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PDF Stroke Iskemik 29-6-18 DD
PDF Stroke Iskemik 29-6-18 DD
IFQBZFH OFP[P
JI[L ZP Pkofrwfhdm
Lmsusuh bikn
lr. Gkmifhm Puifkgfh
Qkgjmgjmhd3
lr. G.\bnf
lr. Q. Nfhlbob
M. MLKH\M\FP QFPMKH
Hfgf 3 \h K
[gur 3 56 tfnuh
Fifgft 3 Okjbh Qfif, @mjflfo
Qkokrcffh 3 Qkokrcf Qfjrmo
Ptftus 3 Ofwmh
Hb ZG 3 ;5=>11
\fhddfi gfsuo ZP 3 = Gkm :16>
MM. FHFGHKPMP
Fhfghksms lmifouofh tfhddfi = Gkm :16>
Okiunfh utfgf 3 Okikgfnfh fhddbtf dkrfo
ZQP / Orbhbibdms
Okikgfnfh fhddbtf dkrfo skjkifn omrm skcfo 6: cfg sgrs. Fwfihyf bs gkhdkiun
sfomt okpfif okgulmfh tmjf-tmjf bs tkrcftun. Okiunfh lmskrtfm lkhdfh jm`frf pkib
sknmhddf bs tmlfo ckifs sfft jkrjm`frf. Okiunfh pfhlfhdfh ofjur (-),
jffi/okskgutfh (-), JFJ lfh JFO tmlfo flf dfhddufh.
dfhddufh.
ZQL 3 Zmwfyft sfomt yfhd sfgf ( - )
Nmpkrtkhsm ( + ), tmlfo pkrhfn obhtrbi/ gkgmhug
gkgmhug bjft
Z. Cfhtuhd (-)
Z.LG ( - )
Z.\rfugf okpfif (-)
Umtfi Pmdh
\L 3 641/661 ggNd
ZZ 3 :1x/ gkhmt
Punu 3 04B@
JJ 3 ;> Od
\J 3 65> `g
Ptftus Mhtkrhus
Okpfif 3 gksbskefi
Gftf 3o
ob
bhcuhdtmvf pf
pfipkpjrf pu
pu`ft (-
(-/-), mo
motkrmo (-
(-/-)
Nmluhd 3 wfr
wfrhf oui
ouimt sfg
sfgf lkh
lkhdfh wfrh
wfrhff oui
ouimt sko
skomtfr, hf
hfef
efss `up
`upmhd
nmluhd (-), lkebrgmtfs (-), skptug lkvmfsm (-), obhof nmpkrkgms (-), pkgjksfrfh
obhof (-), skorkt (-).
\kimhd
\kimhdff 3 wfrhf
wfrhf ouimt
ouimt sfgf
sfgf lkhdfh
lkhdfh wfrhf
wfrhf ouimt
ouimt skomtf
skomtfr,
r, hykrm
hykrm tkofh
tkofh
furmouif (-/-), hykrm tkofh gfstbml (-/-), hykrm tkofh trfdus (-/-), skrugkh (-/-),
GFK nmpkrkgms (-/-), GFK tkrlfpft gfssf (-/-), gkgjrfhk tmgpfhm mhtfok (+/
+).
Guiut 3 Qkrbt ok frfn ofhfh, imp
impftfh hfsbifjmfi (+/-), sul
sulut guiut
ofhfh lfh omrm tmlfo smgktrms, ikgjfj (-), smfhbsms (-), ofrmks dmdm (-), stbgftmtms
(-), imlfn obtbr (-), nmpkrkgms (-), ormptk gkikjfr (-), uvuif nmpkrkgms (-), uvuif
gkgfhcfhd (-).
Iknkr 3 oui
ouimt
mt skpkrt
skpkrtmm wfrhf
wfrhf skomtf
skomtfr,
r, pkgjks
pkgjksfrf
frfh
h okikhc
okikhcfr
fr tmrbml
tmrbml (-),
pkgjksfrfh okikhcfr dktfn jkhmhd (-), lkvmfsm trfokf (-), btbt jfhtu pkrhfefsfh
(-)
\nbrfx 3
:. Qfipfsm
Qfipfsm Hykrm tkofh (-) Hykrm tkofh (-)
Qkikjfrfh M@P (-) Qkikjfrfh M@P (-)
Ptkg erkgmtus lkxtrf7smhmstrf Ptkg erkgmtus lkxtrf7smhmstrf
0. Qkrousm
Qkrousm Pbhbr lm skiurun ifpfhd pfru Pbhbr lm skiurun ifpfhd pfru
Pufrf lfsfr vksmouikr Pufrf lfsfr vksmouikr
Jkifofhd
6. Mh
Mhsp
spko
kosm
sm Pmgktrms, stftms, lmhfgms Pmgktrms, stftms, lmhfgms
:. Qfip
Qfipfs
fsmm Hykrm tkofh (-) Hykrm tkofh (-)
Qkikjfrfh M@P (-) Qkikjfrfh M@P (-)
Ptkg erkgmtus lkxtrf7smhmstrf Ptkg erkgmtus lkxtrf7smhmstrf
0. Qkro
Qkrous
usmm Pbhbr lm skiurun ifpfhd pfru Pbhbr lm skiurun ifpfhd pfru
<. Fuso
Fusoui
uitf
tfsm
sm Pufrf lfsfr vksmouikr Pufrf lfsfr vksmouikr
Zbhom (-) Zbhom (-)
Tnkkzmhd (-) Tnkkzmhd (-)
Cfhtuhd
Mhsp
Mhspko
kosm
sm 3 m`tu
m`tuss `brl
`brlms
ms tm
tmlf
lfo
o tk
tkri
rimn
mnft
ft
Qfip
Qfipfs
fsmm 3 m`tu
m`tuss `brl
`brlms
ms tkr
tkrfj
fjff lm M@P
M@P U : `g gklm
gklmfi
fi imh
imhkf
kf gml
gml`if
`ifvm
vm`u
`uif
if smhm
smhmstr
strff
hfguh tmlfo ouft fhdoft, tnrmii (-), puisus kpmdfstrmug (-), puisus
pfrfstkrhfi (-), stkrhfi imet (-)
Qkrousm 3
jftfs ftfs 3 M@P MM imh.pfrfstkrhfi smhmstrf
Fusouitfsm
Fusouitfsm 3 Pufrf cfhtuhd
cfhtuhd gurhm3
gurhm3 PM,PMM
PM,PMM (hbrgfi)
(hbrgfi) rkduikr.
rkduikr.
Pufrf cfhtuhd tfgjfnfh dfiibp (-), gurgur (-) PMMM (-), PMU (-)
Fjlbgkh
Mhsp
Mhspko
kosm
sm 3 Qkr
Qkrgu
guof
offh
fh lftf
lftfr,
r, wfrh
wfrhff sfgf
sfgf sk
skpk
pkrt
rtmm oui
ouimt
mt lm sk
skom
omtf
tfr,
r, mo
motk
tkrm
rmo
o (-)
(-)
Fusouitfsm 3 Jmsmhd usus (+) hbrgfi
Qkrousm 3 \mgpfhm skiurun rkdmb fjlbgkh, fs`mtks (-)
Qkofo Nkpfr (+)
\mlfo tkrlfpft hykrm oktbo dmhcfi lkxtrf/smhmstrf
Qfip
Qfipfs
fsmm 3 Hyk
Hykrm
rm tko
tkofh (-
(-),
), nkp
kpfr
fr lfh imkh
imkh tml
tmlfo tk
tkrf
rfj
jf, dmh
mhcf
cfii tml
tmlfo
fo tk
tkrf
rfj
jf
Ptftus Hkurbibdmo
Brmkhtfsm 3 Jfmo
Ok`krlfsfh 3 Jfmo
Hkrvm @rfhmfims
H M. (BIEFO\BZM[P)
(BIEFO\BZM[P) Nmluhd Ofhfh Nmluhd Omrm
Lfyf Qkgjfu Hbrgfi Hbrgfi
H MM.(BQ\MO[P)
MM.(BQ\MO[P) Gftf Ofhfh Gftf Omrm
Umsus 5/51 5/51
Qkhdkhfifh Tfrhf + +
Ifpfhd Qfhlfhd + +
Qkrlfrfnfh Frtkrm/Ukhf \mlfo lmifouofh \mlfo lmifouofh
Euhlus bouim \mlfo lmifouofh \mlfo lmifouofh
Qfpmi \mlfo lmifouofh \mlfo lmifouofh
Zktmhf \mlfo lmifouofh \mlfo lmifouofh
H U. (\ZMDKGMH[P)
(\ZMDKGMH[P) Okgfgpufh
Gkhddmdmt +
Gkgjuof guiut +
Pkhsmjmimtfs Guof ftfs +
Pkhsmjmimtfs Guof \khdfn +
Pkhsmjmimtfs Guof jfwfn +
Zkeiko obrhkf +
H UMMM. Ukstmjuib`b`nikfrms
Ukstmjuib`b`nikfrms Ofhfh Omrm
(FO[P\MO[P)
Gkhlkhdfr sufrf jkrjmsmo \mlfo lmifouofh \mlfo lmifouofh
Gkhlkhdfr lktmo fribcm \mlfo lmifouofh \mlfo lmifouofh
\ks Zmhhk \mlfo lmifouofh \mlfo lmifouofh
\ks Tkjkr \mlfo lmifouofh \mlfo lmifouofh
\ks Pwfjf`n \mlfo lmifouofh \mlfo lmifouofh
H.M^(DIBPBEFZMHDK[P
) Ofhfh Omrm
Frous efrmhd Pmgktrms Pmgktrms
Lkfeyifkookg`u
Z fp
ht6
fn/0 jkifofhd +
+ +
+
Pkhdfu - -
\krsklfo - -
JFLFH
Hykrm tkofh 3-
Pkhsmjmimtfs 3 +/+
Zkeiko
Zkeiko lmhl
lmhlmhd
mhd pkrut
pkrut 3 \mlfo
\mlfo lmifo
lmifouof
uofh
h
Zkeiko `r
`rkgfstkr 3 \m
\mlfo lm
lmifouofh
Obhtrfotur - -
Qfipfsm
Qfipfsm 3
Gbtbrmo3
Dkrfofh + -
Okouftfh ;/;/; </</<
\bhus Hbrgbtbhm Nmpkrtbhm
\rbem Hbrgbtrbem Hbrgbtrbem
Pkhsmjmimtfs (Zfjf) + -
Pkhsbrmo3
Hykrm
\krgms +
+ +←
+←
Zfjf + +←
Lmsormgmhfsm + +←
Qbsmsm + +
Umjrfsm + +←
Zkeiko Emsmbibdmo3
Qftkiif + +↖
F``nmiks + +↖
Zkeiko Qftbibdms
Jfjmhsom - +
@nfllb`o - -
Bppkhnkmg - -
D
P`bnrflkbehekr -- --
Gkhlki Jk`ntkrrkw - -
Zbsbimgb - -
Dbhlf - -
Oibhus3
Qftkiif - -
Ofom - -
DKZFO FJHBZGFI
E[HDPM UKDK\F\ME
Gmosm 3 Mhobhtmhkhtmf urmh (-), Zktkhsmb urmh (-), Fhurmf (-), Qbimurmf (-)
QKGKZMOPFFH QKH[HCFHD
6. Nfsm
Nfsmii ifjb
ifjbrf
rftb
tbrm
rmug
ug 3
Nkgbdibjmh 3 6;,=
Ikuobsmt 3 ;=11
\rbgjbsmt 3 65;.111
Nkgftbormt 3 <5,6
DLP 3 =0
[r 3 0;
@r 3 6,16
:. Nfsm
Nfsmii Jrfm
Jrfmh
h @t-
@t-P`
P`fh
fh 3
Lmusuiofh 3
Qrbemi impml
Fsfg urft
Kikotrbimt
Zksugk 3
6. Pujckotme 3 Okikgfnfh fhddbtf dkrfo skjkifn omrm skcfo 6: cfg sgrs. Fwfihyf bs
gkhdkiun sfomt okpfif okgulmfh tmjf-tmjf bs tkrcftun. Okiunfh lmskrtfm lkhdfh
jm`frf pkib sknmhddf bs tmlfo ckifs sfft jkrjm`frf.
:. Bjckotme 3
O[3 @G
QE 3
Okpfif 3 ljh
\nbrfos 3
Fjlbgkh 3 ljh
Kostrkgmtfs 3 ljh
Qx. Hkurbibdms 3 ZE (+) & ZQ (-), Qfrksk H.UMM lfh H.^MM Pmhmstrf
;;;;/<<<<
0. Fssks
ssksg
gkht 3
Lmfdhbsms oimhms 3
<. Qifhhmhd 3
@mtm`bimh :x:;1 gd mv
Gk`bjfifgmh 0x;11 gd mv
Fgiblmpmh 6x61 gd QB
Qkhlmlmofh
Obhsuitfsm
JFJ MM
\MHCF[FH Q[P\FOF
6. Lkemhmsm
Ptrbok
Ptrbok flfifn
flfifn suftu
suftu okflff
okflffh
h nmifhd
nmifhdhyf
hyf skjfdm
skjfdmfh
fh ftfu
ftfu skiurun
skiurun euhdsm
euhdsm hkurbi
hkurbibdm
bdmss
(lkemsmt hkurbibdmo ebofi ftfu dibjfi) yfhd tkrcflm sk`frf gkhlflfo, lmskrtfm dfhddufh
oksflf
oksflfrfh
rfh ftfu
ftfu tmlfo
tmlfo yfhd
yfhd lmskjf
lmskjfjof
jofh
h bikn
bikn dfhddu
dfhddufh
fh pkrklf
pkrklfrfh
rfh lfrfn
lfrfn btfo
btfo ofrkhf
ofrkhf
jkrourfhdhyf supifm lfrfn (strbok msokgmo) ftfu pk`fnhyf pkgjuiun lfrfn sk`frf
spbhtfh (strbok nkgbrfdmo). Ptrbok ftfu skrfhdfh btfo gkrupfofh suftu mstmifn oimhms lfrm
dfhddufh euhdsm btfo yfhd gkhlflfo, tkrcflm jmif pfsbofh lfrfn ok btfo tkrnkhtm ftfu
dfdfi, ftfu lfpft puif skjfdfm fomjft pk`fnhyf pkgjuiun lfrfn lm btfo. Lfifg wfotu
nmtuhdfh lktmo ok gkhmt, ski btfo fofh skdkrf gftm gkifium jkrjfdfm prbsks pftbibdms yfhd
sfft mhm sulfn jfhyfo lmoktfnum.
lmoktfnum.
:. Efot
Efotbr
br Zksm
Zksmob
ob Pt
Ptrb
rbok
ok
]fhd lfpft lmujfn 3
Nmpkrtkhsm,
LG,
Gkrbobo,
Obhtrfskpsm brfi,
Lmsimpmlkgmf.
]fhd tmlfo lfpft lmujfn
[smf yfhd gkhmhdoft,
Ckhms okifgmh
Zfs,
Zmwfyft okiufrdf,
0. \fhl
\fhlff Oimh
Oimhms
ms Pkr
Pkrfh
fhdf
dfh
h
\kofhfh pkreusm btfo gkrupfofh obgpbhkh tkrpkhtmhd pflf smrouifsm lfrfn btfo yfhd
gkrupf
gkrupfofh
ofh mhtkdr
mhtkdrfsm
fsm euhdsm
euhdsm cfhtuh
cfhtuhd,
d, pkgju
pkgjuiun
iun lfrfn
lfrfn lfh obgpbs
obgpbsmsm
msm lfrfn.
lfrfn. \kofhf
\kofhfh
h
pkreusm btfo gkhkhtuofh @krkjrfi Jibbl Eibw (@JE), lmgfhf pkhuruhfh @JE yfhd tmlfo
ikjmn
ikjmn lfrm
lfrm >1% gfsmn gkguh
gkguhdom
domhof
hofh
h ski btfo
btfo uh
uhtuo
tuo puimn
puimn okgjfi
okgjfim.
m. Pklfhd
Pklfhdofh
ofh pflf
pflf
pkhuruhfh ikjmn lfrm >1 % sulfn lmpfstmofh tkrcflm okgftmfh ski btfo. Oknmlupfh ski btfo
sfhdf
sfhdftt tkrd
tkrdfh
fhtu
tuhd
hd pf
pflf
lf smr
smrou
ouif
ifsm
sm ob
obif
iftk
tkrfi
rfi lm bt
btfo
fo,, efotb
efotbrr rksmo
rksmob,
b, lf
lfh
h pk
pkru
rujf
jfnf
nfh
h
gktfjbimsgk lm btfo.
Qflf ugughyf gfhmekstfsm oimhms skrfhdfh btfo lfpft jkrupf3
Jffi, okikgfnfh
okikgfnfh ftfu okiugpun
okiugpunfh
fh pflf wfcfn,
wfcfn, ikhdfh,
ikhdfh, ftfu tuhdofm
tuhdofm sksmsm
ftfu okluf smsm lfrm tujun.
Oksuimtfh gkhkifh
Pfomt okpfif
Okcfhd
Nkgmpfrksk
<. Oifs
Oifsme
memo
mofs
fsmm Ptrb
Ptrbok
ok
Jkrlfsfrofh pftbibdm fhftbgm lfh pkhykjfjhyf
• Ptrbok msokgmo
‐ \rbgjbsms
‐ Kgjbim
• Ptrbok nkgbrfdmo
Jkrlfsfrofh stflmug
•
\rfhsmkht Ms`nkgm` Fttf`o (\MF)
(\MF)
• Zkvkrsmjik Ms`nkgm` Hkurbibdm` Lkem`mt (ZMHL)
• Ptrbok mh kvbiutmbh
kvbiutmbh
• @bgpiktkl Ptrbok
Ptrbok
Jkrlfsfrofh smstkg pkgjuiun lfrfn
• Pmstkg ofrbtms
• Pmstkg vkrtkjrbjfsmikr
Qkrjklffh Ptrbok Nkgbrfdmo Lkhdfh Ptrbok Msokgmo
Ptrbok Nkgbrfdmo Ptrbok Msokgmo
Bhskt Pklfhd ftfu sktkifn Mstmrfnft 8 Fotmemtfs
jkrfotmemtfs
\kofhfh Lfrfn Nfgpmr skifiu tmhddm Hbrgfi ftfu tmhddm
Ptrbok Nkgbrfdmo
Ptrbok
Ptrbok nkgbrf
nkgbrfdmo
dmo gkrupf
gkrupfofh
ofh pkhykj
pkhykjfj
fj utfgf
utfgf oktmlf
oktmlfoo gfgpuf
gfgpufh h pkhlkr
pkhlkrmtf
mtf ftfu
ftfu
lmsfjmimtfs. Nfhyf skomtfr :1% pkhlkrmtf yfhd lfpft jkrlmrm skhlmrm/mhlkpkhlkht lfifg 5
juifh lfh 61% yfhd lfpft jkrlmrm skhlmrm sktkifn 01 nfrm okcflmfh. :1-01% pkrlfrfnfh fofh
jkrtfgjfn lfifg :< cfg lfh mhm lfpft lmoktfnum lkhdfh jkrtfgjfn ckikohyf okflffh ugug
pkhlkrmtf skrtf dkcfif hkurbibdms yfhd tmgjui.
Nfsmi fonmr lfrm strbok nkgbrfdmo mhm fhtfrf ifmh3
- vbiugk nkgftbgk,mhm gkrupfofh nfi yfhd pfimhd pkhtmhd lfifg gkhkhtuofh nfsmi fonmrhyf
- keko obgprksm
- keko lkstruosm
- msonkgmf
- okgfgpufh hkurbtbosmo lfrm nfsmi lkdrflfsm lfrfn
Ibofsm pkrlfrfnfh 51% lkkp suj`brtm`fi, 01% supkremsmfi ftfu ibjfr lfh 61% tkriktfo
mherf tkhtbrmfi/`krkjkiiug. Fhdof okgftmfh lf!fg 01 nfrm pkrtfgf sktkifn tkrcflm pkrlfrfnfh
yfmtu 0;- ;1%? ikjmn lfrm sktkhdfnhyf gftm pflf : nfrm pkrtfgf lfh 5% pkhlkrmtf gftm
skjkiug gkh`fpfm rugfn sfomt.(0,<). \mhddmhyf gbrjmlmty lfh gbrtfimty pflf strbok nkgbrfdmo
bikn ofrkhf gfssf nkgftbgk lfh keko gkofhmo tkrnflfp cfrmhdfh btfo skomtfrhyf.
Ptrbok Msokgmo
Oifsmemofsm Ptrbok Msokgmo
Jkrlfsfrofh bhskt pkhyfomthyf stflmug strbok msokgmo tkrjfdm ftfs3
6. Pkrfhdfh msokgmf ftfu \rfhsmkht Ms`nkgm` Fttf`o (\MF). Qflf jkhtuo mhm dkcfif hkurbibdmo
yfhd tmgjui fomjft dfhddufh pkrklfrfh lfrfn lm btfo fofh gkhdnmifhd lfifg wfotu :< cfg
:. Lkemsmt
Lkemsmt Hkurbi
Hkurbibdm
bdmo
o Msokgmo
Msokgmo Pkpmht
Pkpmhtfs
fs ftfu
ftfu Zkvkrsm
Zkvkrsmjik
jik Ms`nkgm
Ms`nkgm`` Hkurbi
Hkurbibd
bdm`fi
m`fi Lkemsmt
Lkemsmt
(ZMHL). Dkcfif hkurbibdmo yfhd tmgjui fofh gkhdnmifhd lfifg wfotu ikjmn ifgf :< cfg tfpm
tmlfo ikjmn skgmhddu.
0. Ptrbok Qrbdrksme (Qrbdrksmvk Ptrbok ftfu Ptrbok mh kvbiutmbh). Dkcfif hkurbibdmo gfomh
ifgf gfomh jkrft.
<. Ptrbok Obgpikt (@bgpiktkl Ptrbok ftfu Qkrgfhkht Ptrbok), dkcfif oimhms sulfn gkhktfp.
\krlmrm lfrm3
Hbh-nkgbrrnfdm` strbok (mhefro), jfmo ofrkhf trbgjus ftfu kgjbius.
kgjbius.
Ktmbibdm3 Ftrmug emjrmifsmt (;1%), dfhddufh ftfu pkhyfomt oftuj, ofrlmbgmbpftm, mhefro
gmbofrl, tkrutfgf < gmhddu sktkifn skrfhdfh, stkhbsms lfh rkdurdmtfsm oftuj gmtrfi,
khlb`frlmtms mhekosmbsf lfh ifmh-ifmh.
Dkcfif oimhms 3
b Bhskt
Bhskt skrfhdf
skrfhdfh
h mhm gkhlfl
gkhlflfo,
fo, okiunf
okiunfh
h skrmhd
skrmhd pflf
pflf wfotu
wfotu gkhcfif
gkhcfifhof
hofh
h
fotmvmtfs.
b Dfhddufh gbtbrmo ftfu skhsbrmo sksufm iksm.
Qftbemsmbibdm
;. Lm
Lmfd
fdhb
hbsm
smss Pkrf
Pkrfhd
hdfh
fh Btf
Btfo
o
f. Lkemhmsm strbok (TNB, 6=>5? QKZLBPPM, 6===) flfifn tfhlf-tfhlf
oimhms yfhd jkrokgjfhd `kpft fomjft dfhddufh euhdsm btfo ebofi, dibjfi, lkhdfh dkcfif-dkcfif
yfhd
yfhd jkrifh
jkrifhdsu
dsuhd
hd skifgf
skifgf :< cfg ftfu ikjmn
ikjmn ftfu gkhykj
gkhykjfjo
fjofh
fh okgftm
okgftmfh,
fh, tfhpf
tfhpf flfhyf
flfhyf
pkhykjfj ifmh yfhd ckifs skifmh vfsouikr.
j. Lmfdhbsms strbok lmtkdfoofh jkrlfsfrofh tkgufh oimhms.
`. @\ P`
P`fh ok
okpfif tf
tfhpf ob
obhtrfs gk
gkrupfofh pk
pkgkrmosffh jf
jfou kg
kgfs
uhtuo pkrlfrfnfh lm btfo.
l. Jmif tm
t mlfo gk
gkguhdomhofh, l
lffpft lm
lmifouofh @\
@\ P`
P`fh gf
gfof lf
lfpft
lmduhfofh 3
Fidbrmtgk Ptrbok Dfcfn Gflf
F. Qkgkrmosffh Qk
Qkhuhcfhd Zu
Zutmh
Qkhfhdfhfh strbok fout gkgkriuofh pkgkrmosffh obhlmsm yfhd gkhdmrmhdm strbok sknmhddf
nfsmihyf jkrgfhefft uhtuo gkhkhtuofh fhtmsmpfsmhyf.
Ifjbrftbrmug 3
Qkgkrmosffh nmtuhd trbgjbsmt, gfsf pkrlfrfnfh, gfsf pkgjkoufh.
J. Qkgk
Qkgkrm
rmos
osff
ffh
h Qkhu
Qkhuhc
hcfh
fhd
d Onus
Onusus
us Ftfs
Ftfs Lfs
Lfsfr
fr Mhlm
Mhlmof
ofsm
sm Lfh
Lfh Efs
Efsmi
mimt
mtfs
fs
Qflf ofsus strbok yfhd tmlfo spksmemo ftfu lkhdfh mhlmofsm pkhdbjftfh onusus, pkriu suftu
kospibrfsm ikjmn ifhcut skrtf kvfiufsm onusus.
f. Jmif
Jmif flf
flf lud
ludff
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m. Lmifouofh pkgkrmosffh gfsf prbtrbgjmh, FQ\\,
emjrmhbdkh, L-lmgkr, prbtkmh @ lfh P, lfh fdrkdfsm trbgjbsmt.
mm.
mm. Jm
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futbmguh,
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frlm
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fi lfg
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lmifou
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h uhtu
uhtuo
o gkhd
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um
flfhyf vkdktfsm kgjbim lm cfhtuhd lfh fbrtf prbosmgfi.
l. Fhdm
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em skrk
skrkjr
jrfi
fi,, LPF,
LPF, GZF,
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k. PQK@
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o lm
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o
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e. KKD
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ok`f`ftfh. \ucufh utfgf pkhdbjftfh flfifn uhtuo gkgpkrjfmom fimrfh lfrfn ok btfo sk`kpft
guhdomh lfh gkimhluhdm hkurbh lkhdfh gkgbtbhd ofsoflk msokgmo.
Qkhdkibiffh pfsmkh strbok fout pflf lfsfrhyf lfpft lm jfdm lfifg 3
6. Qkhdki
Qkhdkibif
biffh
fh ugug,
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h ;J
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:. Qkhdki
Qkhdkibif
biffh
fh jkrlfsf
jkrlfsfrof
rofh
h pkhykj
pkhykjfjh
fjhyf
yf
• Ptrbok msokgmo
• Gkgpkrjfmom fimrfh lfrfn ok btfo (rkpkreusm)
• Qrkvkhsm tkrcflmhyf trbgjbsms (fhtmobfdufism)
•
Qrbtkosm hkurbhfi/smtbprbtkosm
• Ptrbok Nkgbrfdmo
• Qkhdkibiffh obhskrvftme
• Qkrlfrfnfh mhtrf skrkjrfi
• Qkrlfrfnfh Puj Frf`nhbml
• Qkhdkibiffh bpkrftme
6. Qkhdki
Qkhdkibif
biffh
fh ugug
ugug,, pklb
pklbgfh
gfh ; J
6.f Jrkftnmhd 3 Cfifh hfefs nfrus tkrjuof ikdf, nmsfp
nmsfp ikhlmr lfh sikg uhtu
uhtuo
o gkh`kdfn
okourf
okourfhd
hd bosmdkh
bosmdkh lkhdfh
lkhdfh skdfif
skdfif fomjft
fomjft juruoh
juruohyf.
yf. Lmcfdf
Lmcfdf fdfr bo
bosmd
smdkhf
khfsm
sm lfh
vkhtmi
vkhtmifsm
fsm jfmo,
jfmo, fdfr
fdfr tmlfo
tmlfo tkrcfl
tkrcflmm fspmrfs
fspmrfsmm (dmdm
(dmdm pfisu
pfisu lmjuof
lmjuof).M
).Mhtu
htujfs
jfsmm pflf
pflf pfsmkh
pfsmkh
lkhdfh D@P 9 >. Qflf omrf-omrf 61% pkhlkrmtf phkugbhmf (rflfhd pfru) gkrupfofh
gkrupfofh pkhykjfj okgftmfh utfgf pflf gmhddu ok : ‐ < sktkifn skrfhdfh btfo.
Qkhlkrmtf skjfmohyf jkrjfrmhd lfifg pbsmsm gmrmhd omrm-ofhfh jkrdfhtmfh sktmfp : cfg.
Lfh jmif flf rflfhd ftfu fsgf `kpft lmftfsm.
6.j. Jibbl 3 \kofhfh lfrfn pflf tfnfp fwfi tmlfo jbikn skdkrf lmturuhofh,
lmturuhofh, ofrkhf
lfpft gkgpkrjuruo okflffh, ok`ufim pflf tkofhfh lfrfn smstbimo 8 ::1 ggNd lfh
ftfu lmfstbimo 8 6:1 ggNd (strbok msokgmo), smstbimo 8 6>1 ggNd lfh ftfu lmfstbimo
8 611 ggNd (strbok nkgbrfdmo). Qkhuruhfh tkofhfh lfrfn gfosmgfi :1 %.
Bjft-bj
Bjft-bjft
ft yfhd
yfhd lfpft
lfpft lmpkrd
lmpkrduhf
uhfofh
ofh Hm`frl
Hm`frlmpm
mpmh
h (1,;
(1,; ‐ 5 g`d/od
g`d/od/gk
/gkhmt
hmt mheus
mheus
Oflfr duif lfrfn (DL) yfhd tkrifiu tmhddm tkrjuotm gkgpkrjuruo but`bgk pfsmkh
strbok, pkgjkrmfh mhsuimh rkduikr lkhdfh sofif iuh`ur lkhdfh lbsms DL 8 6;1 ‐ :11
gd/lI : uhmt, tmfp okhfmofh ;1 gd/lI lmhfmoofh lbsms : uhmt mhsuimh sfgpfm lkhdfh
oflfr DL 8 <11 gd/lI lbsms mhsuimh 6: uhmt.
Qkhm
Qkhmhd
hdof
oftf
tfh
h su
sunu
nu tu
tuju
jun
n nf
nfru
russ lmnm
lmnmhl
hlfrm
frm of
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rkhff gkgp
gkgpkr
krjf
jfhy
hyfo
fo pk
pkik
ikpf
pfsfh
sfh
hkurbtrfhsgmtkr kosmtftbrmo, rflmofi jkjfs, okrusfofh JJJ lfh gkrusfo pkguimnfh
gktfjbimsgk khkrsm skrtf gkgpkrjksfr mhnmjmsm tkrnflfp prbtkmh omhfsk.Nmpbtkrgmf
6.l.. Jifll
6.l Jifllkr
kr 3 Nmhlfr
Nmhlfrmm mhekosm
mhekosm sfiurf
sfiurfh
h okgmn
okgmn jmif
jmif tkrcflm
tkrcflm rktkhsm
rktkhsmb
b urmhk
urmhk skjfmo
skjfmohyf
hyf
lmpfsfhd
lmpfsfhd oftktkr mhtkrgmttkh.
mhtkrgmttkh. Jmif tkrcflm
tkrcflm mhobhtmhkhsmf
mhobhtmhkhsmf urmhk, pflf
pflf ifom ifom pfsfhd
obhlbg oftktkr, pflf wfhmtf pfsfhd oftktkr.
6.k. Jbwki 3 Okjutunfh `fmrfh lfh ofibrm pkriu lmpkrnftmofh, nmhlfrm bjstmpfsm, Cfdf
supfyf lkekofsm tkrftur, pfsfhd HD\ jmif lmlfpftofh oksuimtfh gkhkifh gfofhfh.
Okourfhdfh fijugmh pkriu lmpkrnftmofh ofrkhf lfpft gkgpkrjkrft klkgf btfo
:. Qkhdki
Qkhdkibif
biffh
fh jkrlfs
jkrlfsfro
frofh
fh pkhyk
pkhykjfj
jfjhyf
hyf
:.f. Ptrbok msokgmo
- Gkgp
Gkgpkrj
krjfm
fmom
om fimr
fimrfh
fh lfr
lfrfn
fn ok
ok btfo
btfo (rk
(rkpk
pkreu
reusm)
sm)
[sfnff gkhdnm
[sfn gkhdnmifh
ifhdof
dofh
h sugjft
sugjftfh
fh pkhykj
pkhykjfj
fj strbok
strbok gkrupf
gkrupfofh
ofh upfyf
upfyf yfhd
yfhd
pfimhd mlkfi, bjft trbgjbimsms yfhd sulfn lm sktucum bikn ELF flfifn rt-QF
(rk`bgjmhfh tmssuk pifsgmhbdkh f`tmvftbr) lkhdfh lbsms 1,= gd/odJJ gfosmgfi =1
gd (61%
(61% lmjkrmofh
lmjkrmofh jbius
jbius & smsfhyf
smsfhyf mheus
mheus obhtmhyu
obhtmhyu lfifg
lfifg 51 gkhmt).
gkhmt). Pfyfhdhyf
Pfyfhdhyf
jfnwf pkhdbjftfh lkhdfh bjft mhm gkgpuhyfm pkrsyfrftfh pkgjkrmfh nfrusifn
ourfhd lfrm 0 cfg, sknmhddf nfhyf pfsmkh yfhd gfsuo rugfn sfomt lkhdfh bhskt fwfi
lfh lfpft pkhykiksfmfh pkgkrmosffh lfrfn, @\ P`fh okpfif lfh mhebrg `bhskht yfhd
`kpft sfcf yfhd lfpft gkhkrmgf bjft mhm.
@frf
@frf ifmh
ifmh gkgp
gkgpkr
krjf
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momm fimr
fimrfh
fh lfrf
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n fh
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rf if
ifmh
mh lk
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fh gkgp
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momm
nkgbrn
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bdm skpkrtm
skpkrtm bjft
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pkhtbxmem
memiim
iimh
h yfhd
yfhd yfhd
yfhd gkhdur
gkhdurfhd
fhdmm vmsob
vmsobsmtf
smtfss lfrfn
lfrfn
lkhdfh gkhmhdoftofh lkebrgfjmimtfs ski lfrfn gkrfn lkhdfh lbsms 6; gd/odJJ/nfrm.
Bjft ifmh yfhd cudf gkgpkrjfmom
gkgpkrjfmom smrouifsm flfifn hfetmlrbeurm
hfetmlrbeurmii lkhdfh
lkhdfh gkgpkrjfmom
gkgpkrjfmom
fimrf
fimrfh
h lf
lfrfn
rfn gkif
gkifiu
iumm uh
uhsu
surr skiui
skiuikr
kr lf
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n lb
lbsms
sms 51
511
1 gd/n
gd/nfr
frmm skifg
skifgff 61 nf
nfrm
rm mv
lmifhcutofh brfi 011 gd/nfrm.
- Qrkv
Qrkvkh
khsm
sm tkrcfl
tkrcflmh
mhyf
yf trbgj
trbgjbs
bsms
ms (fhtm
(fhtmob
obfd
fdui
uifsm
fsm))
[htuo gkhdnmhlfrm tkrcflmhyf trbgjus ikjmn ifhcut tkrlfpft luf
okifs pkhdbjftfh yfhd tkrsklmf yfmtu fhtm obfduifh lfh fhtm fdrkdfsm trbgjbsmt.
Fhtm obfduifh lmjkrmofh pflf pfsmkh strbok yfhd gkgpuhyfm rmsmob uhtuo
tkrcfl
tkrcflmm kgjbim
kgjbim btfo
btfo skpkrtm
skpkrtm pfsmkh
pfsmkh lkhdfh
lkhdfh okifmh
okifmhfh
fh cfhtuh
cfhtuhd
d emjrmi
emjrmifsm
fsm ftrmug
ftrmug hbh
vfivuifr, tnrbgjus gurfi lfifg vkhtrmoki omrm, mhefro gmbofrl jfru & oftup cfhtuhd
juftfh. Bjft yfhd lfpft lmjkrmofh flfifn nkpfrmh lkhdfh lbsms fwfi 6.111 u/cfg
`ko FQ\\ 5 cfg okgulmfh sfgpfm lm`fpfm 6,; ‐ :,; ofim obhtrbi nfrm ok 0 lmdfhtm fhtm
obfduifh brfi, Nkpfrmh jkrft gbikoui rkhlfn (ITGN) lbsms : x 1,< `` sujoutfh
gbhmtbr trbgjbsmt nfrm ok 6 & 0 (cmof cugifn 9 611.111 tmlfo lmjkrmofh), Tfrefrmh
lkhdfh lbsms nfrm M 7 > gd, nfrm MM 7 5 gd, nfrm MMM pkhyksufmfh lbsms lkhdfh gkimnft
MHZ pfsmkh.
Qfsmk
Qfsmkh
h lk
lkhd
hdfh
fh pf
pfrks
rksms
ms jk
jkrf
rftt yf
yfhd
hd jk
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hd ifgf
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hd jk
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rrmsm
msmob
ob tkrcf
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lm
trbgjbsms vkhf lfifg lfh kgjbim pfru uhtuo prkvkhsm lmjkrmofh nkpfrmh : x ;.111
- Qr
Qrbt
btko
kosm
sm hkurb
hkurbhf
hfi/
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smtb
tbpr
prbt
btko
kosm
sm
Pfhdft gkhfrmo uhtuo gkhdfgftm bjft-bjftfh pflf okibgpbo mhm
of
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rkhff lmnf
lmnfrfp
rfpof
ofh
h lf
lfpf
pftt lk
lkhd
hdfh
fh gkgb
gkgbtb
tbhd
hd of
ofso
sofl
flkk msokg
msokgmo
mo sknmh
sknmhdd
ddff lf
lfpf
pftt
gkh`kdfn okrusfofh ikjmn ifhcut hkurbh. Bjft-bjftfh tkrskjut fhtfrf ifmh 3
@LQ-
@LQ-@n
@nbi
bimh
mhkk jk
jkok
okrc
rcff lk
lkhd
hdfh
fh gkgp
gkgpkrj
krjfm
fmom
om gkgj
gkgjrfh
rfh ski lk
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hdfh
fh `f
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rf
gkhfgj
gkhfgjfn
fn smhtksf
smhtksf pn
pnbsp
bspftm
ftmlyi
lyi`nb
`nbimh
imhk,
k, gkhdnf
gkhdnfgj
gjft
ft tkrjkh
tkrjkhtuo
tuohyf
hyf rflmof
rflmofii
jkjfs lfh cudf gkhfmoofh smhtksms fsktmiobimh suftu hkurbtrfhsgmtkr uhtuo
euhdsmm obdhmtme.
euhds obdhmtme. Gktf fhfimsms
fhfimsms @bn`rfhk Ptrbok Zmvmkw Drbup Ptuly(Pfvkr
:11:) 4
:11:) 4 pkhkimtmfh 6=50 pfsmkh strbok msokgmo lfh pkrlfrfnfh, lbsms ;11 ‐
:.111 gd sknfrm skifgf 6< nfrm gkhuhcuoofh pkhuruhfh fhdof okgftmfh lfh
ok`f`ftfh yfhd jkrgfohf. \nkrfpkutm` Tmhlbws :
Tmhlbws : ‐ 6< nfrm.
Qmrf`ktfg,
Qmrf`ktfg, `frf okrcf sk`frf pfstm lmlfo lmoktfnum,
lmoktfnum, lmpkromrfo
lmpkromrfofh
fh gkgpkrjfmom
gkgpkrjfmom
mhtkdr
mhtkdrmtf
mtfss ski, gkgpkr
gkgpkrjfm
jfmom
om eiumlm
eiumlmtfs
tfs gkgjrf
gkgjrfh
h lfh gkhbrg
gkhbrgfio
fiofh
fh euhdsm
euhdsm
gkgjrfh. Lbsms jbius 6: dr MU lmifhcutofh < x 0 dr mv sfgpfm nfrm ok kgpft,
nfrm ok imgf lmifhcutofh 0 x < dr pkrbrfi sfgpfm gmhddu ok kgpft, gmhddu ok
imgf
imgf sf
sfgp
gpfm
fm gmhd
gmhddu
du ok 6: lmjk
lmjkrm
rmof
ofh
h : x :,
:,<
< dr pk
pkrr br
brfi
fi,.
,. \nkrfpkutm`
Tmhlbws 4
Tmhlbws 4 ‐ 6: cfg.
Ptftmh, lmoimhmo lmduhfofh uhtuo fhtm impml, gkgpuhyfm smeft hkurbprbtkotme
uhtuo msokgmf
msokgmf btfo lfh strbok.
strbok. Gkgpuhyfm
Gkgpuhyfm keko
keko fhtm
fhtm bosmlfh
bosmlfh ’lbwhstrkfg
’lbwhstrkfg
lfh upstrkfg
lfh upstrkfg‗.
‗. Keko lbwhstrkfg
lbwhstrkfg flfifn stfjmimsfsm ftnkrbsoikrbsms sknmhddf
gkhdur
gkhdurfhd
fhdmm pkikpf
pkikpfsfh
sfh pifquk
pifquk trbgjb
trbgjbkgj
kgjbim
bim lfrm frtkrm ok frtkrm.
frtkrm. Keko
Keko
’upstrkfg
upstrkfg‗‗ flfifn gkgpkrjfmom pkhdfturfh kHBP (khlbtnkimfi Hmtrm` Bxmlk
Pyhtnk
Pyhtnksk,
sk, gkgpuh
gkgpuhyfm
yfm smeft
smeft fhtm
fhtm trbgju
trbgjus,
s, vfsblm
vfsblmift
iftfsm
fsm lfh fhtm
fhtm mheifg
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fsm),,
gkhdnfgjft
gkhdnfgjft mHBP (mhlu`mjik
(mhlu`mjik Hmtrm` Bxmlk
Bxmlk Pyhtnksk,
Pyhtnksk, smefthyf jkrifwfhfh
jkrifwfhfh
lkhdfh kHBP), fhtm mheifgfsm lfh fhtm bosmlfh.
@krkjr
@krkjrbim
bimsmh
smh,, suftu
suftu prbtkm
prbtkmh
h btfo
btfo jkjfs
jkjfs ikgfo
ikgfo lkhdfh
lkhdfh onfsmft
onfsmft fhtm
fhtm `fipfm
`fipfmh,
h,
pkhdnfgjft `fspfsk lfh skjfdfm hkurbtrbpmo lbsms 01 ‐ ;1 `` skifgf :6 nfrm
gkhuhcuoofh pkrjfmofh euhdsm gbtbrmo yfhd jkrgfohf.
:. Efsk
Efsk Qfs`
Qfs`f
f Fout
Fout
Pktkifn efsk fout jkrifiu, sfsfrfh pkhdbjftfh lmtmtmo jkrftofh tmhlfofh rknfjmimtfsm
pkhlkrmtf, lfh pkh`kdfnfh tkruifhdhyf strbok.
\krfpm Qrkvkhtme
\ucufhhyf, uhtuo gkh`kdfn tkruifhdhyf ftfu tmgjuihyf skrfhdfh jfru strbok, lkhdfh
cfifh fhtfrf ifmh gkhdbjftm lfh gkhdnmhlfrm efotbr-efotbr rksmob strbok3
Jkrbifnrfdf tkrftur
Fhtmobfduifh 3 wfrefrmh
Fhdmbpifsty lfh stkhtmhd
:. Gkh`kdfn okgftmfh cfhdof p
pffhcfhd, yfhd lfpft lmskjfjofh bikn3 QCO,
mhsekosm sfi. hfpfs, mhekosm smstkgmo ifmhhyf.
0. Zknfjmimtfsm3
Emsmbtkrfpm
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Lfetfr Qustfof
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lfr Qkifyfhfh
Qkifyfhfh Gklms (PQG)
(PQG) lfh Ptfhlfr Qrbsklur Bpkrfsmbhf
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(PQB) Hkurbibdm.:115.
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:. Qrm`k
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tf3 KD@.
KD@. 6==5
6==5
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Pmdhs fhl sçhlr
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bgkss be `krkjrfi
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ry lkem`mk
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fs. Lfifg3
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\bpm`fi lmfdhbsms mh hkurbibdy3 fhftbgy-pnysmbibdy-smdhs-sygptbgs (: hl rkvmskl.).
Hkw ]bro3 \nmkgk Gklm`fi Qujimsnkrs, Mh`. 6=>=.n.
6=>=.n. :=>-011.
;. Fspko Lmfdhb
Lmfdhbstmo,
stmo, Qftbemsmb
Qftbemsmbibdm,
ibdm, gfhfckgk
gfhfckgkh
h Ptrbok.
Ptrbok. Lr. Gmsjf`n
Gmsjf`n NC. Jfifm Qkhkrjm
Qkhkrjmtt
EO[M. :11<. Cfofrtf :11<
5. H Khdi C Gkl,
Gkl, Ubi. 0<<,
0<<, Hb.
Hb. 6=.Gfy
6=.Gfy 61, :116.
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flkl erbg
erbg www.hkcg.b
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