NLVJPLM VKMHLB[N[LM

PHS (Pksperltjry Hestrkss Symhrjak)

Hesusum [mtud Akakmube Xuols Nlpjrlm Emhevehu Vrldtkd Vrjgkse Dkpkrlwltlm

Hkplrtkakm Dkpkrlwltlm Lmld
He Pulmo Ckmhrlwlseb PSH Ehlalm @lmilr`lru

Jnkb9

Mlal9 Aublaalh Lmhrelmmjjr

Lmhrelmmjjr

MEA9 V<?0<00<;<67

VPLDXKD VPJGKSE DKVKPL_LXLM LMLD

VPJOPLA SX[HE VKMHEHEDLM VPJGKSE MKPS
I[P[SLM DKVKPL_LXLM VJNXKDDKS DKAKMDKS ALNLMO
XLB[M LDLHKAED 060</0600
 NKA@LP VKMOKSLBLM

Nlpjrlm Vkmhlbunulm hkmolm PHS ( Pksperltjry Hestrkss Symhrjak) he Pulmo Ckmhrlwlseb

PSH Ehlalm @lmilr`lru. Vkrejhk tlmooln 6< Mjvka`kr 060< s/h <3 Mjvka`kr 060< Xlbum
Ldlhkaed 060<.
Xknlb hesktuiue hlm heslbdlm plhl tlmooln ………………….. 060<

@lmilr`lru, Mjvka`kr 060<

Vrkckptjr Nlblm PS Vrkckptjr Ldlhkaed

MEV/MED. MEV.

Akmoktlbue,
Dkplnl Pulmo ……

MEV/MED.
 NLVJPLM VKMHLB[N[LM

L. Djms
Djmskp
kp Hls
Hlslr
lr
<. Vkmokrtelm
@lyee ylmo
@ly ylmo akmoln
akmolnlae
lae @@NP
@@NP blrus
blrus hepkrb
hepkrblte
ltedlm
dlm plhl
plhl gumose
gumose pkrmlp
pkrmlplslm
lslm,,

dlrkml pkmolt
dlrkml pkmoltur
ur pkrmlp
pkrmlplslm
lslm plhl
plhl `lye
`lye @@NP
@@NP alseb
alseb `knua
`knua skapurm
skapurmll skpkrt
skpkrtee
dkdurlmolm surgldtlm hlm hlplt akmyk`l`dlm PHS plhl `lye. PHS lhlnlb estenlb
ylmo
ylmo `elslm
`elslmyl
yl heouml
heoumldlm
dlm umtud
umtud alslnlb
alslnlb pkmyld
pkmyldet
et hesgum
hesgumose
ose pkrmlp
pkrmlplslm
lslm plhl
plhl
mkjmltus ltlu `lye. Olmooulm eme akrupldlm pkmyldet ylmo `krbu`umolm hkmolm
ealturetls plru skbemool tehld `krdka`lmo hkmolm `led ltlu tehld lhkdultmyl
iuanlb surgldtlm hlnla plru (Alrae & Plblrhij, 06<0). Bln eme hlplt
akmyk`l`dlm `lye akmolnlae pjnl mlpls tehld kgkdteg. Vjnl mlpls tehld kgkdteg
lhlnlb emsprerlse
emsprerlse hlm kdsperlse ylmo tehld aka`kredlm
aka`kredlm vkmtenlse
vkmtenlse ylmo lhkdult
(Xea Vjdil SHDE, 06<7).

Vjnl mlpls tehld kgkdteg plhl `lye hkmolm PHS akrupldlm duapunlm okilnl
ylmo tkrhere hlre hespmkl hlm bepkrpmkl hkmolm grkdukmse pkrmlplslm nk`eb hlre 76
dlne pkr akmet hkmolm selmjses, remteblm, hlm kdsperlse skrtl dknlemlm jtjt – jtjt
pkrmlplslm plhl sllt emsperlse (Dknelt kt ln., 06<2). Vjnl mlpls tehld kgkdteg lhlnlb
pkrmlplslm ylmo slmolt ckplt plhl `lye hkmolm PHS ylmo akmolnlae selmjses
pkrejrln, akremteb wldtu sllt kdsperlse, hlm tkrilhe rktrldse su`strkrmln 5 skrtl
emtkrcjstln.
emtkrcjstln. Dktehld kgkdteglm pjnl mlpls plhl `lye hkmolm PHS yletu tkrilhemyl
tkrilhemyl
emsperlse hlm kdsperlse ylmo tehld aka`kre vkmtenlse skclrl lhkdult.
Semhrjal
Semhrjal ololn mlgls (rksperltjry
(rksperltjry hestrkss
hestrkss semhrja,
semhrja, PHS) lhlnlb estenlb ylmo

heoumldlm umtud hesgumose pkrmlglslm plhl mkjmltus. Olmooulm eme akrupldlm

pkmyldet ylmo `krbu`umolm hkmolm dktkrnla`ltlm pkrdka`lmolm alturetls plru
ltlu tehld lhkdultmyl iuanlb surgldtlm hlnla plru. (Alrae & Plblrhij,06<0).
PHS hesk`ut iuol sk`lole pkmyldet aka`rlm belnem (bylnem aka`rlmk hesklsk,
(BAH)) ltlu pkmyldet plru lde`lt hegesekmse surgldtlm (surglctlmt hkgecekmt numo
heskl
hesklsk
sk (SHN
(SHNH)
H))) (Akt
(Aktll Gk`r
Gk`ree Lore
Loreml
ml,, Lgml
Lgmlme
me Xjye
Xjye`l
`lb,
b, 06
06<7
<7).
). Olmo
Olmoou
oulm
lm
pkrtudlrlm ols lhlnlb dknk`eblm ltlu dkdurlmolm jdseokmlse hlm ltlu kneaemlse
dlr`jmhej
dlr`jmhejdsehl
dsehl plhl aka`rlm
aka`rlm lnvkjnus-dlp
lnvkjnus-dlpenkr
enkr (Xea Vjdil HVV VVME SHDE,
06
06<?
<?).
). Olmo
Olmoou
oulm
lm pk
pkrt
rtud
udlrl
lrlm
m ol
olss akru
akrupl
pldl
dlm
m dk
dklh
lhll
llm
m em
emhe
heve
vehu
hu akmo
akmoln
lnla
laee

pkmurumlm ols `led jdseokm alupum dlr`jm hejdsehl lmtlrl lnvkjne plru hkmolm
sestka vlscunlr, hlplt hepecu jnkb skdrkse ylmo dkmtln ltlu eaj`eneslse lde`lt
 lhlmyl pkmyldet plhl sestka mkurjnjoes, tkrilhe hkprkse plhl susumlm slrlg puslt,
ltlu tkrilhe pkmyldet rlhlmo plhl plru (Au`lrld, 06<;).

0. Ktejnjoe
Vkmyk`l` dkololnlm pkrmlglslm plhl mkjmltus ylmo tkrhere hlre gldtjr e`u,
gldtjr pnlskmtl, gldtjr ilmem hlm gldtjr pkrslnemlm. Gldtjr e`u aknepute bepjdsel

plhl e`u, usel e`u durlmo hlre 06 tlbum ltlu nk`eb hlre 3; tlbum, orlvehl kaplt
ltlu nk`eb, sjseln kdjmjae rkmhlb, alupum pkmyldet pka`unub hlrlb e`u ylmo
akmoolmoou pkrtudlrlm ols ilmem skpkrte bepkrtkmse, pkmyldet ilmtumo, hel`ktks
aknetu
aknetus,
s, hlm nle
nlem-nl
m-nlem.
em. Gldtjr
Gldtjr pnlskm
pnlskmtl
tl aknepu
aknepute
te sjnuse
sjnusej
j pnlskm
pnlskmtl,
tl, pkrhlr
pkrhlrlbl
lblm
m
pnlskmtl, pnlskmtl dkcen, pnlskmtl tepes, pnlskmtl tehld akmkapkn plhl tkapltmyl.
Gldtjr ilmem ltlu mkjmltus aknepute tlne puslt akmua`umo, tlne puslt aknenet
nkbkr, djaprkse tlne puslt lmtlrl ilmem hlm ilnlm nlber, okakne, prkaltur, dknlemlm
djmokmetln plhl mkjmltus hlm nlem-nlem. Gldtjr pkrslnemlm aknepute plrtus nlal,
plrtus hkmolm temhldlm hlm nlem-nlem. Semhrjal ololn mlgls lhlnlb pkrdka`lmolm

ealtur plhl sestka pkrmlglslm ltlu tehld lhkdultmyl iuanlb surgldtlm plhl plru-
plru-plru. Skakmtlrl lgedsel
lg edsel mkjmltjrua akrupldlm olmooulm pkrmlglslm lde`lt
dktehl
dktehldal
dalapu
apulm
lm `lye
`lye `krlhl
`krlhlptl
ptlse
se tkrblh
tkrblhlp
lp lsgedse
lsgedsel.
l. @elslm
@elslmyl
yl alslnl
alslnlb
b eme
hesk`l`dlm
hesk`l`dlm dlrkml lhlmyl
lhlmyl alslnlb-alslnlb
alslnlb-alslnlb dkblaenlm
dkblaenlm hlm plhl sllt pkrslnemlm
pkrslnemlm
(Alrae & Plblrhij, 06<0).
Vkmyk`l` ylmo skremo tkrilhe plhl rksperltjry hestrkss symhrjak (PHS) lhlnlb
durlmo
durlmomy
myll surgldt
surgldtlm
lm plhl
plhl plru-p
plru-plru
lru.. Surgld
Surgldtlm
tlm lhlnlb
lhlnlb clerlm
clerlm ylmo
ylmo aknlpe
aknlpese
se
`loelm hlnla plru-plru. Vlru-plru ilmem aunle aka`ult surgldtlm sknlal
treakstkr dkteol dkblaenlm (aemoou 07 aknlnue pkrslnemlm). Uletu sultu su`stlmse

`loelm hlnla dlmtumo uhlrl he plru-plru. Bln eme ylmo aka`lmtu hlm akmilol
plru-plru tkr`udl skbemool pkalplslm hlplt tkrilhe sktknlb nlber (MBN@E, 06<0).
3. Vltj
Vltjge
gese
sejn
jnjo
joee
Dkolwltlm pkrmlglslm hlplt tkrilhe plhl `lye hkmolm olmooulm pkrmlglslm
ylmo hlplt akmea`undlm
akmea`undlm hlapld
hlapld ylmo cudup `krlt `loe `lye `krupl
`krupl dkrusldlm
dkrusldlm
jtld ltlu `lbdlm dkaltelm. Lde`lt hlre olmooulm plhl sestka pkrmlglslm lhlnlb
tkrilhe
tkrilhemyl
myl dkdurl
dkdurlmol
molm
m jdseok
jdseokm
m (bepjd
(bepjdsel
sel)) plhl
plhl tu`ub
tu`ub `lye
`lye ldlm
ldlm `krlhl
`krlhlptl
ptlse
se
tkrblhl
tkrblhlp
p dkdurl
dkdurlmol
molm
m jdseok
jdseokm
m hkmolm
hkmolm akmold
akmoldtegd
tegdlm
lm aktl`j
aktl`jnes
nesak
ak lmlkrj
lmlkrj`.
`.
Lpl`enl dklhllm bepjdsel skaldem `krlt hlm nlal, aktl`jnesak lmlkrj` ldlm

akmoblsendlm lsla nldtlt.

 Hkmolm
Hkmolm aka`urudyl
aka`urudyl dklhllm lsehjses hlm pkmurumlm
pkmurumlm lnerlm hlrlb dkjtld
dkjtld
aldl ldlm tkrilhe dkrusldlm jtld hlm jrolm nlem dlrkml bepjdsel hlm esdkael.
Vlhll stlheua
Vlh stlheua lwln
lwln tkrilhe
tkrilhe bepkrv
bepkrvkmt
kmtenls
enlsee heedut
heedutee stlheua
stlheua lpmku
lpmku preakr
preakr.. Vlhl
Vlhl
dklhllm eme `lye tlapld selmjses, tktlpe serdunlse hlrlb rknltevk alseb `led. Curlb
ilmtumo ylmo akmemodlt hlm lhlmyl vlsjdjmtredse pkregkr remolm akmea`undlm

pkmemoodltlm tkdlmlm hlrlb hlm rkgnkd `rlhedlrhe remolm. Hkprkse pkrmlglslm

plhl sllt eme hlplt heltlse hkmollm akmemodltdlm eapnus lgkrkm skpkrte
pkrlmoslmolm plhl dunet. Lpmku mjraln `krnlmosumo skdetlr <-0 akmet. Lpmkl
preakr hlplt akalmilmo hlm heedute hkmolm aka`urudmyl sestka serdunlse.
Bepjdsel
Bepjdsel aejdlrheu
aejdlrheua
a hlm lsehjses
lsehjses ldlm akapkr`krlt
akapkr`krlt `rlhedlrhe
`rlhedlrhe,, vlsjdjmtrl
vlsjdjmtrldse
dse
hlm bepjtkmse. Dklhllm eme hlplt tkrilhe slaple ;akmet hlm dkauhelm tkrilhe
lpmku skdumhkr. Sknlal lpmku skdumhkr hkmyut ilmtumo, tkdlmlm hlrlb hlm dlhlr
jdseokm hlnla hlrlb tkrus akmurum. @lye tehld`krkldse tkrblhlp rlmoslmolm hlm
tehl
tehld
d akmu
akmumi
miud
uddl
dlm
m uply
uplyll pkrm
pkrmlg
lgls
lslm
lm sk
skcl
clrl
rl sp
spjm
jmtl
tlm.
m. Dkal
Dkalte
telm
lm ld
ldlm
lm

tkrilhedkculne pkrmlglslm `ultlm hlm pka`krelm jdseokm skokrl heaunle (Alrae

& Plblrhij, 06<0).
 8. Vkak
Vkakre
reds
dsll
llm
m Vkmum
Vkmumil
ilmo
mo
l. Vkakred
Vkakredsllm
sllm LOH hehlplt
hehlplt lhlmyl
lhlmyl bepjdsk
bepjdskael
ael dkauhel
dkauhelm
m bepkrd
bepkrdlpm
lpmee hkmolm
hkmolm
lsehjses rksperltjred.
`. Vkakredsllm rlhejnjoes, aunl-aunl tehld lhl dknlemlm iknls plhl gjtj hlhl,
sktknlb
sktknlb <0-08
<0-08 ila ldlm
ldlm tlapld
tlapld emgent
emgentrltk
rltk lnvkjn
lnvkjnlr
lr tlmpl
tlmpl `ltls
`ltls ylmo
ylmo tkols
tkols

hesknurub plru.
c. @ejpse
@ejpse plru,
plru, tkrhlp
tkrhlplt
lt lhlmyl
lhlmyl pkmouap
pkmouapunl
unlm
m orlmun
orlmunjse
jsett skclrl
skclrl l`mjraln
l`mjraln hlnla
hlnla
plrkmdea plru. (Lnjakhedl, 06<5)
06<5)
;. Vkml
Vkmltl
tlnl
nlds
dslm
lmll
llm
m
Mkjmltus ylmo akmolnlae PHS blrus hetlmolme skckpltmyl lolr tehld
akmea`undlm djapnedlse ylmo tehld heemoemdlm (Gehl & Alyl, 06<0). @kredut
`k`krlpl pkmoj`ltlm ylmo `esl henldudlm9
henldudlm9
l. Nemo
Nemodu
dumo
molm
lm yl
ylmo
mo Jpte
Jpteal
alnn
Subu tu`ub blrus sknlnu heuslbldlm lolr tktlp hlnla `ltls mjraln (37, ; -

3?◧C). [mtud
3?◧C). [mtud akapkrjnkb
akapkrjnkb subu eme, lmld `esl henktlddlm
henktlddlm he hlnla emdu`ltjr.
emdu`ltjr.
Dknka`lplm rulmolm iuol blrus lhkdult, yletu ?6-26%.
`. Vka`krelm Jdseokm
Vka`kr
Vka`krelm
elm jdseo
jdseokm
km blrus
blrus blte-b
blte-blte
lte dlrkml
dlrkml hlplt
hlplt `krpkm
`krpkmolr
olrub
ub djapnk
djapnkds
ds
tkrblhlp `lye ylmo nlber prkaltur. [mtud akmckolb tea`unmyl djapnedlse
tkrsk`u
tkrsk`ut,
t, pka`kr
pka`krelm
elm J0 sk`led
sk`ledmyl
myl hedute
hedute hkmolm
hkmolm pkakred
pkakredsllm
sllm lmlnese
lmlnesess ols
hlrlb. Xkdlmlm ilnlm mlpls pjseteg skclrl djmtemu aknlnue dlmun mlsln umtud
akmckolb dkbenlmolm vjnuak sknlal kdsperlse.
c. Vka`
Vka`kr
krel
elm
m surgl
surgldt
dtlm
lm kds
kdsjo
jokm
km

Dkaliulm
Dkaliu lm tkrldbe
tkrldberr hlnla
hlnla pkmoj`
pkmoj`ltl
ltlmm plsekm
plsekm VAB lhlnlb
lhlnlb pka`kr
pka`krelm
elm
surgldtlm kdsjokm aknlnue kmhjtrld`kln tu`k. J`lt eme tkr`udte slmolt kgkdteg
hlnla akmoj`lte tkrilhemyl PHS.
h. Vka`
Vka`kr
krel
elm
m Lmte
Lmte`e
`ejt
jted
ed
Vka`kr
Vka`krelm
elm lmte`e
lmte`ejte
jted
d `krtui
`krtuiulm
ulm akmcko
akmckolb
lb emgkdse
emgkdse skdumh
skdumhkr.
kr. @lye
@lye hlplt
hlplt
he`kre pkmesenem hkmolm hjses ;.6666-<6.6666 [/do @@/blre hkmolm ltlu tlmpl
okmtlaecem 3-;/do @@/blre.

@. Djmskp
Djmskp Lsu
Lsublm
blm Dkpk
Dkpkrlw
rlwlt
ltlm
lm
 <. Vkmodlielm
Vkmodl
Vkmodliel
ielm
m akrupl
akrupldlm
dlm nlmodl
nlmodlb
b lwln
lwln hlnla
hlnla lsublm
lsublm dkpkrlw
dkpkrlwltl
ltlm
m aknlnu
aknlnuee
pkmhkdltlm prjsks dkpkrlwltlm ylmo `krtuiulm umtud pkmouapunlm hltl ltlu
emgjralse, lmlneses hltl hlm pkmkmtulm pkralslnlblm ltlu helomjses dkpkrlwltlm.
Almgllt
Almgllt pkmodl
pkmodlielm
ielm dkpkrlw
dkpkrlwltl
ltlm
m lhlnlb
lhlnlb aka`lm
aka`lmtu
tu akmoeh
akmoehkmt
kmteged
egedlse
lse stltus
stltus

dk
dkskb
skblt
ltlm
lm,, pj
pjnl
nl pk
pkrt
rtlb
lblm
lmlm
lm dnek
dnekm,
m, dk
dkdu
dult
ltlm
lm skrtl
skrtl akru
akruau
ausd
sdlm
lm he
helo
lomj
mjsl
sl
dkpkrlwltlm ylmo tkrhere hlre teol tlblp yletu pkmouapunlm, pkmoknjapjdlm hlm
pkmojrolmeslselm skrtl akmolmlnesl hlm akruausdlm helomjsl dkpkrlwltlm
(_lbet Eq`ln Au`lrld, hdd 06<;).
l. Pewly
ewlylt
lt Vkm
Vkmyl
ylde
dett
<) Dlie
Dlie re
rewl
wlyl
yltt dk
dkbl
blae
aenl
nlm
m sk
skdl
dlrl
rlmo
mo (l
(lpl
pldl
dlb
b sknla
sknlall bl
blae
aenn e`
e`u
u akmh
akmhkr
kret
etll
bepjtkmse ltlu pkrhlrlblm)
0) Dlie
Dlie rewl
rewlyl
yltt mk
mkjm
jmlt
ltus
us (nlbe
(nlberr lgeds
lgedsel
el ld
lde`
e`lt
lt be
bepj
pjds
dsel
el ld
ldut
ut,, tk
tkrp
rpli
lilm
lm pl
plhl
hl
dklhllm bepjtkrael)

3) Dlie
Dlie Pewl
Pewlyl
yltt dkn
dknul
ulro
roll
8) Dlie
Dlie menle lpolr
lpolr rkmhlb
rkmhlb (`enl
(`enl rkmhlb
rkmhlb he nldud
nlduddlm
dlm temh
temhldl
ldlm
m rksustls
rksustlsee plhl
`lye)
;) Vlhl
Vlhl pkakre
pkakreds
dsll
llm
m ge
gesed
sed ldlm hetka
hetkaud
udlm
lm tl
tlmh
mhll hl
hlm
m ok
okil
ilnl
nl PHS.
PHS. Skpkrt
Skpkrte9
e9
tldepmkl
tldepmkl (=76x/akme
(=76x/akmet),
t), pkrmlplslm
pkrmlplslm akmhkmodu
akmhkmodur,
r, rktrldse
rktrldse hemhemo
hemhemo hlhl,
pkrmlplslm cupemo behumo, puclt, selmjses, lpmkl.
0. Helomjsl
Helomjsl Dkpkrlwltlm ylmo aumodem aumcun
l. H.666<
H.666< @krseblm
@krseblm ilnlm mlpls tehld kgkdteg
kgkdteg `krbu`umolm
`krbu`umolm hkmolm
hkmolm pkmuapudl
pkmuapudlm
m

skdrkt plhl plru-plru

`. H.6663 Olmooulm pkrtudlrlm ols `krbu`umolm hkmolm pkru`lblm aka`rlm
lnvkjnlr-dlpenkr
c. H.666;
H.666; Vjnl mlgls tehld kgkdteg
kgkdteg `krbu`umolm
`krbu`umolm hkmolm
hkmolm bepkrvkmten
bepkrvkmtenlse
lse
h. H.6<36 Bepjtkrael `krbu`umolm
`krbu`umolm hkmolm
hkmolm lhlptlse nemodumolm
nemodumolm nulr rlbea
k. H.6<80
H.6<80 Pesedj emgkdse
emgkdse `krbu`umolm
`krbu`umolm hkmolm
hkmolm prjskhur emvlseg,
emvlseg, tkrplilm dualm
dualm
pltjokm
 Helomjsl
Mj. SNDE SEDE
Dkpkrlwltlm
<. H.666< @krseblm N.6<66< @krseblm Ilnlm Mlgls E.6<
E.6<6<
6<33 Al Almlmlik
ikak
akm m Wkmt
Wkmtenl
enlse
se
ilnlm mlpls tehld Xuiulm9 Akdlmed
kgkdteg `krbu`umolm Sktknlb henldudlm temhldlm J`skrvlse
hkmolm pkmuapudlm dkpkrlwltlm 3x08 ila heblrlpdlm  Vk
Vkre
red
dsl emhe
emheddlse
lse vkm
kmte
tenl
nltj
tjrr
`esl akapkrtlblmdlm ilnlm mlgls akdlmed
akdlm ed (aessln.
(aessln. Dknknl
Dknknlblm
blm jjt
skdrkt plhl plru-
tktlp pltkm. Hkmolm dretkrel blsen. ml
mlgl
gls,
s, hesg
hesgum
umos
osee mk
mkur
urjn
jnjo
joes
es,,
plru
Dretkrel blsen9 lsehjses lsperltjred).
<. Vrjhudse sputua akmurum  Ajmetjr kgkd vkmtenltjr tkrblhlp
hkmolm sdlnl ;. stltus jdseokmlse (aessln. @umye
0. Akmo
Akmoee akmu
akmuru
rumm hkmo
hkmolm
lm sdl
sdlnl
nl plru, x rly plru, LOH, SlJ0,
;. SvJ0, KXCJ0, rkspjm su`ykdteg
3. _bkkzem emoo akmurum hkmolm plsekm).
sdlnl ;.  Ajme
Aj metj
tjrr dre
dretkr
tkrel pkr
krnu
num
myl
8. Akdjmeu eua
a (plhl mkjmltus) pkmylpeblm vkmtenltjr.
akmurum hkmoml sdlnl ;.  Ajmetjr kgkd mkoltevk vkmtenltjr
;. GrGrkd
kdkm
kmse
se mlgl
mlglss hlm pjn
pjnll mlgl
mlglss (aessln. Hkvelse trldkl,
aka`led hkmolm sdlnl ;. `lrjtrlual, vjutrlual,
pkmurumlm curlb ilmtumo,
hestkmse olstk
stkr, kageskal
su`dutlm).
 Ajme
Aj metj
tjrr okokil
ilnl
nl pkpkme
memo
modldltl
tlm
m
pkrmlplslm (aessln.
Vkme
Vkmemo
modl
dltl
tlm
m hk hkmy
myut
ut ilmt
ilmtum
umoo
ltlu
ltlu pkrmlp
pkrmlplsllslm,
m, pkmemo
pkmemodlt
dltlm
lm
tkdl
tkdlml
mlm
m hlrlhlrlb,b, help
helpbj
bjrk
rkse
ses,
s,
pkru`lblm stltus akmtln).
 Ajmetjr djmhese ylmo
akmemodltdlm djmsuase
jdseo
seokm (aess
essln. Hkala,
akmooeoen, dkilmo, hlm mykre).
 Ajmetjr olmooulm audjsl jrln,
mlsln, trldkl, hlm nlremo.
Xkrlpkuted9
 Ltur pjsese 86-76 hkrlilt umtud
akmckolb lsperlse.

Pk
Pkpj
pjses
sesee pl
plsek
sekm
m sk
sktel
telpp 0 il
ila,
a,
iedl pkrnu
 Nl
Nlddud
udlm
lm pkr
krlw
lwlt
ltlm
lm au
aunu
nutt
skclrl rutem, tkralsud sedlt oeoe
sktelp <0 ila
 Nldudl
Nld udlm m gesejt
gesejtkrl
krlpe
pe hlhl,
hlhl, ied
iedll
pkrnu
 Nldu
Nldudldlmm pk pkmo
mobe
besl
slpl
plmm nkmh
nkmhkr
kr
sksule dk`utublm
 Olmte serduet vkmtenltjr sktelp 08
ila ltlu sksule prjtjcjn
 Selp
Selpdl
dlmm `lo lov
vlnvk
lnvk alsd
alsd he
sl
slap
apem
emo
o tkap
tkapltlt tehu
tehurr umtu
umtudd
lmteseplse alngumose aksem


@kredlm a(aessln.
`krdjaumedlse khel umtud
Dkrtls,
punpkm)
  Hjduakmtlsedlm rkspjm
tkrblhlp vkmtenltjr
Djnl`jrlse
 Djnl
Dj nl`j
`jrl
rlee pkaen
kaeneb
eblm
lm aj
ajhkhk
vkmt
vkmten
enlt
ltjr
jr (a
(aes
essl
sln.
n. Cjmt
Cjmtrj
rjnn
vjnuak
vjnuak,, cjmcjmtrj
trjnn tkdlml
tkdlmlm m ltlu
ltlu
ol`umolm)
 Djnl
Dj nl`j
`jrl
rlse
se pka`
pka`krkrel
elm
m lokm
lokm
pknuapub jtjt, skhltevk,
lmlnoksec, sksule dk`utublm
 Djnl`jrlse pkmooumllm VS ltlu
VKKV
VK KV umtu
umtudd akakae
aeme
meal
alnd
ndlm
lm
bepjvkmtenlse lnvkjnus.
0. H.6663 Olmooulm N.6<663 Vkrtudlrlm Ols E.6<607 Xkrlpe Jdseokm
pkrtudlrlm ols Xuiulm9 J`skrvlse9
`krbu`umolm hkmolm Sktknlb henldudlm temhldlm  Ajmetjr dkckpltlm lnerlm
pkru`lblm aka`rlm dkpkrlwltlm 3x08 ila heblrlpdlm jdseokm
olmooulm pkrtudlrlm ols akmurum,  Ajmetjr pjsese lnlt tkrlpe
lnvkjnlr-dlpenkr
hkmolm dretkrel blsen. jdseokm
Dretkrel Blsen9  Ajmetjr lnerlm jdseokm
<. Xemo
Xemodl
dltt dksl
dkslhl
hlrlrlm
m aka`
aka`le led
d skclrl pkrejhec hlm plstedlm
hkmolm sdlnl ;. grldse ylmo he`kredlm cudup
0. Hespmkl
Hespmkl akmurum
akmurum hkmolm
hkmolm sdlnl 

;. Ajmetjr
jdsjokm kgkdtegetls
(aessln. tkrlpe
Jdseaktre,
3. Xl
Xlde
dedl
dlrh
rhee aka`l
ka`led ed hk hkm
mol
olmm Lmlnesl ols hlrlb), iedl pkrnu
sdlnl ;.  Ajmetjr dkalapulm
8. Vj
Vjnl
nl ml
mlgl
glss aka`
aka`le led
d hkmo
hkmolm
lm aknkplsdlm jdseokm sllt aldlm
sdlnl ;.
 Ajmetjr tlmhl-tlmhl
;. _lrm
_lrmll dudunet
net aka`
aka`le led
d hkhkmo
molm
lm
bepjvkmtenlse
sdlnl ;.
 Ajmetjr tlmhl hlm okilnl
tjdsedlse jdseokm hlm ltknkctlses
 Ajmetjr temodlt dkckalslm
lde`lt tkrlpe jdseokm
 Ajmetjr emtrkoetls audjsl
behumo lde`lt pkalslmolm
jdseokm
Xkrlpkuted9
 @krsebdlm skcrkt plhl
aunut, behumo hlm trldkl, iedl
pkrnu
 Vkrtlblmdlm dkpltkmlm
ilnlm mlgls
 Selpdlm hlm ltur pkrlnltlm
pka`krelm jdseokm
 @kredlm jdseokm tla`lblm,
iedl pkrnu
 Xktlp `kredlm jdseokm sllt
plsekm hetrlmspjrtlse
 Oumldlm pkrlmodlt jdseokm
ylmo sksule hkmolm temodlt
aj`enetls plsekm
Khudlse
 Lilrdlm plsekm hlm
 dknulrol clrl akmooumldlm
jdseokm he rualb
Djnl`jrlse
Djnl`j
Djn l`jrlse
rlse pkm
pkmkmt
kmtulm
ulm hjses
hjses
jdseokm
djnl`jrlse pkmooumllm
jdseokm sllt ldtevetls hlm/ltlu
tehur
3. H.666; Vjnl mlgls N.6<668 Vjnl Mlpls E.6<
E.6<6<
6<33 Al Almlmlik
ikak
akm m Wkmt
Wkmtenlenlse
se
tehld kgkdteg Xuiulm9 Akdlmed
`krbu`umolm hkmolm Sktknlb henldudlm temhldlm J`skrvlse
bepkrvkmtenlse dkpkrlwltlm 3x08 ila heblrlpdlm  Vk
Vkre
red
dsl emhe
emheddlse
lse vkm
kmtetenl
nltj
tjrr
pjnl mlpls aka`led, hkmolm akdlmed (aessln. Dknknlblm jtjt
dretkrel blsen. ml
mlgl
gls,
s, hesghesgum
umososee mk
mkur
urjn
jnjo
joes
es,,
Dretkrel Blsen9 lsehjses lsperltjred).
<. Wkmt
Wkmtenenls
lsee skskak
akme
mett akme
akmemo
modl
dltt  Ajmetjr kgkd vkmtenltjr tkrblhlp
hkmolm sdlnl ;. stltus jdseokmlse (aessln. @umye
0. Hespmkl
Hespmkl akmurum
akmurum hkmolm
hkmolm sdlnl plru, x rly plru, LOH, SlJ0,
;. SvJ0, KXCJ0, rkspjm su`ykdteg
3. Vkmo
Vkmoououml
mllmlm jt
jtjt
jt `l`lmt
mtu
u ml
mlpl
plss plsekm).
akmurum hkmolm sdlnl ;.  Ajme
Aj metj
tjrr dre
dretkr
tkrel pkr
krnu
num
myl
8. Grkdukmse mlpls aka`led pkmylpeblm vkmtenltjr.
hkmolm sdlnl ;.  Ajmetjr kgkd mkoltevk vkmtenltjr
;. Dkhl
Dkhlnl nlal
alm m mlp lpls
ls aka`lka`led
ed (aessln. Hkvelse trldkl,
hkmolm sdlnl ;. `lrjtrlual, vjutrlual,
pkmurumlm curlb ilmtumo,
hestkmse olstk
stkr, kageskal
su`dutlm).
 Ajme
Aj metj
tjrr okokil
ilnl
nl pkpkme
memo
modldltl
tlm
m
pkrmlplslm (aessln.
Vkme
Vkmemo
modldltl
tlm
m hk hkmy
myut
ut ilmt
ilmtum
umoo
ltlu
ltl u pkrmlp
pkrmlplsllslm,
m, pkmemo
pkmemodltdltlm
lm
tkdl
tkdlml
mlmm hlrlhlrlb,b, help
helpbjbjrk
rkse
ses,
s,
pkru`lblm stltus akmtln).
 Ajmetjr djmhese ylmo
akmemodltdlm djmsuase
jdseo
seokm (aess
essln. Hkala,
akmooeoen, dkilmo, hlm mykre).
 Ajmetjr olmooulm audjsl jrln,
mlsln, trldkl, hlm nlremo.
Xkrlpkuted9
 Ltur pjsese 86-76 hkrlilt umtud
akmckolb lsperlse.
 Pk
Pkpj
pjses
sesee pl
plsek
sekm
m sk
sktel
telp
p 0 il
ila,
a,
iedl pkrnu
 Nl
Nlddud
udlm
lm pkr
krlw
lwltltlm
lm au
aunu
nutt
skclrl rutem, tkralsud sedlt oeoe
sktelp <0 ila
 Nldudl
Nld udlm m gesejt
gesejtkrl
krlpe
pe hlhl,
hlhl, ied
iedll
pkrnu
 Nldu
Nldudldlmm pkpkmo
mobe
besl
slpl
plmm nkmh
nkmhkr
kr
sksule dk`utublm
 Olmte serduet vkmtenltjr sktelp 08
ila ltlu sksule prjtjcjn
  Selp
Selpdl
dlmm `lo
lovvlnvk
lnvk alsd
alsd he
sl
slap
apememo
o tkap
tkaplt
lt tehu
tehurr umtu
umtud
d
lmteseplse alngumose aksem
 @kredlm akhel umtud
`krdjaumedlse (aessln. Dkrtls,
punpkm)
 Hjduakmtlsedlm rkspjm
tkrblhlp vkmtenltjr
Djnl`jrlse
 Djnl
Dj nl`j
`jrl
rlee pkaen
kaeneb
eblm
lm aj
ajhkhk
vkmt
vkmten
enlt
ltjr
jr (a
(aes
essl
sln.
n. Cjmt
Cjmtrj
rjnn
vjnuak
vjn uak,, cjmcjmtrj
trjnn tkdlml
tkdlmlm m ltlu
ltlu
ol`umolm)
 Djnl
Dj nl`j
`jrl
rlse
se pka`
pka`kr krel
elm
m lokm
lokm
pknuapub jtjt, skhltevk,
lmlnoksec, sksule dk`utublm
Djnl`jrlse pkmooumllm VS ltlu
VKKV umtud akaemealndlm
bepjvkmtenlse lnvkjnus.
8. H.6<36 Bepjtkrael N.<8<3; Xkrajrkounlse Mkjmltus E.<8;?2 Pkounlse Xkapkrltur
`krbu`umolm hkmolm Xuiulm9 J`skrvlse9
lhlptlse nemodumolm Sktknlb henldudlm temhldlm  Ajmetjr subu `lye slaple
dkpkrlwltlm 3x08 ila heblrlpdlm stl`en (37,;C-3?,;C)
nulr rlbea Subu
Sub u plhl
plhl `ltls
`ltls mjraln
mjraln,, hkm
hkmolm
olm  Ajmetjr subu tu`ub lmld
dretkrel blsen. telp hul ila, iedl pkrnu
Dretkrel Blsen9  Ajmetjr tkdlmlm hlrlb,
<. Akmooeo eoeen akmurum hkmolm grkdukmse pkrmlplslm hlm mlhe
sdlnl ;.  Ajmetjr wlrml hlm subu
0. Su Subbu tu`ub
tu`ub akm
akmu uru
rum
m hkmo
hkmolm
lm dunet
sdlnl ;.  Ajmetjr hlm cltlt tlmhl hlm
3. Subu dunet akmurum hkmolm okilnl bepjtkrael ltlu
sdlnl ;. bepkrtkrael
8. Grkdukmse mlhe akmurum Xkrlpkuted9
hkmolm sdlnl ;.
 Vlslmo lnlt pkalmtlulm
subu djmtemu, iedl pkrnu
 Xemodltdlm lsuplm clerlm
hlm mutrese ylmo lhkdult
 @khjmo `lye skokrl sktknlb
nlber umtud akmckolb
dkbenlmolm plmls
 Alsuddlm `lye @@NP dk
hlnla pnlstec skokrl sktknlb
nlber (aessln. @lblm
pjnyktbynkmk, pjnyurktblmk)
 Oumldlm tjpe `lye umtud
akmckolb dkbenlmolm plmls
plhl `lye `lru nlber
 Xkapltdlm `lye `lru nlber
he `lwlb rlhelmt wlrakr
 Vkrtlblmdlm dknka`l`lm
emcu`ltjr ;6% ltlu nk`eb umtud

akmourlmoe
dlrkml prjsksdkbenlmolm
kvlpjrlse plmls
  Ltur subu emcu`ltjr sksule
dk`utublm
 Blmoltdlm tkrnk`eb hlbunu
`lblm-`lblm ylmo ldlm djmtld
djmtld
hkmolm `lye (aessln. Skneaut,
dlem `khjmolm, stktjsdjp)
 Bemhlre aknktlddlm `lye he
hkdlt ikmhknl tkr`udl ltlu he
lrkl lnerlm pkmhemoem rulmolm
ltlu depls lmoem
 Oumldlm altrls
pkmoblmolt, skneaut blmolt, hlm
pkmoblmolt rulmolm umtud
akmleddlm subu tu`ub, iedl
pkrnu
 Oumldlm Dlsur pkmhemoem,
wltkr cercunltemo `nlmdkts, eck
plcd ltlu okn plh hlm
emtrlvlscunlr cjjnemo
cltbktkrezltejm umtud
akmurumdlm subu tu`ub
 Sksuledlm subu nemodumolm
hkmolm dk`utublm plsekm
Khudlse
 Iknlsdlm clrl pkmckolblm
bklt kxblustejm hlm bklt strjdk
 Iknlsdlm clrl pkmckolblm
bepjtkrae dlrkml tkrplplr uhlrl
hemoem
 Hkajmstrlsedlm Xkdmed
pkrlwltlm aktjhk dlmouru
(VAD) umtud `lye @@NP
Djnl`jrlse
Djnl`jrlse pka`krelm
lmteperkted, iedl pkrnu
;. H.6<80 Pesedj N.<8<3? Xemodlt emgkdse E.<8;35 Vkmckolblm Emgkdse
emgkdse `krbu`umolm Xuiulm 9 J`skrvlse9
hkmolm prjskhur Sktknlb henldudlm temhldlm lsublm 
Ajmetj
Ajme tjrr tlmh
tlmhll hl
hlmm okokil
ilnl
nl
emvlseg, tkrplilm dkpk
dkpkrl
rlwl
wltl
tlm
m he hebl
blrl
rlpd
pdlm
lm temo
temodl
dltt emgkdse njdln hlm sestkalted
emgkdsem `esl akmurum hkmolm Xkrlpkuted9
dualm pltjokm
dretkrel blsen.  @ltlse iuanlb pkmoumiumo
Dretkrel Blsen 9  @kredlm pkrlwltlm dunet plhl
<. Dk`k
Dk`krrse
sebl
blm
m tl
tlm
mol
olm
m akm
akmemod
emodllt lrkl khkal
hkmolm sdlnl ;.  Cuc
ucee tlmo
tlmolm
lm sksk`k
`knu
nua
a hlm
0. Dk`krseb seblm `lhlm akmemo emodlt sksuhlb
sksuhl b djmtld hkmolm plsekm
hkmolm sdlnl ;. hlm nemodumolm plsekm
3. Mlgsu aldlm akmemodlt  Vkrt
Vkrtlb
lblm
lmdl
dlm
m tkdm
tkdmed
ed lskp
lskpted
ted
hkmolm sdlnl ;. plhl plsekm `kresedj temooe
8. Hkal
Hkala a akmu
akmuru
rum
m hkmo
hkmolm
lm sdln
sdlnll Khudlse9
;. Ik
Iknl
nlsd
sdlm
lm tlmh
tlmhll hlm
hlm okil
okilnl
nl

;. Dkakrlblm akmurum hkmolm
emgkdse
sdlnl ;.

7. Mykre akmurum hkmolm sdl sdlnl Lilrdlm clrl akmcuce tlmolm
Lilrdlm
hkmolm `kmlr
;.
?. @kmodld akmurum hkmolm  Lilrdlm ktedl `ltud
sdlnl ;.  Lilrdlm clrl akakredsl
djmhese nudl ltlu nudl jpkrlse
 Lmiurdlm akmemodltdlm
lsuplm mutrese
 Lmiurdlm akmemodltdlm
lsuplm clerlm
Djnl`jrlse9

Djnl`jrlse pka`krelm
eaumeslse, iedl pkrnu
 HLGXLP V[SXLDL

Loreml
Loreml,, A. G., Xjye`l
Xjye`lb,
b, L., & Iuprey
Iupreyjmj
jmj.. (06<7)
(06<7).. Xemodl
Xemodltt Dkilhe
Dkilhelm
lm Pksper
Pksperltj
ltjry
ry
Hestrkss Symhrjak
Symhrjak (PHS)
(PHS) Lmtlrl @`nr Vrktkra Hlm @`nr Hesaltur. Iurmln
Slem Wktkremkr, 3(0), <0;–<3<.
Mjvetlslre, L., Butlae, A. S., & Vrestyl, X. U. P. (0606). Vkmckolblm hlm
Vkmokm
Vkmokmhln
hlnelm
elm @@NP
@@NP He Emhjmk
Emhjmksel9
sel9 Systka
Systkaltec
ltec Pkvekw
Pkvekw.. Vkmckolblm Hlm
Vkmokmhlnelm @`nr He Emhjmksel,
Emhjmksel, 0(3), <?;–<20.
bttp9//hje.wenky.cja/<6.<660/<87;<2;2.CH6<3;?8
VVME, 06<?. Stlmhlrt Helomjses Dkpkrlwltlm Emhjmksel9 Hkgemese hlm Emhedltjr
Helomjsted, Khese <. Ildlrtl 9 HVV VVME
VVME, 06<5. Stlmhlrt Nulrlm Dkpkrlwltlm Emhjmksel9 Hkgemese hlm Cretkrel Blsen
Dkpkrlwltlm Khese <. Ildlrtl 9 HVV VVME
VVME, 06<2. Stlmhlrt Emtkrvkmse Dkpkrlwltlm Emhjmksel9
Emhjmksel9 Hkgemese hlm Xemhldlm
Dkpkrlwltlm, Khese <. Ildlrtl 9 HVV VVME
Ujskgl Aje, A. (06<5). Lsdkp Vlhl @lye My. X Hkmolm PHS herulmolm MBC[
PS[H Vrjg.HP._.Y. Ijblmks Duplmo. Ijurmln jg Cbkaecln Emgjraltejm lmh
Ajhknemo, ;3
;3((5), <725–<755.
bttp9//rkpjsetjry.pjntkdksduplmo.lc.eh/;78/</DXEZALPEL
bttp9//rkpjsetjry.pjntkdksduplmo.lc.eh/;78/</DXEZALPEL UJSKGL AJE.phg
Suhlrte & Gluzelb. (06<3). Lsublm Mkjmltus Pksedj Xemooe hlm Dkolwltlm. Cktldlm
E. Ujoyldlrtl9 Mubl akhedl