Metodos de Nodulizacion

 

Kcia Khau

3¶F grac` grac`c c EINTC / ICU sgdrh nua`ieiõa Khau

Pcdoh gn  Egathats

Cutjgr Ia`hx

Hxit

]TG@XEEIGA @H JIHTTG @XEPIOEGK]CTCEIGA @H KHPG@GU  COO PHTACPI^GU  C PHTAC PI^GU @H PTCPCKIHAPG PTCPC KIHAPG Ho gdfhtivg `h hstc prhshatceiõa hs gnrhehr uac visiõa bhahrco sgdrh ogs `inhrhaths prgehsgs `is pgaidohs pcrc oc prg`ueeiõa `ho jihrrg `öetio, y ha hspheico, `hseridir ocs priaeipcohs vhatcfcs y `hsvhatcfcs `h ogs `ivhrsgs kétg`gs. ]rgdcdohkhath, ho pcsg kcs ikpgrtcath ha oc prg`ueeiõa `h jihrrg `öetio- ag`uocr shc oc c`ieiõa `h cbhaths ag`uoizcaths pcrc nua`ir jihrrg. Ho kcbahsig hs ho hohkhatg hsnhri`izcath kãs utioizc`g, y nrheuhathkhath sh og utioizc ega ho ehrig y gtrgs kcthricohs `h tihrrcs rcrcs. Thegr`hkgs quh6 ‟Ho gdfhtivg `h uac nua`ieiõa hs prg`ueir oc ecoi`c` hxibi`c co khagr egstg pgsidoh‛. Oc rheuphrceiõa `ho kétg`g `h trctckihatg y `h oc cohceiõa sga ncetgrhs eocvhs ha hsth csphetg. Ocs vcricdohs quh iaei`ha sgdrh oc rheuphrceiõa iaeouyha6 • Pipg `h euejcrc • Oc thkphrcturc `ho khtco • Pipg y tckcóg `h kcthrico ag`uoizcath • Ecati`c` `h khtco kh tco c trctcr  • ^hogei`c` `h egoc`g y kétg`g `h trctckihatg.

IAPTG@XEEIGA Ho kcbahsig hs ho cbhath ag`uoizcath kãs pgpuocr, y bhahrcokhath sh og cbrhbc egkg uac cohceiõa `h köotipohs egkpgahaths quh egatihaha hohkhatgs quh6 • Th`ueha oc vigohaeic `h oc rhceeiõa • ]rgkuhvha oc hsnhrgi`izceiõa hsn hrgi`izceiõa `ho brcnitg • Ahutrcoizca ho hnhetg `h ocs ikpurhzcs ha oc kgrngogbëc `ho brcnitg • Egatrgoca oc hstrueturc `h oc kctriz Ocs cohceigahs kãs egkuahs pcrc ag`uoizcr ho jihrrg sga ho nhrrgsioieig quh egatihaha `hs`h 5 c 34 % `h kcbahsig. Ho kcbahsig (Kb) y sus cohceigahs tihaha thkphrcturcs `h vcpgrizceiõa dcfcs y ha egasheuhaeic sh `hdha cbrhbcr co jihrrg nua`i`g ega hxtrhkg eui`c`g. Ho trctckihatg hs uac ngrkc `h kg`iniecr oc hstrueturc `h sgoi`inieceiõa `h kcahrc tco quh oc ncsh `h brcnitg sh prheipith y ngrkh pcrtëeuocs hsnériecs ha oubcr `h hseckcs, y csë sh ogbrh jihrrg nua`i`g ega prgpih`c`hs kheãaiecs sibainiectivckhath khfgrhs. Oc ceeiõa ag`uoizcath puh`h shr egasi3¶ Fgrac`c EINTC/ ICU sgdrh nua`ieiõa, 4==8, Uca Aiegocs, Crbhatiac ->2-

 

Kcia Khau

3¶F grac` grac`c c EINTC / ICU sgdrh nua`ieiõa Khau

Pcdoh gn  Egathats

Cutjgr Ia`hx

Hxit

`hrc`c egkg ua trctckihatg sikuotãahg `h `hsuonurceiõa y `hsgxi`ceiõa, `ga`h sh cbrhbca hohkhatgs quh thabca uac cotc cniai`c` tcatg pgr ho czunrh egkg pgr ho gxëbhag . Euca`g ho gxëbhag y ho czunrh `isuhotg sh hxtrcha `ho oëqui`g, ho brcnitg erhehrã ha ngrkc `h aõ`uogs `h ceuhr`g c sus ecrcethrëstiecs eristcogbrãniecs.

]TGEHUGU @H PTCPCKIHAPG EGA KCBAHUIG Xac visiõa bhahrco sgdrh ogs prgehsgs `h trctckihatg `h jihrrg `öetio-ag`uocr kãs egkuahs ha oc cetucoi`c` sga6 • Kétg`g sca`wiej • Pua`isj eudihrtg • Ia kgo`  • Noufg egatiaug • Uukhrsiõa • Egavhrti`gr  Egavhrt i`gr  •Cockdrh ega cokc `h kcbahsig Hstcyc sëathsis rhsuotc iathrés pcrc cquhoocs nua`ieigahs quhpcrc `hshca egkhazcr c prg`ueir @h jihrrg `öetio quh quh sirvh pcrc`hhohbir ho egaehptg `h prgehsg egrrhetg ua prgpõsitg prgp õsitg hspheënieg. hstc kcahrc, sh gnrheh uac duhac dcsh c ocs nua`ieigahs quh `hshca khfgrcr oc hnieihaeic `h ua prgehsg hxisthath `h jihrrg `öetio ―ag`uocr, `hkgstrca`g euãohs sga ocs o cs cothractivcs quh sh puh`ha c`gptcr kãs nãeiokhath, y qué khfgrcs h iavhrsigahs shrëca ahehscrics si sh c`gptcrca `iejcs cothractivcs. ]crãkhtrgs c thahr ha euhatc pcrc `hniair ho cbhath c`heuc`g pcrc ho prgehsg6 • Ho egathai`g `h kcbahsig • Oc rheuphrceiõa `h kcbahsig • Oc thkphrcturc `h trctckihatg • @ishóg `ho rheipihath • Uhoheeiõa `h oc cohceiõa • Egkpgsieiõa `ho khtco dcsh Gtrgs ncetgrhs c thahr ha euhatc pcrc oc `heisiõa `ho prgehsg c c`gptcr6 • Nohxidioi`c` bhahrco `ho prgehsg (oc oidhrtc` quh ec`c prgehsg c`kith pcrc cothrcr ho tckcóg `ho trctckihatg, oc udieceiõa , ocs prhpcrceigahs, oc egkpgsieiõa `h jihrrg, ocs tcsc `h cohceigahs cbrhbc`cs, hte.) • Bcshs hkiti`gs (euãatg bcs `h Kb hkcacrã `h ec`c prgehsg) • Eocsinieceiõa `h ogs prgehsgs (cquhoogs quh cpoieca kcthricohs ega cotg egathai`g `h Kb, tco egkg ho Kb khtãoieg, bhahrca uac kcygr ecati`c` `h jukgs quh ogs quh usca cohceigahs `h KbNhUi ega corh`h`gr `h ua 8 % `h Kb< hstg sibainiec quh pcrc ocs rhceeigahs vigohatcs sh ahehsitc ua ‟sisthkc `h hxtrceeiõa `h bcshs‛, y ogs öaiegs 4 prgehsgs quh, `h ceuhr`g c ocs hxibhaths agrkcs ck3¶ Fgrac`c EINTC/ ICU sgdrh nua`ieiõa, 4==8, Uca Aiegocs, Crbhatiac ->:-

 

Kcia Khau

3¶F grac` grac`c c EINTC / ICU sgdrh nua`ieiõa Khau

Pcdoh gn  Egathats

Cutjgr Ia`hx

Hxit

 dihatcohs cetucohs, prgdcdohkhath ag rhquihrca hxtrceeiõa shpcrc`c `h jukg sga ho prgehsg `h Pua`isj-Egvhr y ho prgehsg Ia Kgo`) • Thstrieei quh sh rhegkiha`c  Thstrieeigahs gahs sgdrh ho khtco dcsh (euão hs ho egathai`g kãxikg `h czunrh quh ha ho jihrrg prhvig c su trctckihatg6 pcrc oc kcygrëc `h ogs prgehsgs quh utioizc uac nhrrgcohceiõa ega 5 co 3=% `h Kb, sh rhegkiha`c ag hxeh`hr ho =.=5% `h czunrh ha ho jihrrg dcsh, kihatrcs quh  pcrc ogs prgehsgs ega cotg egathai`g `h Kb/ Kb khtãoieg, tcohs egkg ‟sukhrsiga‛, ‟egavhrti`gr‛ y ‟cockdrh‛, sh cehptc uac kcygr ecati`c` `h czunrh `h jihrrg dcsh, cobuacs `h hstcs rhceeigahs vigohatcs puh`ha prg`ueir jihrrg `öetio `irhetckhath c pcrtir `h ua jihrrg dcsh `h eudiogth ega cotg czunrh) • Hnhetg `h iageuoceiõa iageuoceiõa `ho Jihrrg ag`uoizc`g ag`uoizc`g • Ho egstg `h oc pocatc (si hs ahehscrig rhcoizcr gtrcs iavhrsigahs pcrc c`cptcr ho prgehsg) • Pckcóg `h oc uai`c` `h prg`ueeiõa c`heuc`c co prgehsg (ho tckcóg `h nua`ieiõa quh rhsuotc cprgpic`g pcrc c`gptcr ua prgehsg `c`g< bhahrcokhath, oc kcygrëc `h ogs prgehsgs `h KbNhUi puh`ha cpoiecrsh tcatg ha ocs nua`ieigahs phquhócs egkg ha ocs `h kcygr tckcóg, kihatrcs quh ocs iavhrsigahs csgeic`cs co ‟egavhrti`gr‛ y co ‟cockdrh `h kcbahsig‛ rhquihrha uac nua`ieiõa kcs brca`h quh puh`ca cnrgatcr ogs egstgs hxtrcs)

3. ]TGEHUG UÃA@RIEJ Ho térkiag sãa`wiej `hrivc `ho jhejg `h quh sh egogec ua kcthrico `h egdhrturc g uac ecpc tipg sãa`wiej sgdrh oc cohceiõa hsnhrgi`izcath prhvig c oc c`ieiõa `h jihrrg nua`i`g pcrc rhtcr`cr ho egkihazg `h oc rhceeiõa `h oc cohceiõa. Hs egköa uscr ho 3 co 4 % `h rhegrths `h rhkcejc`g `h cehrg `h hsphsgrhs c`heuc`gs egkg kcthrico `h egdhrturc cuaquh tckdiéa sh usca gtrgs kcthricohs tcohs egkg ho nhrrgsioieig. C`hkãs C`hkãs `h rhrhtcr`cr ho egkihazg `h oc rhceeiõa, ho kcthrico `h egdhrturc hanrëc ho khtco quh sh haeuhatrc prõxikg c oc rhceeiõa `h kcbahsig. @iejg @iejg hnhetg `h hanrickihatg cprgvhejc pcrc quh oc rheuphrceiõa `ho kcbahsig cukhath c kh`i`c quh `iskiauyh oc thkphrcturc `ho khtco. Ega ho trctckihatg sãa`wiej, oc rheuphrceiõa `ho kcbahsig bhahrcokhath hs duhac y puh`h vcricr hatrh ho 0= y >=%. Oc rhoceiõa hatrh oc coturc y ho `ëckhtrg `ho erisgo `hdh shr 4,8 / 3.

^hatcfcs •Pihkpgs `h trctckihatg egrtgs • Nohxidioi`c`  • Uikpoiei`c`  Uikpoi ei`c` 

3¶ Fgrac`c EINTC/ ICU sgdrh nua`ieiõa, 4==8, Uca Aiegocs, Crbhatiac ->9-

 

Kcia Khau

3¶F grac` grac`c c EINTC / ICU sgdrh nua`ieiõa Khau

Pcdoh gn  Egathats

Cutjgr Ia`hx

Hxit

@hsvhatcfcs • ]ér`i`c `h thkphrcturc ohvhkhath kcygr `hdi`g co ecogr c`ieigaco ahehscrig pcrc nua`ir oc eg dhrturc • Kuejgs jukgs

4. ]TGEHUG PXA@IUJ EXDIHTPG Ocs pér`i`cs `h kcbahsig egkg KbG sh rh`ueha sibainiectivckhath `hdi`g c quh ag jcy iabrhsg `h auhvg gxëbhag co erisgo uac vhz quh ho khtco eudrh ho grinieig `h oohac`g `ho sãa`wiej. Ocs rheuphrceigahs `h kcbahsig puh`ha shr `h jcstc 2=-28 %, ua cvcaeh egasi`hrcdoh ha egkpcrceiõa co sikpoh kétg`g sãa`wiej. Ha hsth kétg`g ag hs tca ikpgrtcath oc rhoceiõa `iãkhtrg / coturc `h oc euejcrc, ho prgehsg pg`rëc khfgrcr cöa kãs ega rhoceigahs kãs brca`hs. Ho rheipihath õptikg pcrc ua prgehsg `h tua`isj eu dihrtg hs ua tudg quh tihah ua tcdiquh vhrtieco pcrc pcr c nceioitcr nceio itcr ho cogfckihatg `ho ag`uoizcath. Ho prgehsg `h tua`isj eudihrtg hs c`heuc`g pcrc tg`gs ogs tckcógs `h trctckihatg quh vcrëha hatrh 3== Lb y 3= tgahoc`cs. Oc tcpc `ho tua`isj-egvhr sh puh`h `ishócr pcrc eukpoir ega `ivhrscs ega`ieigahs `h nua`ieiõa. Cobuags hfhkpogs sga uac tcpc nifc, ega hohvceiõa cutgkãtiec g uac tcpc quh sh rhtirc kcaucokhath. Ho grinieg `h scoi`c `ho khtco ha oc tcpc `hdh thahr ua tckcóg quh sh c`heuh c oc ecati`c` `h jihrrg quh sh hstã trctca`g. Oc iaegrpgrceiõa `h `gs eãkcrcs sikétriecs pcrc oc cohceiõa ha oc pcrth ianhrigr `ho erisgo hs ua `ishóg vhatcfgsg pcrc hsth egaehptg `h prgehsg. ]gr kh`ig `h hstcs `gs `gs eãkcrcs, ho erisgo puh`h cutghoikiacr oc ceukuoceiõa `h hsegric. Oc cutgoikpihzc sh rhcoizc eckdica`g hatrh ecrbc y `hsecrbc `h oc cohceiõa ha ckdcs eãkcrcs. C kh`i`c quh oc eãkcrc quh egatihah oc cohceiõa ceukuoc hsegric, oc tcpc sh `hspoczc 3:= brc`gs y pgsthrigrkhath sh utioizc oc eãkcrc `h vhrti`g oikpic pcrc oc cohceiõa. Oc eãkcrc pcrc oc cohceiõa egatckiac`c ega oc hsegric sh oikpic auhvckhath pgr kh`ig `h ua ejgrrg `h khtco ecoihath y turduohatg euca`g sh oc egogec `irhetckhath dcfg ho grinieig `h oc tcpc.

@inhrhaths tipgs `h `ishóg `ho erisgo ega Pua`isj-Egvhr6 • ]crth ]crth suphrigr suphrigr nifc Oc tcpc nifc `hdh `hdh thahr ua grinieig `h hatrc`c pcrc pcrc ecrbcr oc cohceiõa `h KbNhUi. Pckdiéa sh rhegkiha`c egogecr oc cohceiõa ha ua dgosioog ha ho oc`g gpuhstg `h oc pcrth ianhrigr `ho erisgo `ga`h ejgec ho ejgrrg `h khtco `urcath ho prgehsg `h oohac`g. Bhahrcokhath rhsuotc `inëeio scecr oc hsegric `h ogs erisgohs ega tcpc nifc y, ega ho tihkpg, oc ceukuoceiõa `h hsegric puh`h oohbcr c shr ua prg dohkc. ]gr og tcatg, ega hsth `ishóg, sh rhegkiha`c utioizcr cohceigahs ega dcfc ngrkce ngrkceiõa iõa `h hsegric (dcfg egathai`g `h Ec, Co y TH) pcrc kiaikizcr oc ngrkceiõa `h hsegric `hatrg `ho erisgo.

3¶ Fgrac`c EINTC/ ICU sgdrh nua`ieiõa, 4==8, Uca Aiegocs, Crbhatiac -2=-

 

Kcia Khau

3¶F grac grac`c `c EINTC / ICU sgdrh nua`ieiõa Khau

Pcdoh gn  Egathats

Cutjgr Ia`hx

Hxit

• Erisgo ha ngrkc `h ththrc Ogs erisgohs tipg ththrc gnrheha oc vhatcfc quh ho jihrrg oëqui`g sh puh`h vhrthr c trcvés `ho pieg `h oc ththrc. Hstg sibainiec quh sh hoikiac ho rheipihath ega tcpc. Ha ogs erisgohs tipg ththrc sh puh`ha utioizcr tcatg ocs tcpcs nifcs egkg ocs quh sh sceca. Ha ho ecsg `h ogs erisgohs quh gphrca ega ua sgog pieg, hxisth ho rihsbg pgsidoh `h quh ho öotikg jihrrg quh sh oh cbrhbc ag sh trcth ega Kb. Ho jihrrg `hdh phrkcahehr ha ho pieg jcstc quh rhdcsh, y si sh og usc `irhetckhath ha h a ua kgo`h `hdh shr jihrrg sudtrctc`g g jihrrg bris. ]crc hvitcr tcohs t cohs prg dohkcs sh puh`h `ishócr uac `gdoh ththrc ega ua pieg pcrc oohac`g ooh ac`g y gtrg pcrc vhrti`g. Ogs erisgohs tipg ththrc bhahrcokhath sukiaistrcrãa khtco kãs oikpig ha ogs erisgohs vhrth`grhs y ha ogs cutgvhrth`grhs `hdi`g co hnhetg `h hsquiokh hfhrei`g pgr ho pieg.

• Pcpc shpcrcd shpcrcdoh oh Ho `ishóg euyc tcpc sh shpcrc g sh ohvcatc, prgdcdohkhath shc ho kãs nohxidoh y nãeio `h kcathahr. Ocs tcpcs quh sh ohvcatca puh`ha hstcr iathbrc`cs co erisgo pgr kh`ig `h ua caioog ia`hpha`ihath `h shpcrceiõa g puh`ha egastruirsh egkg uac tcpc tgtcokhath shpcrcdoh usca`g, pgr hfhkpog, ua cutghohvc`gr. Oc tcpc tckdiéa sh puh`h kgatcr kgatcr sgdrh ho pieg `ho jgrag. Ocs vhatcfcs kãs ikpgrtcaths ha rhoceiõa c ocs tcpcs shpcrcdohs sga6 oc nãeio oikpihzc y hoikiaceiõa `h hsegric `h ogs erisgohs, y oc pgsidioi`c` `h utioizcr oc kiskc tcpc pcrc `istiatgs `istiatgs erisgohs. Oc cohceiõa KbNhUi sh puh`h puh`h ecrbcr nãeiokhath utioizca`g hkdu`gs pcrc quh ho KbNhUi sh cogfh ha ho `iquh/ dgosioog egrrhspga`ihath.

5. ]TGEHUG IA - KGO@ Hsth prgehsg sirvh pcrc hsnhrgi`izcr ho jihrrg jihrrg nua`i`g `hatrg `ho prgpig kgo`h. Xac eãkcrc `h `h rhceeiõa hspheico sh iaegrpgrc `hatrg `ho sisthkc `h egoc`c `ho kgo`h. Ocs cohceigahs hsnhrgi`izcath sh egogeca ha oc eãkcrc y oc rhceeiõa geurrh `urcath ho prgehsg `h vhrti`g `h oc cohceiõa. Ho prgehsg rhquihrh ua egatrgo prheisg pcrc prg`ueir uac hsnhrgi`izceiõa õptikc y duhacs pihzcs. Xac rhceeiõa egatrgoc`c hatrh ho khtco y oc cohceiõa `hpha`h `hpha`h `h cobuags ncetgrhs egkg6 oc thkphrcturc `ho khtco, oc vhogei`c` `ho ejgrrg, oc ngrkc `h oc cohceiõa, ho tckcóg y oc bhgkhtrëc `h oc egoc`c. Hs cdsgoutckhath hshaeico quh caths `ho trctckihatg ho czunrh sh kcathabc co =.=3% g pgr `hdc fg `h hsth aivho pcrc kiaikizcr oc pgsidioi`c` `h quh geurrca `hn `hnhetgs hetgs `h iaeousiõa. Ogs tihkpgs `h vhrti`g `hdha shr sgkhti`gs c ua egatrgo eui`c`gsg pcrc cshburcr quh oc cohceiõa sh `isuhovc c trcvés `h tg`c oc sheuhaeic `h oohac`g.

^hatcfcs Theuphrceiõ rceiõa a • Theuph

`ho 2= ―:= % `h Kcbahsig Kcbahs ig • Hoikiaceiõa `h oc ahehsi`c` `h uac c`ieiõa `h iageuoceiõa sudsibuihath pgrquh ho prgehsg pgr  së kiskg prg`ueh ua hnhetg `h aueohceiõa kuy duhag. • Ag bhahrc hkcaceiõa `h jukgs

3¶ Fgrac`c EINTC/ ICU sgdrh nua`ieiõa, 4==8, Uca Aiegocs, Crbhatiac -23-

 

Kcia Khau

3¶F grac` grac`c c EINTC / ICU sgdrh nua`ieiõa Khau

Pcdoh gn  Egathats

Cutjgr Ia`hx

Hxit

@hsvhatcfcs • Tha`ikihatg

khagr ha oc egoc`c `hdi`g c quh oc eãkcrc `h rhceeiõa hs pcrth `h ec`c sisthkc `h

egoc`g. • Kcygr pgsidioi`c` `h quh oc hsegric y gtrgs prg`uetgs `h oc rhceeiõa iabrhsha c oc egoc`c. • Ec`c kgo`h hs ua trctckihatg

0. ]TGEHUG EGA COCKDTH @H KCBAHUIG (Egrh` Rirh) Cquë ho tudg `h cockdrh juheg hstc rhoohag `h Kb khtãoieg g `h uac cohceiõa ega cotg egathai`g `h kcbahsig. Ouhbg ho cockdrh sh iayhetc co jihrrg oëqui`g pgr kh`ig `h uac kcquiac coikhatc`grc. Hstc téeaiec hs egagei`c egkg ‟iayheeiõa `h havciac`gs pcrc ho trctckihatg `h Kb pcrc oc ag`uoizceiõa `h khtco dcsh‛, oc euco rhquihrh `h `gs hohkhatgs hshaeicohs pcrc su cpoieceiõa6 pgr  ua oc`g, ho havciac`g, y pgr ho gtrg, ho `ispgsitivg `h iayheeiõa. iayheeiõa.

Ho havciac`g Ho havciac`g g ‟egrh` wirh‛ hs ua prg`uetg tuduocr ha euyg iathrigr sh haeuhatrc ho Nh-Ui-Kb c iayhetcr. Ho tudg `h cehrg puh`h shr `h `istiatgs `iãkhtrgs ( 9 y 35 kk), su ogabitu` vcrëc hatrh 4=== y 8=== k y sh prgvhh ha dgdiacs. Oc egkpgsieiõa `ho prg`uetg egathai`g ha ho havciac`g `h`h pha`hrã `ho khtco c trctcr y `h ogs rhsuotc`gs `hshc`gs.

Ho `ispgsitivg `h iayheeiõa Ho `ispgsitivg `h iayheeiõa egkprha`h6 oc kãquiac `h iayheeiõa, su hstrueturc pgrtcath, ho tudg buëc, tcpcs, hxtrcetgrhs `h jukg, jukg, hte. Pg`gs hstgs hohkhatgs y su `ishóg rhsuotca tca ikpgrtcaths ikpgrtcaths  pcrc ua prgehsg hxitgsg egkg ho kiskg `ishóg `ho haecpsuoc`g c utioizcr. Oc kãquiac hs ho egkpgegkpgahath quh kh`icath oc ceeiõa `h rg`ioogs ha`hrhzc`grhs y trcetgrhs ikpuosca ho havciac`g c trcvés `ho tudg buëc jceic ho dcóg oëqui`g. Oc kiskc hs uac pihzc nua`ckhatco ha ho prgehsg yc quh hs oc quh pgshh ogs hohkhatgs `h egatrgo quh phrkitha oc c`ieiõa `h uac `hthrkiac`c ogabitu` c uac vhogei`c` prheisc. Uh sukca c hstcs `gs ecrcethrëstiecs uac shrih `h nuaeigahs quh nceioitca y gr`haca gr`haca oc prãetiec gphrctivc, tcohs egkg rhbistrgs, rhtrgehsg `ho tudg uac vhz niacoizc`c oc gphrceiõa, eãoeuog `h oc ogabitu` c iayhetcr, hte.

Ha egaeousiõa - rhsphetg co prgehsg ega cockdrh `h kcbahsig ―pg`hkgs `heir quh ocs egkpgsieigahs `h ogs havciac`gs utioizc`gs vcrëca `h ceuhr`g co egathai`g `h czunrh `ho khtco dcsh c trctcr, y gtrcs vcricdohs gphrctivcs egkg ecpcei`c` `h oc euejcrc, thkphrcturc, hte. Ha sukc, sh trctc `h pg`hr ogbrcr, pcrtiha`g `h ua czunrh iaieico `c`g, ua egathai`g `h Kb rhsi`uco quh cshburh oc kãxikc ag`uoizceiõa ha oc pihzc nua`i`c. Egageiha`g ocs ega`ieigahs gphrctivcs `h ocs pocatcs ha eucatg co khtco dcsh `ispgaidoh, sh shoheeigac oc egkpgsieiõa c`heuc`c.

3¶ Fgrac`c EINTC/ ICU sgdrh nua`ieiõa, 4==8, Uca Aiegocs, Crbhatiac -24-

 

Kcia Khau

3¶F grac` grac`c c EINTC / ICU sgdrh nua`ieiõa Khau

Pcdoh gn  Egathats

Cutjgr Ia`hx

Hxit

^hatcfcs • ]hrkith ho trctckihatg `h jihrrgs dcsh `h uac ckpoic bckc `h egathai`g `h U6 oc ag`uoizceiõa sh rhcoizc ha uac sgoc gphrceiõa ha jihrrgs dcsh ega vcogrhs hatrh =.=3= c =.=:=% `h U< hstg hvitc ho trctckihatg `h `hsuonurc`g ega EcE4 y oc `ispgsieiõa `h ocs hsegrics rhcetivcs quh hsth trctckihatg bhahrc. • Khfgr egatrgo `h ocs c`ieigahs6 `iskiauyha`g oc `isphrsiõa `h rhsuotc`gs. • Khfgrc ocs ega`ieigahs ckdihatcohs6 co rhcoizcrsh ho trctckihatg ha uac hstceiõa shpcrc`c quh  puh`h hstcr ogecoizc`c ogeco izc`c ha eucoquihr oubcr `h oc pocatc. • Khagr `isphrsiõa ha ogs rhsi`ucohs `h Kb6 hsth hs ua ncetgr ikpgrtcath yc quh phrkith `iskiauir ho % `h Kb `hshc`g. • Uikpoiei`c` `ho trctckihatg • Khagr pér`i`c `h thkphrcturc `urcath ho trctckihatg trctckih atg ega ho egasheuhath cjgrrg `h hahrbëc y kcygr vi`c `h rhvhstikihatg rhnrcetcrig `ho jgrag. • Hstrietg egatrgo `h ogs trctckihatgs y kcthrico utioizc`g co `ispgahr `h ua rhbistrg `htcooc`g `h ec`c trctckihatg prgpgreigac`g pgr oc kãquiac `h iayheeiõa. • Nãeio egatrgo egkputcrizc`g `h oc gphrceiõa. •Cyu`c ―c trcvés `h ocs o cs vhatcfcs vhatc fcs caths cat hs khaeigac`cs khaei gac`cs ―c oc ikpohkhatce ikpoh khatceiõa iõa `h oc pgoëtiec pgoët iec `h Cshburckihatg `h oc Ecoi`c` y oc agrkc IUG 9===.

@hsvhatcfcs • Kg`hrc`cs ecati`c`hs `h jukgs csgeic`cs c oc rhceeiõa

 CAÃOIUIU  CAÃ OIUIU @H KC KCBAHUIG BAHUIG Oc kcygrëc `h ocs nua`ieigahs `h jihrrg ag`uocr utioizca ua hsphetõbrcng g hsphetrõkhtrg pcrc kh`ir ho oockc`g egathai`g rhsi`uco `h kcbahsig. Ha dcsh c oc hxphrihaeic, ha ec`c nua`ieiõa sh haeuhatrc ua eihrtg oëkith ianhrigr `h Kb quh prgpgreigac oc ag`uocri`c` rhquhri`c ha sus egoc`cs. Hsth oëkith puh`h vcricr `h kcahrc sibainiectivc `h uac nua` nua`ieiõa ieiõa c gtrc. Kihatrcs quh uac nua`ieiõa nua`ieiõa ogbrc uac ag`uocri`c` hxehohath ega kcbahsig rhsi`uco `h =.=48%, gtrc puh`h ahehsitcr =.=>% `h Kb pcrc gdthahr duhacs hstrueturcs `h aõ`uogs. Hstcs `ivhrbhaeics surbha `hdi`g c og sibuihath6 Ho egathai`g Kb rhsi`uco ha ho jihrrg `öetio prgvihah `h trhs cpgrths `inhrhaths. Pcatg ho Kb `i3¶ Fgrac`c EINTC/ ICU sgdrh nua`ieiõa, 4==8, Uca Aiegocs, Crbhatiac - 25-

 

Kcia Khau

3¶F grac` grac`c c EINTC / ICU sgdrh nua`ieiõa Khau

Pcdoh gn  Egathats

Cutjgr Ia`hx

Hxit

suhotg egkg ocs kierg-pcrtëeuocs quh egatihaha Kb, csë egkg ocs pcrtëeuocs gecsigacohs `h hsegric g hsegric rhsi`uco egatriduirãa co Kb cacoëtieg tgtco haega haegatrc`g. trc`g. Ag hxisth ua duha kétg`g cacoëtieg quh shpcrh hstgs trhs cpgrths, pgr og tcatg, ogs caãoisis `h Kb ha ocs nua`ieigahs rhprhshatcrãa tcatg ho Kb `isuhotg ega ho egkdiac`g. Oc nrceeiõa `h hsegric ha uac kuhstrc vcricrã sibainiectivckhath `h uac c gtrc ega`ieiõa `h trctckihatg, ecusca`g vcriceigahs ha ho Kb cacoëtieg gdshrvc`g hatrh ocs nua`ieigahs. Gtrg ncetgr ikpgrtcath quh quh cnhetc ogs vcogrhs `h Kb cacoëtieg hs oc téeaiec `h kuhstrhg quh quh sh cpoiec. Ui sh tgkc uac kuhstrc kuhstrc `h oc pcrth suphrigr `ho erisgo ha rhpgsg y `ho öotikg oëqui`g quh sh jcyc vhrti`g, sh haegatrcrãa haegatrcrãa `inhrhaths aivhohs `h Kb. @h ceuhr`g ega oc ohy `h Utglhs, ocs kierg pcrtëeuocs y oc hsegric hse gric nogtcrãa ha ho oëqui`g, oë qui`g, ocs pcrtëeuocs `h kcygr tckcóg nogtcr nogtcrãa ãa kuejg kãs rã pi`ckhath quh ocs `h khagr tckcóg. Ega ho tihkpg hst hstg g oohvc c uac `istridueiõa ag jgkgbéahc `h ocs pcrtëeuocs ag khtãoiecs ha ho jihrrg, y ho Kb cacoëtieg vcricrã ha nuaeiõa `ho tihkpg y `h oc pgsieiõa `h ocs kuhstrcs. kuhstrcs. Hstgs nhaõkhags tckdiéa egatriduirãa c ocs vcriceigahs vcriceigahs gdshrvc`cs `h uac nua`ieiõa c gtrc, yc quh ogs ncetgrhs `h tihkpg y ocs téeaiecs `h kuhstrhg puh`ha shr dcstcath `inhrhaths.

NHTTGUIOIEG KCBAHUIG Kuejcs `h ocs ecrcethrëstiecs `h uac cohceiõa `h KbNhUi sh `hdha c oc kierghstrueturc `ho Kb nhrrgsioieig. Ho KbNhUi hs ua kcthrico cobg egkpohfg egkpohfg egkpuhstg `h ncshs `inhrhaths. @urcath oc `isgoueiõa `h oc cohceiõa ha ho jihrrg nua`i`g oëqui`g, ec`c ncsh cetucrã `h kcahrc ia`ivi`uco ega uac vhogei`c`  `h rhcetivi`c` y `isgoueiõa `inhrhath. Oc ncsh `h KbNhUi hs ua egkpuhstg rhcetivg ha jihrrg oëqui`g, cuaquh su rhcetivi`c` hs rhoctivckhath dcfc ha egkpcrceiõa co Kb khtãoieg purg ha egatcetg ega jihrrg oëqui`g. oëqui`g. Ho Kb4Ui sh `isgovhrã `urcath oc hvgoueiõa `h uac uac eihrtc pcrth `h ocs durdufcs `h vcpgr `ho kcba kcbahsig. hsig. Uia hkdcrbg, oc kcygr pcrth `ho kcbahsig, `hdi`g c uac egaehatrceiõa e gaehatrceiõa ogeco cotc `h Ui sh `isgovhrã y `inua`irã jceic ogs ãtgkgs U y G kãs ehrecags pcrc ngrkcr suonurg y õxi`gs. Egkg ho Kb4Ui hs ua egkpuhstg dcstcath rhcetivg, agrkcokhath sh oh cbrhbc Ecoeig pcrc `iskiauir oc rhcetivi`c` tgtco `h oc cohceiõa. Oc ncsh Ec-Kb-Ui quh sh ngrkc hs ua egkpuhstg kãs hstc doh quh ho Kb4Ui, og quh sibainiec quh `urcath oc prg`ueeiõa `h KbNhUi hstc ncsh iaegrpgrcrã uac ecati`c` sudstcaeico `ho Kb tgtco `ispgaidoh. Ha egkpcrceiõa ega ho Kb4Ui, `urcath `urcath oc `isgoueiõa `h oc cohceiõa, ho Ec-Kb-Ui kuhstrc ua egkpgrtckihatg kuejg khags rhcetivg. ]gr og tcatg, co cucukhatcr ho egathai`g `h Ecoeig, oc ngrkceiõa `h uac ncsh Ec-Kb-Ui khags rhcetivc rh`ueirã oc rhcetivi`c` `h oc cohceiõa y ha egasheuhaeic egasheuhaeic khfgrcrã oc rheuphrceiõa `ho kcbahsig tgtco. Ocs ncshs `h nhrrgsioieig (NhUi y NhUi4) sh `isgovhrãa sia vigohaeic `h rhceeiõa, prgpgreigaca`g ua hariquheikihatg ogeco `h sioieig ha ho jihrrg quh hstã c puatg `h `isgovhr ocs pcrtëeuocs `h oc cohceiõa. Oc egaehatrceiõa `h Ui Ui echrã `hs`h ho 08% ha oc iathrncsh cohceiõa-pcrtëeuoc jcstc ho 4.8% ha oc kcsc `h jihrrg quh sh haeuhatrc c uac eihrtc `istcaeic `h oc pcrtëeuoc. Ho cotg Uioieig ogeco cukhacukhatcrã sibainiectivckhath oc sgoudioi`c` `ho Kb ha ho jihrrg `urcath oc `isgoueiõa `h oc cohceiõa. C su vhz, hstg khfgrcrã oc rheuphrceiõa `ho Kb yc quh uac brca ecati`c` `ho kiskg puh`h shr cdsgrdi`c 3¶ Fgrac`c EINTC/ ICU sgdrh nua`ieiõa, 4==8, Uca Aiegocs, Crbhatiac -20-

 

Kcia Khau

3¶F grac grac`c `c EINTC / ICU sgdrh nua`ieiõa Khau

Pcdoh gn  Egathats

Cutjgr Ia`hx

Hxit

 pgr ho jihrrg cotg ha Ui pcrc oc `inusiõa jceic ogs ãtgkgs kãs ehrecags `h suonurg y gxëbhag ha vhz `h ngrkcr durdufcs `h vcpgr `h Kb. Oc kcygrëc `h ocs cohceigahs `h NhKbUi egatihaha corh`h`gr `ho 08% ` `hh sioieig. Hsth hs ho aivho këaikg rhquhri`g pcrc ogs hohkhatgs cotckhath rhcetivgs tcohs egkg ho Kb, Ec, Eh, hte., pcrc ngrkcr egkpuhstgs ega ho sioieig (sioiei`cs). Ocs sioiei`cs sga ocs öaiecs egkdiaceigahs hstcdohs p pcrc crc ho Kb, Ec y Eh ha ocs cohceigahs ega dcsh `h NhUi. Ui ho sioieig `iskiauyh c aivhohs pgr ` `hdcfg hdcfg `ho 05% jcdrã uac ncotc `h Ui `ispgaidoh pcrc prg`ueir tcohs sioiei`cs. Egkg ocs ncshs quh egatihaha egatihaha Nh (pgr hfhkpog NhUi, NhUi4) ag egkdiaca ai `isuhovha yc shc ho Kb, Ec g Eh, hstgs hohkhatgs sh phr`hrãa `urcath oc prg`ueeiõa `h `h cohceiõa ha aivhohs `h sioieig pgr `hdcfg `ho 05%. 05%. Oc phquhóc ecati`c` `h oc ncsh `h Ui oidrh ha oc kierghstrueturc ia`iec quh jcy ua phquhóg hxehsg `h Ui.

HUSXHKC HUSXH KC @H KHFGTCKIHAPGU HA OC THEX]H THEX]HTCEIÕA TCEIÕA @H KCBAHUIG

 Oc brcniec `h dcrrcs kuhstrc kuhstrc ocs c`ieigahs `h cohceiõa cohceiõa rhquhri`cs pcrc pcrc gdthahr hstrueturcs hstrueturcs ag `uocrhs ha ocs quh sh `hseridha ocs sibuihaths vcriceigahs6

3) Ho prgehsg iaieico hs ua erisgo `hseudihrtg ega dcsh pocac. Ho KbNhUi egatihah 8% `h Kb y =.8% `h Ec y ho tckcóg hs `h 3=-0= kk. ]crc hsth ecsg iaieico, oc c`ieiõa `h cohceiõa rhquhri`c puh`h shr `h co khags 3.:% `h phsg. 4) Co iaeouir ua sikpoh dgosioog `h cohceiõa g uac pcrh` `ivisgric ha oc pcrth ianhrigr `ho erisgo, sh hvitcrã quh ocs pcrtëeuocs sh kuhvca `urcath ho oohac`g iaieico `ho erisgo. Co kcathahr oc cohceiõa `hatrg `h hsh dgosioog, ho rha`ikihatg puh`h khfgrcr y oc c`ieiõa `h cohceiõa sh rh`ueirã 3¶ Fgrac`c EINTC/ ICU sgdrh nua`ieiõa, 4==8, Uca Aiegocs, Crbhatiac -28-

 

Kcia Khau

3¶F grac` grac`c c EINTC / ICU sgdrh nua`ieiõa Khau

Pcdoh gn  Egathats

Cutjgr Ia`hx

Hxit

`h 3.: jcstc 3.> % ega rhsphetg co jihrrg trctc`g.

5) Co eudrir oc cohceiõa ega uac tcpc tipg sãa`wiej (cehrg g nhrrgsioieig), ho egkihazg `h oc rhceeiõa sh `hkgrcrã y ho rha`ikihatg khfgrcrã. Ocs tcscs `h c`ieiõa puh`ha puh`ha shr `iskiaui`cs cöa kãs6 corh`h`gr `h 3.8 phsg %. 0) Ui sh hkpohc ua kétg`g tua`isj-egvhr , c`hkãs `ho prgehsg ega tcpc tipg sãa`wiej, sh hoikiacrãa tcatg ogs jukgs egkg oc nuoburceiõa y ho prgehsg khfgrcrã sibainiectivckhath. ]uh`h shr   pgsidoh uac rh`ueeiõa `h ehrec `ho 3.5 % `h phsg ha oc c`ieiõa `h oc cohceiõa y cöa csë gdthahr ua duha jihrg `öetio. 8) Ui ho prgehsg ega tua`isj- egvhr sh kcatihah sia eckdigs, y ocs `ikhasigahs `h oc cohceiõa sh eckdica `h ogs 3=-0= kk c 3-4= kk, hs pgsidoh quh sh ogbrha kãs khfgrcs. ]crtëeuocs kãs  phquhócs y caejcs prgpgreigacrãa uac egkpcetceiõa `h cohceiõa kãs `hasc ha ho sãa`wiej y csë sh rh`ueirã oc rhcetivi`c`. Ha oc c`ieiõa, puh`h shr pgsidoh uac rh`ueeiõa c 3.4 phsg %. >) Ui sh cukhatc ho egathai`g `h ecoeig `h oc cohceiõa `h =.8% c, pgr hfhkpog, 3.8%, oc rhcetivi`c` `iskiauirã sibainiectivckhath. Ocs c`ieigahs sh puh`ha rh`ueir cöa kãs, c ua aivho k kuy uy  dcfg `h corh`h`gr `h 3.3 phsg %, cöa prg`ueiha`g hxehohaths hstrueturcs hst rueturcs `h jihrrg `öetio. Hsth ecsg - c kg`g `h hfhkpog ―kuhstrc quh co cpoiecr ceeigahs kuy sikpohs, ho prgehs prgehsg g `h trctckihatg `h Kb sh puh`h puh`h khfgrcr `h kcahrc sibainiectivc. @hs`h auhstrc phrsphetivc, ocs nua`ieigahs - ha bhahrco ―cbrhbcrãa hatrh 3.= y 4.8 % `ho phsg `ho khtco `hpha`iha`g `h oc dga`c` `ho prgprg ehsg `h trctckihatg `h ogs erisgohs y ha pcrtieuocr `h ogs pcrãkhtrgs cathrigrkhath `hseriptgs.

3¶ Fgrac`c EINTC/ ICU sgdrh nua`ieiõa, 4==8, Uca Aiegocs, Crbhatiac -2>-