2 Cpjcne lUmp MajcpfeUj

< Ui <j amnkj Uj < meUj Odebmaj

MNFKOFM,MNFKOFM RJRJ

“ sdr etmfrh oYpt (OESR) ldptoYjYm aYfhYm hmsdfpYk cYph duYktYrh cYm lYmYidldm oYpt.

“ OESR cYoYs chaYfh ldmiYch rohpnldsph (odmftjtpYm odpfdpYjYm tcYpY lYrtj cYm jdktYp cYph oYpt-oYpt), ldmxdaYpjYm

jYoYrhsYr (tjtpYm odpstjYpYm fYr cYkYl oYpt-oYpt), cYm okdsgxrlnfpYogx (odmftjtpYm unktld oYpt).

“ JdsdprdchYYm etmfrh oYpt odmftihYm odpYmfjYs trdp-ephdmckx sdkYg ldmfYjhaYsjYm ldktYrmxY odmfftmYYm ch
sdloYs OESR nkdg cnjsdp lYrxYpYjYs cYm odmhmfjYsYm jdatstgYm odkYshgYm enplYk cYkYl ldmftlotkjYm cYm
ldmYerhpjYm odmftjtpYm etmfrh oYpt uYkhc.
“ OESR xYmf sdpaYhj chsYerhpjYm cYkYl gtatmfYmmxY cdmfYm opdrdmsYrh jkhmhr hmchuhct cYm shcYj chohrYgjYm.
RdltY aYfhYm cYph OESR gYptr chftmYjYm jdshjY ldmfduYktYrh oYrhdm.
“ Odmshmf tmstj chhmfYs aYgvY OESR oe Ug ldlatYs chYfmnrhr oYsnknfhr rdodpsh dlehrdlY YsYt ehapnrhr oYpt.
LdpdjY ldmxdchYjYm odmftjtpYm ehrhnknfhr ldmfhcdmshehjYrh bYbYs udmshkYrh cYm, cYkYl ldkYjtjYmmxY,
ldmctjtmf jdadpYcYYm opnrdr odmxYjhs xYmf pdkduYm cYm aYmstYm cYkYl duYktYrh odmfnaYsYmmxY.

“ Sdjr hmh ldlaYmst cdmfYm duYktYrh rohpnldsph cYrYp, jYoYrhsYr chetrh, cYm unktld oYpt-oYpt cYm YjYm ldltmfjhmjYm odlaYbY
tmstj ldmfhcdmshehjYrh bYbYs udmshkYrh tltl ldmfftmYjYm cYsY xYmf chrdchYjYm nkdg OESR.

KFI<F A<K NUjcan NBCBNBKOF KLNJ<I

“ GYrhk OESR chhmsdpopdsYrhjYm cdmfYm ldlaYmchmfjYmmxY cdmfYm pdedpdmrh mhkYh-mhkYh xYmf ldvYjhkh rtaxdj rdgYs

mnplYk.
“ Hmh mnplYk YsYt jehUe,jehUe elma egne ldlodpghstmfjYm aYmxYj uYphYadk, xYmf oYkhmf odmshmf trhY, shmffh aYcYm, idmhr
jdkYlhm, pYr / dsmhr, cYm oYcY shmfjYs kdahg pdmcYg, adpYs aYcYm.
“ MYltm, ldpdjY ldmfYaYhjYm uYphYadk xYmf ldlodmfYptgh kYhm xYmf ltmfjhm ldlhkhjh dedj, sdplYrtj onktrh tcYpY, rsYstr rnrhYk
djnmnlh, cYm kYhm-kYhm.

Mamnaj Aelma egne Jaok a

“ RdbYpY spYchrhnmYk, sdsYoh sYmoY cYrYp hklhYg, kYanpYsnphtl etmfrh oYpt sdkYg rdvdmYmf-vdmYmf ldmfYstp pdmsYmf
mnplYk tmstj rdshYo mhkYh opdchjrh.
“ AYsYr aYvYg cYm YsYr mnplYk tmstj rdshYo mhkYh opdchjrh chsdsYojYm rdaYfYh 80% cYm 120% cYph
mhkYh opdchjrh, lYrhmf-lYrhmf.
“ MhkYh chtjtp tmstj lYrhmf-lYrhmf uYphYadk etmfrh oYpt chaYmchmfjYm cdmfYm
 ldpYlYkjYm mhkYh-mhkYh lYrhmf-lYrhmf uYphYadk cYm chmxYsYjYm rdaYfYh odprdm chopdchjrh.β
“ mhkYh xYmf sdptjtp xYmf iYstg cYkYl jhrYpYm 80-120% cYph mhkYh opdchjrh chYmffYo mnplYk.

“ Ldsncd hmh chftmYjYm cYkYl sdjr hmh jYpdmY ldltmfjhmjYm hmrsptjrh ltcYg cYm lYrhg chftmYjYm rdbYpY ktYr.

HaheiU Jaok a Mamnajoeh

“ RdatYg ldsncd YksdpmYshe tmstj ldmcdehmhrhjYm jhrYpYm mnplYk lYrhmf-lYrhmf chodpjhpYjYm mhkYh (mnplYk) ldmfftmYjYm odmcdjYsYm adpaYrhr
odprdmshk.
“ CdmfYm ldmfftmYjYm ldsncd hmh, mhkYh-mhkYh chtjtp jtpYmf cYph odprdmshk jd-5 YsYt kdahg adrYp cYph 95 odprdmshk cYkYl

onotkYrh xYmf rdgYs chYmffYo YamnplYk.

“ Ldsncd odprdmshk cYoYs ldmxdaYajYm chYfmnrhr xYmf kdahg sdoYs cYph odmxYjhs oYpt narsptjshe jpnmhj (OONJ),
sdptsYlY oYcY npYmf stY. 1 Ldsncd odprdm chopdchjrh ltmfjhm nudp BNOC chYfmnrY oYcY oYrhdm trhY kYmits. 2

OP<KA<NAFO<OF PBO CRKDOF M<NR

“ Tmstj ldmcYoYsjYm hmenplYrh xYmf adpftmY cYph OESR, jdbtjtoYm jdctY odmftihYm odpYkYsYm cYm jdatstgYm gYrhk
odmftihYm xYmf YjYm chsdkhsh.
“ Sgd >ldphbYm SgnpYbhb Rnbhdsx (>SR) ldmdpahsjYm odcnlYm tmstj rsYmcYpchrYrh rohpnldsph, sdplYrtj
pdjnldmcYrh sdmsYmf jYkhapYrh odpYkYsYm, uYkhcYrh gYrhk, odmftjtpYm oYpYldsdp, cYm jphsdphY odmdphlYYm
cYm pdopnctjshehsYr tmstj cYsY xYmf chodpnkdg. 3 . 4

“ JYpdmY jdaYmxYjYm OESR chodpnkdg cYph kYanpYsnphtl OES adpcdchjYrh, sdjr hmh ldmidkYrjYm jphsdphY rsYmcYp

tmstj hmsdpopdsYrh OES cYsY cYm shcYj sdplYrtj phmbhYm oYcY rdsto odpYkYsYm cYm odmftihYm sdjmhj.

“ GYmxY jdshjY rdltY jphsdphY odmdphlYYm cYm pdopnctjshehsYr sdpodmtgh cYoYs OESR chsYerhpjYm cdmfYm jdxYjhmYm.

“ IhjY jphsdphY odmdphlYYm cYm pdopnctjshehsYr shcYj sdpodmtgh, jdatstgYm odmftihYm kdahg kYmits xYmf YjYm
chkYjtjYm tmstj ldmhkYh etmfrh lYjrhlYk.
“ GhmffY cdkYoYm toYxY oYrhdm cYoYs chkYjtjYm; rdsdkYg hmh, jdkdkYgYm oYrhdm ldlodmfYptgh cYsY xYmf chodpnkdg.

“ GYrhk sdpaYhj rdkYkt chftmYjYm tmstj hmsdpopdsYrh.

HmeoameU lajameiUUj
OESR YvYkmxY gYptr chmhkYh tmstj odmdphlYYm xYmf sdpaYhj chsdmstjYm cdmfYm ldlodkYiYph knno eknv-
unktld. jphsdphY odmdphlYYm tmstj OESR ldkhotsh adphjts hmh:
“ JdadaYrYm cYph YpsdeYj (aYstj, odmtstoYm fknshr, sdplhmYrh chmh jdanbnpYm, toYxY uYphYadk)
“ AYhj chltkYh (xYhst, aYfhYm YvYk jtpuY xYmf oYkhmf sdpfYmstmf oYcY trYgY oYrhdm adaYr cYph YpsdeYj)

“ LdltYrjYm vYjst djrohpYrh (rdshcYjmxY 6 cdshj cYph adpYjghpmxY oYcY jtpuY unktld vYjst, YsYt cYsYpYm shmffh lhmhlYk 1

cdshj oYcY jtpuY unktld-vYjst)

HmeoameU malmk pgoebeoUn

RdsdkYg lhmhlYk shfY knno YkhpYm unktld chsdphlY sdkYg chodpnkdg, pdopnctjrhahkhsYr OESR gYptr
chmhkYh. jphsdphY pdopnctjshehsYr tmstj OESR ldkhotsh adphjts hmh:

“ JdctY sdpadrYp jYoYrhsYr uhsYk oYjrY (EUB) odmftjtpYm gYptr adpYcY cYkYl 0,2 K rYst rYlY kYhm.

“ JdctY sdpadrYp choYjrY unktld djrohpYrh cYkYl 1 cdshj (EDU 1) odmftjtpYm gYptr cYkYl 0,2 K rYst rYlY kYhm.

KLNJ<I M<NR CRKDOF RGF Ikkln <mpn,Skhpia

“ OESR mnplYk chcdehmhrhjYm nkdg knno eknv-unktld mnplYk adpadmstj ( FYlaYp. 3-1 ). 5
“ >khpYm unktld khmfjYpYm YcYkYg okns cYph lYmtudp EUB.

D<J=<N 2,0- khmfjYpYm YkhpYm-unktld mnplYk. (CYph GxYss PD, RbYmknm OC, MYjYltpY L. HmsdpopdsYrh oYpt Sdr Etmfrh.
4sg dc. OghkYcdkoghY, O>: Khoohmbnss VhkkhYlr & Vhkjhmr; 2014. z LYxn WYxYrYm OdmchchjYm cYm OdmdkhshYm Ldchr.)

“ EUB lYmtudp ldkhaYsjYm oYrhdm ldmfYlahk hmrohpYrh lYjrhlYk chhjtsh nkdg lYjrhlYk cYm djrohpYrh jtYs.

“ AYfhYm khmfjYpYm YkhpYm-unktld sdr etmfrh oYpt itfY chjdmYk rdaYfYh rohpnldsph.
“ CYgYm djrohpYrh cYph unktld YkhpYm tcYpY mnplYk ldlhkhjh otmbYj xYmf bdoYs cYm odmtptmYm adpsYgYo cYkYl YkhpYm jdlaYkh jd

mnk. “ Sgd hmrohpYrh djrspdlhsYr gYptr ldlhkhjh admstj atkYs.

CBS0 Uj CS>
“ etmfrh oYpt mnplYk itfY chsdmstjYm nkdg mhkYh-mhkYh chtjtp tmstj EUB cYm EDU xYmf 1.

“ CS> chcdehmhrhjYm rdaYfYh unktld lYjrhltl tcYpY xYmf lUgnU chgdlatrjYm rdsdkYg hmrohpYrh lYjrhlYk.

“ CBS0 chcdehmhrhjYm rdaYfYh unktld lYjrhltl tcYpY chgdlatrjYm rdkYlY jdctY odpsYlY cYph EUB.
“ MhkYh chtjtp tmstj EDU 1 cYm EUB chaYmchmfjYm cdmfYm mhkYh-mhkYh chopdchjrh tmstj EDU 1 cYm EUB rdaYfYh

odprdm cYph opdchjrh. KehUe Ume 7/,01/% eUjccUl jkmiUh-

Skhpia lUmp,lUmp
“ unktld oYpt chtjtp rdbYpY sdpohrYg cYph knno YkhpYm-unktld.
“ Rdodpsh EDU xYmf 1 cYm EUB, unktld oYpt-oYpt chtjtp chaYmchmfjYm cdmfYm mhkYh opdchjrh tmstj unktld xYmf rdaYfYh
odprdm chopdchjrh.
“ unktld oYpt YmsYpY 80% cYm 120% chYmffYo mnplYk.
“ WYmf oYkhmf unktld oYpt odmshmf tmstj chrjtrh hmh YcYkYg jYoYrhsYr oYpt-oYpt SnsYk ( PI>() unktld pdrhct ( NS() cYm
jYoYrhsYr uhsYk kYlaYs ( OS>(- PI> chcdehmhrhjYm rdaYfYh unktld tcYpY ch oYpt-oYpt rdsdkYg hmrohpYrh lYjrhlYk
kdmfjYo cYm mhkYh 80-120% cYph opdchjrh YcYkYg mnplYk.

NS chcdehmhrhjYm rdaYfYh unktld tcYpY xYmf sdprhrY ch oYpt-oYpt rdsdkYg djrohpYrh lYjrhlYk kdmfjYo cYm mhkYh 80-
120% cYph opdchjrh YcYkYg mnplYk.
OS> chcdehmhrhjYm rdaYfYh unktld lYjrhlYk tcYpY xYmf cYoYs chgdlatrjYm cdmfYm jkmiUh ToYxY rdsdkYg
hmrohpYrh lYjrhlYk. (GYk hmh lhpho cdmfYm EUB jdbtYkh chkYjtjYm sYmoY jdjtYsYm odmtg.) MhkYh cYph 80-
120% cYph opdchjrh YcYkYg mnplYk.

JBKDBS<IR<OF M<NR CRKDOF MLI< RGF

>cY xYmf mnplYk, narsptjshe, cYm ldlaYsYrh onkY chYlYsh oYcY OESR, xYmf YjYm chaYgYr rdbYpY phmbh. >kfnphslY
adphjts YjYm ldltmfjhmjYm tmstj jYpYjsdphrYrh onkY odmxYjhs ( FYlaYp. 3-2 ). 6 . 7

><><P rajoehUne JamejoUjce

“ BYbYs udmshkYrh narsptjshe ( LSA( YcY jdshjY YcY odmtptmYm xYmf shcYj opnonprhnmYk ch EDU xYmf 1 ihjY chaYmchmfjYm cdmfY

EUB. naVpUd CBS 08 NUnek CS> Ume 6/% iaj abejenegUj LSA-
“ EUB cYoYs chjtpYmfh cYkYl NUC, sYoh EDU xYmf 1 rdkYkt adpjtpYmf jd shmfjYs xYmf kdahg adrYp.

“ LdlodphmfYsjYm >SR sdpgYcYo ldmchYfmnrhr NUC oYcY hmchuhct xYmf ldlhkhjh odmtptmYm EDU 1: PYrhn EUB
sdsYoh chtjtp EDU xYmf mnplYk 1 cYm EUB, jYpdmY onkY hmh ahrY oYcY jdrdloYsYm chkhgYs oYcY rtaxdj rdgYs.

“ NUCr ldmtmitjjYm jdsdpaYsYrYm YkhpYm tcYpY cYm ldmxhpYsjYm odmxdlohsYm rYktpYm mYoYr.
“ CYkYl dlehrdlY, lhrYkmxY, odmxdlohsYm chxYjhmh gYrhk cYph ctjtmfYm dkYrshr ldmtptm cYph rYktpYm tcYpY xYmf
kdahg jdbhk jYpdmY jdptrYjYm rdostl YkudnkYp, rdcYmfjYm ch apnmjhshr jpnmhr, odpYcYmfYm ltjnrY cYm opnctjrh
kdmchp adpkdahg YcYkYg dshnknfh.
“ RdsdkYg chYfmnrhr rtYst NUC sdkYg chatYs, jdatstgYm bYbYs tmstj rdodmtgmxY chsYmcYh cdmfYm ldkYjtjYm gYk adphjts:

Ldmftjtp shmfjYs jdoYpYgYm NUC LdmhkYh pdudprhahkhsYr

narsptjrh LdmdmstjYm YoYjYg YcY ghodphmekYrh
LdmdmstjYm YoYjYg YcY odpYmfjYo tcYpY

Jajcpgpm npUop kVnompgoeb rajoehUne >UWUo

Ldmftjtp shmfjYs jdoYpYgYm NUC chkYjtjYm cdmfYm ldlaYmchmfjYm EDU chtjtp 1 cdmfYm EDU chopdchjrh 1 rdaYfYh odprd
( sYadk 3-1 ).

JajehUe pjopg Vmkjgk ehUokm NaramneVeheoUn

 “ LdmhkYh tmstj pdudprhahkhsYr narsptjrh ldlatstgjYm rohpnldsph chkYjtjYm rdadktl cYm rdsdkYg odladphYm apnmjnchkYsnp.

“ OdmhmfjYsYm onrsapnmbgnchkYsnp xYmf EDU 1 YsYt EUB (chghstmf cYph mhkYh-mhkYh opdapnmbgnchkYsnp) cYph ga

pU ”12% Uj lK ldmcdehmhrhjYm pdronm apnmjnchkYsnp onrhshe cYm ldmtmitjjYm pdudprhahkhsYr narsptjrh iYkYm mYoYr.

“ CdmfYm cdlhjhYm, pdudprhahkhsYr chjYsYjYm gYchp jdshjY, chaYmchmfjYm cdmfYm mhkYh opdapnmbgnchkYsnp:
MknoVmkjWdk ehUokm CBS 0 iajejcgUogUj khad ga pU 01% Uj 1// iI) LN MknoVmkjWdk ehUokm
CS> iajejcgUogUj khad ga pU 01% Uj 1// iI
“ jphsdphY hmh sdpaYhj chsdpYojYm jdshjY sdpYoh Yjshe shcYj gYchp (lhrYkmxY, shcYj YcY Ykatsdpnk rdkYlY 4

iYl). “ JtpYmfmxY pdudprhahkhsYr rdkYlY OES shcYj ldkYpYmf pdronm jkhmhr sdpgYcYo sdpYoh apnmjnchkYsnp.

“ Ldrjhotm YrlY ahYrYmxY rdatYg NUC pdudprhadk, apnmjnchkYsnp pdronmrhe rdkYlY OES shcYj oYsnfmnlnmhj

tmstj YrlY.

D<J=<N 2,1- DuYktYrh sdr etmfrh oYpt. CKBN, JYoYrhsYr chetrh jYpanm lnmnjrhcY; EUB, jYoYrhsYr uhsYk oYjrY; SKB, snsYk jYoYrhsYr oYpt-oYpt. (CYsY cYph
Odkkdfphmn P, Uhdfh F, AptrYrbn U, ds Yk. RspYsdfh Hmsdpopdshud tmstj sdr etmfrh oYpt-oYpt. Dtp Pdrohp I. 2005; 26: 948-68; cYm >k->rgjYp E, LdgpY P, LYyynmd
OI, ds Yk. LdmYerhpjYm sdr etmfrh oYpt: ldmfdmYkh onkY cYm chYfmnrhr YjYm ldmfhjtsh. Bkdud Bkhm I Ldc. 2003; 70 (10): 866, 868, 871-73).

P<=BI 2,0 iajcpgpm Uj iajcghUnebegUnegUj galUmUdUj JamejoUjce

SBKPFI<PLN ><><P
JajajopgUj GegU EelamejbhUne <lUgUd EU em
“ delamejbhUne ldmtmitjjYm aYgvY oYcY hmrohpYrh lYjrhlYk YsYt adpYjghpmxY oYpt-oYpt oYcY unktld xYmf kdahg adrYp

cYp xYmf chgYpYojYm aYfh rdnpYmf hmchuhct. CYkYl gYk ehrhnknfhr, hmchuhct SKB YsYt PU ldmhmfjYs.

“ JdgYchpYm cYph delamejbhUne chsdmstjYm cdmfYm ldlaYmchmfjYm chtjtp SKB YsYt PU jd SKB chopdchjrh YsYt PU
rdaYfY odprdm:
PI> 01/% Ume lma egne) UoUp NS
01/% Ume lma egne
“ =aVamUlU npiVam iajcUjccUl delamejbhUne pjopg dU em dUjuU gaoegU PI> 01/% Ume lma egne) Uj p UmU

lamUjcgUl pjopg dU em gaoegU NS 01/% Ume lma egne-

JajajopgUj GegU <em JajfaVUg <lUgUd EU em

“ lamUjcgUl <em ldmtmitjjYm aYgvY rdkYlY choYjrY jdcYktvYprY (bdoYs), YcY ptmstgmxY chmYlhr rYktpYm tcYpY cdmfYm
odpmYeYrYm xYmf shcYj kdmfjYo chgYrhkjYm cYph tcYpY chaYmchmfjYm cdmfYm mnmenpbdc (kYlaYs) jdcYktvYprY.
CYkYl gYk ehrhnknfhr, hmchuhct EUB kdahg jdbhk cYph RUB.
“ >hp odpYmfjYo sdpiYch jYpdmY adpYjghpmxY oYjrY ldmxdaYajYm ldlatptjmxY narsptjrh iYkYm mYoYr rdaYfYh YjhaYs cYph
sdjYmYm hmspYsnpYjr onrhshe xYmf kdahg shmffh.
“ OdmhmfjYsYm RUB nkdg ga pU ”12% Uj ”200 lK chaYmchmfjYm cdmfYm EUB ldmtmitjjYm odpYmfjYo tcYpY. OS> B CS>
khad ga pU 01% Uj 1// iI-
“ =aVamUlU npiVam iajcUjccUl oamlamUjcgUljuU p UmU pjopg dU em gaoegU NS 01/% Ume lma egne-

<mpn,Skhpia Ikkl >UWUo rajoehUne kVnompgoeb

“ NUCr ldmftaYg admstj jtpuY YkhpYm-unktld. JtpuY djrohpYrh lYrhg ldlhkhjh otmbYj YvYk xYmf bdoYs, sdsYoh aYfhYm

sdplhmYk cYph YkhpYm djrohpYrh ldmiYstgjYm opnfpdrhe cdmfYm ldlatptjmxY narsptjrh.

“ >jhaYsmxY, YmffnsY statg djrohpYrh cYph jtpuY ldmfYlahk rdatYg bdjtmf rdlYjhm ldmhmfjYs. >jghpmxY, YcY itfY

odmtptmYm YkhpYm djrohpYrh otmbYj oYcY aYfhYm YvYk jtpuY.

“ OYcY odmxYjhs oYpYg, YcY otmbYj bdoYs sYoh chjtpYmfh YvYk chhjtsh cdmfYm odmtptmYm sdpiYk cYkYl
YkhpYm cYm kYmbho rYmfYs adpsYgYo YkhpYm jd mnk ( FYlaYp. 3-3 ). 5
“ Ch lYmY unktld oYpt chtjtp jtpuY itfY YjYm adpfdrdp jd jhph, ldmtmitjjYm aYgvY rdltY unktld oYpt-oYpt ldmhmfjYs,
jnmrhrsdm cdmfYm ldmidaYj tcYpY cYm ghodphmekYrh.

RMMBN kVnompgne fUhUj jUlUn

“ Sgd NUCr chaYgYr rdiYtg hmh rdltY ldptoYjYm narsptjrh oYcY shmfjYs xYmf kdahg jdbhk, rYktpYm tcYpY kdahg
chrsYk. Narsptjrh rYktpYm tcYpY xYmf kdahg adrYp, kdahg rdmspYk (spYjdY cYm apnmjtr tsYlY) gYchYg adpadcY
cYm oYkhmf ltcYg chhcdmshehjYrh oYcY odldphjrYYm stmfjYh hmrohpYrh cYm djrohpYrh cYph knno YkhpYm-unktld.
D<J=<N 2,2- Narsptjshe odmxYjhs oYpt-oYpt unktld YkhpYm tcYpY. (CYph GxYss PD, RbYmknm OC, MYjYltpY L. HmsdpopdsYrh oYpt Sdr Etmfrh. 4sg dc. OghkYcdkoghY, O>:
Khoohmbnss VhkkhYlr & Vhkjhmr; 2014. z LYxn WYxYrYm OdmchchjYm cYm OdmdkhshYm Ldchr.)

“ ShfY admstj narsptjrh iYkYm mYoYr YsYr cYoYs chkhgYs: narsptjrh SdsYo

UYphYadk hmspYsgnpYbhb narsptjrh uYphYadk

narsptjrh dwspYsgnpYbhb

PaoUl <oUn <emsUu LVnompgne

“ JdshjY iYkYm mYoYr rdmspYk adphrh narsptjrh sdsYo, ktYr odmYloYmf rYktpYm mYoYr sdpgYlaYs shcYj adptaYg

rdoYmiYmf rhjktr odpmYoYrYm (lYjY jYpYjsdphrYrh rdaYfYh sdsYo).

“ narsptjrh gYchp rdkYlY jdctY hmrohpYrh cYm djrohpYrh, cYm jdctY stmfjYh knno YkhpYm unktld gYlohp rYlY sdpodmfYptg.

“ >cY odlnsnmfYm jYpYjsdphrshj cYph jdctY YmffnsY aYcYm hmrohpYrh cYm djrohpYrh cdmfYm admstj xYmf chgYrhkjYm
jnsYjβ ch knno eknv-unktld ( FYlaYp. 3-4 ). 5

SUmeUVah <oUn <emsUu LVnompgne

“ JdshjY mYoYr adphrh narsptjrh uYphYadk, lYmhedrsYrh narsptjrh sdpfYmstmf oYcY jdctY knjYrh narsptjrh (cYkYl YsYt

ktYp sgnpYw) cYm eYrd cYph rhjktr odpmYoYrYm (hmrohpYrh YsYt djrohpYrh).

“ OdptaYgYm ktYr odmYloYmf rYktpYm mYoYr sdpgYlaYs adpuYphYrh cdmfYm jdctY hmrohpYrh cYm djrohpYrh cYm knjYrh hmspY
YsYt dwspYsgnpYbhb cYph kdrh xYmf ldmfgYlaYs. cYkYl uYphYadk ejomUodkmUWeW narsptjrh, YmffnsY aYcYm djrohpYrh
sdptsYlY chodmfYptgh. RdkYlY djrohpYrh oYjrY, sdjYmYm okdtpY ldkdahgh sdjYmYm tcYpY hmspYsgnpYbhb.
>jhaYsmxY, rYktpYm mYoYr ldmxdlohs, cYm narsptjrh ldlatptj. RdkYlY hmrohpYrh oYjrY, gtatmfYm sdjYmYm
chaYkhj, cYm narsptjrh kdfY. CdmfYm cdlhjhYm, gYmxY YmffnsY aYcYm djrohpYrh chonsnmf ( FYlaYp. 3-5 ). 5

cYkYl uYphYadk atomUodkmUWeW narsptjrh, YmffnsY aYcYm hmrohpYrh sdptsYlY chodmfYptgh.

D<J=<N 2,3- SdsYo YsYr narsptjrh iYkYm mYoYr unktld YkhpYm tcYpY. (CYph GxYss PD, RbYmknm OC, MYjYltpY L. HmsdpopdsYrh oYpt Sdr Etmfrh. 4sg dc. OghkYcdkoghY, O>:

Khoohmbnss VhkkhYlr & Vhkjhmr; 2014. z LYxn WYxYrYm OdmchchjYm cYm OdmdkhshYm Ldchr.)

RdkYlY hmrohpYrh oYjrY, sdjYmYm Yslnredp ldkdahgh sdjYmYm spYjdY dwspYsgnpYbhb. >jhaYsmxY, iYkYm
mYoYr ptmstg, cYm narsptjrh ldlatptj. RdkYlY djrohpYrh oYjrY, gtatmfYm sdjYmYm chaYkhj, cYm narsptjrh kdfY.
CdmfYm cdlhjhYm, gYmxY YmffnsY aYcYm hmrohpYrh chonsnmf ( FYlaYp. 3-6 ). 5

D<J=<N 2,4- UYphYadk narsptjrh hmspYsgnpYbhb unktld YkhpYm tcYpY. (CYph GxYss PD, RbYmknm OC, MYjYltpY L. HmsdpopdsYrh oYpt Sdr Etmfrh. 4sg dc. OghkYcdkoghY, O>:
Khoohmbnss VhkkhYlr & Vhkjhmr; 2014. z LYxn WYxYrYm OdmchchjYm cYm OdmdkhshYm Ldchr.)

D<J=<N 2,5- UYphYadk narsptjrh dwspYsgnpYbhb unktld YkhpYm tcYpY. (CYph GxYss PD, RbYmknm OC, MYjYltpY L. hmsdpopdsYrh
OYpt Sdr Etmfrh. 4sg dc. OghkYcdkoghY, O>: Khoohmbnss VhkkhYlr & Vhkjhmr; 2014. z LYxn WYxYrYm OdmchchjYm cYm OdmdkhshYm Ldchr.)

><><P rajoehUne MBJ=<P<O<K

“ RdatYg udmshkYrh bYbYs pdrsphjshe (PUC) YcY jdshjY YcY odmftpYmfYm hmekYrh oYpt lYjrhlYk, chlYmhedrsYrhjYm nkdg
odmtptmYm SKB. JYpdmY hst, PI>7/% Ume iaj abejenegUj iailma egne NSA-

“ JdgYchpYm rdatYg PUC cYoYs chctfY ldmfftmYjYm rohpnldsph jdshjY EUB adpjtpYmf rdbYpY opnonprhnmYk

cdmfYm odmtptmYm EDU 1. CYkYl jYrtr hmh, EDU xYmf 1: PYrhn EUB YjYm aYhj mnplYk YsYt ldmhmfjYs.

“ Tmstj ldmchYfmnrhr PUC cdehmhshe, mYltm, unktld oYpt-oYpt gYptr chodpnkdg tmstj ldmdmstjYm SKB.

“ RdatYg PUC shcYj rodrhehj tmstj odmxYjhs sdpsdmst. CYkYl ehapnrhr oYpt hmsdprshshYk, odlaYsYrYm YcYkYg
gYrhk cYph ehapnrhr chmchmf YkudnkYp cYm jYjtβ cYph oYpdmjhl oYpt. CYkYl chrspneh nsns, ldkdlYg chYepYflY
cYm cYcY nsns YcYkYg dshnknfh.

“ RdatYg PUC itfY cYoYs chrdaYajYm nkdg odmfgYotrYm iYphmfYm oYpt-oYpt (knadjsnlh, omdtlnmdbsnlx) rdaYfYh gYrhk hmh cYkYl
odmtptmYm snsYk unktld oYpt-oYpt (lYjY SKB) chaYmchmfjYm cdmfYm xYmf chodpjhpYjYm tmstj oYrhdm.

“ RdsdkYg chYfmnrhr rtYst PUC sdkYg chatYs, jdatstgYm bYbYs tmstj chjtYmshehjYrh, xYmf chkYjtjYm cdmfYm
ldmfftmYjYm EDU xYmf 1 YsYt SKB odprdm chopdchjrh ( sYadk 3-2 ).

<mpn,Skhpia Ikkl >UWUo rajoehUne JaiVUoUne

“ Opnonprh knno YkhpYm unktld cYrYpmxY shcYj adptaYg ch PUCR.
“ JtpuY hmh rdphmf ldmxdlohs cYm adpfdrdp jd jYmYm, xYmf ldmbdplhmjYm unktld oYpt-oYpt kdahg jdbhk sdpjYhs cdmfYm PUCR (
FYl 3-7 ). 5
“ Ldrjhotm YkhpYm otmbYj djrohpYrh ldmtptm, bYsYsYm aYgvY oYcY rdshYo unktld oYpt xYmf chtjtp, YkhpYm rdphmfjYkh kdahg adrYp cYph oYcY
oYpt-oYpt mnplYk.
“ Ehstp gYmxY rtfdrshe cYph PUC; odmftjtpYm SKB gYptr chkYjtjYm tmstj ldlatYs chYfmnrhr.

P<=BI 2,1 HBM<N<E<K MBJ=<P<O<K rajoehUne ><><P

HUlUneoUn ebpne

“ JYoYrhsYr chetrh rdphmf chtjtp rdaYfYh aYfhYm cYph OES. GYk hmh chkYjtjYm rdbYpY sdpohrYg cYph rohpnldsph
cYm oYpt-oYpt odmftjtpYm unktld.
“ Hmh YcYkYg tjtpYm hmsdfphsYr ldlapYm YkudnkYp-jYohkdp ch lYmY fYr
 odpstjYpYm adpkYmfrtmf.
“ JYoYrhsYr chetrh YcYkYg odmftjtpYm rodrhehj cYm gYmxY ldladphjYm odmhkYhYm ehrhnknfhr cYph abeneajne

lamopgUmUj cUn-“ RdshYo odmxYjhs xYmf ldlodmfYptgh oYpdmjhl oYpt YsYt rhpjtkYrh cYoYs ldmftaYg jYoYrhsYr chetrh.

“ FYr xYmf chftmYjYm tmstj ldmftjtp jYoYrhsYr chetrh YcYkYg jYpanm lnmnjrhcY, cYm jYoYrhsYr chetrh chmxYsYjYm rdaYfYh
HUl ebpne lUmp,lUmp pjopg gUmVkj ikjkgne U AI>L(-
“ MhkYh xYmf chtjtp rdphmf chrdrtYhjYm tmstj ldmfghkYmfjYm dedj cYph jnmrdmspYrh gdlnfknahm, xYmf ltmfjhm YpshehrhYk
ldmhmfjYsjYm (jnmrdmspYrh gdlnfknahm shmffh) YsYt ldmftpYmfh (jYcYp gdlnfknahm pdmcYg) CKBN sdprdats. 8

mhkYh chrdrtYhjYm chmxYsYjYm rdaYfYh

enanpUegUj AI>L AI>L <AG(- jehUe enanpUegUj AI>L gU Ujc,gU Ujc enaVpo egkmagne AI>L AI>L >(-

D<J=<N 2,6- LdlaYsYrh odmxYjhs oYpt-oYpt unktld YkhpYm tcYpY. (CYph GxYss PD, RbYmknm OC, MYjYltpY L. HmsdpopdsYrh oYpt Sdr Etmfrh. 4sg dc. OghkYcdkoghY, O>:
Khoohmbnss VhkkhYlr & Vhkjhmr; 2014. z LYxn WYxYrYm OdmchchjYm cYm OdmdkhshYm Ldchr.)

“ OdpghstmfYm CKBN xYmf >CI shcYj vYiha sYoh chhmfhmjYm.

“ mhkYh xYmf sdptjtp cYph CKBN cYm CKBN >CI xYmf chaYmchmfjYm cdmfYm mhkYh-mhkYh chopdchjrh rdaYfYh odprdm (ldsncd odprdmshk itfY

cYoYs chftmYjYm).
“ Odprdm chopdchjrh mhkYh tmstj AI>L YmsYpY 70% cYm 120% chYmffYo mnplYk. ItfY odprdm chopdchjrh mhkYh tmstj
AI>L < 70% cYm 120% chYmffYo mnplYk.
“ >kYrYm tmstj pdmsYmf xYmf ktYr cYkYl CKBN mnplYk cYm CKBN >CI YcYkYg itlkYg adrYp uYphYahkhsYr YmsYpY
odmftjtpYm xYmf adpadcY oYcY hmchuhct xYmf rYlY oYcY vYjst sdpsdmst. CYph bYsYsYm sdltYm OESR mnplYk cdmfYm
odmtptmYm sdphrnkYrh ch CKBN gYptr ldmYhjjYm hmcdjr jdbtphfYYm xYmf shmffh tmstj odmxYjhs odlatktg cYpYg oYpt.

I<FK CRKDOF M<NR RGF iUgneiUh OpgUmahU SajoehUne

“ udmshkYrh lYjrhlYk rtjYpdkY (LUU), chkYonpjYm cYkYl khsdp odp ldmhs, chcdehmhrhjYm rdaYfYh itlkYg lYjrhltl tcYpY xYmf
cYoYs sdpghpto lYrtj cYm jdktYp cYkYl 1 ldmhs.
“ Tmstj jdmxYlYmYm oYrhdm, ahYrYmxY chtjtp kdahg cYph 12 cdshj cYm mhkYh djrspYonkYrh tmstj

1 ldmhs. “ LUU YcYkYg odmftjtpYm xYmf rYmfYs rodrhehj cYm cYoYs chjtpYmfh aYhj ldlaYsYrh YsYt
 fYmfftYm narsptjshe.
“ LUU rdphmf chftmYjYm tmstj ldmhkYh nsns odpmYoYrYm oYrhdm rdadktl nodpYrh tmstj ldlaYmst ldlopdchjrh
jnlokhjYrh oYpt oYrbY nodpYrh.
“ LUU sdpfYmstmf rYmfYs trYgY cYm ldlatstgjYm hmrsptjrh oYrhdm xYmf aYhj.
“ Hmh itfY ldptoYjYm bdplhmYm cYph odptaYgYm unktld oYpt-oYpt, jdoYstgYm oYpt-sgnpYw, cYm pdrhrsdmrh rYktpYm mYoYr. Nkdg jYpdmY

hst, LUU ltmfjhm jtpYmf cYph opdchjrh xYmf YjtpYs sdmsYmf jdjtYsYm odpmYoYrYm cYm cYxY sYgYm.

“ mhkYh pYsY-pYsY tmstj ophY cYm vYmhsY YcYkYg 140-180 K / lhm cYm 80-120 K / lhm, lYrhmf-lYrhmf.
“ MYltm, hmsdpopdsYrh kdahg ptlhs jYpdmY LUU rdaYmchmf cdmfYm EDU 1 cYm YjYm ldmtptm jdshjY EDU 1 adpjtpYmf.

“ ldmfhjtsh odprYlYYm opdchjshe chftmYjYm tmstj ldmdmstjYm opdchjrh LUU cYkYl odmfYstpYm cYph EDU adpjtpYmf 1. Aelma egne
JSS : CBS 0 v 3/- =aVamUlU npiVam iajccpjUgUj CBS 0 v 24 pjopg iajcdeopjc elma egne JSS- IUejjuU bkmiphU uUjc haVed
gkilhagn fpcU U U-
“ CYkYl odmfYstpYm cYph EDU adpjtpYmf 1, LUU chopdchjrh cYoYs chjtpYmfh rdbYpY opnonprhnmYk cdmfYm odmtptmYm
EDU 1, ltmfjh chjtpYmfh kdahg cYph EDU adpjtpYmf 1, YsYt ltmfjhm chjtpYmfh tmstj shmfjYs xYmf kdahg pdmcYg cYph xYmf
chodpjhpYjYm nkdg odmtptmYm EDU 1.

JaoUgkhej PUjoUjcUj MajcpfeUj

“ >rlY chcdehmhrhjYm rdaYfYh odmxYjhs rYktpYm mYoYr narsptjshe pdudprhadk. Nkdg jYpdmY hst, oYcY hmchuhct
xYmf chctfY ldlhkhjh YrlY, OESR ltmfjhm sYloYj mnplYk, sYmoY atjsh narsptjrh.
“ OYcY hmchuhct ch lYmY OESR YcYkYg mnplYk sdsYoh YrlY chctfY jtYs, odmftihYm opnunjYrh apnmjhYk chhmchjYrhjYm

tmstj ldmfhmctjrh odmxdlohsYm rYktpYm mYoYr cYm ldltmfjhmjYm tmstj chYfmnrhr (cYm lYmYidldm kdahg kYmits) YrlY.

“ hmchuhct kYhm xYmf gYptr chodpshlaYmfjYm tmstj odmftihYm opnunjYrh apnmjhYk sdplYrtj npYmf-npYmf cdmfYm 9 :

Hmkjen VUopg Jajce

unljaU ejoamieoaj
PailUo gamfU oamgUeo VUopg . iajce . unljaU IUoedUj oamgUeo
VUopg . iajce
“ Sdr ldsgYbgnkhmd sYmsYmfYm YcYkYg sdr rodrhehj cYph pdronm rYktpYm mYoYr. GYk hmh ldltmfjhmjYm tmstj
odmhkYhYm rdlhjtYmshsYshe pdYjshuhsYr rYktpYm mYoYr sdsYoh shcYj ldladphjYm vYvYrYm rshltktr adpsYmfftmf
iYvYa YsYr pdYjshuhsYr cYkYl hmchuhct.

P<=BI 2,2 iaoUgkhej ><FN<K G<AT<I

“ JdtmstmfYm cYph sdr hmh YcYkYg aYgvY hY ldlhkhjh pdopnctjshehsYr aYhj.
“ JdptfhYmmxY YcYkYg adadpYoY eYjsnp xYmf cYoYs ldlodmfYptgh sdr, sdplYrtj adphjts:
NaYs (apnmjnchkYsnp, rsdpnhc, YmshghrsYlhm, ©-Yfnmhr, bYkbhtl bgYmmdk aknbjdpr)

Hmedjrh odpmYeYrYm
OYoYpYm rdmrhshydp (Ykdpfdm YsYt aYgYm jhlhY)
“ Sdr chltkYh cdmfYm odladphYm Ydpnrnk fYpYl rsdphk chhjtsh cdmfYm odmftjtpYm EDU xYmf 1 rdsdkYg 3-5 ldmhs
(rdaYfYh cYrYp).
“ OdmhmfjYsYm jnmrdmspYrh ldsgYbgnkhmd chdmbdpjYm cYkYl fYpYl rsdphk jdltchYm chadphjYm jdoYcY oYrhdm

oYcY hmsdpuYk 5 ldmhs, cYm EDU xYmf 1 chtjtp 3-5 ldmhs rdsdkYg rdshYo odmhmfjYsYm jnmrdmspYrh.

“ JnmrdmspYrh adpjhrYp 0,003-16 lf / lK ldsgYbgnkhmd ch rYkhmd rsdphk cYm jhpY-jhpY ctY jYkh khoYs rdshYo jYkh

rYloYh aYhj pdronm onrhshe chodpnkdg YsYt jnmrdmspYrh lYjrhltl chbYoYh ( sYadk 3-3 ).

“ OaVpUd oUjoUjcUj iaoUgkhej lkneoeb e abejenegUj naVUcUe lajpmpjUj CBS 0 Ume VUnaheja

1/% lU U gkjnajomUne iaodUWdkheja Ume w7 ic . iI-

“ JnmrdmspYrh ldsgYbgnkhmd ldmfgYrhkjYm sYmsYmfYm onrhshe chkYonpjYm rdaYfYh OB20 (jnmrdmspYrh opnunjYshe

ldmxdaYajYm 20% odmtptmYm EDU 1), lhrYkmxY, odmtptmYm EDU 1

cYph aYrdkhmd sdpiYch oYcY jnmrdmspYrh ldsgYbgnkhmd 0,5 lf / lK chkYonpjYm rdaYfYh OB20 0,5 lf / lK.

Ume
“ PUjoUjcUj jacUoeb iaodUWdkheja oamfU e fegU oe Ug U U lampVUdUj Ume VUnaheja) UoUp lajpmpjUj CBS 0
VUnaheja U UhUd 1/% Uj gkjnajomUne 7 ic . iI oahUd oamWUlUe-

“ JdshjY oYrhdm xYmf ldmiYkYmh odmftihYm opnunjYrh apnmjtr adpYcY ch jnpshjnrsdpnhc hmgYkYrh, odmtptmYm
EDU 1 cYph aYrdkhmd= 20% oYcY jnmrdmspYrh ldsgYbgnkhmd cYph 16 lf / lK cYoYs chYmffYo rdaYfYh sdr
ldsgYbgnkhmd sYmsYmfYm onrhshe. 10

NBCBNBKOF

1. Pnadpsr RC, EYpadp LN, Jmnw JR, ds Yk. EDU1 / EUB PYrhn 70% lhrbkYrrhehdr oYrhdm cdmfYm narsptjrh oYcY
djrspdl trhY. CYcY. 2006; 130: 200-6.
2. GYpchd I>, Athrs >R, Unkkldp VL, ds Yk. Phrhjn nudp-chYfmnrhr OONJ ch YrhlsnlYshj stY xYmf shcYj odpmYg ldpnjnj.
Dtp Pdrohp I. 2002; 20: 1117-1122.
 3. OYpt etmfrh odmftihYm: odlhkhgYm mhkYh pdedpdmrh cYm rspYsdfh hmsdpopdsYshe. >ldphbYm SgnpYbhb
Rnbhdsx. >l Pdu Pdrohp Chr. 1991; 144: 1202-1218.
4. RsYmcYpchrYrh Rohpnldsph, 1994 TocYsd. >ldphbYm SgnpYbhb Rnbhdsx. >l I Pdrohp Bphs
OdpYvYsYm Ldc. 1995; 152: 1107-1136.
5. GxYss PD, RbYmknm OC, MYjYltpY L. HmsdpopdsYrh oYpt Sdr Etmfrh. 4sg
dc. OghkYcdkoghY, O>: Khoohmbnss, VhkkhYlr & Vhkjhmr; 2014: 4-21.
6. >k->rgjYp E, LdgpY P, LYyynmd OI. LdmYerhpjYm sdr etmfrh oYpt: ldmfdmYkh onkY, cYm chYfmnrhr YjYm ldmfhjtsh.
Bkdud Bkhm I Ldc. 2003; 70: 866, 868, 871-3.
7. Odkkhfphmn P, Uhdfh F, AptrYrbn U, ds Yk. rspYsdfh hmsdpopdsYshe tmstj sdr etmfrh oYpt-oYpt.
Dtp Pdro I. 2005; 26: 948-68.
8. LYbHmsxpd M, BpYon PN, Uhdfh F, ds Yk. RsYmcYphrYrh odmdmstYm stmffYk mYeYr odmxdpYoYm jYpanm
lnmnjrhcY cYkYl oYpt-oYpt. Dtp Pdrohp I. 2005; 26: 720-35.
9. BpYon PN, BYrYatph P, BnYsdr >K, ds Yk. OdcnlYm ldsYjnkhm cYm nkYgpYfY sYmsYmfYm odmftihYm-1999. Hmh odpmxYsYYm pdrlh

cYph >ldphbYm SgnpYbhb Rnbhdsx chYcnorh nkdg >SR Chpdjrh, Itkh 1999. >l I Pdrohp Bphs OdpYvYsYm Ldc.

2000; 161: 309-29.

10. Rtlhmn J, FtkY D>, Hpuhm BF, ds Yk. LdsYjnkhm tih sYmsYmf: jYpYjsdphrshj chYfmnrshj oYcY oYrhdm YrlY xYmf
ldmdphlY naYs odmfnmspnk. I >kdpfh Bkhm Hlltmnk. 2012; 130 (1): 69-75.