генеза и определены перспективы совершенствования фармакоте-
рапии хронической боли. Предложена организационная модель сис-
темы паллиативной помощи этому контингенту больных, вклю-
чающая территориальные организационно-методические центры
паллиативной помощи онкологическим больным, разработаны по-
ложения о кабинетах противоболевой терапии, отделениях пал-
лиативной помощи и патронажной помощи инкурабельным онко-
логическим больным на дому, определены направления их деятель-
ности. Освещены вопросы обучения специалистов методам лече-
ния хронической боли и организации паллиативной помощи инку-
рабельным онкологическим больным. Определены перспективы
развития и совершенствования системы паллиативной помощи
онкологическим больным с хронической болью в России. Статья
предназначена для онкологов, врачей общей лечебно-профилакти-
ческой сети, анестезиологов-реаниматологов, врачей кабинетов
противоболевой терапии и отделений паллиативной помощи.
Present-day status of care of incurable cancer patients referred to
clinical group IV is discussed. The authors criticize tlie current
approaches to the treatment of chronic pain in cancer patients and out-
line the prospects of improving drug therapy of chronic pain. They pro-
pose an organizational model of the system of palliative aid to this patient
population, including local organizational and methodological centers
for palliative aid to cancer patients, a system of analgesic therapy rooms,
palliative care departments, and public health service rendered by visit-
ing nurses to incurable cancer patients, and define tlie main trends of
their activities. The problems related to training of specialists in the treat-
ment of chronic pain and organization of palliative care to incurable can-
cer patients are discussed. Prospects in tlie development and improve-
ment of tlie system of palliative care of cancer patients with chonic pain
in Russia are outlined. This paper is intended for oncologists. general
practitioners, anesthesiologists and reanimatologists, physicians special-
ized in antipain therapy and palliative care.
Aiaeec aaiiuo AIC, iinayuaiiuo i?iaeaia ?aea [29, 30],
naeaaoaeunoaoao i a?aaiaiii ?inoa caaieaaaaiinoe. Anee a
1986 a. ?ae aeaaiinoe?iaai o 6 000 000 iiauo aieuiuo e aieaa
4 000 000 oia?ee io ?aea, oi o?a a 1990 a. yoe iieacaoaee au?in-
ee ai 7 000 000 e 5 000 000 niioaaonoaaiii. Nia?oiinou, naycai-
iay n iieieiae?aneeie caaieaaaieyie, ninoaaeyao 8-10% anao
neo?aaa nia?oiinoe a ie?a [65]. Ii aaiiui ?yaa aaoi?ia, o 30-
50% iieieiae?aneeo aieuiuo aieu yaeyaony iniiaiui neiioi-
iii [50, 55-57], i?e?ai o aieuiuo n iaecea?eiui ?aeii yoio ii-
eacaoaeu oaaee?eaaaony ai 70% e oieuei 20-50% ec ieo iieo?a?o
yooaeoeaiia iaacaieeaaiea [51, 55].
Yenia?ou AIC n?eoa?o, ?oi oaiaaioey e ?inoo caaieaaaaii-
noe ?aeii aoaao nio?aiyouny, i?e?ai ai 90% iaoeaioia n ii?a-
aaeaiiuie eieaeecaoeyie iiooieaaiai i?ioanna aoaoo eieo?a-
aaeuiuie [61]. A ?acoeuoaoa aey aieuoeinoaa iieieiae?aneeo
aieuiuo i?ioeaiaieaaay oa?aiey e nano?eineee ooia yaey?ony
aaeinoaaiiie ?aaeuiie iaaeoeineie iiiiuu? [30].
A i?ia?aiia AIC ii ai?uaa i?ioea ?aea i?iaeaia ea?aiey
eieo?aaaeuiuo iieieiae?aneeo aieuiuo n o?iie?aneie aieu?
(OA) i?aanoaaeyao niaie iaio ec 4 i?ei?eoaoiuo caaa? ia?yao n
ia?ae?iie i?ioeeaeoeeie, ?aiiei auyaeaieai e ea?aieai eo-
?aaaeuiuo oi?i ?aea.
I?iaeaia ea?aiey OA ?anniao?eaaaony yenia?oaie AIC
oieuei eae iaei ec iniiaiuo eiiiiiaioia nenoaiu iaeeeaoea-
iie iiiiue, eioi?ay iai?aaeaia ia iaeaa?aiea niiaoe?aneiai,
ineoe?aneiai e aooiaiiai ninoiyiey, a oae?a nioeaeuio? iia-
aa??eo [64].
A auniei?acaeouo no?aiao oe?iei i?aanoaaeaia naou aieu-
ieo, aaa ieacuaaaony iiiiuu eieo?aaaeuiui iieieiae?aneei
aieuiui, e nouanoao?o niaoeaeece?iaaiiua oaio?u iaeaa?aiey
aiee [58, 59, 60, 62, 63].
Ii iiaie? yenia?oia AIC, nenoaia iaeeeaoeaiie iiiiue
aie?ia aee??aou neaao?uea eiiiiiaiou: aiaoeaoi?io? e noa-
oeiia?io? iiiiuu, iiiiuu ia aiio, eiinoeuoaoeaio? neo?ao e
iiaaa??eo ?ianoaaiieeia iinea eii?eiu iaoeaioa. Eeanne?an-
eie iiaaeu? i?aaiecaoee iaeeeaoeaiie iiiiue yaeyaony Aaee-
eia?eoaineee oinien -niaoeaeece?iaaiiay aieuieoa, aaa ieacu-
aa?ony eaaeeoeoe?iaaiiay iaaeoeineay, nioeaeuiay iiiiuu e
aooiaiay iiaaa??ea aaciaaa?iui iieieiae?aneei aieuiui e
eo ?ianoaaiieeai. A a?oaeo no?aiao ie?a ea?aieai eieo?aaaeu-
iuo iieieiae?aneeo aieuiuo caieia?ony a niaoeaeece?iaaiiuo
ioaaeaieyo iieieiae?aneeo einoeoooia e eeeiee (a Aa?iaiee, Aa-
no?aeee, NOA) eee ia aiio (a Eoaeee, O?aioee, Oeieyiaee). Ia-
iaei ia iaeeeaoeaiia ea?aiea aieuiuo aa?a a ?acaeouo no?aiao
i?eoiaeony oieuei 10% n?aanoa, auaaeaiiuo ia ai?uao n ?aeii
[30], ?oi ia?yao n a?oaeie i?e?eiaie ii?aaaeyao ieceee o?i-
aaiu iiiiue yoei iaoeaioai.
Ianiio?y ia iaeioi?ia oeo?oaiea iiiiue eieo?aaaeuiui
iieieiae?aneei aieuiui a oao no?aiao, aaa ia i?aeoeea ?aaeeco-
aony iieeoeea AIC, a oaeii i?iaeaia iaeeeaoeaiiai ea?aiey ai
ianoiyuaai a?aiaie ia ?aoaia, e a?aaiaii ieeeeiiu aieuiuo
?aeii eniuouaa?o no?aaaiey, eioi?uo ii?ii auei au ecaa?aou
[30]. Ia yaeyaony enee??aieai e iaoa no?aia.
A ?innee a?aaiaii oie?a?o io ?aea aieaa 290 000 iaoeai-
oia. Ionoonoaea a iaoae no?aia niaoeaeuiie noaoenoe?aneie
oi?iu o?aoa iieieiae?aneeo aieuiuo n OA ia iicaieyao i?iaa-
noe yieaaieieiae?aneia enneaaiaaiea ?eneaiiinoe aieuiuo n
OA i?e ceiea?anoaaiiuo iiaiia?aciaaieyo ia oa??eoi?ee ?in-
nee. Aaiiua AIC i ?eneaiiinoe yoiai eiioeiaaioa aieuiuo a ?ac-
iuo no?aiao ie?a [51, 55] iicaiey?o i?aaiiei?eou, ?oi a ?innee
aieaa 200 000 eieo?aaaeuiuo iieieiae?aneeo aieuiuo no?aaa?o
io aiee ?acee?iie eioaineaiinoe. Yoe iieacaoaee niaeano?ony n
aaiiuie ?yaa ioa?anoaaiiuo aaoi?ia [10, 46] e ?acoeuoaoaie
i?iaaaaiiiai a IIEIE ei. I. A. Aa?oaia [45, 49] noaoenoe?anei-
ai aiaeeca ?anoiou OA o iieieiae?aneeo aieuiuo Iineau, eioi-
?ue iieacae, ?oi a n?aaiai ieiei 12 500 iieieiae?aneeo aieu-
iuo no?aaa?o eioaineaiui aieaaui neia?iiii, ii iiaiao ei-
oi?iai iieo?a?o noaiaa?oio? oa?aie? ia?eioe?aneeie aiaeuaa-
oeeaie (eiaaei, i?iiaaie, iiiiiii, ii?oei). Aaoi?u yoiai en-
neaaiaaiey n?eoa?o, ?oi enoeiiay ?eneaiiinou iieieiae?aneeo
aieuiuo, no?aaa?ueo OA, aa?iyoii, cia?eoaeuii aieuoa, oae eae
iaoeaiou ni neaaui aieaaui neia?iiii, iieo?aaoea iaia?ei-
oe?aneea aiaeuaaoeee, a aiaeec ia aioee a nayce n ionoonoaeai
niaoeaeuiie aieoiaioaoee aey eo o?aoa.
Ii iiaie? yenia?oia AIC [29, 30], 70% aieuiuo iaecea?e-
iui ?aeii no?aaa?o io aiee ?acee?iie eioaineaiinoe. Neaai-
aaoaeuii, eo ?eneaiiinou a Iineaa ninoaaeyao 16 000. I?eaioe-
?iai?ii ieiei 3500 ec ieo no?aaa?o neaaie OA e iieo?a?o ia-
ia?eioe?aneea aiaeuaaoeee.
Ea?aiea OA iieieiae?aneiai aaiaca ai ianoiyuaai a?aiaie
o?aaeoeiiii i?iaiaeony, niaeanii ?aeiiaiaaoeyi AIC, ia?ei-
oe?aneeie aiaeuaaoeeaie, ianiio?y ia eo iaainoaoee e iiai?-
iua yooaeou. Ia?aaei ea?aiea iieaoaie ia?eiaaony caaieai ai
nia?oe aieuiuo, ?oi naeaaoaeunoaoao i iaainoaoi?iii niae?aa-
iee iniiaiuo i?eioeiia oa?iaeioa?aiee OA, ?aeiiaiaiaaiiuo
AIC. I?a?aaa?aiaiiia iacia?aiea neeuiuo iieaoia i?eaiaeo
e auno?iio ?acaeoe? ?acenoaioiinoe e ia?eioe?aneei aiaeuaa-
oeeai, nie?auaao i?iaie?eoaeuiinou eo yooaeoeaiiai aiaeuaa-
oe?aneiai aaenoaey e o?aaoao i?ia?anneaiiai oaaee?aiey aice-
?iaie. Ea?aiea aieuoeie aicaie ia?eioe?aneeo aiaeuaaoeeia
nii?iai?aaaony ?acaeoeai iianiuo iiai?iuo yooaeoia (oaia-
oaieai niciaiey e aaeaaoaeuiie aeoeaiinoe, ?acaeoeai oioii-
ou, ?aiou, caii?ia e caaa??ee ii?e), inei?iy?ueo ninoiyiea
oy?aeuo iieieiae?aneeo aieuiuo, e o?aaoao iinoiyiiiai iaae-
oeineiai iaae?aaiey e ooiaa.
A ?innee nioie ouny? eieo?aaaeuiuo iieieiae?aneeo aieuiuo
n OA ia iieo?a?o niaoeaeece?iaaiiie iaaeoeineie iiiiue e a
no?aaaieyo caeai?eaa?o naie ?eciaiiue ioou aiia. Ii aaiiui
neo?au nei?ie iiiiue Iineau, a?a?aaiuie e oaeuaoa?neeie
a?eaaaaie a?aaiaii inouanoaeyaony io 47 000 ai 69 000 auci-
aia ia aii e eieo?aaaeuiui iieieiae?aneei aieuiui n OA aey
eiuaeoee aiaeuaaoeeia. A iniiaiii a?eaaau nei?ie iiiiue au-
ac?a?o e aieuiui a ii?iua e oo?aiiea ?anu, eiaaa ia ?aaioaao
iaaeoeineee ia?niiae ?aeiiiuo iieeeeeiee, inouanoaey?uee
a aiaaiia a?aiy iao?iia? yoeo aieuiuo ia aiio. Iiiaie?aoiia
ia?auaiea aieuiuo iaecea?eiui ?aeii e eo ?ianoaaiieeia e
oneoaai nei?ie iiiiue ia?aa?o?a?o aa ?aaioo ianiaoeaeece-
?iaaiiuie auciaaie, o?aao?ueie aieuoeo oeiainiauo cao?ao.
Neooaoe? inei?iy?o ionoonoaea iaeiaaceaiuo eaea?noaaiiuo
oi?i ioa?anoaaiiuo oaio?aeuiuo aiaeuaaoeeia, ianiiniaiinou
iaoae oa?iaoaaoe?aneie i?iiuoeaiiinoe iaania?eou anao io-
?aa?ueony aieuiuo iaiaoiaeiui eiee?anoaii i?ioeaiaiea-
auo eaea?noaaiiuo n?aanoa e iaaaaeaaoiinou caeoiee ii eiii?-
oo neioaoe?aneeo aiaeuaaoeeia iineaaiaai iieieaiey. A ?acoeu-
22
Антология научных публикаций
