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PDF Laporan Kasus Stroke Iskemik DD
PDF Laporan Kasus Stroke Iskemik DD
Kip`rig Jisus
RT\@JC MRJCHMJ
9619112<
Qchlmhlmge >
JITI QCGEIGTI\
Dikih jcschpitig mgm pcgukms mgemg hcgyihpimjig tcrmhijismf jcpidi dr. Hirmi Rmtcpu,
Rp.R sclieim pclmhlmge yige tckif ligyij hchlcrmjig lmhlmgeig sckihi jcpigmtcriig jkmgmj dm
liemig Mkhu Qcgyijmt Ririo.
Qcgukms hcgyidirm lifwi hijikif mgm hismf tcrdipit ligyij jcjurigeig yige firus
dmpcrlimj
dmpcrl imjm,
m, hiji
hiji dirm
dirm mtu
mtu pcgukm
pcgukmss hcgefi
hcgefirip
ripjig
jig jrmtm
jrmtmj
j dig sirig
sirig dirm
dirm lcrliei
lcrlieimm pmfij
pmfij yige
yige
smoitgyi hchligeug
Ijfm
Ijfmrr ji
jiti
ti pcguk
pcgukms
ms lcrfi
lcrfiri
rip
p tukm
tukmsi
sig
g mgm
mgm dipit
dipit lcrhi
lcrhigo
goiit
iit li
liem
em jm
jmti
ti sc
schu
huii yige
yige
hcgeeugijiggyi.
m
DIOTI\ MRM
DIOTI\
DIOTI\ MRM ....
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LIL 9 QCGDIF
QCGDIFSKS
SKSIG
IG ...
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... 9
9.9............................................................................................................................ Kitir
lckijige ..............................................................................................
................................................. .....................................................
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...... 9
<.9. Dcom
Dcomgms
gmsmm str`jc
str`jc .....
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... <
<.<. Cpmdch
Cpmdchm`k
m`k`em
`em str`jc
str`jc ...
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<.2. Ctm`k`
Ctm`k`em
em str`c
str`c msjc
msjchmj
hmj ....
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.... 2
<.4. Oijt`r
Oijt`r rmsmj
rmsmj`
` str
str`jc
`jc msjchm
msjchmj...
j.......
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....... 4
<.3. Jkismo
Jkismomji
mjism
sm str`
str`jc
jc msjc
msjchmj
hmj ...
......
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.. 5
<.?. Higmoc
Higmocsti
stism
sm jkmgms
jkmgms str
str`jc
`jc msjchm
msjchmj
j ....
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.. 6
<.5. Dcrini
Dcrinitt str`jc
str`jc msjchm
msjchmj
j hcguru
hcgurutt GMFRR.
GMFRR.....
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... 6
<.6. Qit`ec
Qit`ecgcs
gcsms
ms str
str`jc
`jc ms
msjch
jchmj.
mj....
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... =
<.=. Qcgceij
Qcgceijjig
jig dmieg`s
dmieg`sms
ms str
str`jc
`jc msjchm
msjchmj
j .....
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<.91.. Titi
<.91 Titikij
kijsig
sigii str`
str`jc
jc msjchm
msjchmj
j ....
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LIL 2 RTIT
RTITSR
SR QIRMC
QIRMCG
G ........
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.... 93
LIL 4 QCHLIF
QCHLIFIRI
IRIG
G JIRSR
JIRSR ...
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... 2?
LIL 3 JCRMHQ
JCRMHQSKI
SKIG
G ......
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DIOTI\
DIOTI\ QSRTIJI
QSRTIJI ....
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... 2=
mm
Kihpmrig ..........................................................................................................................
49
mmm
LIL M
QCGDIFSKSIG
9.9. Kitirlckijige
Rtr`jc hcrupijig pcgyijmt itiu eigeeuig ougesm`gik `tij lcrupi jckuhpufig
sirio (dcombmt
(dcombmt gcur`k`emb)
gcur`k`emb) ijmlit tcrfihlitgyi ikmrig dirif jc `tij. Rtr`jc idikif smgdr`h
yige tcrdmrm dirm tigdi dig/itiu ecniki fmkigegyi ougesm smstch sirio pusit o`jik (itiu ek`lik)
yige lcrjchlige bcpit (dikih dctmj itiu hcgmt). Ecniki-ecniki mgm lcrkigesuge kclmf dirm <4
nih itiu hcgycliljig jchitmig, sckimg hcgycliljig jchitmig str`jc nuei ijig
hcgei
hcgeijm
jmlit
litji
jig
g di
dihp
hpij
ij ug
ugtu
tuj
j jc
jcfm
fmdu
dupi
pig.
g. Dihpi
Dihpij
j st
str`
r`jc
jc dm
dmigt
igtir
irig
igyi
yi,, mg
mgei
eiti
tig
g ni
nidm
dm
tcreig
tcreigeeu
eeu dig tcrnid
tcrnidmm pcgurug
pcgurugig
ig diyi
diyi mgeit,
mgeit, hcguru
hcgurugji
gjig
g juikmti
juikmtiss fmdup
fmdup pcgdcr
pcgdcrmti
mti nuei
nuei
jcfmdupig jckuirei dig `rige-`rige dm scjckmkmgegyi, hcgeikihm pcgurugig juikmtis fmdup
yige kclmf dristms, jcbibitig omsmj hiupug hcgtik pidi usmi pr`dujtmo dig usmi kignut dig
jchitmig dikih wijtu smgejit.
Rcri
Rcrige
geig
ig st
str`
r`jc
jc dcge
dcgeig
ig oijt
oijt`r
`r rmsm
rmsmj`
j` yi
yige
ge tc
tcrn
rnid
idmm pi
pidi
di us
usmi
mi hudi
hudi ij
ijig
ig
hcgeijmlitji
hcgeijmlitjig
g idi pcgurugig
pcgurugig pirsmik/t
pirsmik/t`tik
`tik ecrijig kcgeig dig tugejim,
tugejim, lcrhisikif
lcrhisikif dikih
lcrpmjmr dig hcgemgeit, hcgdcrmti dcprcsm, dig hcgeikihm jcsukmtig lmbiri, hcgckig, scrti
hchlcdijig jigig dig jmrm. Rtr`jc tij kiem figyi hcgycrige jck`hp`j kigsmi, gihuh jmgm
bcgdcruge hcgycrige ecgcrism hudi yige hismf pr`dujtmo. Nmji str`jc sudif hcgycrige
us
usmi
mi hu
hudi
di yi
yige
ge pr
pr`du
`dujt
jtmo
mo,, fi
fikk mtu
mtu ijig
ijig lc
lcrd
rdih
ihpi
pij
j tc
tcrf
rfid
idip
ip hcgu
hcguru
rugg
ggyi
yi tm
tmge
geji
jitt
pr`dujtmomtis pcgdcrmtigyi.
9
LIL MM
TMGNISIG QSRTIJI
<.9. Dcomgmsm
Dcomgmsm str`jc
str`jc
Rtr`jc dmdcomgmsmjig sclieim dcomsmt gcur`k`ems o`jik itiu ek`lik ijut yige tcrnidm
hcgdidij dig bcpit, lcrkigesuge kclmf dirm <4 nih itiu hcgycliljig jchitmig dig
yige tmdij idi ctm`k`em sckimg visjukir 9. Rtr`jc dmjkismomjismjig hcgnidm fch`riemj dig
msjchmj tcreigtuge pidi pr`scs pit`k`ems yige hcgdisirmgyi 9. Lclcripi pcgckmtmig tckif
hcgugnujjig lifwi sultmpc msjchmj hcgyuhlige nuhkif jisus str`jc yige kclmf lcsir.
Rtr`jc msjchmj idikif cpms`dc dmsougesm gcur`k`ems yige dmscliljig `kcf mgoirj scrclrik,
spmgik
spmgik itiu rctmgi<. Rtr`jc
itiu rctmgi Rtr`jc msjchm
msjchmj
j tcrnid
tcrnidmm jctmji
jctmji pchluk
pchlukuf
uf dirif
dirif `tij
`tij tcr
tcrsuh
suhlit
lit,,
hcgefikigem ikmrig dirif jc scliemig `tij 9.
<.<. Cpmdchm`k`e
Cpmdchm`k`emm str`jc
str`jc
Rtr`jc tctip hcgnidm pcgyclil jchitmig g`h`r dui dm tmgejit ek`lik dig dm
jiwisig Cr`pi9. Dirm 3? nuti jchitmig yige tcrnidm sctmip tifug dm sckuruf dugmi, 91,6%
dmscliljig `kcf str`jc. Dckipig pukuf kmhi pcrscg dirm jchitmig ijmlit str`jc dm igtiri
schui uhur tcrnidm dm gceiri-gceiri lcrjchlige 9. Uigmti hchmkmjm rmsmj` str`jc yige
kclmf tmgeem dmligdmgejig prmi, jmri-jmri situ dirm kmhi wigmti (<1% - <9%) dig situ dirm
cgih prmi (94% - 95%) ijig hcgdcrmti str`jc hcgurut pcgckmtmig <11? 9.
<
Tctipm igeji jchitmig str`jc scbiri jcsckurufig tckif hcgurug dm sckuruf dugmi
hcsjmpug idi pcgmgejitig pcrscgtisc pidi `rige lcrusmi dm itis ?3 tifug (53% j`rlig
str`jc lcrusmi dm itis ?3 tifug)9. Mgm tcrutihi dmscliljig `kcf pcgurugig pipirig oijt`r
rmsmj`, tcrutihi fmpcrtcgsm dig hcr`j`j dig hcgmgejitgyi ijscs jc kiyigig jcscfitig9.
Qrcvik
Qrcvikcgs
cgsmm jcnidm
jcnidmig
ig st
str`j
r`jcc dmpcrj
dmpcrjmri
mrijig
jig ijig hcgmge
hcgmgejit
jit scbiri
scbiri smegmo
smegmomji
mjig
g dm
sckuruf
sckuruf dugmi jircgi p`pukism ek`lik
ek`lik yige lcrusmi kclmf dirm ?3 tifug tcrus hcgmgejit
hcgmgejit
scjmtir schlmkig nuti `rige pcr tifug9. Dm Cr`pi, pr`p`rsm p`pukism yige lcrusmi dm itis
?3 tifug dmpcrjmrijig ijig hcgmgejit dirm <1% pidi <111 hcgnidm 23% pidi <131.
Nuhkif jcnidmig str`jc dm Cr`pi dmprcdmjsm hcgmgejit dirm 9,9 nuti pidi <111 hcgnidm
9,3 nuti
nuti pcr tifug
tifug pidi
pidi tifug
tifug <1<3,
<1<3, scliem
scliemig
ig lcsir
lcsir dmscli
dmscliljig
ljig `kcf p`pukis
p`pukismm yige
yige
hcgui9.
Jircgi p`pukism yige hcgui, tcrutihi dm gceiri-gceiri yige siit mgm hcgeikihm
pcrtuhlufig cj`g`hm yige bcpit, pr`ycjsm fmgeei <1<1 hcgugnujjig lifwi str`jc
ij
ijig
ig hcgb
hcgbipipim
im ?,
?,2%
2% di
dirm
rm t`ti
t`tikk lc
lclig
lig pc
pcgyi
gyijm
jmtt9. Rc
Rcki
kimg
mg mt
mtu,
u, pc
pcrj
rjmr
mrii
iig
g ti
tifu
fug
g <1
<114
14
hchpcr
hch pcrjmr
jmriji
ijig
g lifwi
lifwi str
str`jc
`jc ijig hcgnid
hcgnidmm dm igtiri
igtiri kmhi
kmhi pcgyclil
pcgyclil pikmge
pikmge pcgtmge
pcgtmge
dmsilmkmtis dm gceiri lcrjchlige dig gceiri hinu. Nckis lifwi str`jc ijig hcgmgejit
sc
scbi
biri
ri dr
drih
ihit
itms
ms limj
limj dm Cr
Cr`p
`pii hiupu
hiupug
g dm sc
scku
kuru
ruf
f dugmi
dugmi di
diki
kih
h lc
lclcr
lcrip
ipii dc
dcji
jidc
dc
hcgditige.
<.2. Ctm`k`em
Ctm`k`em str`jc
str`jc msjchmj
msjchmj
Rtr`jc msjchmj tcrnidm jctmji supkim dirif jc liemig `tij tmli-tmli tcreigeeu `kcf
`jkusm2. Qcgyijmt scrclr`visjukir msjchmj tcrutihi dmscliljig `kcf tr`hl`sms, chl`km
dig fmp`pcrousm
fmp`pcrousm o`jik yige schuigyi dipit hcgeirif
hcgeirif pidi pcgeurigeig itiu eigeeuig
ikmrig dirif `tij yige hchpcgeirufm ougesm gcur`k`ems jircgi jcjurigeig ekuj`si dig
`jsmecg2. Rcjmtir 43% dirm str`jc msjchmj dmscliljig `kcf tr`hlus irtcrm jcbmk itiu
lcsir, <1% lcrisik dirm chl`km dig yige kimggyi `kcf pcgyclil yige tmdij dmjctifum2.
Rtr`jc msjchmj o`jik dmscliljig `kcf eigeeuig ikmrig dirif irtcrm jc irci dcpcgdcg
pircgjmh `tij `kcf tr`hlus itiu chl`kus2. Dc
Dcge
geig
ig ji
jiti
ti ki
kimg
mg,, st
str`
r`jc
jc ms
msjc
jchm
hmj
j
dmdcom
dmdcomgms
gmsmji
mjig
g scliei
sclieimm `gsct
`gsct ijut
ijut (hcgmt
(hcgmt itiu
itiu nih)
nih) dirm
dirm dcomsm
dcomsmtt gcur`k
gcur`k`em
`emss o`jik
o`jik yige
j`gsmstcg dcgeig kcsm visjukir yige lcrtifig sckihi kclmf dirm <4 nih 2.
2
Rtr`jc msjchmj idikif pr`scs yige dmgihms dm higi schijmg kihi `jkusm irtcrm
lcrtifig schijmg lcsir ujurig mgoirj dig schijmg tmgeem rmsmj` pcrdirifig pisbi
pcrousm2. Rtr`jc msjchmj idikif pcgyijmt yige j`hpkcjs dcgeig lcrieih ctm`k`em dig
higmocstism jkmgms yige lcrvirmism. Dikih 91 dctmj sctckif ikmrig `tij lcrfcgtm, jceieikig
hctil`kmshc nirmgeig `tij tcrnidm 2. CCE hcgugnujjig pcrkihlitig ijtmvmtis kmstrmj dig
dmsoug
dmsougesm
esm `tij
`tij hcgnid
hcgnidmm gyiti
gyiti scbiri
scbiri jkmgms
jkmgms.. Nmji
Nmji smr
smrjuk
jukism
ism scecri
scecri dmpukm
dmpukmfjig
fjig,, tcr
tcrnid
nidmm
pchukmfig ougesm `tij scbiri tmli-tmli dig kcgejip2.
Dmilctcs hckkmtus
Ikb`f`k
Qcgyijmt nigtuge
4
i. Oi
Oijt
jt`r
`r yig
yige
e tmdi
tmdij
j dipit
dipit dm
dmh`
h`dm
dmom
omjis
jismm
Oijt`r rmsmj` yige tmdij dipit dmh`dmomjism ugtuj str`jc idikif usmi, ncgms
jckihmg, ris-ctgms dig ecgctmji 4. Rcbiri uhuh str`jc idikif pcgyijmt
pcgyijmt tcrjimt usmi.
Mgsmdcg str`jc hcgmgejit dcgeig lcrtihlifgyi usmi, dcgeig jcnidmig dui jikm kmpit
ugtuj sctmip dcjidc sctckif usmi 33 tifug 4. Ssmi riti-riti jcnidmig str`jc msjchmj
pidi tifug <113 idikif usmi ?= tifug. Lujtm tcrliru hcgugnujjig lifwi jcnidmig
tcrsclut dig prcvikcgsm str`jc msjchmj tckif hcgmgejit dm jck`hp`j usmi <1 fmgeei
34 tifug, dirm 9<,=% pidi 9==2/9==4 fmgeei 96,?% dm tifug <113 4.
Fulugeig igtiri ncgms jckihmg dcgeig rmsmj` str`jc tcreigtuge pidi usmi 4.
Dm usmi hudi, wigmti hchmkmjm rmsmj` str`jc yige kclmf tmgeem itiu kclmf tmgeem prmi,
hcsjmpug pidi usmi yige kclmf tui rmsmj` rckitmo scdmjmt kclmf tmgeem ugtuj prmi 4.
\msmj`
\msmj` str
str`jc
`jc kclmf
kclmf tmgeem
tmgeem dm igtiri
igtiri wigmti
wigmti yige
yige usmi
usmi kclmf
kclmf hudi,
hudi, bcgdcru
bcgdcruge
ge
hcgbcrhmgjig rmsmj` yige tcrjimt dcgeig jcfihmkig dig pisbi pcrsikmgig scrti
oijt`r f`rh`g
oijt`r f`rh`gikik kimggyi
kimggyi,, scpcrt
scpcrtmm pcgeeug
pcgeeugiig
iig j`gtris
j`gtriscps
cpsmm f`rh`g
f`rh`gikik4. Rc
Rcbi
biri
ri
jcsckurufig, kclmf ligyij str`jc tcrnidm pidi wigmti dirmpidi prmi, jircgi rcgtige
fmdup wigmti yige kclmf pignige dmligdmgejig dcgeig prmi 4.
@rige
@rige jukmt
jukmt fmtih
fmtih hchmkm
hchmkmjm
jm rms
rmsmj`
mj` dui jikm
jikm kmpit
kmpit tcr
tcrjcgi
jcgi str
str`jc
`jc lmk
lmkii
dmligdmgejig dcgeig `rige jukmt putmf dig hchmkmjm igeji jchitmig yige kclmf
tmgeem tcrjimt dcgeig str`jc 4. \is jukmt fmtih tckif dmmdcgtmomjism hchmkmjm oijt`r
rmsmj`
rmsmj` dikih
dikih str
str`jc
`jc tctipm
tctipm mgm lmsi dmjimt
dmjimtjig
jig dcgeig
dcgeig hisiki
hisikif
f dcgeig
dcgeig ijscs
ijscs jc
pcriwitig jcscfitig4.
l. Oijt`r rmsmj` yige dipit dmh`dmomjism
Tcjigig dirif tmgeem
Tcjigi
Tcjigig
g dirif
dirif tmgeem
tmgeem idikif
idikif situ-s
situ-situ
itugyi
gyi oijt`r
oijt`r rms
rmsmj`
mj` pikmge
pikmge
pcgtmge yige dipit dmh`dmomjism ugtuj str`jc2. Irt
Irtcrm
crmik
ik fypcrtc
fypcrtcgsm
gsm`g
`g
hchl
hchlcr
crmj
mjig
ig j`
j`gt
gtrm
rmlu
lusm
sm ?1
?1%
% di
dirm
rm sc
schu
huii st
str`
r`jc
jc dc
dcge
geig
ig lc
lclc
lcri
ripi
pi
hcji
hcjigm
gmsh
shcc sc
scpc
pcrt
rtmm itfc
itfcr`
r`hi
hi pi
pidi
di ji
jir`
r`tm
tmd,
d, ir
irtc
tcrm
rm vc
vcrt
rtcl
clri
rikm
kmss di
dig
g
kcgej
kcgejug
ugeig
eig i`
i`rt
rti,
i, jc
jcri
ripu
pufig
fig pc
pchl
hluk
ukuf
uf di
diri
rif
f `t
`tij
ij jc
jcbm
bmk,
k, dm
dmso
souge
ugesm
sm
vcgtrmjck jmrm dig omlrmkism itrmuh. Qcge`litig dmpcrkujig nmji TD7 941 /
=1 hhFe2.
Dmilctcs hckkmtus
3
Fypcrkmpmdchmi
Fypcrkmpmdc
Fypcrkmpmdchmi
hmi idikif oijt`r rmsmj`
rmsmj` tctip ugtuj str`jc.
str`jc. Tmgejit
Tmgejit
j`kcstcr`k hcrupijig oijt`r rmsmj` yige pcgtmge dig dipit dmh`dmomjism
ugtuj pcgyijmt irtcrm j`r`gcr (BID) 2. Gihug, fulugeig cpmdchm`k`ems
igtiri j`kcstcr`k dig str`jc hismf j`gtr`vcrsmik. Fulugeig igtiri jidir
j`kc
j`kcst
stcr
cr`k
`k sc
scru
ruh
h dig
dig mg
mgsm
smdc
dcg
g di
dig
g tm
tmge
geji
jitt st
str`
r`jc
jc lc
lcru
ruki
kige
ge lc
lcku
kuh
h
dmtugnujjig scbiri nckis2.
Hcr`j`j
Hcr`j`j
Hcr`j`j dig pinigi
pinigig
g tcr
tcrfid
fidip
ip isip
isip hcrupij
hcrupijig
ig oijt`r
oijt`r rms
rmsmj`
mj`
mgdcp
mgdcpcg
cgdcg
dcg ugtuj
ugtuj st
str`
r`jc
jc ms
msjch
jchmj
mj pr
prmhcr 2. \m
mhcr \msm
smj`
j` tc
tcrn
rnid
idmg
mgyi
yi st
str`
r`jc
jc
hugejmg dui jikm kmpit pidi pcr`j`j dmligdmgejig dcgeig lujig pcr`j`j.
\msmj` yige tcrjimt dcgeig hcr`j`j idi pidi schui usmi, pidi jcdui
ncgms jckihmg dig dm igtiri jck`hp`j ris/ctgms yige lcrlcdi. Nikur
pit`k`ems yige lcrj`gtrmlusm tcrfidip pcgmgejitig rmsmj` tcrhisuj
pcrulifig dmgihmji dirif dig stcg`sms visjukir 2.
Ikj`f`k
Qcgeeugiig ikj`f`k tckif dmjimtjig dcgeig pcgmgejitig tmgejit
str`jc pidi pismcg dcgeig str`jc msjchmj sclckuhgyi 2. Hcjigmshc rmsmj`
yige hugejmg tcrhisuj idikif fmpcrtcgsm yige dmmgdujsm ikj`f`k, jcidiig
fmpcrj`ieukilck, lcrjurigegyi ikmrig dirif `tij dig itrmik omlrmkism (IO)2.
Omlrmkism itrmuh
?
Tr`hl`sms scrclrm
Chl`km scrclrm
l. Rtr`jc Fch`riemj 3
Qcrdirifig mgtriscrclrik
Qcdirifig suliribfg`md
3
L. Lcrdisirjig stidmuh/pcrtmhligeig wijtu
i. Tr
Trigs
igsmc
mcgt
gt Msb
Msbfc
fchm
hmbb Itti
Ittibj
bj
l. Rtr`jc mg cv`kutm`g
b. B`hp
B`hpkc
kctc
tcd
d st
str`
r`jc
jc
B. Lcrdisirjig smstch pchlukuf dirif3
i. Rms
Rmstch jir
jir`tm
`tms
l. Rmstch vcrtclr`-lismkcr
Rtr`jc msjchmj dipit tcrnidm lcrdisirjig 2 hcjigmshc yimtu tr`hl`sms scrclrm,
chl`km
chl`km scrclr
scrclrmm dig pcgeur
pcgeurigei
igeig
g pcrous
pcrousmm smt
smtchm
chmj uhuh3. Tr`
j uhuh Tr`hl`
hl`sms
sms scrclr
scrclrmm idikif
idikif
`lstrujsm ikmrig dirif yige tcrnidm pidi pr`scs `jkusm situ itiu kclmf pchlukuf dirif
5
k`jik.
k`jik. Chl`km
Chl`km scrclr
scrclrmm idikif
idikif pchlcgt
pchlcgtujig
ujig hitcrm
hitcrmik
ik dirm
dirm tchpit
tchpit kim
kimg
g dikih
dikih smstch
smstch
visjukcr
visjukcr dig tcrsigejut
tcrsigejut dikih pchlukuf
pchlukuf dirif tcrtcgtu
tcrtcgtu scfmgeei
scfmgeei hchlk`jidc
hchlk`jidc ikmrig
dirif3. Qcgeur
Qcgeurigei
igeig
g pcrous
pcrousmm sm
smstc
stchmj
hmj dipit
dipit hcgeijm
hcgeijmlit
litjig
jig j`gdmsm
j`gdmsm msjchm
msjchmj
j jircgi
jircgi
jceieikig p`hpi nigtuge itiu pr`scs pcrdirifig itiu fmp`v`kchmj. Rtr`jc fch`riemj
tcrnidm ijmlit pcbifgyi pchlukuf dirif limj dm dikih nirmgeig `tij yige hcgeijmlitjig
pcrdirifig mgtriscrclrik itiu dm ruige sulirijfg`md yige hcgycliljig pcrdirifig
sulirijfg`md3.
Ieir dipit hcgecgikm dig scecri lcrtmgdij lmki tcrnidm scrigeig str`jc dipit
dmeugijig hct`dc OIRT yimtu Oibc dr``pmge (winif tcrjukim), Irh wcijgcss (kcgeig
kchif), Rpccbf dmoombukty (eigeeuig lmbiri) dig Tmhc t` bikk =99 (hchigeemk ligtuig)5.
6
Qchcrmjsiig
Qchcrmjsiig gcur`k`emj
gcur`k`emj dikih pcgigeigig jceiwitdirur
jceiwitdiruritig
itig tcrhisuj
tcrhisuj jisus
str`jc msjchmj firuskif bcpit, tcpit dig hcgyckuruf. Fik mgm dipit dmkijujig dcgeig
hcgeeugijig sjiki itiu smstch sj`rmge yige o`rhik scpcrtm Gitm`gik Mgstmtutcs `o Fciktf
Rtr`jc Rbikc (GMFRR). GMFRR tmdij figyi hcgmkim dcrinit dcomsmt gcur`k`ems tctipm nuei
hchoismkmtism j`hugmjism igtiri pismcg dig tcgiei hcdms, hcgemdcgtmomjism jchugejmgig
suhlitig pchlukuf dirif, hcgcgtujig pr`eg`sms iwik dig j`hpkmjism scrti hcgcgtujig
mgtcrv
mgtcrvcgs
cgsmm yige dmpcrk
dmpcrkujig
ujig.. Rj`r
Rj`r GMFRR;
GMFRR;<1
<1 hcgemg
hcgemgdmj
dmjism
ismjig
jig str
str`jc
`jc dikih
dikih tmgeji
tmgejitt
rmgeig sihpim scdige. Rj`r GMFRR7<1 hcgemgdmjismjig str`jc dikih tmgejit pirif.
mrrcvcrsmlkc mgnury jctmji ikmrig dirif `tij ; 21 he/dk3. Ikmrig dirif `tij yige lcrfcgtm
sckihi 21 dctmj ijig hcgycliljig eigeeuig pidi hctil`kmshc `tij, scsudif 9 hcgmt
ougesm
ougesm gcur`g
gcur`g dipit
dipit tcrfcg
tcrfcgtm,
tm, scsudi
scsudif
f 3 hcgmt
hcgmt ig`jsm
ig`jsmii ijig
ijig hcgemg
hcgemgmsm
msmism
ism rigejim
rigejimig
ig
jcnidmig
jcnidmig yige dipit hcgycliljig
hcgycliljig mgoirj
mgoirj scrclrik.
scrclrik. \igejimig jcnidmig dikih tcrnidmgyi
tcrnidmgyi
mgoirj
mgoirj idikif
idikif vis`dm
vis`dmkit
kitism
ism k`jik,
k`jik, euhpik
euhpikig
ig dirif
dirif stitms
stitms dcgeig
dcgeig scehcg
scehcgtis
tismm sck dirif
dirif
hcri
hcrif
f dmmj
dmmjut
utmm cd
cdch
chii dig
dig gcjr
gcjr`s
`sms
ms nirm
nirmge
geig
ig `tij 3. Lc
`tij Lcrl
rlie
ieim
im hcji
hcjigm
gmsh
shcc di
dipi
pitt
hcgeijmlitjig
hcgeijmlitjig str`jc msjchmj.
msjchmj. Mgoirj
Mgoirj fch`dmgihmj
fch`dmgihmj hcrupijig
hcrupijig fismk dirm fihlitig
fihlitig
dikih pcrousm g`rhik yige dmscliljig `kcf stcg`sms irtcrm lcrit itiu suhlitig yige
lcrisik dirm itcr`sjkcr`sms dig tr`hl`sms. Jckimgig pchlukuf dirif jcbmk tcrnidm jctmji
kmp`fmikmg`
kmp`fmikmg`sms
sms itiu pcgyijmt itcr`sjkcr
itcr`sjkcr`tmj
`tmj k`jik hcgycliljig pcgyuhlitig
pcgyuhlitig pcgctrigt
irtcry. Qr`scs yige lcrpcrig ugtuj hcjigmshc dirm mgoirj scrclrik scrmge dmeugijig
irtcry.
ugtuj hcgeitie`rmjig str`jc msjchmj hcgnidm lclcripi sultmpc sclieim lcrmjut3>
i. Rtr`
Rtr`jc
jc jird
jirdm`
m`ch
chl`
l`km
km
Chl`km yige lcrisik dirm nigtuge hcrupijig pcgyclil yige pikmge uhuh
yige dipit dmmdcgtmomjism pidi pismcg str`jc msjchmj 3. Igeji jcnidmiggyi scjmtir
93-21% dirm sckuruf str`jc msjchmj. Chl`km nigtuge dipit hcgunu jc smrjukism
`tij dig hcgyuhlit ikmrig dirif `tij dcgeig hcge`jkusm irtcrm, yige higi
dmihctcr kuhcg irtcrm sihi dcgeig ujurig dirm chl`km. Ruhlcr pikmge uhuh dirm
=
ji
jird
rdm`
m`ch
chl`
l`km
km tr`h
tr`hlus
lus mgtr
mgtriji
ijird
rdmi
mij
j di
dig
g huri
hurikk yi
yige
ge di
dipi
pitt dm
dmsc
scli
lilji
ljig
g `k
`kcf
cf
omlrmkism itrmuh,
itrmuh, jirdm`hm`pitm dcgeig pcgeurigeig orijsm cncjsm dig ilg`rhikmtis
pcrecrijig dmgdmge yige hcgemjutm mgoirj hm`jirdmuh. Qcgyijmt jitup nigtuge
tcrutihi ijmlit pcgyijmt nigtuge rchitmj, rceuremtism itiu stcg`sms hmtrik lcrit,
jitup nigtuge luitig dig cgd`jirdmtms nuei hcrupijig sikif situ pcgyclil yige
bujup scrmge.
scrmge. Qcgyclil yige nirige
nirige idikif
idikif itrmik hyx`hi
hyx`hi yige higi chl`km
scliemig lcsir hcrupijig sck gc`pkistmj. Qirtmjck kimggyi dipit hcgunu smrjukism
vcgi dig hcgechl`kmsism hckikum dcocj pidi nigtuge, sclieim b`gt`f kchij dirm
orij
orijtu
turr tuki
tukige
ge,, ud
udir
irii di
dirm
rm triu
triuhi
hi it
itiu
iu pr
pr`s
`scd
cdur
ur pc
pchl
hlcd
cdifi
ifig
g pi
piru
ru,, sm
smgus
gus
durihitcr, itiu vcgi nueukirms3.
scrmge hcgecgim
scrmge hcgecgim kijm-kijm
kijm-kijm dmligdmgejig
dmligdmgejig dcgeig pcrchpuig
pcrchpuig3. Ijuhuki
Ijuhukismsm pkij
pkij
itcr`sjkcr`tmj dikih kuhcg irtcrm lcrujurig lcsir itiu hcdmuh, lmisigyi pidi
lmourjism` itiu kcgejugeig pidi pchlukuf dirif `tij lcrpcrig dikih tcrnidmgyi
str`jc msjchmj 3. Lcrlieim tc`rm hcgecgim pr`scs tcrnidmgyi pkij itcr`sjkcr`tmj mgm,
yige
yige pcrtih
pcrtihii dmigee
dmigeeip
ip scliei
sclieimm ijmlit
ijmlit dirm
dirm ikm
ikmrig
rig dirif
dirif yige hcgmhl
hcgmhlukj
ukjig
ig
jcrusijig tugmji mgtmhi scfmgeei kmpmd dipit tcrsckmp dmliwifgyi, scdigejig pidi
tc`rm yige jcdui dmigeeip sclieim rcijsm sck cgd`tck tcrfidip idigyi tr`hlus
scfmgeei tcrnidm dcecgcrism tr`hlus hcgnidm kmpmd dm sulcgd`tck. Hcjigmshc yige
hcgdisirm tcrnidmgyi str`jc itcr`sjkcr`tmj idikif pirtmjck chl`km dipit kcpis dirm
pkij itcr`sjkcr`tmj dig hcgyuhlit irtcrm scrclrik yige kclmf dmstik, pkij
itcr`s
itcr`sjkc
jkcr`t
r`tmj
mj dipit
dipit hcgycli
hcgyclilji
ljig
g stcg`s
stcg`sms
ms pr`erc
pr`ercsmo
smo irt
irtcrm
crm scfmge
scfmgeei
ei tcr
tcrnid
nidmm
suhlit
suhlitig
ig dig mgoirj
mgoirj dirm
dirm tr`hl
tr`hl`sm
`smss k`jik,
k`jik, msjchm
msjchmii yige tmhluk
tmhluk ijmlit
ijmlit tm
tmdij
dij
idcjuitgyi
idcjuitgyi ikmrig
ikmrig dirif j`kitcrik scfmgeei scbiri
scbiri pr`ercsmo
pr`ercsmo pcgychpmtig
pcgychpmtig itiu
suhlitig
suhlitig itcr`sjkcr`tmj lcrit3. Qchluk
itcr`sjkcr`tmj Qchlukuf
uf dirif
dirif `tij
`tij yige scrmge
scrmge hcgeik
hcgeikihm
ihm
itcr`sjkcr`tmj jimtiggyi dcgeig str`jc msjchmj idikif pcrbiligeig irtcrm jir`tms
j`hugms, pigejik irtcrm scrclrm igtcrm`r dig hcdmi, pigejik irtcrm vcrtclrikms 3.
b. Rtr`
Rtr`jc
jc kibu
kibugi
girr
91
Mgoirj kijugir tcrnidm scjmtir 93-21% dirm str`jc msjchmj. Mgoirj yige
tcrkmfit lmisigyi hchpugyim dmihctcr jurige dirm 9 bh dig dmscliljig `kcf
pcgyuhlitig scluif pcgctritmge
scluif pcgctritmge irtcry jcbmk yige hcgsupkim dirm dccp strubturcs
dm `tij scpcrtm jipsuki mgtcrgi, eigekmi lisikms, j`r`gi ridmiti, tikihus dig litige
`tij 3. Qc
Qcgyc
gycli
lil
l di
dirm
rm pcgyu
pcgyuhl
hlit
itig
ig pc
pchl
hluk
ukuf
uf di
diri
rif
f jc
jcbm
bmkk dm `t
`tij
ij lm
lmis
isig
igyi
yi
dmscliljig jcrusijig cgd`tck ijmlit fmpcrtcgsm dig dmilctcs yige lcrkigesuge
ki
kihi
hi,, lcrh
lcrhig
igmo
mocs
csti
tism
sm sc
scli
liei
eimm kmp`
kmp`fm
fmik
ikmg
mg`s
`sms
ms it
itiu
iu hmjr
hmjr`i
`itc
tcr`
r`hi
hi yi
yige
ge
hcgych
hcgychpmt
pmtjig
jig pcgctritmge irtcry.
irtcry. Qcgyuhlitig pchlukuf dirif jcbmk dm `tij
dipit dmscliljig `kcf hmjr`chl`km pr`jsmhik itiu itcr`sjkcr`sms pchlukuf dirif
hcgbiligejig pcgctritmge irtcry3.
pr`jsmhik yige hcgbiligejig pcgctritmge
d. Rt
Rtr`
r`jc
jc jr
jrmp
mpt`
t`ec
ecgm
gmj
j
Rcliemig lcsir jisus, <1-41% str`jc tmdij dipit dmtcgtujig pcgyclilgyi
99
=
Eihlir <.2. Rtr`jc Fch`riemj =
Eihlir <.<. Rtr`jc Msjchmj
b. Rmrm
Rmrmri
rinn str`
str`jc
jc sj`
sj`rr
9<
Ipilmki sj`r yige dmdipitjig ; 9 hiji dmieg`smsgyi str`jc msjchmj dig ipilmki
dmdipitjig sj`r ≣ 9 hiji dmieg`smsgyi str`jc pcrdirifig 91.
92
Ipil
Ipilmk
mkii tcrd
tcrdip
ipit
it pi
pism
smcg
cg st
str`
r`jc
jc ij
ijut
ut dc
dcgei
geig
g it
itiu
iu ti
tigp
gpii pcgur
pcgurugi
ugig
g
jcsidirig, gycrm jcpiki dig tcrdipit rcokcj lilmgsjm itiu dui dirm jctmeigyi hiji
hcrupijig
hcrupijig str`jc
str`jc fch`riemj.
fch`riemj. Nmji dmtchujig
dmtchujig pcgurugig
pcgurugig jcsidirig
jcsidirig itiu gycrm
jc
jcpi
piki
ki mgm
mgm nuei
nuei hcru
hcrupi
piji
jig
g st
str`
r`jc
jc g`g fc
fch`
h`ri
riem
emj.
j. Rcdig
Rcdigeji
ejig
g lm
lmki
ki fi
figyi
gyi
dmdipitjig
dmdipitjig rcokcj lilmgsjm
lilmgsjm p`smtmo
p`smtmo itiu tmdij dmdipitjig
dmdipitjig pcgurugig jcsidirig,
jcsidirig,
gycrm jcpiki dig rcokcj lilmgsjm hiji hcrupijig str`jc g`g fch`riemj.
94
LIL MMM
93
RTITSR QIRMCG
Rtitus > Hc
H cgmjif
Tckiif > Qismcg ditige dcgeig jckufig kchif igee`ti ecrij jmrm
yige dmrisijig tmli-tmli dig schijmg hchlcrit tmei
firm sclckuh hisuj jc ruhif sijmt. Qismcg nuei
hcgeckufjig gycrm jcpiki (+), jcnige (+), lmbiri
pck` (+), huik (+), hugtif (+) scligyij situ jikm.
\mwiyit triuhi jcpiki dmsigejik `kcf pismcg.
\mwiyit
\mwiyit Qcgyijm
Qcgyijmtt Tcrd
Tcrdifu
ifuku
ku > Kchif
Kchif igee`t
igee`tii ecrij
ecrij jigig
jigig scjm
scjmtir
tir dui tifug
tifug yige
yige kiku
kiku,,
fm
fmpc
pcrt
rtcg
cgsm
sm sc
scki
kihi
hi 91 titifu
fug,
g, dm
dmil
ilct
ctcs
cs hckk
hckkmt
mtus
us,,
j`kcstcr`k.
\m
\mwi
wiyit
yit Qc
Qcgee
geeug
ugii
iig
g @li
@litt > Gcu
Gcur`
r`ti
tih
h 611
611 he,
he, ihk
ihk`dm
`dmpm
pmgc
gc 91 he,
he, bk`
bk`pm
pme
e 53
53 he.
he.
9?
Trijtus Dmecstmvus > LIL tmdij kigbir chpit firm sclckuh hisuj \R
Qcgy
Qcgyij
ijmt
mt Tcr
Tcrdi
difu
fuku
ku dig
dig Jcb
Jcbck
ckij
ijii
iig
g > Tmdi
Tmdij
j idi
idi jcku
jckufi
fig
g
Jcki
Jckifm
fmri
rig
g dig
dig Qcrt
Qcrtuh
uhluf
lufig
ig > Qism
Qismcg
cg kif
kifmr
mr g`
g`rh
rhik
ik dig
dig tm
tmdi
dij
j eigee
eigeeui
uig
g pcrt
pcrtuh
uhluf
lufig
ig
Qcrjiwmgig dig Igij > Hcgmjif situ jikm dig hchmkmjm kmhi `rige igij
95
Jukmt di
dig Rc
Rckipu
putt Kc
Kcgdmr > Di
Dikih li
litis g`rhik
Jckc
Jckcgn
gnir
ir di
dig
g Ect
Ectif
if Lcgm
Lcgmge
ge > Dik
Dikih
ih li
liti
tiss g`r
g`rhi
hikk
2.?.4. ECGMTIKMI
96
2.5.<. J\IGMSH
Trigsm
Trigsmkuh
kuhmgi
mgism
sm > Tmdij
Tmdij dmkiju
dmkijujig
jig pchcrm
pchcrmjsi
jsiig
ig
9=
GC\_SR M
GC\_SR MM
pchcrmjsiig pchcrmjsiig
Kipigeig pigdige
<1
Qupmk
\cokcⅽ bifiyi
(+) (+)
kigesuge
\cokcⅽ bifiyi
tmdij kigesuge (+) (+)
Dcvmism
b`gnueitc (-) (-)
GC\_SR _
Jigig Jmrm
H`t`rmj
Rcgs`rmj
Jukmt Dikih
Dikih litis
litis g`rhi
g`rhikk Diki
Dikih
h liti
litiss g`r
g`rhi
hikk
<9
pchcrmjsiig pchcrmjsiig
GC\_SR _MM
Jigig Jmrm
H`t`rmj
Hmhmj Ismhctrms
Rcgs`rmj
Qcgecbipig </2
dcpig kmdif Dikih litis g`rhik Dikih litis g`rhik
Qr`d
Qr`duj
ujsm
sm jck
jckcgni
cgnir
r Tmdij dmkijujig Tmdij dmkijujig
kudif pchcrmjsiig pchcrmjsiig
GC\_SR _MMM
Jigig Jmrm
Iudmt`rmus
<<
_cstmlukirms
GC\_SR MV, V
GC\_SR VM
Jigig Jmrm
Ouge
Ougesm
sm `t`t
`t`t st
stcr
crg`
g`bk
bkcm
cmd`
d`hi
hist
st`m
`mdc
dcus
us Diki
Dikih
h li
liti
tiss g`
g`rh
rhik
ik Diki
Dikih
h li
liti
tiss g`
g`rh
rhik
ik
GC\_SR VMM
Kmdif
Trch`r (-)
Itr`km
(-)
<2
Oismjukism (-)
Snuge kmdif scwijtu mstrifit Dcvmism jc jigig
Tr`om (-)
Rmji
Rmjip
p (d
(dud
uduj
uj-l
-lcr
crdm
dmrm
rm-l
-lcr
crli
lirm
rmge
ge)) Rb`k
Rb`km`
m`sm
smss
Trch`r (-)
Jf`rci (-)
Likkmshus (-)
Hm`jk`gus (-)
Itct`sms (-)
Dyst`gmi (-)
Rpishc (-)
Tmb (-)
Dig kimg-kimg (-)
<4
2.91. \COKCJR
Jigig Jmrm
\cokcjs omsm`k`ems
\cokcjs pit`k`ems
2.99. J@@\DMGIRM
<3
Qcrb`liig Ip
Iprijsmi Tmdij d
dmmkijujig pc
pchcrmjsiig
Hmhmj Tmdij dmkijujig pchcrmjsiig
Tc
Tcst
st Tc
Tcku
kugn
gnuj
uj-T
-Tck
ckug
ugnu
nuj
j Tm
Tmdi
dij
j dm
dmki
kiju
juji
jig
g pchcr
pchcrmj
mjsi
siig
ig
Tcst
cst Tck
Tckugn
ugnuj-F
uj-Fmmduge
duge Tmdi
Tmdij
j dmki
dmkiju
juji
jig
g pch
pchcr
crmmjsii
jsiig
g
Dmid`jf`jmgcsmi Tmdij dmkijujig pchcrmjsiig
Tcst Tuhmt-Kutut Tmdij dmkijujig pchcrmjsiig
2.9<. _CECTITMO
2.92. _C\TCL\I
Lcgtuj
µ G`rhik (-)
µ Rb`km`sms (+)
µ Fmpcrk`rd`sms (-)
Qcrecrijig
Kiscquc (-)
Br`ss Kiscquc (-)
Tcst Kfcrhmttc (-)
Tcst Gioozmecr (-)
Itijsmi (-)
Dmsirtrmi (-)
Trch`r (-)
<?
Gmstiehus (-)
Ocg`hcgi \cl`ugd (-)
_crtme` (-)
Dig Kimg-Kimg (-)
Trch`r (-)
\memdmtis (-)
Lridmjmgcsmi (-)
Dig Kimg-Kimg (-)
Jcsidirig Juikmtitmo
@rmcgtism
Ioismi
Ieg`smi
<5
µ Dms`rmcgtism Jigig-
(-)
Jmrm
Fchit`k`em
Fichiek`lmg 92,= e/dk 9<,3-9? e/dk
Gmkim-gmkim HB
Fmtuge ncgms
<6
Lis`omk 9% 1-9%
Kmvcr ougbtm`g
\cgik ougbtm`g
Ckcbtr`kytc tcs
Gitrmuh 943 hh`k/k 923-945 hh`k/k
\cgik ougbtm`g
Kmpmd pr`omkc
<=
9. BT-s
BT-sbig
big jcp
jcpik
ikii (92-6
(92-6-<
-<19
19=)
=)
Jcsmhpukig>
Tigdi huktmpkc mgoirj kibugir bcrclrm jmrm, scliemig `kd kibugir mgoirbtm`g,
<. O`t`
O`t` tf`r
tf`riⅽ
iⅽ supmgc
supmgc (94-6-
(94-6-<19=
<19=))
Itfcr`sbkcr`sms i`rti
2.9=. Dmieg`sms
21
Rtr`jc Fch`rfiemb
2.<9. Tcripm
2.<<. O`kk`w up
29
CRD> 2 CRD> 2
CRR> 4 CRR> 4
CMD> 4 CMD> 4
CMR> 4 CMR> 4
Ihk`dmpmgc 9ⅽ91 he
Bigdcsirtig 9ⅽ6 he
2<
R Kchi
chif kcge
geiig dig tugej
ejiim jmrm Kch
chiif kcge
geiig dig tug
uge
ejim jmrm
CRD> 2 CRD> 2
CRR> 4 CRR> 4
CMD> 4 CMD> 4
CMR> 4 CMR> 4
22
R Kchi
chif kcge
geiig dig tugej
ejiim jmrm Kch
chiif kcge
geiig dig tug
uge
ejim jmrm
CRD> 2 CRD> 2
CRR> 4 CRR> 4
CMD> 4 CMD> 4
CMR> 4 CMR> 4
Q Omsm`tcripm Omsm`tcripm
24
23
LIL M_
QCHLIFIRIG JIRSR
G` Tc`rm Jisus
9 Lcrdisirjig dcomgmsm UF@, Rtr`jc Qi
Qidi
di ji
jisu
suss mg
mgm,
m, pi
pism
smcg
cg di
diti
tige
ge jc \R HTHF
HTHF
dmdcomgmsmjig sclieim dcomsmt dcg
dcgeig
eig jckufig
jckufig kchif
kchif igee`ti
igee`ti ecrij
ecrij jmrm
jmrm yige
gcur`k`ems o`jik itiu ek`lik ijut yige dmrisi
dmrisijig
jig tm
tmli-t
li-tmli
mli dig schijm
schijmg
g hchlcr
hchlcrit
it tm
tmei
ei
tcrnidm hcgdidij dig bcpit, firm sclckuh hisuj jc ruhif sijmt. Dui tifug
lcrkigesuge kclmf dirm <4 nih itiu yige kiku pismcg pcrgif dmriwit dm ruhif sijmt
hcgycliljig jchitmig dig yige tmdij dcg
dcgeig
eig ecniki
ecniki kchif
kchif igee`t
igee`tii ecrij
ecrij jigig
jigig dig
idi ctm`k`em sckimg visbukir. su
sukm
kmtt lc
lcrl
rlmb
mbir
iri.
i. Qi
Qism
smcg
cg ru
rutm
tmg
g hcgej
hcgej`g
`gsu
suhs
hsmm
ihk`dmpmgc 91 he, bk`pme 53 he dig gcur`tih
611 he.
< Higm
igmocst
cstism
ism jkmg
jkmgmms str`
str`jc
jc ms
msjch
jchmj yige
yige Qis
Qismcg
mcg ditige
ditige jc MED HTHF dcgeig
dcgeig jckufi
jckufig
g
dipi
dipitt tmhlu
mhlukk yim
yimtu Fchm
Fchmpi
pirrcsm
csms, kch
kchif
if igee`ti
igee`ti ecrij
ecrij sclcki
sclckif
f jmrm,
jmrm, gycrm
gycrm jcpiki
jcpiki
h`g`p
`g`pir
ircs
csmms itiu
itiu quid
quidrrmp
mpir
ircs
csmms dig lmbiri
lmbiri pck`.
pck`. Qidi pchcrm
pchcrmjsi
jsiig
ig gcur`k`
gcur`k`ems
ems
(nirige),
(nirige), Dcomsmt
Dcomsmt fchmscgs`r
fchmscgs`rm,
m, Dcomsmt
Dcomsmt dmtchujig dcvmism kmdif jc jigig, jcjuitig `t`t
kipigeig pigdige, Dmpk`pmi, hckchif pidi jcchpit igee`ti ecrij dig tigeig
Dmsirtfrmi, Oibmik dr`p, Itismi, jigig hcgeikihm spishc.
_crtme`, Ioismi, Jcsidirig hcgurug.
2 Qcgyijmt str`jc msjchmj hchmkmjm Qismcg
Qismcg hchmkm
hchmkmjm
jm oijt`r
oijt`r rms
rmsmj`
mj` yige
yige tmdij
tmdij dipit
dipit
oijt`r rmsmj` yige tmdij dipit dmh`dmomjism yimtu usmi 3= tifug, ncgms jckihmg
dmh`dmomjism yimtu usmi, ncgms jckihmg, pcrchpuig dig nuei hchmkmjm oijt`r rmsmj` yige
ris
ris di
dig
g ec
ecgc
gctm
tmj.
j. Rc
Rcdi
digej
gejig
ig oijt
oijt`r
`r dipit dmh`dmomjism yimtu rmwiyit fmpcrtcgsm sckihi
rmsmj
rmsmj`
` yige tmdij
tmdij dipit
dipit dmh`dm
dmh`dmomj
omjism
ism 91 tifug,
tifug, dmilct
dmilctcs
cs hckkmtu
hckkmtuss tmpc
tmpc MM, j`kcst
j`kcstcr`
cr`k,
k,
yim
yimtu fmpc
fmpcrrtcgs
cgsm, hcr
hcr`j`j
`j`j,, ris
rism` jirdm`hceikm dig rmwiyit str`jc dui tifug yige
pmgeeige/pmgeeuk, dmct, ijtmvmtis omsmj, kiku.
fy
fypc
pcrk
rkmp
mpmd
mdch
chmi
mi,, dm
dmilc
ilctc
tcss hckk
hckkmt
mtus
us,,
ikb`f`k, pcgyijmt nigtuge.
4 Sgtuj hcgceijjig dmieg`sc str`jc Jcsmhpukig pchcrmjsiig Bt-sbig jcpiki>
Tij tihpi
ihpij j ti
tigd
gdi-
i-ttigdi
igdi pcr
pcrdir
dirifig
ifig
msjch
msjchmm hiji
hiji dmkiju
dmkijujig
jig pchcrm
pchcrmjsi
jsiig
ig
mgtribrigmik siit mgm
pchcrmjsiig pcgugnige yimtu
Tigdi huktmpkc mgoirj kibugir bcrclrm jmrm,
2?
25
LIL _
JCRMHQSKIG
Qidi jisus mgm pismcg lcrmgmsmik Gy. \G lcrncgms ckihmg pcrchpuig lcrusmi 3= tifug
dmdmie
dmdmieg`s
g`sii str`jc
str`jc msjchm
msjchmj
j lcrdis
lcrdisirj
irjig
ig fismk
fismk igihgc
igihgcsms
sms,, pchcrm
pchcrmjsi
jsiig
ig oms
omsmj,
mj, pchcrm
pchcrmjsi
jsiig
ig
gcur`k`ems
gcur`k`ems dig pchcrmjsiig
pchcrmjsiig pcgugnige. Dirm fism iut`igihgcsms
iut`igihgcsms pismcg
pismcg hcgeckufjig
hcgeckufjig kchif
igee`tii ecrij sclckif jmrm yige tmli-tmli hugbuk tmei firm sclckuh hisuj ruhif sijmt,
igee`t sijmt, gycrm
jcpiki, jcnige scligyij situ jikm yige tmdij dmmjutm pcgurugig jcsidirig, lmbiri pck`, huik-
hugtif scligyij situ jikm. Qismcg pcrgif dmriwit sclckuhgyi `kcf jircgi str`jc yimtu kchif
igee`ti ecrij liemig jigig, sukmt lcrlmbiri yige tmli-tmli hugbuk dui tifug yige kiku. Rckihi
mgm pismcg hchmkmjm rmwiyit pcgyijmt fmpcrtcgsm sckihi scpukuf tifug, j`kcstcr`k dig DH tmpc MM.
Qismcg rutmg hcge`gsuhsm ihk`dmpmgc 91 he, bk`pme 53 he dig gcur`tih 611 he.
Qidi pchcrmjsiig omsmj dmtchujig dmtchujig tcjigig dirif 931/61 hhFe, gidm ?4
ⅽ/hc
ⅽ/hcgm
gmt,
t, orcj
orcjuc
ucgs
gsmm giois
giois <1 ⅽ/
ⅽ/hc
hcgm
gmt,
t, tchp
tchpcr
crit
itur
urcc 25,2
25,2 ˞B
˞B.. Qi
Qidi
di pc
pchc
hcrm
rmjs
jsii
iig
g gcur`
gcur`k`
k`em
emss
dmtchujig pircsc gcrvus _MM, sudut hukut tcrtirmj jc jigig dig pircsc gcrvus VMM, kmdif dcvmism
jc jigig. Qchcrmjsiig rcokcjs omsm`k`ems dikih litis g`rhik. Qchcrmjsiig rcokcjs pit`k`ems
F`oohig-Tr`hgcr (+/-), Lilmgsjm (-/+) dig bfidd`bj (-/+). Jcjuitig cjstrchmtis jmrm supcrm`r-
mgocrm
mgocrm`r
`r dig cjtrch
cjtrchmti
mtiss jigig
jigig mgocrm
mgocrm`r
`r lcrgmk
lcrgmkim
im 4 yimtu
yimtu hihpu
hihpu hckiwi
hckiwig
g eiyi erivmt
erivmtism
ism dig
tifigig rmgeig. Jcjuitig cjtrchmtis jigig supcrm`r lcrgmkim 2 yimtu hihpu hckiwig erivmtis
dig tcrdipit
tcrdipit pcrecrijig
pcrecrijig pidi scgdm. Qidi pchcrmjsii
pchcrmjsiig
g kil`rit`rm
kil`rit`rmuh
uh dmtchujig
dmtchujig t`tik j`kcstcr`k
j`kcstcr`k
<11 he/dk dig FDK j`kcstcr`k 4? he/dk.
Qidi pchcrm
pchcrmjsi
jsiig
ig Bt-sbi
Bt-sbig,
g, dmtchu
dmtchujig
jig Tigdi
Tigdi huktmp
huktmpkc
kc mgoirj
mgoirj kibugir
kibugir bcrclr
bcrclrmm jmrm,
jmrm,
scliemig `kd kibugir mgoirbtm`g, dmscrtim dcgeig tigdi kibugir bcrclrm jigig. Qcgitikijsigiig
yige dmlcrmjig lcrupi M_OD \ R@K 311 hk/9< nih/M_, mgncjsm `hcpriz`kc 41 he/<4 nih/ M_,
mgncjsm `gdigscgtr`g 4 he/ 6 he/ M_, mgncjsm bmtmbf`kmgc 311 he/9< nih/M_, mgncjsm hcb`likihmg
311 he/9< nih/M_, bk`pmd`erck 9ⅽ53 he, ihk`dmpmgc 9ⅽ91 he dig bigdcsirtig 9ⅽ9? he.
26
LIL _M
DIOTI\ QSRTIJI
9. Umttcgiucr \, Rhmtf K. Msbfichmb igd Fich`rrfiemb Rtr`jc ZMgtcrgctX. <19< Zbmtcd <19=
Iue <?X. Ivimkilkc or`h>
fttps>//www.wf`.mgt/hcdmbmgcs/ircis/prm`rmtyPhcdmbmgcs/LQ?P?Rtr`jc.pdo
<. @gwucjwc M, Czciki-Idmjimlc L. Msbfchmb str`jc igd gcur`pr`tcbtm`g. Igg Hcd Fciktf
Rbm \cs ZMgtcrgctX. <19< Nuk Zbmtcd <19= Iue <?X:<(<)>96?‒=1. Ivimkilkc or`h>
fttps>//pdos.schigtmbsbf`kir.`re/oio=/i2o14cb=i?55o43ci1l2b93l5=?3b6561l96.pdo
2. Jigyik G. Tfc Rbmcgbc `o Msbfchmb Rtr`jc. Mgt N Qfirhi \cs \cv ZMgtcrgctX. <193 Zbmtcd
<19= Iue <?X:4(91)>?3‒64. Ivimkilkc or`h>
fttps>//pdos.schigtmbsbf`kir.`re/oio=/i2o14cb=i?55o43ci1l2b93l5=?3b6561l96.pdo
4. L`cfhc IJ, Cscgwi B, Ckjmgd HR _, Omsfcr H, Midcb`ki B, Ribb` \. Rtr`jc rmsj oibt`rs,
ecgctmbs igd prcvcgtm`g. <195 Zbmtcd <19= Iue <?X: Ivimkilkc or`h>
fttp>//bmrbrcs.ifin`urgiks.`re
3. \ifhig I. Jirijtcrmstmj pcgdcrmti str`jc msjchmj ijut dm \uhif Rijmt Shuh Qusit Finm
Idih Hikmj Hcdig Tifug <19?. <195: Ivimkilkc or`h>
fttp>//rcp`smt`rm.usu.ib.md/lmtstrcih/figdkc/9<243?56=/4639/941911156.pdo0
scqucgbc89&msIkk`wcd8y
?. Niubf CB. Msbfchmb Rtr`jc ZMgtcrgctX. Hcdsbipc. <19= Zbmtcd <19= Iue <5X. Ivimkilkc
or`h> fttps>//chcdmbmgc.hcdsbipc.b`h/irtmbkc/9=9?63<-`vcrvmcw
5. Ucdr` L. Rtr`jc ZMgtcrgctX. HcdmbmgcGct. <19= Zbmtcd <19= Iue <5X. Ivimkilkc or`h>
fttps>//www.hcdmbmgcgct.b`h/str`jcPsyhpt`hsPigdPtrcithcgt/irtmbkc.fth
6. Husuji TD, Umkt`g RL, Tril`uksm H, Fmkk HD. Dmieg`sms igd higiechcgt `o ibutc
msbfchmb str`jc. BHIN ZMgtcrgctX. <193 Rcp 6 Zbmtcd <19= Iue <5X:965(9<)>665‒=2.
Ivimkilkc or`h> fttp>//www.gblm.gkh.gmf.e`v/pulhcd/<?<4269=
=. F`pyig N, Bmirikk` I, D`wkitsfifm D, F`wird Q, N`fg _, ]cuge \, ct ik. Bcrtimgty `o
Rtr`jc Dmieg`sms> Mgbrchcgtik Lcgcomt wmtf BT Qcrousm`g `vcr G`gb`gtrist BT igd BT
Igem`eripfy. \idm`k`ey ZMgtcrgctX. <191 Ipr Zbmtcd <19= Iue <5X:<33(9)>94<‒32.
2=
91. Q`ugevirmg G, _mrmyivcnijuk I, J`h`gtrm B. Rmrmrin str`jc sb`rc igd vikmditm`g study t`
dmstmgeumsf supritcgt`rmik mgtribcrclrik fich`rrfiec or`h mgoirbtm`g. LHN ZMgtcrgctX. 9==9
Nug <= Zbmtcd <19= Iue <6X:21<(?5=<)>93?3‒5. Ivimkilkc or`h>
fttp>//www.gblm.gkh.gmf.e`v/pulhcd/9633149
99. Kihsudmg \. Ike`rmthi str`jc eidnif hidi. 9==?: Ivimkilkc or`h> fttp>//m-
kml.ueh.ib.md/nurgik/d`wgk`id.pfp0ditiMd89116
41
LIL _MM
KIHQM\IG
49