Infarto Agudo de Miocardio

 

Gkiartl aeuf aeufll fn hg hglcar lcarfgl fgl Nj gkiartl aeufl fn hglcarfgl  («aeufl² sgekgigca ‐sýogtl‗, hgl hgl   ‐hýscujl‗ y carfgl carfgl   ‐clrazók‗), irncunktnhn irncunk tnhnktn ktn aornvgafl clhl GAH  l GHA, y clklcgfl nk nj jnkeuamn jnkeuamn cljlqugaj cljlqugaj clhl parl , ataqun rnijnma ijnma carfgacl carf gacl carfga cl  l prlvlcafa gkiartl gkiar tl, rn hunr hunrtn tn fn cçjujas carfgacl carfèacas plr gsqunhga rnsujtaktn fnj fnsnqugjgorgl nktrn fnhakfa fnha kfa y nj aplrtn fn rgnel sakeuèknl  sakeuèknl   plr cgrcujacgók cgrcu jacgók clrlkarga.1 ?   

Gkiartl aeufl fn hglcarfgl

ja ja ja ja

Ja prgkcgpaj prgkcgpaj causa ns ja ja nkinrhnfaf fn jas artnrgas clrlkargas clk rgnel sakeuèknl gksuigcgnktn, qun prlfucn fañl tgsujar nk uka partn fnj clrazók clrazók prlfucgfl plr ja lostruccgók nk uka fn jas artnrgas clrlkargas, irncunktnhnktn plr ruptura fn uka pjaca pjaca fn atnrlha vujknraojn. Ja  Ja  gsqunhga gsqunhga l suhgkgstrl fnigcgnktn fn lxèenkl qun rnsujta fn taj lostruccgók prlfucn ja akegka fn pnc`l, qun sn rncakajgza rncakajgz prnclzhnktn, kl prlfucn hunrtn fnjsgtnmgfl carfèacla, carfèacl, hgnktras hgnk tras qun sg sn haktgnkn ja aklxga (iajta (iajta fn fn lxèenkl lxèen kl nk uk tnmgfl) l `gplxga (fgshgkucgók (fgshgkuc gók fnj fnj suhgkgstrl suhg kgstrl fn lxèenkl), sn prlfucn ja jnsgók jnsgók fnj fnj hglcarfgl y igkajhnktn ja kncrlsgs, ns fncgr, nj nj gkiartl. gkiart l. Nj gkiartl aeufl fn hglcarfgl ns ja prgkcgpaj causa causa fn hunrtn fn `lhorns y humnrns nk tlfl nj hukfl. 3   Ja iacgjgfaf iacgjgfaf fn  fn prlfucgr arrgthgas, iukfahnktajhnkt iukfahnktajhnktnn ja igorgjacgók vnktrgcujar, ns ja causa hás irncunktn irncunktn fn hunrtn nk nj gkiartl aeufl fn hglcarfgl nk jls jl s 6 prghnrls hgkutls,   razók plr ja qun nxgstn ja tnkfnkcga a cljlcar fnsigorgjaflrns nxtnrkls autlhátgcls nk juearns pýojgcls clkcurrgfls.

 

Fgaeraha fn uk gkiartl aeufl aeufl f fn n hglcarfgl h glcarfgl (?)  (?) nk ja pukta fn ja parnf aktnrglr fnj fnj clrazók (uk gkiartl apgcaj ) junel fn ja lcjusgók (1) fn uka u ka fn jas rahas fn ja artnrga clrlkarga gzqugnrfa (JCA), (JCA), artnrga clrlkarga fnrnc`a (_CA). (_CA).

Nspncgajgfaf

carfgljleèa Sgkókghls Sgkó kghls

Gkiartl Ataqun aj clrazók Ataqun carfgacl  Av  Avgsl hç hçfgc fgcl

Jls prgkcgpajns rgnsels qun prnfgsplknk a uk gkiartl slk ja atnrlscjnrlsgs u ltra nkinrhnfaf fn jas clrlkargas, aktncnfnktns fn akegka fn pnc`l, fn uk gkiartl aktnrglr l fn trastlrkls fnj rgthl carfèacl, asè clhl ja nfaf, prgkcgpajhnktn nk `lhorns haylrns fn 64 añls y humnrns haylrns fn >4 añls. Cgnrtls `áogtls hlfgigcaojns, clhl taoaqugshl, clksuhl nxcnsgvl fn onogfas ajcl`ójgcas, lonsgfaf y kgvnjns ajtls fn nstrçs tahogçk clktrgouynk sgekgigcatgvahnktn sgekgigcatgvahnktn a u uk k haylr rgnsel fn f n tnknr uk gkiartl.> 9    ^k gkiartl aeufl fn hglcarfgl ns uka nhnrenkcga hçfgca plr fnigkgcgók y sn fnon ouscar atnkcgók hçfgca gkhnfgata. Jas fnhlras slk uk nrrlr eravn qun clora hgjns fn vgfas cafa añl. Nj prlkóstgcl vgtaj fn uk pacgnktn clk gkiartl fnpnkfn fn ja nxtnksgók fnj hgshl (ns fncgr, ja caktgfaf fn hýscujl carfèacl pnrfgfl clhl clksncunkcga fn ja iajta fn grrgeacgók sakeuèkna) y ja rapgfnz fn ja atnkcgók rncgogfa.

 

Ns ja causa hás irncunktn, pnrl kl ja ýkgca, fn hunrtn sýogta carfèaca, hnfgaktn jas rninrgfas arrgthgas. Nj cuafrl ns fn uk parl carfèacl. Sgk nhoarel, nk ja haylr partn fn jls casls `ay actgvgfaf njçctrgca nk nj clrazók, cuyl parl punfn rnvnrtgrsn clk uka fnsigorgjacgók prnclz.

Èkfgcn Ja cuarta fnigkgcgók ukgvnrsaj fnj gkiartl Gkiartl aeufl fn hglcarfgl n gksuigcgnkcga  carfèaca  Npgfnhgljleèa  Ntgljleèa  Vrlhol y çholjl Iactlrns fn rgnsel Iactlrns fn prltnccgók Tatljleèa  @gstlpatljleèa

Gkiartl fn hglcarfgl

Cuafrl cjèkg c jèkgcl cl Nxahnk ièsgcl Fljlr tlrácgcl Fgigcujtaf rnspgratlrga Sgekls eravns Nk jas humnrns Gkiartls Gkiar tls sgk fljlr l sgk l ltrls trls sèkt sèktlhas lhas

Fgaekóstgcl Crgtnrgls fn fgaekóstgcl Harcaflrns carfèacls Akegleraièa Fgaekóstgcl fginrnkcgaj Vratahgnktl Cugfafls gkhnfgatls Gktnrvnkcgók Gktnr vnkcgók clrlkarga pnrcutákna Trlkóstgcl y clhpjg cl hpjgcacglkns cacglkns Yçasn tahogçk _ninrnkcgas Nkjacns nxtnrkls

Ja cuarta fnigkgcgók ukgvnrsaj fnj gkiartl Nk nj añl ?410 ja Slcgnfaf Nurlpna fn Carfgljleèa R1X (`ttps=//www.nscarfgl.lre/) puojgcó nj clksnksl slorn ja cuarta fnigkgcgók ukgvnrsaj fnj gkiartl fn hglcarfgl. 5   Nj tçrhgkl gkiartl aeufl fn hglcarfgl sn fnon usar cuakfl `aya fañl hglcárfgcl aeufl clk nvgfnkcga cjèkgca fn gsqunhga hglcárfgca aeufa. Ja

 

fnigkgcgók ukgvnrsaj clktnhpja cgkcl tgpls fn gkiartl fnj f nj hglcarfgl.

Gkiartl aeufl aeufl fn hglcarfgl n ggksu ksuigcgn igcgnkcga kcga carfèaca  Gkiartl aeufl fn hglcarfgl  Gkiartl hglcarfgl   n gksuigcgnkcga carfèaca  carfèaca  kl slk tçrhgkls sgkókghls. Nk ja gksuigcgnkcga carfèaca nxgstn uk trastlrkl fnj olhonl sakeuèknl, jl cuaj, nk cgnrtls casls, punfn snr nj rnsujtafl fn uk gkiartl. Sg ja gksuigcgnkcga carfèaca sn prlfucn fn ilrha sýogta, nk nj gkiartl nxtnksl punfn jjnvar a uk nfnha aeufl fn pujhók clk uka gktnksa fgskna l a`lel fnj pacgnktn. Jls sèktlhas uk gkiartlcunjjl, aeufl nspajfa, fn hglcarfgl gkcjuynk fljlr supnrglrns fn pnc`l (prnflhgkaktnhnktn lprnsgvl qun punfn grrafgarsn a jlscjásgcls `lhorls,fnhakfèouja, npgeastrgl, hgnhorls orazl gzqugnrfl) y rnstl fnj tórax aktnrglr, fgigcujtaf rnspgratlrga, vóhgtls, káusnas, pajpgtacglkns, suflracgók y aksgnfaf. Tlr jl enknraj, jls sèktlhas nk jas humnrns fgignrnk fn jls sèktlhas nk jls `lhorns, aukqun cnrca fn uk cuartl fn jls casls slk asgktlhátgcls. Ja atnkcgók aj pacgnktn qun prnsnkta uk cuafrl suscnptgojn fn snr uk gkiartl fnon snr prglrgtarga, nstakfl nk jls sgstnhas fn trgamn clhl uka atnkcgók fn háxghl kgvnj. Nk ja atnkcgók hçfgca fn urenkcga, qun gkcjuyn lxgenkltnrapga, aspgrgka y ejgcnrgj trgkgtratl. Nj ajgvgl fnj fljlr sn jlera cjásgcahnktn clk ja hlrigka. 0   Nj ajgvgl fnj fljlr ns prghlrfgaj, ya qun nj fljlr auhnkta ja aksgnfaf y ja actgvgfaf fnj sgstnha knrvglsl autóklhl, prlvlcakfl auhnktl fnj traoaml y fnhakfa fn lxèenkl plr partn fnj clrazók. 7  

Npgfnhgljleèa Nj gkiartl aeufl fn hglcarfgl ns ja prnsnktacgók hás irncunktn fn ja carfglpatèa gsquçhgca. Ja LHS nstghó qun nk nj añl ?44? nj 1?,9 % fn jas hunrtns a kgvnj hukfgaj sn fnognrlk a uka carfglpatèa gsquçhgca, 3  qun ns ja prgkcgpaj causa fn hunrtn nk paèsns fnsarrljjafls y ja tnrcnra causa fn hunrtn nk paèsns nk vèas fn fnsarrljjl, fnspuçs fnj sgfa n gkinccglkns rnspgratlrgas rnspgratlrgas oamas.14   Nk paèsns fnsarrljjafls clhl Nstafls ^kgfls, jas hunrtns plr carfglpatèas slk hás kuhnrlsas qun ja hlrtajgfaf plr cákcnr.11  Jas clrlkarglpatèas causak uka fn cafa cgkcl hunrtns nk jls Nstafls ^kgfls y flkfn hás fn uk hgjjók fn pnrslkas suirnk uk ataqun clrlkargl cafa añl, fn jas cuajns uk 64 % hlrgrá clhl clksncunkcga fnj gkiartl.1?   Fn hlfl qun uk nstaflukgfnksn hlrgrá cafa hgkutl fn uk nvnktl clrlkargl patljóegcl. Vahogçk sn prnsnktak nk nj pacgnktn qun kl sn atgnkfn uka eastrgtgs qun `a careafl plr uk tgnhpl fntnrhgkafl y nk nj pacgnktn qun nstá slhntgfl a nstrçs clkstaktn. Nk ja Gkfga, ja nkinrhnfaf carfglvascujar ns ja prgkcgpaj causa fn hunrtn.13  Nk nstn paès, uk tnrcgl fn jas hunrtns furaktn nj añl ?445 sn fnognrlk a uka u ka nkinrhnfaf carfglvascujar, carfglvascujar, cgira qun sn nspnra auhnktará fn uk hgjjók nk 1774 y 1,9 hgjjlkns nk ?4442 a fls hgjjlkns para nj añl ?414. 16 1>   19    

Ntgljleèa Nj gkiartl aeufl fn hglcarfgl sn prnsnkta nk pacgnktns clk carfglpatèa gsquçhgca, ya sna nk aqunjjls qun ya saoèak qun pafncèak nsta nkinrhnfaf y rncgoèak tratahgnktl plr njja, l clhl npgslfgl gkgcgaj fn ja patljleèa. Sunjn nstar prncnfgfl plr aktncnfnktns fn akegka gknstaojn, klhorn qun rncgonk jls npgslfgls fn fljlr tlrácgcl qun sn `acnk hás irncunktns, hás furafnrls, qun aparncnk clk nsiunrzls hnklrns qun nk ja nvljucgók prnvga l qun kl cnfnk clk ja hnfgcacgók `aogtuaj. Nj hglcarfgl (nj hýscujl fnj clrazók), suirn uk gkiartl cuakfl nxgstn uka nkinrhnfaf clrlkarga avakzafa. Nk enknraj nstl sn prlfucn cuakfl uka pjaca fn atnrlha qun sn nkcunktra nk nj gktnrglr fn uka artnrga clrlkarga sn ujcnra l sn rlhpn, causakfl uka lostruccgók aeufa fn nsn vasl.

 

Ja clrlka fn vasls sakeuèknls qun jjnvak lxèenkl y kutrgnktns aj prlpgl hýscujl carfèacl (artnrgas ( artnrgas clrlkargas)) punfn fnsarrljjar pjacas fn atnrlha, jl qun clhprlhntn nk haylr l hnklr erafl nj ijuml fn clrlkargas lxèenkl y kutrgnktns aj prlpgl clrazók, clk ninctls qun varèak fnsfn uka akegka fn pnc`l (cuakfl ja gktnrrupcgók fnj ijuml fn sakern aj clrazók ns tnhplraj), a uk gkiartl aeufl fn hglcarfgl (cuakfl ns pnrhaknktn n grrnvnrsgojn). grrnvnrsgojn).

Vrlhol Vr lhol y çholjl Ja prnsnkcga fn artnrglscjnrlsgs nk uk vasl sakeuèknl `acn qun nk fgc`l vasl nxgstak nstrnc`ahgnktls y qun nk njjls sn fnsarrljjn hás iácgjhnktn iácgjhnktn uk trlhol= trlhol= uk cláeujl fn pjaquntas, prltnèkas fn ja claeujacgók y fnsnc`ls cnjujarns qun acaoa taplkakfl nj vasl. ^k çholjl ns uk trlhol qun `a vgamafl plr ja sakern `asta jjnear a uk vasl pnqunñl flkfn sn nkcjava clhl uk çholjl.

Iactlrns fn rgnsel Jls iactlrns fn rgnsel nk ja apargcgók fn uk gkiartl fn hglcarfgl nsták huy rnjacglkafls clk jls iactlrns fn rgnsel fn ja artnrglscjnrlsgs artnrglscjnrlsgs n gkcjuynk, nktrn ltrls=

ja `gpnrtnksgók `g pnrtnksgók artnrgaj2 (Trnsgók artnrgaj aj ajta ta l haylr a jls paráhntrls nstaojncgfls). nstaojncgfls). cljnstnrlj ajtl2 nj taoaqugshl2 ns hás clhýk nk `lhorns qun nk humnrns2 hum nrns2 ja `gpnrcljnstnrljnhga l, hás nspncèigcahnktn, ja `gpnrjgplprltngknhga, nk partgcujar jls kgvnjns njnvafls fn ja jgplprltnèka fn oama fnksgfaf (JFJ) y jls kgvnjns oamls fn ja jgplprltnèka fn ajta fnksgfaf (@FJ)2 ja `lhlcgstngknhga, ns fncgr, uka njnvacgók nk ja sakern fn ja clkcnktracgók fn `lhlcgstnèka, uk ahgklácgfl tóxgcl qun sn njnva clk oamls kgvnjns l gksuigcgnktns nk ja gkensta fn vgtahgka O ?, fn O9, fn O1? y fn ácgfl iójgcl2 ja fgaontns hnjjgtus (clk l sgk rnsgstnkcga a ja gksujgka)2 ja nkinrhnfaf cnjèaca, qun sunjn pasar sgk rnclklcnr kg fgaeklstgcar, prgkcgpajhnktn plrqun sunjn cursar sgk sèktlhas fgenstgvls nvgfnktns. Jls rntrasls nk nj fgaekóstgcl fn ja nkinrhnfaf cnjèaca punfnk prlvlcar qun jls fañls nk nj clrazók snak grrnvnrsgojns215   ja lonsgfaf,10  qun sn fnigkn a travçs fnj èkfgcn fn hasa clrplraj (uk èkfgcn haylr fn 34 be/h¿), fn ja cgrcukinrnkcga aoflhgkaj l fnj èkfg be/h¿), èkfgcn cn cgktura/cafnra2 nj nstrçs.

Iactlrns fn prltnccgók p rltnccgók Huc`ls fn jls iactlrns fn rgnsel carfèacls slk hlfgigcaojns, fn hlfl qun huc`ls ataquns fnj clrazók punfnk nvgtarsn sg jlera haktnknrsn uk nstgjl fn vgfa hás sajufaojn. Ja actgvgfaf ièsgca, plr nmnhpjl, sn aslcga clk rgnsels hás oamls.17  Tlr supunstl, ajeukls fn jls iactlrns fn rgnsel kl punfnk hlfgigcarsn= ja nfaf, nj snxl, jls aktncnfnktns iahgjgarns y ltrls iactlrns fn prnfgsplsgcgók enkçtgcls.?4   Jas humnrns qun usak pastgjjas aktgclkcnptgvas clhogkafas sunjnk prnsnktar uk auhnktl jnvn nk nj rgnsel fn gkiartl fn hglcarfgl, nk nspncgaj sg sn prnsnktak ltrls iactlrns fn rgnsel, clhl plr nmnhpjl nj `áogtl fn iuhar.?1  

 

Sn saon qun ja gkijahacgók ns uk pasl ghplrtaktn nk nj prlcnsl fn ilrhacgók fn uka pjaca atnrlscjnrótgca.??  Ja prltnèka C rnactgva ns uk harcaflr snksgojn aukqun kl nspncèigcl, fn ja gkijahacgók. Tlr nsa razók, uka njnvacgók sakeuèkna fn ja prltnèka C rnactgva punfn prnfncgr nj rgnsel fn uk gkiartl, asè clhl fn uk accgfnktn cnrnorlvascujar y nj fnsarrljjl fn ja fgaontns, aukqun kl nstá cjarl sg munea uk papnj fgrnctl nk ja ilrhacgók fn ja atnrlscjnrlsgs. ??  Hás aýk, cgnrtls iárhacls utgjgzafls nk nj tratahgnktl fnj gkiartl fnj hglcarfgl punfnk rnfucgr jls kgvnjns fn ja prltnèka C rnactgva.??  Kl sn rnclhgnkfa nj usl fn nxáhnkns fn ajta snksgogjgfaf para ja prltnèka C rnactgva nk ja plojacgók enknraj, aukqun punfnk usarsn a fgscrncgók fn uk prlinsglkaj fn ja sajuf nk pnrslkas clk ltrls iactlrns fn rgnsel ghplrtaktns. ?3   _ncgnktnhnktn, sn `a rnjacglkafl clk ja nkinrhnfaf pnrglflktaj clk ja clrlkarglpatèa y, sgnkfl qun ja pnrglflktgtgs ns huy clhýk, punfnk tnknr clksncunkcgas nk ja sajuf pýojgca. ?6  Jls nstufgls snrljóegcls qun `ak hnfgfl aktgcunrpls nk clktra fn oactnrgas qun causak ja pnrglflktgtgs cjásgca nkclktrarlk qun nstls aktgcunrpls nsták prnsnktns nk pnrslkas clk clrlkarglpatèas. ?>  Ja pnrglflktgtgs sunjn auhnktar jls kgvnjns sakeuèknls fn ja prltnèka C rnactgva, fnj igorgkóenkl y fn jas cgtlqugkas2?9   plr jl qun ja pnrglflktgtgs punfn hnfgar nj rgnsel fn gkiartl plr nstls iactlrns.?5   Sn `a suenrgfl qun ja aerneacgók pjaquntarga hnfgafa plr oactnrgas causaktns fn pnrglflktgtgs punfn prlhlvnr ja ilrhacgók fn hacróiaels nspuhlsls,?0 ?7    asè clhl ltrls prlcnsls nspncèigcls qun aýk kl sn `ak fntnrhgkafl clk cjargfaf. 34   Nj fnpósgtl fn cajcgl ns ltra fn jas ntapas fnj prlcnsl fn ilrhacgók fn ja pjaca atnrlscjnrótgca. Nsa acuhujacgók fn cajcgl nk jas artnrgas clrlkargas punfn fntnctarsn clk ayufa fn uka tlhleraièa y punfn tnknr vajlr prnfgctgvl hás ajjá fn jls iactlrns fn rgnsel cjásgcls. 31 3?   33    Sn `ak nstufgafl huc`ls ltrls 36 iactlrns, gkcjugfas jas suturas fn ja lrnma  y ltrls sgekls fnrhatljóegcls.3>  

Tatljleèa Ja apargcgók fn uk gkiartl aeufl fn hglcarfgl sn iukfahnkta nk fls suotgpls fnj sèkfrlhn clrlkargl aeufl, a saonr, nj gkiartl fn hglcarfgl sgk njnvacgók fnj snehnktl SV  y  y nj gkiartl fn hglcarfgl clk njnvacgók fnj snehnktl SV , jls cuajns slk, clk irncunkcga, uka hakginstacgók fn uka clrlkarglpatèa, ns fncgr, fn uka nkinrhnfaf fn jas artnrgas clrlkargas. Nj nvnktl gkgcgaj hás clhýk ns nj fnsprnkfghgnktl fn uka pjaca atnrlscjnrótgca fn uka fn jas artnrgas clrlkargas fnj npgcarfgl, ns fncgr, fn ja cuognrta fnj clrazók, qun clkjjnva a ja gkgcgacgók fn ja cascafa fn ja claeujacgók, jl qun nk lcasglkns enknra ja lcjusgók tltaj fn ja artnrga. _nprnsnktacgók fn uk gkiartl fn ja parnf aktnrglr fnj clrazók.

Sg nj fnigcgnktn ijuml sakeuèknl aj clrazók fura jl suigcgnktn, punfn gkgcgarsn uk prlcnsl jjahafl cascafa gsquçhgca, nk ja qun jas cçjujas fnj clrazók hunrnk, prgkcgpajhnktn plr kncrlsgs, y ya kl punfnk rnenknrarsn. Nk nsn puktl fn hunrtn cnjujar sn ilrha uka cgcatrgz fn cljáenkl pnrhaknktn, qun faña ja arqugtnctura carfèaca. Ajeukls nstufgls rncgnktns `ak gkfgcafl qun nj prlcnsl fn hunrtn cnjujar fnklhgkafl aplptlsgs tahogçk fnsnhpnña uk papnj ghplrtaktn nk nj prlcnsl fn fañl tgsujar fnspuçs fn uk gkiartl fn hglcarfgl.39  Nk clksncunkcga, nj tnmgfl igorótgcl plkn aj pacgnktn nk uka sgtuacgók fn rgnsel fn ja apargcgók fn trastlrkls fnj rgthl carfèacl qun tgnkfn a snr pltnkcgajhnktn pnjgerlsl para su vgfa, gkcjugfa ja apargcgók fn uka aknurgsha vnktrgcujar qun punfn fnsearrarsn clk clksncunkcgas catastróigcas, enknrajhnktn hlrtajns. Nj tnmgfl carfèacl asè fañafl clkfucn jls ghpujsls njçctrgcls hás jnktahnktn, y nsa fginrnkcga nk ja vnjlcgfaf fn clkfuccgók punfn causar jl qun sn clklcn clhl uk cgrcugtl fn rnnktrafa, rnnktrafa, ukl fn jls plsgojns causaktns fn arrgthgas jntajns. Nk nj cgrcugtl fn rnnktrafa, nj ghpujsl njçctrgcl qun sajn fn uk klfl jjnea a uk puktl igorótgcl nk su cahgkl qun `acn qun nj ghpujsl rnernsn y nstghujn aj hgshl klfl qun jn fgl lrgenk, jl cuaj punfn lrgegkar uk haylr kýhnrl fn clktraccglkns qun nk clkfgcglkns

 

klrhajns. Ja arrgthga hás snvnra ns ja igorgjacgók vnktrgcujar (aornvgafl nk gkejçs YI , gkgcgajns fn vnktrgcujar igorgjatglk), igorgjatglk), qun clksgstn nk clktraccglkns nxtrnhafahnktn rápgfas y caótgcas qun jjnvak a uka hunrtn sýogta carfèaca. Geuajhnktn eravn ns ja taqugcarfga vnktrgcujar, aukqun nj prlkóstgcl tgnkfn a snr hnkls jntaj. ^ka taqugcarfga vnktrgcujar y nk nspncgaj uka YI ghpgfnk qun nj clrazók olhonn ja sakern nigcazhnktn, jl qun `acn qun nj eastl carfèacl y ja prnsgók artnrgaj cageak a kgvnjns pnjgerlsls, y punfn prlvlcar uka haylr gsqunhga y uk gkiartl hás nxtnksl.

@gstlpatljleèa  Nj nxahnk `gstlpatljóegcl fnj clrazók punfn hlstrar uk gkiartl, plr jl enknraj furaktn uka autlpsga. Oaml nj hgcrlsclpgl, uk gkiartl fn hglcarfgl sn prnsnkta clhl uka rnegók cgrcukscrgta plr gsqunhga y kncrlsgs claeujatgva, gfnktgigcaojns nk jas prghnras 1? `lras fnj gkcgfnktn.35   ^kl fn jls prghnrls cahogls qun sn hunstrak nk uk clrazók gkiartafl ns ja apargcgók fn igoras lkfnaktns. lkfnaktns.30  Tlstnrglr a njjl nj cgtlpjasha fnj hglcgtl sn vunjvn rlsafl l nlsgklièjgcl y pgnrfnk jas nstrèas traksvnrsajns qun jas caractnrgza y igkajhnktn pgnrfnk ja nkvljtura kucjnar.37   Nj gktnrstgcgl qun rlfna ja rnegók gkiartafa sn gkigjtra

Ghaenk hgcrlscópgca (haek. 144x, `nhatlxgjgka y nlsgka) fn uka hunstra fn autlpsga 5 fèas plst-gkiartl.

gkgcgajhnktn fn knutróigjls, junel jgkilcgtls y hacróiaels, jls cuajns gkegnrnk ja cçjuja hunrta. Nsa rnegók cgrcukvncgka sn jjnka prlernsgvahnktn fn uka capa fn cljáenkl qun cgcatrgza aj árna. Tunfn tahogçk vnrsn gkigjtracgók fn ejóoujls rlmls.35  Nstas slk caractnrèstgcas nk casls flkfn kl sn rnstauró ja pnriusgók sakeuèkna, puns jls gkiartls rnpnriukfgfls punfnk prnsnktar ltrls njnhnktls, clhl oakfas kncrótgcas.64  

Cuafrl cjèkgcl Aprlxghafahnktn ja hgtaf fn jls pacgnktns clk gkiartl prnsnktak sèktlhas fn afvnrtnkcga aktns fnj gkcgfnktn.61  Ja apargcgók fn jls sèktlhas fn uk gkiartl fn hglcarfgl lcurrn, plr jl enknraj, fn haknra erafuaj, nk nj trakscursl fn 6?

vargls hgkutls, y rara vnz lcurrn fn haknra gkstaktákna.  Cuajqugnr kýhnrl fn sèktlhas clhpatgojns clk uka rnpnktgka gktnrrupcgók fnj ijuml sakeuèknl aj clrazók sn aerupak fnktrl fnj sèkfrlhn clrlkargl aeufl.63  

Nxahnk Nxahn k ièsg ièsgcl cl Ja apargnkcga enknraj fn jls pacgnktns clk gkiartl fn hglcarfgl varèa fn acunrfl a jls sèktlhas. Sn punfn vnr pacgnktns cóhlfls l pacgnktns aegtafls clk uka irncunkcga rnspgratlrga auhnktafa. Ns irncunktn vnr uk cljlr fn pgnj pájgfa, jl qun suegnrn vaslclkstrgccgók. Ajeukls pacgnktns punfnk tnknr uka ignorn jnvn (30–37 ´C), clk prnsgók artnrgaj njnvafa l nk ajeukls casls fgshgkugfa y nj pujsl punfn p unfn vljvnrsn grrneujar.66 6>    

Ygsta aktnrglr fn jas prgkcgpajns zlkas fn fljlr fn pnc`l nk uk gkiartl fn hglcarfgl (rlml lscurl 8 ja zlka hás irncunktn, rlml cjarl 8 ltras plsgojns rneglkns).

Sg aparncn uka gksuigcgnkcga carfèaca, sn punfn nkclktrar nk ja nxpjlracgók ièsgca uka njnvafa prnsgók vnklsa yueujar, rnijuml `npatlyueujar l `gkc`azók fn jas pgnrkas fnogfl a nfnha pnrgiçrgcl. Yargas aklrhajgfafns punfnk snr lèfas furaktn ja auscujtacgók, tajns clhl uk tnrcnr y uk

 

cuartl rugfl carfèacl, rlcn pnrgcárfgcl, fnsflojahgnktl parafómgcl fnj sneukfl rugfl y crnpgtaktns slorn nj pujhók. 66 69    

NCE. Sg uka pnrslka suirn sèktlhas clhpatgojns clk uk gkiartl, sn jn `ará uk NCE (njnctrlcarfgleraha) gkhnfgatahnktn, gkcjusl nk ja ahoujakcga qun jn trasjafn. Fn `nc`l, nstará ukgfl a uk hlkgtlr fn NCE furaktn tlfl nj tgnhpl qun nstç nk nj @lspgtaj, aj hnkls sg sn gkernsa nk ja saja fnfgcafa a jls nkinrhls eravns fnj clrazók l ukgfaf clrlkarga. Sn fnon rnajgzar hás fn uk NCE nk plcas `lras fafl qun, nk jas prghnras `lras, nj rnsujtafl punfn snr klrhaj, gkcjusl nk prnsnkcga fn gkiart gk iartl. l.

Fljlr tlrácgcl Nj fljlr tlrácgcl rnpnktgkl ns nj sèktlha hás irncunktn fn uk gkiartl, plr jl enknraj ns prljlkeafl y sn pnrcgon clhl uka prnsgók gktnksa, qun punfn nxtnkfnrsn l prlpaearsn `asta jls orazls y jls `lhorls, slorn tlfl fnj jafl gzqugnrfl, a ja nspajfa, aj cunjjl n gkcjusl a jls fgnktns y ja hakfèouja. Nj fljlr fn pnc`l fnogfl a gsqunhga l uka iajta fn suhgkgstrl sakeuèknl aj clrazók sn clklcn clhl akelr l akegka fn pnc`l, aukqun kl slk plcl irncunktns jls gkiartls qun cursak sgk fljlr, l clk fljlrns atèpgcls qun kl clgkcgfnk clk jl aquè fnscrgtl.

Ygsta plstnrglr fn jas prgkcgpajns zlkas fn fljlr fn pnc`l nk uk gkiartl fn hglcarfgl (rlml lscurl 8 ja zlka hás irncunktn, rlml cjarl 8 ltras plsgojns rneglkns).

Njnctrlcarfgleraha fn 1? Tlr nsl sn fgcn qun nj fgaekóstgcl ns sgnhprn cjèkgcl, fnrgvacglkns hlstrakfl njnctrlcarfgleráigcl y fn jaolratlrgl, ya qun sójl nstls trns njnhnktls njnvacgók gkinrglr fnj snehnktl  muktlss pnrhgtgr  muktl pnrhgtgrák ák rnajgzar rnajgzar uk fgaekóstgcl fgaekóstgcl prncgsl. prncgsl. Cuakfl ns tèpgcl, tèpgcl, nj SV nk jas fnrgvacglkns GG, GGG, y fljlr sn fnscrgon clhl uk puñl nklrhn qun rntunrcn nj clrazók. aYI muktl clk fnprnsgók Clrrnsplkfn a uka akegka fn pnc`l, pnrl prljlkeafa nk nj tgnhpl, y rncèprlca fnj snehnktl SV nk jas kl rnsplkfn a ja afhgkgstracgók fn jls hnfgcahnktls clk jls qun fnrgvacglkns G y aYJ. aktns sn ajgvgaoa (plr nmnhpjl, ja kgtrlejgcnrgka suojgkeuaj) kg cnfn tahplcl clk nj rnplsl. Nj fljlr a vncns sn pnrcgon fn ilrha fgstgkta, l kl sgeun kgkeýk patrók igml, slorn tlfl nk jas pnrslkas akcgakas y nk jas pnrslkas clk fgaontns.

Nk jls gkiartls qun ainctak ja cara gkinrglr l fgairaehátgca fnj clrazók punfn tahogçk pnrcgogrsn clhl uk fljlr prljlkeafl nk ja partn supnrglr fnj aoflhnk qun nj gkfgvgful plfrèa, nrróknahnktn, atrgougr a gkfgenstgók l acgfnz. Nj sgekl fn Jnvgkn sn `a catnelrgzafl clhl uk sgekl cjásgcl y prnfgctgvl fn uk gkiartl, nk nj qun nj ainctafl jlcajgza nj fljlr fn pnc`l aearrakfl iunrtnhnktn su tórax a kgvnj fnj nstnrkók.65  

Fgigcujtaf Fgig cujtaf rnspgratlrg rnspgratlrga  a  Ja fgskna l fgigcujtaf para rnspgrar, lcurrn cuakfl nj fañl fnj clrazók rnfucn nj eastl carfèacl fnj vnktrècujl gzqugnrfl, causakfl gksuigcgnkcga vnktrgcujar gzqugnrfa y, clhl clksncunkcga, nfnha pujhlkar. Ltrls sgekls gkcjuynk ja fgailrnsgs l uka huy huc`a suflracgók, fnogjgfaf, harnls (nk uk 14 plr cgnktl fn jls casls ns nj ýkgcl sèktlha), pajpgtacglkns, káusnas fn lrgenk fnsclklcgfl, vóhgtls y fnsiajjncghgnktl. Ns prloaojn qun ja apargcgók fn nstls ýjtghls sèktlhas sna clksncunkcga fn uka jgonracgók hasgva fn catncljahgkas fnj sgstnha knrvglsl sghpátgcl,60   uka rnspunsta katuraj aj fljlr y jas aklrhajgfafns `nhlfgkáhgcas qun rnsujtak fn ja fgsiukcgók carfèaca.

Sgekls eravns

 

Jls sgekls hás eravns gkcjuynk ja pçrfgfa fn clklcghgnktl fnogfl a uka gkafncuafa pnriusgók cnrnoraj, s`lcb carfgleçkgcl n gkcjusl hunrtn sýogta, plr jl enknraj fnogfl a uka igorgjacgók vnktrgcujar.

Nk jas humnr hu mnrns ns Yçasn tahogçk=  Sèkfrlhn fn Wnktj

Jas humnrns tgnkfnk a nxpnrghnktar sèktlhas harcafahnktn fgstgktls a jls fn jls `lhorns. Jls sèktlhas hás clhukns nk jas humnrns slk ja fgskna, ja fnogjgfaf, ja iatgea n gkcjusl ja slhkljnkcga, jls cuajns sn hakgignstak `asta uk hns aktns fn ja apargcgók cjèkgca fnj gkiartl gsquçhgcl. Nk jas humnrns, nj fljlr fn pnc`l punfn snr hnkls prnfgctgvl fn uka gsqunhga clrlkarga qun nk jls `lhorns. 67  

Gkiartls sgk fljlr l sgk ltrls sèktlhas Aprlxghafahnktn uk cuartl fn jls gkiartls fn hglcarfgl slk sgjnktns, ns fncgr, aparncnk sgk fljlr fn pnc`l y sgk ltrls sèktlhas.>4   Nstls gkiartls sunjnk fnscuorgrsn tgnhpl fnspuçs furaktn njnctrlcarfglerahas suosgeugnktns l furaktn uka autlpsga sgk aktncnfnktns fn sèktlhas rnjacglkafls clk uk gkiartl. Nstn cursl sgjnktn ns hás clhýk nk jls akcgakls, nk jls pacgnktns clk fgaontns>1   y fnspuçs fn uk traspjaktn fn clrazók, prloaojnhnktn fnogfl a qun uk clrazók flkafl kl nstá clknctafl a jls knrvgls fnj pacgnktn `lspnfaflr.>?  Nk pacgnktns clk fgaontns, jas fginrnkcgas nk nj uhoraj fnj fljlr, ja knurlpatèa autlkóhgca y ltrls iactlrns igsgljóegcls slk plsgojns nxpjgcacglkns fn ja ausnkcga fn sgktlhatljleèa furaktn uk gkiartl.>1  

Fgaekóstgcl Nj fgaekóstgcl fn uk gkiartl fn hglcarfgl fnon ilrhujarsn gktnerakfl aspnctls cjèkgcls fn ja nkinrhnfaf actuaj fnj gkfgvgful y uk nxahnk ièsgcl, gkcjugfl uk njnctrlcarfgleraha y prunoas fn jaolratlrgl qun gkfgqunk ja prnsnkcga l ausnkcga fn fañl cnjujar fn jas igoras huscujarns.>3   Tlr nsta razók, ja snhgljleèa qun nj cjèkgcl fnon apjgcar aktn ja prnsnkcga fn uk fljlr prnclrfgaj (plr sus caractnrèstgcas y plr su furacgók) fnon lojgearjl a prlplknr nj fgaekóstgcl fn gkiartl aeufl fnj hglcarfgl (GAH) clk suigcgnktn prnhura, ya qun nj rntrasl nk nj pjaktnahgnktl sn trafucn nk ja pçrfgfa fn uk tgnhpl vajglsl

Akegleraièa clrlkarga clk akeglpjastga.

kncnsargl para gkstgtugr nj hçtlfl fn rnpnriusgók fgsplkgojn clk ja gfna fn rncupnrar ja haylr nxtnksgók fn hglcarfgl ya qun, clhl ns ognk saogfl, nxgstn uka rnjacgók gkvnrsa nktrn nj tgnhpl trakscurrgfl para gkgcgar nj prlcnfghgnktl y ja caktgfaf fn hýscujl ‚sajvafl‘.

Crgtnrgls fn fgaekóstgcl Jls crgtnrgls fn ja Lreakgzacgók Hukfgaj fn ja Sajuf (LHS) >6   slk jls qun oásgcahnktn sn usak nk nj fgaekóstgcl fn uk gkiartl fn hglcarfgl. ^k pacgnktn rncgon nj fgaekóstgcl prloaojn fn gkiartl sg prnsnkta fls fn jls sgeugnktns crgtnrgls, crgtnrgls, y nj fgaekóstgcl snrá fnigkgtgvl sg prnsnkta jls trns=

1. `gstlrga cjèkgca fn fljlr flj lr fn pnc`l gsquçhgcl qun furn plr hás fn 34 hgkutls2 ?. cahogls njnctrlcarfgleráigcls nk uka snrgn snrg n fn trazls, n 3. gkcrnhnktl l caèfa fn oglharcaflrns sçrgcls, tajns clhl ja crnatgka qugkasa tgpl HO y ja trlplkgka.

 

Nstls crgtnrgls fn ja LHS iunrlk rnfnigkgfls nk nj ?444 para far prnflhgkgl a jls harcaflrns carfèacls.>>   Fn acunrfl clk jas kunvas fgsplsgcglkns, uk auhnktl fn ja trlplkgka carfèaca, aclhpañafa fn sèktlhas tèpgcls, fn lkfas Q patljóegcas, fn njnvacgók l fnprnsgók fnj snehnktl SV l fn gktnrvnkcgók clrlkarga, ns suigcgnktn para fgaeklstgcar uk gkiartl fn hglcarfgl. Nj fgaekóstgcl cjèkgcl fnj GAH sn fnon oasar, nktlkcns, nk ja clkmukcgók fn jls trns sgeugnktns fatls= fljlr caractnrèstgcl, cahogls njnctrlcarfgleráigcls suenstgvls y njnvacgók fn jas nkzghas, y fnon tnknrsn prnsnktn qun nsta ýjtgha punfn kl prnsnktarsn nk ilrha lplrtuka, plr jl qun jls fls prghnrls cahogls fnonrák tlharsn nk cunkta para gkgcgar ja rnpnriusgók a ja ornvnfaf plsgojn.

Harcaflrns carfèacls Jas nkzghas carfèacas slk prltnèkas prlvnkgnktns fnj tnmgfl carfèacl y qun sn jgonrak a ja cgrcujacgók sakeuèkna clhl clksncunkcga fnj fañl aj clrazók, taj clhl ns nj casl nk uk gkiartl fn hglcarfgl. @asta jls añls 1704 sn usaoak fn rutgka jas nkzghas aspartatl ahgkltraksinrasa y jactatl fns`gfrlenkasa para ja nvajuacgók fnj fañl carfgacl. Sn fnscuorgó junel ja njnvacgók fnsprlplrcglkaj fnj suotgpl HO fn ja nkzgha crnatgka qugkasa (CB) nspncèigcahnktn clhl prlfuctl fn uk fañl hglcárfgcl. Jas rneujacglkns actuajns tgnkfnk a iavlrncnr a jas ukgfafns G y V fn ja trlplkgka, jas cuajns slk nspncèigcas fnj hýscujl carfèacl2 `asta sn pgnksa qun clhgnkzak a njnvarsn aktns fn qun lcurra nj fañl huscujar.>9  Ja njnvacgók fn ja trlplkgka nk uk pacgnktn clk fljlr fn pnc`l punfn prnfncgr acnrtafahnktn ja prloaogjgfaf fn uk gkiartl fn hglcarfgl nk nj iuturl cnrcakl. >5   ^k harcaflr carfèacl rncgnktn ns ja gslnkzgha OO fn ja ejucóenkl ilsilrgjasa.>0   Cuakfl lcurrn fañl aj clrazók, jls kgvnjns fn jls harcaflrns carfèacls suonk clk nj trakscursl fnj tgnhpl, plr jl qun sn aclstuhora tlhar hunstras fn sakern y akajgzar jls kgvnjns fn nstls harcaflrns nkzghátgcls nk uk pnrèlfl fn ?6 `lras. Fnogfl a qun nstas nkzghas carfèacas kl sgnhprn sn gkcrnhnktak gkhnfgatahnktn fnspuçs fn uk ataqun aj clrazók, aqunjjls pacgnktns clk fljlr fn pnc`l tgnkfnk a snr tratafls asuhgnkfl qun tgnknk uk gkiartl `asta qun sna plsgojn nvajuarjls nk ousca fn uk fgaekóstgcl hás prncgsl.>7   Ns huy ghplrtaktn fntnrhgkar ja haekgtuf fnj fañl aj hglcarfgl, y clk oasn nk njjl `acnr uka prnfgccgók fnj kgvnj fn rncupnracgók fn ja iukcgók carfgaca qun pufgnsn nspnrarsn. @ly nk fèa sn utgjgzak tçckgcas qun clhogkak nj usl fn harcaflrns clhl ja trlplkgka 1 clk jas vnktamas qun lirncn ja rnslkakcga haekçtgca carfglvascujar. Tlr nmnhpjl, ja gfnktgigcacgók l hapnl fn ja trlplkgka 1 (V1) hnfgaktn rnslkakcga haekçtgca sgk clktrastn pnrhgtn gfnktgigcar tnhprakahnktn ja snvnrgfaf fnj fañl fnj tnmgfl nk nj gkiartl aeufl fnj hglcarfgl. Nsnkfncgr, sg hnfgaktn fn gháenkns fn rnslkakcga gkcrnhnktls ghplrtaktns jls vajlrns fn V1,njja usl prloaogjgfaf fn rncupnracgók fnj haekçtgca tnmgfl a jls sn sngsnkcunktrak hnsns fn nvljucgók fgshgkuyn.94  

Akegleraièa  Nk jls casls hás clhpjgcafls l nk sgtuacglkns flkfn sn ahnrgtn uka gktnrvnkcgók para rnstaurar nj ijuml sakeuèknl, sn punfn rnajgzar uka akegleraièa fn jas clrlkargas. Sn gktrlfucn uk catçtnr nk uka artnrga, plr jl enknraj ja artnrga inhlraj, y sn nhpuma `asta jjnear a jas artnrgas qun grrgeak aj clrazók. Sn afhgkgstra junel uk clktrastn rafgl-lpacl y sn tlha uka sncunkcga fn rafgleraièas (ijulrlsclpèa). Jas artnrgas lostrugfas l nstrnc`as punfnk snr gfnktgigcafas clk nstn prlcnfghgnktl, pnrl sljl fnon snr rnajgzafa plr uk nspncgajgsta cajgigcafl.

Nstufgls gsltópgcls l catntnrgshl carfèacl (clrlkargleraièa). Clhl njnhnktl fn fgaekóstgcl, sn pjaktnak cuakfl ya `a pasafl ja iasn aeufa. Kl lostaktn punfn pjaktnarsn ja rnajgzacgók fn uka cgknakeglclrlkargleraièa plr catnrgshl carfèacl, a jls

 

ninctls fn fntnrhgkar fntnrhgkar nj l jjls ls vasls lostrugfls y pjaktnar uka fnslostruccgók nk aeufl, plr akeglpjastga pnrcutákna clk l sgk cljlcacgók fn stnkts l, hás rarahnktn plr nkfartnrnctlhèa.

Fgaekóstgcl fgi fginrnkcgaj nrnkcgaj Nj fgaekóstgcl fginrnkcgaj gkcjuyn ltras causas rnpnktgkas fn fljlr fn pnc`l, clhl trlholnholjgshl pujhlkar, fgsnccgók aórtgca, fnrrahn pnrgcárfgcl qun causn taplkahgnktl carfèacl, knuhltórax a tnksgók y fnsearrl nsliáegcl.91  

Vratahgnktl ^k ataqun aj clrazók ns uka nhnrenkcga hçfgca, plr jl qun fnhakfa atnkcgók gkhnfgata. Nj lomntgvl prgkcgpaj nk ja iasn aeufa ns sajvar ja haylr caktgfaf plsgojn fn hglcarfgl y prnvnkgr clhpjgcacglkns afgcglkajns. A hnfgfa qun pasa nj tgnhpl, nj rgnsel fn fañl aj hýscujl carfèacl auhnkta, plr jl qun cuajqugnr tgnhpl qun sn pgnrfa ns tnmgfl qun geuajhnktn sn `a pnrfgfl. 9?  Aj nxpnrghnktar sèktlhas fn uk gkiartl, ns prninrgojn pnfgr ayufa y ouscar atnkcgók hçfgca gkhnfgata. Kl ns rnclhnkfaojn gktnktar clkfucgrsn ukl hgshl `asta uk `lspgtaj.

Cugfafls gkhnfgatls Cuakfl aparnzcak sèktlhas fn uk gkiartl fn hglcarfgl, ja haylrèa fn jls pacgnktns nspnrak nk prlhnfgl trns `lras, nk vnz fn prlcnfnr fn ja haknra rnclhnkfafa= `acnr uka jjahafa fn auxgjgl fn gkhnfgatl.93 96     Njjl prnvgnkn fañls slstnkgfls aj clrazók, fgc`l fn hlfl fn nxprnsgók= «tgnhpl pnrfgfl ns hýscujl pnrfgfl².9?   Cgnrtas plsgcglkns pnrhgtnk qun nj pacgnktn fnscaksn hgkghgzakfl ja fgigcujtaf rnspgratlrga, taj clhl ja rnqunrgfaX Nj accnsl a lxèenkl açrnl hnmlra sg sn aorn plsgcgók hnfgl-snktafl clk jas rlfgjjas rlf gjjas flojafas.Rcgta rnqunrgfaX jas vnktakas fnj autlhóvgj l sg sn sunjta nj oltók fnj cunjjl fn ja cahgsa. Sg nj gkfgvgful kl ns ajçregcl, sn punfn afhgkgstrar uka taojnta fn aspgrgka, sgk nhoarel sn `a fnhlstrafl qun nj tlhar aspgrgka aktns fn jjahar a uk snrvgcgl hçfgcl fn nhnrenkcga punfn nstar aslcgafl a rntrasls gknspnrafls.9>  Ja aspgrgka tgnkn uk ninctl aktgaerneaktn pjaquntargl, n gk`gon ja ilrhacgók fn cláeujls nk jas artnrgas. Sn prnignrnk jas prnsnktacglkns sljuojns, sgk cuognrtas nktçrgcas l jas hastgcaojns, para qun su aoslrcgók plr nj lreakgshl sna hás rápgfa. Sg nj pacgnktn kl punfn traear, sn rnclhgnkfa uka prnsnktacgók suojgkeuaj. Tlr jl enknraj sn rnclhgnkfa uka flsgs nktrn 19?-3?> he.99   Aj jjnear a ja saja fn nhnrenkcga, nj hçfgcl prloaojnhnktn afhgkgstrará afhgkgstrará vargas fn jas sgeugnktns tnrapgas= tnrapgas=

Lxèenkl. Klrhajhnktn sn sunjn afhgkgstrar clk eaias kasajns a ? l 3 jgtrls. Tunfn snr ja prghnra hnfgfa nk nj `lspgtaj l ja prlpga ahoujakcga. Akajeçsgcls (hnfgcahnktls para nj fljlr). Sg nj fljlr tlrácgcl pnrsgstn y ns gkslplrtaojn, sn afhgkgstra hlrigka (ahpljjas fn cjlrurl hlrigcl fn 1 hgjgjgtrl clk 14 he) l hnfgcahnktls sghgjarns para ajgvgarjl (pntgfgka-fljaktgka). Aktgaerneaktns pjaquntargls. Slk hnfgcahnktls qun ghpgfnk ja aerneacgók pjaquntarga nk ja ilrhacgók fnj trlhol. Jls hás nhpjnafls slk nj aspgrgka nk flsgs fn 144-344 he aj fèa, y nj cjlpgflernj. Vrlholjètgcls. Slk hnfgcahnktls para fgsljvnr nj cláeujl qun ghpgfn qun ijuya ja sakern. Sn plknk sustakcgas clhl ja nstrnptlqugkasa l uk "actgvaflr fnj pjashgkóenkl tgsujar", ognk nk ja j a vnka, l ognk fgrnctahnktn nk nj cláeujl plr hnfgl fn uk catçtnr (uk tuogtl jarel y

 

ijnxgoj n). Nstn hnfgcahnktl fnon snr apjgcafl nk jas prghnras sngs `lras fn gkgcgafl nj ijnxgojn). fljlr, fn ajjè ja ghplrtakcga fn uka atnkcgók rápgfa. Jls trlholjètgcls sójl punfnk afhgkgstrarsn nk uk cnktrl nspncgajgzafl, `aogtuajhnktn uka ^kgfaf fn Cugfafls Gktnksgvls, aukqun ya sn `a clhnkzafl a rnajgzar ja igorgkljgsgs nxtra`lspgtajarga plr jls nqugpls fn nhnrenkcgas hóvgjns clk nj igorgkljètgcl VKBasn® (tnknctnpjasa) clk nj lomntl fn gkgcgar gkg cgar jl hás rápgfahnktn plsgojn nj trat tratahgnktl ahgnktl nspncèi nspncèigcl. gcl. Kgtratls. Jls fnrgvafls fn ja kgtrlejgcnrgka actýak fgshgkuynkfl nj traoaml fnj clrazók y plr taktl sus kncnsgfafns fn lxèenkl. Nk ja akegka fn pnc`l sn tlhak nk pastgjjas fnoaml fn ja jnkeua l tahogçk nk spray . Vahogçk Vahogçk punfnk tlharsn nk pastgjj pastgjjas as fn accgók prljlkeafa l plknrsn nk parc`ns fn jgonracgók jnkta slorn ja pgnj. Nk ja iasn aeufa fn uk ataqun aj clrazók, sunjnk usarsn plr vèa vnklsa (Sljgkgtrgka (Sljgkg trgka nk pnriusgók gktravnklsa). Ontaojlqunaktns. Actýak ojlqunakfl huc`ls ninctls fn ja afrnkajgka nk nj cunrpl, nk partgcujar nj ninctl nstghujaktn slorn nj clrazók. Nj rnsujtafl ns qun nj clrazók jatn hás fnspacgl y clk hnkls iunrza, y plr taktl kncnsgta hnkls lxèenkl. Vahogçk fgshgkuynk ja tnksgók artnrgaj. Fgegtájgcls. Jls hnfgcahnktls fnrgvafls fn ja fgegtaj, clhl ja fgelxgka, actýak nstghujakfl aj clrazók para qun olhonn hás sakern. Nstl gktnrnsa slorn tlfl sg nj ataqun aj clrazók prlfucn gksuigcgnkcga gksuigcgnkcg a carfèaca nk nj clktnxtl clktnxtl fn uka igorgjacg igorgjacgók ók aurgcujar (arrgthga oastaktn irncunktn irncunktn nk pnrslkas akcgakas) clk rnspunsta vnktr vnktrgcujar gcujar rápg rápgfa. fa. Jls cajcgl aktaelkgstas l ojlqunaflrns fn jls cakajns fnj cajcgl ghpgfnk ja nktrafa fn cajcgl nk jas cçjujas fnj hglcarfgl. Nstl fgshgkuyn ja tnkfnkcga fn jas artnrgas clrlkargas a nstrnc`arsn y afnhás fgshgkuyn nj traoaml fnj clrazók y plr taktl sus kncnsgfafns fn lxèenkl. Vahogçk fgshgkuynk ja tnksgók artnrgaj. Kl sunjnk usarsn nk ja iasn aeufa fn uk ataqun aj clrazók, aukqun sè gkhnfgatahnktn fnspuçs.

Gktnrvnkcgók Gkt nrvnkcgók c clrlkarg lrlkarga a pn pnrcut rcutákna  ákna  clrlkargl. Yçaksn tahogçk=  Akeglpjastga y Oagpás clrlkargl. Ja gktnrvnkcgók clrlkarga pnrcutákna clksgstn nk uk akegleraha gkgcgaj para fntnrhgkar ja uogcacgók akatóhgca fnj vasl gkiartafl, sneugfl plr uka akeglpjastga clk oajók fnj snehnktl trlholsafl. Nk ajeukls aolrfamns sn nhpjna ja nxtraccgók fnj trlhol plr uk catçtnr aspgraflr. Nj usl fn uk stnkt kl tgnkfn a hnmlrar jls rnsujtafls a clrtl pjazl, aukqun fgshgkuynk ja caktgfaf fn sneukfas lpnracglkns nk clhparacgók clk ja akeglpjastga fn oajók.95   Yçasn tahogçk=  Vnrapga Eçkgca y Cnjujar

Vçckgca klvnflsa fnsarrljjafa nk iasn prn-qugrýregca nk @lustlk (NN. ^^.) y nk iasn cjèkgca nk nj `lspgtaj Ernelrgl Harañlk fn Hafrgf-Nspaña2 sn oasa nk ja utgjgzacgók fn cçjujas hafrn nk ja rnenknracgók fnj tnmgfl carfèacl. Jas cçjujas hafrn prlcnfnk fn ja prlpga hatnrga erasa fnj pacgnktn gktnrvnkgfl, nstas slk gkynctafas nk ja zlka fañafa fnj clrazók.90   Sn `a fnhlstrafl qun nxgstnk onknigcgls fn uka Gktnrvnkcgók clrlkarga pnrcutákna rnajgzafa plr uk nspncgajgsta, slorn ja tnrapga trlholjètgca nk casls fn uk gkiartl caractnrgzafl plr njnvacgók aeufa fnj snehnktl SV.97 54   51    Jls ýkgcls fnsaièls qun lostacujgzak nstn prlcnfghgnktl sunjnk snr ja apjgcacgók fn ja akeglpjastga vèa catntnrgzacgók carfèaca, asè clhl jls rncursls nclkóhgcls fnj pacgnktn. 5?   Nj lomntgvl prgkcgpaj fn uka gktnrvnkcgók clrlkarga pnrcutákna ns nj aorgr ja juz fn ja artnrga ainctafa jl hás prlktl plsgojn, fn prninrnkcga nk jls prghnrls 74 hgkutls fnsfn ja jjneafa fnj pacgnktn a ja nhnrenkcga, aolrtakfl asè nj gkiartl fn hglcarfgl. Tlr jl enknraj, jls `lspgtajns qun `acnk ja gktnrvnkcgók tgnknk nj rnspajfl qugrýregcl fn uk nqugpl fn oagpás clrlkargl.99  Jas prghnras akeglpjastgas clrlkargas nk gkiartls aeufls fn hglcarfgl, iunrlk practgcafas plr nj Fr. Clkstaktgkl Clkstaktgkg nk nj Gkstgtutl Hlfnjl fn Carfgljleèa nk Córfloa, Arenktgka nk nj añl 170>. Ja ghpjnhnktacgók fn nstn tratahgnktl iun hltgvl fn uka nklrhn fgscusgók furaktn añls nk nj áhogtl hçfgcl `asta su acnptacgók enknrajgzafa ognk nktrafls jls 74.

 

Trlkóstgcl y clhpjgcacglkns Sg nj árna fn gkiartl ns pnqunña y kl clhprlhntn aj sgstnha ogl-njçctrgcl qun clktrlja jls jatgfls fnj clrazók, jas prloaogjgfafns fn slornvgvgr a uk gkiartl slk ajtas. Sgk nhoarel, uka fn cafa trns pnrslkas qun suirnk uk gkiartl hunrn aktns fn plfnr rncgogr atnkcgók hçfgca (hunrtn sýogta). @acn huy plcls añls jas nstafèstgcas nstafèstg cas nrak aýk pnlrns (uk iajjncghgnktl prnclz plr cafa fls gkiartls). Ja hnmlra fn nstas nxpnctatgvas nstá jgeafa a jls avakcns nk rnsucgtacgók carfglpujhlkar (_CT), nk prunoas fgaekóstgcas nspncgajns y nk atnkcgók urenktn, gkcjuynkfl ahoujakcgas 'hnfgcajgzafas' y ukgfafns clrlkargas. Fnogfl a ja irncunkcga fn hunrtn sýogta carfèaca, jas tçckgcas fn rnsucgtacgók carfglpujhlkar fnonk apjgcarsn cuaktl aktns a cuajqugnr pnrslka qun nstç suirgnkfl uk ataqun aj clrazók. Ja haylrèa fn jls qun nstçk vgvls ? `lras fnspuçs fn uk ataqun slornvgvgrák. ^ka vnz qun sajnk fnj `lspgtaj rnclhgnkfak rnplsl, fgnta sgk erasa y sgk saj. Sgk nhoarel, nxgstnk ajeukas clhpjgcacglkns plsgojns=

Arrgthga carfgaca= Nxgstn uk sgstnha ogl-njçctrgcl qun clktrlja jls jatgfls fnj clrazók. Sg sn faña nk nj gkiartl, punfnk aparncnr arrgthgas huy eravns, clhl ja jjahafa igorgjacgók vnktrgcujar, nk ja qun jls vnktrècujls sn clktrank fn ilrha rápgfa, fnscllrfgkafa n gknigcaz clhl uka "oljsa fn eusakls" y, a ninctls fn olhonl fn sakern, nj clrazók sn para. Nk ltras pnrslkas punfnk aparncnr arrgthgas arrgthgas jnktas, ns fncgr, nj jatgfl ns n s fnhasgafl jn jnktl ktl para qun nj clrazók iukcglkn klrhajhnktn, fnogfl a ojlqunls nk nj sgstnha fn clkfuccgók fn jls ghpujsls njçctrgcls a kgvnj fnj clrazók l a hunrtn fn jls klfls ("autlhátgcls") qun enknrak nstn ghpujsl. Nstl punfn rnqunrgr ja ghpjaktacgók tnhplraj l fnigkgtgva fn uk harcapasls artgigcgaj artgigcgaj.. Gksuigcgnkcga carfèaca= Cuakfl nj árna fn gkiartl ns nxtnksa, nj rnstl fnj clrazók punfn snr gksuigcgnktn para rnajgzar nj traoaml fn olhonl. Hunrtn= Nk uka fn cafa cuatrl pnrslkas qun suirnk hunrtn sýogta, kl nxgstèak sèktlhas prnvgls fn carfglpatèa. Clk huc`l, ja causa hás irncunktn fn hunrtn sýogta plr gkiartl ns ja igorgjacgók vnktrgcujar. Ja cjasgigcacgók prlpunsta plr Bgjjgp y Bghoajj pnrhgtn nstaojncnr uk prlkóstgcl razlkaojn fn acunrfl a jls sgekls y sèktlhas prnsnktns aj hlhnktl fnj gkernsl a uk cnktrl `lspgtajargl.

Yçasn tahogçk Akegka fn pnc`l Vrastlrkls fnj rgthl carfèacl Nfnha aeufl fn pujhók

_ninrnkcgas 1. AOFG, Aofgbargh2 Oaseut, Ogjenk (mukgl fn ?419). «Ak Nvgfnkcn-Oasnf _nvgnw li Tagk Hakaenhnkt gk Acutn Hylcarfgaj Gkiarctglk² R^ka rnvgsgók oasafa nk ja nvgfnkcga fnj haknml fnj fljlr nk nj gkiartl aeufl fn hglcarfglX (`tt (`ttps=// ps=//wno.arc`gvn.lr wno.arc`gvn.lr e/wno/?4154613?36964/`ttps=//www.mscghn fcnktraj.clh/Carfgljley/carfgljley-6-149 5.pfi).  Mlurkaj li Carfglj Carfgljley ley & Cjg Cjgkgcaj  kgcaj  _nsnarc`  (nk gkejçs) _nsnarc` gkejçs)  6 (6)= 1495. Arc`gvafl

fnsfn nj lrgegkaj (`ttps=//www.mscghnfcnktr aj.clh/Carfgljley/carfgljley-6-1495.pfi) nj 13 fn aorgj fn ?415. Clksujtafl nj 13 fn aorgj fn ?415. ?. V`yensnk, Brgstgak2 Ajpnrt, Mlsnp` S.2 U`gtn, @arvny F.2 Maiin, Ajjak S.2 Appjn, Irnf S.2 Eajvakg, Harcnjjl2 Batus, @uel A.2 Knwoy, J.liBrgstgk nt aj.  aj.  (?445). «^kgvnrsaj fnigkgtglk hylcarfgaj gkiarctglk= Brgstgak V`yensnk, Mlsnp` S. Ajpnrt akf @arvny F. U`gtn lk on`aji li t`n Mlgkt

 

NSC/ACCI/A@A/U@I Vasb Ilrcn ilr t`n rnslurcn/gssk/4344-073?). _nfnigkgtglk li Hylcarfgaj Gkiarctglk² flg=14.1419/m.rncnsp.?410.11.447 (`ttps=//fx.flg.lre/ RFnigkgcgók ukgvnrsaj fnj gkiartl fn 14.1419%?Im.rncnsp.?410.11.447). Clksujtafl nj hglcarfgl=Brgstgak V`yensnk, Mlsnp` S. 1? fn hayl fn ?4?1. Ajpnrt y @arvny F. U`gtn nk klhorn fn ja 0. Nr`arft J, @nrjgtz @nrjg tz M, Olssanrt J, nt aj  (?44?).  (?44?). Iunrza fn Varnas NSC/ACCI/A@A/U@I «Vasb ilrcn lk t`n hakaenhnkt li c`nst ukgfls para ja rnfnigkgcgók fnj gkiartl fn pagk² (`ttp=//nur`nartm.lxilrfmlurkajs.lre/ce hglcarfglX (`ttps=//acafnhgc.lup.clh/nur`n g/rnprgkt/?3/1>/11>3) (TFI). (TFI). Nur. @nart M.  M.  ?3 artm/artgcjn-jllbup/flg/14.1473/nur`nartm/n` (1>)= 11>3-59. THGF 1??491?5 (`ttps=//www.kcog. h3>>). Nur @nart M   (nk gkejçs)  gkejçs)  ?0  (?4)= kjh.kg`.elv/puohnf/1??491?5). ?>?>-?>30. flg=14.1473/nur`nartm/n`h3>> (`ttps=// flg=14.14>3/nu`m.?44?.3176 (`ttps=//fx.flg.lre/14.14> fx.flg.lre/14.1473%?Inur`nartm%?In`h3>>). 3%?Inu`m.?44?.3176). Clksujtafl Clksujtaf l nj 13 fn aorgj fn ?415. 7. frsclpn. Gkiartl aeufl fnj Hglcarfgl (`ttp 3. «V`n Ulrjf @naj @najt` t` _nplrt ?446 s=//wno.arc`gvn.lre/wno/?4404>?91646>1/ C`akegke @gstlry² (`ttp=//www.w`l.gkt/nktgt `ttp=//www.frsclpn.clh/carfgljlega/pac/gki (TFI).. y/w`r/?446/nk/rnplrt46\nk.pfi) (TFI) artl.`th) `ttp=//www.w`l.gkt/nk/   (Lreakgzacgók 14. «Causn li Fnat` - ^ ^C C Atjas li Ejloaj Hukfgaj fn ja Sajuf). ?446. pp. 1?4-6. GSOK Gknquajgty² (`ttps=//wno.arc`gvn.lre/wno/?4 7?-6-1>9?9>-P. 454143413464/`ttp=//ucat 454143413464/`ttp= //ucatjas.ucsc.nfu/caus jas.ucsc.nfu/caus 6. Tjak Akfajuz fn urenkcgas y nhnrenkcgas. n.p`p#). Cnktnr ilr Ejloaj, Gktnrkatglkaj Haknml fnj gkiartl aeufl fn hglcarfgl (`ttp akf _neglkaj Stufgns (CEG_S) at t`n s=//wno.arc`gvn.lre/wno/?44743494943?6/ ^kgvnrsgty li Cajgilrkga Sakta Cruz. `ttp=//pnrslkaj.tnjnilkgca.tnrra.ns/wno/nkinr Arc`gvafl fnsfn nj lrgegkaj (`ttp=//ucatjas.u hnrgaavakzafa/HAK^AJNS%?4NHN_EN csc.nfu/causn.p`p) nj 3 fn nknrl fn ?445. KCGAS/gkiartl.pfi) Clksujtafl nj 5 fn fgcgnhorn fn ?449. >. Oax J, Aj Ajera era A A,, Hajg UT UT,, N Nfjgke fjgkenr nr H, 11. «Fnat`s akf pnrcnktaen li tltaj fnat` ilr Onutjnr MM, vak fnr Eraai W (?440). «_nkaj t`n 14 jnafgke causns li fnat`= ^kgtnf iukctglk as a rgsb gkfgcatlr ilr Statns, ?44?-?443² (`ttp=//www.cfc.elv/kc carfglvascujar nvnkts gk 3?19 patgnkts wgt` `s/fata/`nstat/jnafgkefnat`s43\taojns.pfi) hakginst artnrgaj artnrgaj fg fgsnasn² snasn² (`ttp=// (`ttp=//jgkbg jgkbgke`uo. ke`uo. (TFI).. Katglkaj Cnktnr li @najt` Statgstgcs. (TFI) njsnvgnr.clh/rntrgnvn/pgg/S44?1-71>4(45)44 Clksujtafl nj 15 fn aorgj fn ?445. 590-P). At`nrlscjnrlsgs 590-P).  At`nrlscjnrlsgs.. THGF 10?6105? (`ttp 1?. «@nart Attacb akf Akegka Akeg ka Statgstgcs² (`tt (`ttp=// p=// s=//www.kcog.kjh.kg`.elv/puohnf/10?6105?).  www.ahnrgcak`nart.lre/prnsnkt  www.ahnrgcak`nart. lre/prnsnktnr nr.m`thj  (9)= ?>7-95. Ugjbgks. Ugjbg ks. p. >69. GSOK 4-5015-6533-3. flg=14.1419/m.hgcpat`.?443.45.44? (`ttps=//fx.flg.lr 30. Ngc`oauh IU. "'Uavy' hylcarfgaj igonrs gk e/14.1419%?Im.hgcpat`.?443.45.44?). THGF splktaknlus akf nxpnrghnktaj afrnknregc 16>04307. carfglpat`gns" Carfgljley   175>2 94(9)= 34. Spa`r A, Bjngk N, B`usnygklva K, Olncb` 3>0–9>. THGF 50?54> C, Huc`n _, Bukzn H, _lt`nkoac`nr F, Tnzns`bg E, @liihngstnr A, Blnkge U. 37. tlpat`ljley-gkfga.knt/@nart>.`th). S _ly _ ly.. Hylcarfgaj gkiarctglk (`ttp=// (`ttp=//www.`gs www.`gs (?449). «Tnrglflktaj gkinctglks akf _ntrgnvnf Klvnhonr ?0, ?449. clrlkary `nart fgsnasn= rljn li pnrglflktaj Igs`ong k HC. (1774). «_npnrius «_npnriusglk glk gkmury. g kmury.². ². oactnrga akf ghplrtakcn li tltaj pat`lenk 64. Igs`ongk Cjgk Carfglj  13 (3)= ?13-5. THGF ?10??65 ?10??65. ourfnk gk t`n Clrlkary Nvnkt akf Tnrglflktaj Fgsnasn (CL_LFLKV) 61. F Jnn, F Bujg Bujgcb, cb, M Harbs. @nart A Attacb ttacb stufy.².  Arc` Gktnr Gktnrk k Hnf   199  (>)= >>6-7. (Hylcarfgaj Gkiar Gkiarctglk) ctglk) (`tt (`ttp=// p=//www.hnfgcgkn www.hnfgcgkn flg=14.1441/arc`gktn.199.>.>>6 (`ttps=//fx.flg.lre/14. knt.clh/`nart\attacb/artgcjn.`th) oy 1441%?Iarc`gktn.199.>.>>6). THGF 19>36463. HnfgcgknKnt.clh. _ntrgnvnf Klvnhonr ?0, ?449. 31. Ernnkjakf T, JaOrnn J, Aznk ST, Fl`nrty VH, Fntrakl _C. Clrlkary artnry cajcguh 6?. Katglkaj @nart, Juke akf Ojllf Gkstgtut Gkstgtutn. n. sclrn clhogknf wgt` Irahgke`ah sclrn ilr @nart Attacb Uarkgke Sgeks (`ttps=//wno.arc rgsb prnfgctglk gk asyhptlhatgc gkfgvgfuajs. `gvn.lre/wno/?44911451965>6/`ttp=//www.  MAHA. . ?4462?71=?14-?1>. 165??165 3?. MAHA Fntrakl _, Eunrcg AF, THGF Carr MM, nt aj . Clrlkary cajcguh as a prnfgctlr p rnfgctlr li clrlkar clrlkary y nvnkts gk ilur racgaj lr nt`kgc erlups. K Nkej M Hnf . ?44023>0(13)=1339-6>. THGF 10395539 33. Araf W, Ellfhak B, _lt` H, Knwstngk F, Eunrcg AF. Clrlkary cajcgigcatglk, clrlkary fgsnasn rgsb rg sb iactlrs, C-r C-rnactgvn nactgvn prltngk, akf at`nrlscjnrltgc carfglvascujar fgsnasn nvnkts= t`n St. Irakcgs @nart Stufy.  M Ah Cljj Carfglj . ?44>269=1>0-19>. THGF 1>77?9>1 36. Jgc`stngk N, C`affa BF, K Kagb agb F F,, Eupta TB. (1756). «Fgaelkaj nar-jlon crnasn= Trnvajnkcn akf ghpjgcatglks as a clrlkary

k`jog.kg`.elv/actgktghn/`aws/`aws.`th). _ntrgnvnf Klvnhonr ??, ?449. 63. Acutn Clrlkary Sykfrlhn (`ttp=//www.ahn rgcak`nart.lre/prnsnktnr rgcak`nart.lre/ prnsnktnr.m`thj95.`th  www.nhnfgcgkn.clh/h nf/tlpgc1>95.`th). ). nHnfgcgkn. _ntrgnvnf Klvnhonr ??, ?449. 6>. Baspnr FJ, Oraukwaj Oraukwajf f N, Iaucg AS, @ausnr SJ, Jlkel FJ, Mahnslk MJ. @arrgslk's Trgkcgpjns li Gktnrkaj Hnfgcgkn. Hnfgcgkn . p. 1666. Knw Wlrb= HcEraw-@gjj, ?44>. GSOK 4-45-137164-1. 69. Baspnr FJ, nt aj.  aj.  @arrgslk's Trgkcgpjns li  Gktnrkaj Hnfgcgkn. Hnfgcgkn. p. 16>4.

 

65. Harcus EH, C Cl`nk l`nk M, Yarlsy TF TF,, nt aj  (?445). «V`n utgjgty li ensturns gk patgnkts  wgt` c`nst fg fgsclhilr sclhilrt² t² (`ttp= (`ttp=//jgkbgke`uo.njs //jgkbgke`uo.njs nvgnr.clh/rntrgnvn/pgg/S444?-7363(49)4499 0-1).  Ah. M. Hnf. Hnf.   1?4  (1)= 03-7. THGF 15?40403 (`ttps=//www.kcog.kjh.kg`.elv/puoh nf/15?40403). flg=14.1419/m.ahmhnf.?449.4>.46> (`tt ps=//fx.flg.lre/14.1419%?Im.ahmhnf.?449.4>.46>) .

60. Jgttjn _ _A, A, Irayk BK, _ _akfajj akfajj TN, nt aj  (1709). «Tjasha catnc`ljahgkns gk t`n acutn p`asn Arc` li t`nNhnre rnsplksn tl gkiarctglk². Hnf    3hylcarfgaj   (1)= ?4-5.

Mlgkt Nurlpnak Slcgnty li Carfgljley/Ahnrgcak Cljjnen li Carfgljley Clhhgttnn ilr t`n rnfnigkgtglk li hylcarfgaj gkiarctglk.².  M Ah Cljj Carfglj  39 (3)= 7>7-97. THGF 147059?0. >9. Ngsnkhak A (?449). «Vrlplkgk assays ilr t`n fgaeklsgs li hylcarfgaj gkiarctglk akf acutn clrlkary sykfrlhn= w`nrn fl wn stakf47-16. flg=14.1>09/1655745?.6.6.>47 (`ttps=//fx.f lg.lre/14.1>09%?I1655745?.6.6.>47). 19710?97.

THGF

THGF 3>?6>77 (`ttps=//www.kcog.kjh.kg`.elv/puohn >5. Avgjns _M, Asbarg AV, Jgkfa`j O, Uajjnktgk f/3>?6>77). J, Mga E, L`hak NH, Ha`aiiny BU, Knwoy

67. HcSwnnkny MC, Clfy H, L'Sujj L'Sujjgvak gvak T, Njonrslk B, Hlsnr FB, Earvgk OM (?443). «Ulhnk's narjy warkgke syhptlhs li acutn hylcarfgaj gkiarctglk². Cgrcujatglk 140  (?1)= ?917-?3. flg=14.1191/41.CG_.4444475119.?79?>.5C (`ttps=//f x.flg.lre/14.1191%?I41.CG_.4444475119.?79?>.5C). THGF 16>75>07.

>4. Bakknj UO. (1709). « «Sgj Sgjnkt nkt hylcarfgaj gsc`nhga akf gkiarctglk= gksge`ts irlh t`n Irahgke`ah Stufy.². Carfglj Cjgk  Cjgk  6  (6)= >03-71. THGF 3557517 3557517. >1. Favgs VH, Ilrtuk T, Hujfnr M, Favgs UA, Orucn FE (?446). «Sgjnkt hylcarfgaj gkiarctglk akf gts prleklsgs gk a clhhukgtyoasnf cl`lrt li Vypn ? fgaontgc patgnkts= t`n Irnhaktjn Fgaontns Stufy². Fgaontljlega   Fgaontljlega (3)= 37>-7. 65  flg=14.1445/s441?>-446-1366-6 (`ttps=//fx.flg.lre/1 4.1445%?Is441?>-446-1366-6) . THGF 16793960.

>?. _uog _uogk, k, Nhakunj2 Elrst Elrstngk, ngk, Irnf2 _uogk, _ap`anj2 Sc`wartgke, _ljakf2 Straynr, Favgf (?441). _uogk's Tat`ljley -

JB, Cajgii _H, Sghllks HJ, Vlplj NM, Onrenr T, Jaunr HS (?44?). «Vrlplkgk V jnvnjs gk patgnkts wgt` acutn clrlkary sykfrlhns, wgt` lr wgt`lut rnkaj fysiukctglk.². K Nkej M Hnf   369  (?9)= ?465->?. flg=14.14>9/KNMHla4136>9 (`ttps=//fx.f lg.lre/14.14>9%?IKNMHla4136>9). THGF 1?405164.. Suhhary ilr jayhnk (`ttp=//www.c ham.ca/ceg/clktnkt/iujj/195/9/951) >0. Appjn IS, Uu A@, Hag Hagrr M, nt aj   (?44>). «Iuturn oglharbnrs ilr fntnctglk li gsc`nhga akf rgsb stratgigcatglk gk acutn clrlkary sykfrlhn² (`ttps=//wno.arc`gvn.lr e/wno/?41147?5416141/`ttp=//www.cjgkc`n h.lre/ceg/clktnkt/iujj/>1/>/014). Cjgk. C`nh.   >1 (>)= 014-?6. THGF 1>556>53 (`ttps=// C`nh.  www  ww w.kcog.kjh.kg`.elv/puohnf .kcog.kjh.kg`.elv/puohnf/1>55 /1>556>5 6>53) 3). flg=14.1353/cjgkc`nh.?446.469?7? (`ttps=//fx.flg.lr e/14.1353%?Icjgkc`nh.?446.469?7?). Arc`gvafl

fnsfn nj lrgegkaj lrgeg kaj (`tt (`ttp=// p=//www.cjgkc`nh.lre/c www.cjgkc`nh.lre/c eg/clktnkt/iujj/>1/>/014) nj ?5 fn snptgnhorn fn ?411. Clksujtafl nj 1> fn hayl fn ?440.

Cjgkgclpat`ljlegcaj Ilukfatglks li  >7. Cajgii Oraukwaj Oraukwajf f N, AkthakHF, N NH, H,@lc`hak Onasj Onasjny ny MU MU, _H, C`ngtjgk MS,, Hnfgcgkn.. Haryjakf= Jgppgkcltt Ugjjgahs & Hnfgcgkn Mlkns _@, Bnrngabns F, Bupnrshgt` M, Ugjbgks. Ugjbg ks. p. >67. GSOK 4-5015-6533-3. Jnvgk VK, Tnpgkn CM, Sc`aniinr MU, Shgt` >3. Hylcarfgaj gkiarctglk= fgaeklsg fgaeklsgs s akf NN GGG, Stnwarf FN, V`çrlux T. (?44?). gkvnstgeatglks (`ttp=//www.epkltnollb.cl.u «ACC/A@A ?44? eugfnjgkn upfatn ilr t`n b/sghpjnpaen.cih056&jgkbGF8 hakaenhnkt li patgnkts wgt` ukstaojn ?3?50&cllb8yns) - ETkltnollb, rntrgnvnf akegka akf klk–SV-snehnkt njnvatglk Klvnhonr ?5, ?449. hylcarfgaj gkiarctglk= a rnplrt li t`n >6. Egj Egjjuh juh _I _I,, Ilrthakk ST ST,, Trgk Trgknas nas _M, Ahnrgcak Cljjnen li Carfgljley/Ahnrgcak Blttbn VN. Gktnrkatglkaj fgaeklstgc crgtnrgl @nart Asslcgatglk Vasb Ilrcn lk Tractgcn ilr acutn hylcarfgaj gkiarctglk akf acutn Eugfnjgkns Eugfnjg kns (Clhhgttnn lk t`n Hakaenh Hakaenhnkt nkt strlbn.  Ah @nart M   17062140=1>4-0. THGF li Tatgnkts Ugt` ^kstaojn ^ kstaojn Akeg Akegka).² ka).² (`t (`ttps=/ tps=/// 9531?9>  wno.arc`gvn.lre/wno/?44743?914194?/`tt >>. Ajpnrt MS, V`yensnk B, Akthak N, Oassakf MT. (?444). «Hylcarfgaj gkiarctglk rnfnigknf--a clksnksus flcuhnkt li V`n

p=//www.acc.lre/quajgtyakfscgnkcn/cjgkgcaj/ eugfnjgkns/ukstaojn/gkclrplratnf/^A\gkclr plratnf.pfi) (TFI). (TFI).  M Ah Cljj Carfglj   64=

 

1399-56. THGF 1?303>00. Arc`gvafl fnsfn nj ilr t`n Hakaenhnkt li Tatgnkts Ugt` Acutn lrgegkaj (`tt (`ttp=// p=//www.acc.lr www.acc.lre/quajgtyakfscgnk e/quajgtyakfscgnk Hylcarfgaj Gkiarc Gkiarctglk)² tglk)² (`tt (`ttps=// ps=//wno.arc`gvn. wno.arc`gvn. cn/cjgkgcaj/eugfnjgkns/ukstaojn/gkclrplratn lre/wno/?4144>4741?764/`ttp=// lre/wno/?4144>4741?764/`tt p=//www.acc.l www.acc.l f/^A\gkclrplratnf.pfi) nj ?9 fn harzl fn re/quajgtyakfscgnkcn/cjgkgcaj/eugfnjgkns/stn ?447. hg/eugfnjgkn1/gkfnx.`th). M hg/eugfnjgkn1/gkfnx.`th).  M Ah Cljj Carfglj  C arfglj  66= 951-517. THGF 1>3>046>. Arc`gvafl 94. Nrgca Fajj‗Arhnjjgka1, Stniak B Tgnc`kgb1, fnsfn nj lrgegkaj lrgeg kaj (`tt (`ttp=// p=//www.acc.lr www.acc.lre/quajgty e/quajgty Yaknssa H Inrrngra1, Quake Jn Sg?, akfscgnkcn/cjgkgcaj/eugfnjgkns/stnhg/Eugfnj Hatt`nw F _loslk1, Makn H Irakcgs1, gkn1/gkfnx.`th) nj 7 fn hayl fn ?414. (?41?). Carfglvascujar haekntgc rnslkakcn oy klk clktrast V1 happgke 95. Ergkns CJ, Clx FA, Stlkn EU, Earcga N, ajjlw li snvnrgty li gkmury gk Hattls JA,L,Egahoartljlhng A, Jaksby Orlfgn O_, acutn assnsshnkt hylcarfgaj gkiarctglk  gkiarctglk   (`ttp=//www.ogl Haflkka Ngmenjs`lvnk H, AM, hnfcnktraj.clh/clktnkt/pfi/1>3?-6?7P-16L'Kngjj UU, Hlrgcn HC. (1777). «Clrlkary 1>.pfi) (16). p. 1>. Clksujtafl nj ?> fn akeglpjasty wgt` lr wgt`lut stnkt aelstl fn ?41>. ghpjaktatglk ilr acutn hylcarfgaj gkiarct g kiarctglk. glk. Stnkt Trghary Akeglpjasty gk Hylcarfgaj 91. Olgn NV (?44>). «Gkgtgaj nvajuatglk li c`nst Gkiarctglk Stufy Erlup.². K Nkej M Hnf   361 pagk² (`ttp=//jgkbgke`uo.njsnvgnr.clh/rntrgnv (?9)= 1767->9. THGF 14945011. n/pgg/S4533-09?5(4>)444>7-3). Nhnre Hnf  Cjgk Klrt K lrt` ` Ah  Ah ?3 (6)= 735->5. THGF 1917733? 90. `ttps= `ttps=//wno.arc //wno.arc`gvn.lre/wno/?41441?946434 `gvn.lre/wno/?41441?946434 (`ttps=//www.kcog.kjh.kg`.elv/puohnf/1917733?). 97. Bnnjny NC, Olura MA, Ergkns CJ. (?443). flg=14.1419/m.nhc.?44>.45.445 (`ttps=//fx.flg.lre/14. «Trghary akeglpjasty vnrsus gktravnklus 1419%?Im.nhc.?44>.45.445). t`rlholjytgc t`nrapy ilr acutn hylcarfgaj 9?. VGHN GS H^SCJN VGHN UASVN ASVNF F GS gkiarctglk= a quaktgtatgvn rnvgnw li ?3 H^SCJN JLSV (`ttp=//www.n`ac.lre/st-ae rakflhgsnf trgajs.². Jakcnt   391 (73>1)= 13flg=14.1419/S4164-9539(4 539(43)1?1 3)1?113-5 13-5 (`ttps=// (`ttps =//fx.f fx.f kns/N@AC\JginakfFnat`/VghngsHuscjn.`t ?4. flg=14.1419/S4164-9 h). Narjy @nart Attacb Carn, St. Aekns lg.lre/14.1419%?IS4164-9539%?043%?71?113-5) . @najt`carn. @naj t`carn. _ntrgnvnf Klvnhonr ?7, ?449. THGF 1?>15694. 93. @nart attacb igrst agf (`ttp=//www.kjh.kg`.el 54. Ergkns CJ, Orlwkn O rlwkn BI B I, Harcl M, _lt`oauh v/hnfjgknpjus/nkcy/artgcjn/444493.`th). F, Stlkn EU, L'Bnnin M, Lvnrjgn T, HnfjgknTjus. _ntrgnvnf Fncnhonr 3, ?449. Flkl`un O, C`njjga` K, Vghhgs EC, nt aj. (1773). «A clhpargslk li ghhnfgatn 96. Act Gk Vghn tl @nart Attacb Sgeks (`ttps=//wn akeglpjasty wgt` t`rlholjytgc t`nrapy ilr o.arc`gvn.lre/wno/?4404>47173563/`ttp=// acutn hylcarfgaj gkiarctglk. V`n Trghary  www.k`jog.kg`.elv/act  www.k`jog.kg `.elv/actgktghn/gkfnx.`th) gktghn/gkfnx.`th) Akeglpjasty gk Hylcarfgaj Gkiarctglk Stufy K@JOG. K@JO G. _ntr _ntrgnvnf gnvnf Fncnhonr 13, ?449. Erlup.². K Nkej M Hnf   3?0  (14)= 953-7. 9>. Orlwk AJ, Hakk KC, Faya H, Eljfonre _, flg=14.14>9/KNMH177343113?01441 (`ttps=//fx.flg.l Hngsc`bn @, Vayjlr Vayjlr M, Shgt` B, Lseakgak S, re/14.14>9%?IKNMH177343113?01441) . THGF Cllpnr J. (?444). «Fnhlerap`gc, onjgni, 06335?>. akf sgtuatglkaj iactlrs gkijunkcgke t`n 51. V`n Ejloaj ^sn li S Stratnegns tratnegns tl Lpnk fncgsglk tl utgjgzn nhnrenkcy hnfgcaj Lccjufnf Clrlkary Artnrgns gk Acutn snrvgcns ahlke c`nst pagk patgnkts. _apgf Clrlkary Sykfrlhns (E^SVL GGo) Narjy Actglk ilr Clrlkary Vrnathnkt Akeglpjasty Akeglpj asty Suostufy Gkvnstgeatlrs. ((1775). 1775). (_NACV) (_NAC V) stufy stufy.². .². Cgrcujatglk Cgrcujatglk   14?  (?)= 153«A cjgkgcaj trgaj clhpargke prghary clrlkary 0. THGF 140071?5. akeglpjasty wgt` tgssun pjashgklenk 99. Akthak NH, Akon FV FV,, Arhstrlke TU, actgvatlr ilr acutn hylcarfgaj gkiarctglk.². Oatns N_, Ernnk JA, @akf H, @lc`hak K Nkej M Hnf   339  (?3)= 19?1-0. THGF MS, Bruh`ljz @H, Bus`knr IE, Jahas EA, 7153?54. Hujjaky CM, Lrkatl MT, Tnarjn FJ, Sjlak HA, Shgt` SC Mr (?446). «ACC/A@A 5?. Olnrsha N2 V`n Trghary Clrlkary Akeglpjasty Akeglpj asty vs. V`rlholjysgs Erlup. "Flns eugfnjgkns ilr t`n hakaenhnkt li patgnkts tghn hattnr< A plljnf akajysgs li  wgt` SV-njnvatglk hylcarfgaj gkiarctglk= a rakflhgznf cjgkgcaj trgajs clhpargke rnplrt li t`n Ahnrgcak Cljjnen li prghary pnrcutaknlus clrlkary gktnrvnktglk Carfgljley/Ahnrgcak @nart Asslcgatglk akf gk-`lspgtaj igorgkljysgs gk acutn Vasb Ilrcn lk Tractgcn Eugfnjgkns (Clhhgttnn tl _nvgsn t`n 1777 Eugfnjgkns

 

hylcarfgaj gkiarctglk patgnkts." Nur @nart M  ?4492 ?5(5)=557(5)=557-00. 00. THGF 19>1 19>13993 3993

Nkjacns nxtnrkls HnfjgknTjus Nkcgcjlpnfga 44417> (`ttp=//www.kjh.kg`.elv/hnfjgknpjus/spakgs`/nkcy/artgcj  n/44417>.`th) IL_^HCJGKGC Gkilrhacgók para pacgnktns slorn gkiartl aeufl fn hglcarfgl nk Nspañlj y Cataják= vèfnls, kltgcg kltgcgas as y ilrls (`ttps=/ (`ttps=//wno.arc`gvn.lre/ /wno.arc`gvn.lre/wno/?44540?5476963/`ttp= wno/?44540?5476963/`ttp=//www.i //www.il l ruhcjgkgc.lre/nkinrhnfafns/carfglpatga-gsqunhgca) Vutlrgajns Vut lrgajns Gktnr Gktnractgvls actgvls fn Sa Sajuf juf Hnfj Hnfjgkn gkn T Tjus= jus= Gkiartl aeufl fnj hglcarfg hglcarfgl l (`ttps=/ (`ttps=//wno.arc`g /wno.arc`g vn.lre/wno/?44743?643>93?/`ttp= vn.lre/ wno/?44743?643>93?/`ttp=//www.kjh. //www.kjh.kg`.elv/hnfjgknpj kg`.elv/hnfjgknpjus/spakgs`/tut us/spakgs`/tutlrgajs/`nartatt lrgajs/`nartatta a cbspakgs`/`th/gkfnx.`th) cbspakgs`/`th/ gkfnx.`th) ^tgjgza eráigcas akghafas akg hafas y sn punfn nscuc`ar nj tutlrgaj

Lotnkgfl fn «`ttps=//ns.wgbgpnfga.lre/w/gkfnx.p`p40995²

Nsta páegka sn nfgtó plr ýjtgha vnz nj ?? snp ?4?1 a jas 1>=6?. Nj tnxtl nstá fgsplkgojn oaml ja Jgcnkcga Crnatgvn Clhhlks Atrgoucgók Clhpartgr Geuaj 3.42 punfnk apjgcarsn cjáusujas afgcglkajns. Aj usar nstn sgtgl, ustnf acnpta kunstrls tçrhgkls fn usl y kunstra pljètgca fn prgvacgfaf. Ugbgpnfga® ns uka harca rnegstrafa fn ja Iukfacgók Ugbghnfga, Gkc., uka lreakgzacgók sgk ákghl fn jucrl.