
74
Ar4't1.1t:a
B1(oM Bla
ao 12 pot<ir, ulo npoxoAr4Jrl4 arur6y.natopue liryeauH;r s rtprlBoIy fPBI. 3a ansafiHola Aoc.ni4xeHua rpurepixuu nn.nro.reuux6ywr guT tturl nir, naxnHicrr, cl.lrffiroMis |PBI rpusa;ricrro
Ao 36 roAuu ei4 novarry 3axBoproBaHHfl ra ni4cyruicrt ivyHoAe(biqurnerx cranin, aaepriuHux BaxBoproBaHb ra qyKpoBoro
gia6ery. OcuonHy rpyny cxrrarru 50 airer;r, axi orpuuynann
eriorponuy repanirc nporanipycunrvr :aco6ov <.Epe6pa> (3AT
{Dapvuenrp <.BI"IIAP>, UA /12485/01/01) na TJIi :araffHux
3axoAiB airynaHua pecniparopnux BipycHr4x in$ercuii;i (liNxonraii pexuu, pgcHe rrr{TTs, 3porxe}tHt rropoxlltinti flooa
3
coJtboB.l,tMu po3q[HaMr4, 3acTocyBaHHq x€po3HI,1)l(yB:lJr6H]IX,
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1
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A6arypos A. E. Karuonuue asrutr.,rt,'txpo6rure nenru4bt cr4creMbr HecneLlu-
to.
Quvecxoil eaqr,trsr pecnuparopHoro rparra: 4eQelelrrbt rl Karen14qr4Al4uu. [eQersurur
MoneKynhr, nepexilBaou]ue peHeccaHc (9acru 4) /
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A. E. A6arypos
2.
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