Risque Infectieux en Chirurgie Orthopédique

LDH-Pbudkticignl Irtbipîmnl 0 (066) 82 (2) 0> (1) 82 (2) 0; ()

XHE Xtrlptihiquls @khnccls æ Grkd‘ Kekîri`nls Hucturl stîrncl Kutrls Nealhtnie dnxtl XHE : stkpbycihiqul æ hikgucksl eîgktnvl.

Xtlholc`lrg26 (e 4 ;608) Keeîls ;>1>-;>>; 0=6 (08%) 0>> pkr ck Xihnîtî arkeçknsl m„kelstbîsnl lt ml rîkendktnie (XAKP) lt rlpirtîls mkes cl   ]k`clku 2. 2.7< Mls dimnanhktnies pluvlet êtrl levnskgîls piur kmkptlr hls rlhiddkemktnies kux mieeîls dnhri`nicignquls îpnmîdnicignquls priprls æ hbkqul uentî, le khhirm kvlh cls kelstbîsnstls, cls hbnrurgnles lt cls rlprîsletkets ml ck dnhri`nicignl lt mu Hidntî ml cuttl hietrl cls nealhtnies eisihidnkcls (HCNE) ml hbkqul îtk`cnssldlet lt vkcnmîls hiccîgnkcldlet mkes ue pritihicl hiddue. Hlrtknes pktnlets siet æ trâs bkut rnsqul ml hiciensktnie ml glrdls ductnrîsnstkets qun, le hks m„netlrvletnie hbnrurgnhkcl, piurrknlet prîsletlr mls NXI eie prîvleuls laanhkhldlet pkr uel ketn`nipripbyckxnl « hckssnqul ¿. Hls pktnlets rlcâvlet mieh m„uel ketn`nipripbyckxnl « plrsieekcnsîl ¿ tleket hidptl mls mieeîls dnhri`nicign dnhri`nicignquls quls priprls mu pktnlet. Le rknsie mu rnsqul îhicignqul ndpirtket cnî æ c„utncnsktnie ml dicîhucls æ trâs ckrgl splhtrl ketn`khtîrnle, hls sntuktnies minvlet rlstlr lxhlptnieelccls le rîmunsket cl pcus pissn`cl clur murîl m„kmdnenstrktnie. Vkr lxldpcl, cls pktnlets rlclvket m„uel rlprnsl prîhihl piur bîdktidl, cuxktnie iu tiut kutrl ditna eie nealhtnlux mlvrknl mlvr knlet et pri pri`k` `k`cld cldlet let rlh rlhlvi lvinr nr uel dic dicîhu îhucl, cl, prleket le hidptl cl rnsqul ml hiciensktnie pkr uel acirl trkesntknrl pitletnlccldlet rîsnstketl, tlccl qul ck vkehidyhnel iu ck tînhipckenel. Le sntuktnie m„îpnmîdnl æ `khtîrnl æ Grkd‘ ductnrîsnstket, uel kutrl dicîhucl plut êtrl kjiutîl le l e tleket hidptl mls mieeîls dnhri`nicignquls mnspien`cls.

]suokykdk21 (e  4 ;61) Keeîls ;>26-;>>; 88 (8;%) > mls rlhiddkemktnies nssuls ml ck hieaîrlehl ml hieslesus ml mîhld`rl ;>>0  (dimnanî ml : www.sakr.irg : www.sakr.irg)).7< Khtl hbnrurgnhkc Vritbâsl krtnhucknrl

Vrimunt Hîakzicne nell

Hîak Hî akdk dkem emic icll Hîa îaur uriixn xnd dl Kcclrg Kcc lrgnl nl : vke vkehid hidyhn yhnel* el* Hbnrurgnl irtbipîmnqul + dnsl le pckhl ml dktîrnlc, grlaal isslusl, cngkdletipckstnl, arkhturl alrdîl Hbnrurgnl irtbipîmnqul kutrl lt krtbrishipnl mnkgeistnqul Arkhturl iuvlrtl (grkmls N lt NN ml Gustnci) Dêdl typl ml arkhturl kvlh pcknl siunccîl

Hîakzicnel Kcclrgnl Kcclrg nl : vke vkehid hidyhn yhnel* el* Vks m„K@V

;< dg og‘; prîipîrktinrl

Hîakzicnel

0 g prîipîrktinrl (rînej ejllhtnie ml ; g æ ck =l ‘; blurl) puns ; g 2 b 0 g prîipîrktinrl (rînejlhtnie ml ; g sn murîl 5 0 b puns 0 g 2 b ‘;) 0 æ 8 dg og‘; 0= b‘; 166 dg (rînejlhtnie ml 166 dg sn murîl 5 = b) puns 166 dg 1 b‘; 0 æ 8 dg og‘; 0= b‘; 0 g prîipîrktinrl

Vîen K + N@** + gletkdnhnel Kcclrgnl : hcnemkdyhnel + gletkdnhnel

Vicytrkudktnsdl kvlh hbih bîdirrkgnqul

Visicignl 0 g prîipîrktinrl (rîne nejjlhtnie ml ; g sn murîl 5 = b) puns ; g 2 b ‘; ;, % ml slptnhîdnls, ;6 % ml hbihs slptnquls, > % ml syemridls syemrid ls ml mîtrlss mîtrlssll rlspnrktinrl rlspnrktinrl knguï lt = % ml mîakncckehls mîaknc ckehls ductnvnshîrkcls ductnvnshîrkcls.. Vkrdn cls 8; pktnl pktnlets ets mîhîmîs () piur clsqulcs ck hievlrsnie îtknt rîkcnsîl le mlux tldps. Mkes cls hks ml arkhturl mu tn`nk, hlttl kttntuml ml hievlrsnie le istîisyetbâsl netlrel sld`cl pcus mnshutk`cl kvlh ue rnsqul nealhtnlux pcus îclvî.16 Ck grkvnt grkvntîî mls nealhtnies hblz cl picytrk picytrkudktn udktnsî sî plut dlttrl le jlu cl prieistnh vntkc lt justnanl uel prnsl le hbkrgl ductnmnshnpcneknrl, kssihnket hbnrurgnles, kelstbîsnstls lt rîkendktlurs, kvlh c„i`jlhtna ml trkntlr cl dkxndud ml cîsnies istîikrtnhucknrls pr prîh îhih ihld ldle lett mk mkes es cl rls rlsplh plhtt ml mlss hi hiet etrlrlnemnhktnie nemnh ktniess gîeîrkcls lt vnsh vnshîrkcls. îrkcls. Cl rlhiurs æ ck anxktnie lxtlrel mls arkhturls mu aîdur, mkes hls mlrenlrs hks, lst uel kctlrektnvl netîrlssketl qun kutirnsl uel hievlrsnie le istîisyetbâsl netlrel mkes ue mîckn hiurt. Anmâcls æ ck pbncisipbnl mu trkntldlet mîeiddîl pkr Jumlt « cl tiut le ue tldps ¿, eius prîhiensies cl trkntldlet mls cîsnies istîikrtnhucknrls le urglehl, ml akçie hidpcâtl dkns pks airhîdlet mîanentnvl.

Pnsqul nealhtnlux cnî æ c„levnrieeldlet mu pktnlet (`cih, îqunpl hbnrurgnhkcl) Cls rnsquls ml hietkdnektnie ml ck pcknl ipîrktinrl cnîs æ c„levnrieeldlet qul hiestntul cl `cih ipîrktinrl siet cnîs æ ml eid`rlux akhtlurs miet cls pcus ndpirtkets siet ck hiehlptnie mu `cih ipîrktinrl, ck qukcntî ml c„knr lt ml c„lku, lt cls râgcls rîgnssket c„khtnvntî budknel. Cl rnsqul ml hietkdnektnie pkr vinl kîrnleel lst pripirtnieelc æ ck quketntî ml pkrtnhucls prîsletls mkes cl `cih ipîrktinrl, hbkqul pkrtnhucl piuvket êtrl cl vlhtlur m„ue kglet nealhtnlux. Nc lst le aknt kmdns qul ck pri`k`ncntî ml triuvlr ue glrdl vnvket sur uel pkrtnhucl lst ml ;/;66 666 ;/; 666 (c„ (c„knr knr pur ekt ekturlc urlc hid hidpir pirtl tl 166 666 æ ;,0 dnccnie ml pkrtnhucls pkr pnlm/hu`l).

Pâgcls ml `ksl ku `cih ipîrktinrl \e `cih ipîrktinrl mint sîpkrlr cls hnrhunts m„kpprivnsnieeldlet, mu pktnlet lt mu plrsieelc. \el ziel

B. Dngkum lt kc. sks mint sîpkrlr cls hnrhucktnies mu `cih ipîrktinrl ml hlccls mu rlstl ml c„îtk` c„îtk`cnssl cnssldlet. dlet. Cl `cih ipîrktinrl mint êtrl uel struhturl nemîplemketl mu rlstl ml c„býpntkc miet nc mint êtrl sîpkrî sîpk rî pkr  pkr mnaaîrlets systâdls cl rlemket « îtkehbl ¿. =6 Cl rlgriupldlet mls `cihs ipîrktinrls plut êtrl levnskgî piur rîmunrl cls hiÿts æ hiemntnie ml el pks dlttrl le jlu ck sîhurntî nealhtnlusl. Ck skccl m„netlrvletnie mint hidpirtlr mls durs cnssls lt mnspislr m„ue systâdl m„îvkhuktnie mls mîhblts. Cl elttiykgl (`nielttiykgl, h„lst-æ-mnrl æ ck ains dîhkenqul, lt mîhietkdneket) mls surakhls birnzietkcls (sics, pckaiem) lt mls surakhls vlrtnhkcls (durs) e„lst rîlccldlet pissn`cl qul sn cls kearkhtuisntîs lt nrrîguckrntîs ml hls surakhls siet rîmuntls ku dnendud : h„lst cl hiehlpt mu « dur cnssl ¿, skes krdinrls, krdinrls, en `nle sÿr ml « hktgu hktgutnlr tnlr ¿. Xn cl mig migdl dl ml ck miu miu`cl `cl hnr hnrhuc hucktn ktnie, ie, hnrhunt hnrhunt priprl lt hnrhunt skcl, e„lst pcus rltleu khtulccldlet cirs ml ck hiehlptnie m„ue eiuvlku `cih, cls mîhblts lt cl dktîrnlc hietkdneîs minvlet êtrl îvkhuîs mkes mls hietlelurs îtkehbls. Nc akut êtrl trâs vngncket kux prihîmurls lt ku `ie îtkt mls hbkrnits m„îvkhuktnie mu dktîrnlc hietkdneî, lt mls mîhblts cirsqul ck ziel « priprl ¿ lst trkvlrsîl. Ie el rlhiddkeml pks ml aknrl mls prîcâvldlets systîdktnquls mkes c„knr iu sur cls surakhls le rîgndl ml hrinsnârl mu `cih lt ml ck vletncktnie. Le rlvkehb rlvkehbl, l, hls prîcâvldlets siet rlhid rlhiddkemîs dkemîs le hietlxtl îpnmîdnqul, lt cirs ml ck dnsl le riutl mu `cih kprâs uel pîrniml ml trkvkux. Nc akut îvntlr ck stîrncnsktnie acksb ml c„nestrudletktnie skua hks pkrtnhucnlr m„urglehl. \e tldps ml rlpis lst eîhlssknrl letrl hbkqul `cih piur îvntlr uel kugdle kugdletktni tktniee ndpirt ndpirtketl ketl mls pkrtnhucls mieeket eknsskehl æ hicienl (VEH). Eitkddlet cl ckvkgl (sic lt surakhls) mint êtrl sunvn m„uel pîrniml ml rlpis, cl ckvkgl letrkåeket pkr cun-dêdl uel îcîvktnie mls VEH. Cls systâdls m„kspnrktnie m„kspnrktnie hcis minvlet êtrl prîaîrîs sn ue mrknekgl lst eîhlssknrl.==,7> Æ hl tntrl, c„utncnsktnie m„ue mrknekgl e„lst pks i`cngktinrl lt mkes hlrtknels nemnhktnies, mls îtumls rkemidnsîls e„iet pks dietrî c„netîrêt mu mrknekgl systîdktnqul. Nc akut îvntlr ml cknsslr cls mrknes le pckhl pcus ml =2 æ 70 blurls. Viur tius cls singekets lxpisîs kux prijlhtnies, cl pirt ml cuelttls lst nemnsplesk`cl.

Vîeîtrktnie mu pktnlet ku `cih ipîrktinrl Cl cnt iu cl hbkrnit qun iet slrvn ku trkespirt mu dkckml mlpuns sk hbkd`rl el minvlet pks pîeîtrlr cl `cih. \e trkesalrt mint êtrl laalhtuî mkes uel ziel spîhnanqul sur ue hbkrnit el sirtket pks mu

Pnsqul nealhtnlux le hbnrurgnl irtbipîmnqul `cih ipîrktinrl. Vuns hl hbkrnit, qun lst ku dnlux cl pcktlku ml ck tk`cl m„ipîrktnie, mint êtrl hiemunt le skccl m„netlrvletnie iu ml prîkelstbîsnl kprâs prîpkrktnie mu pktnlet (`ieelt piur hiuvrnr cls hblvlux, hiuvlrturl ...).

Glstnie ml c„knr C„utncnsktnie C„utncnsktn ie mls acux ckdne ckdneknrls knrls lst rlhidd rlhiddkemîl kemîl =7 dkns eie nemnsplesk`cl. Le mlbirs mls acux ckdneknrls, piur clsqulcs uel eirdl lst gkrketnl pkr cl ak`rnquket

Hietkdnektnie m„irngnel budknel ]iutls cls eirdls siet îtk`cnls « le hiemntnie ml aiehtnieeldle aiehtn ieeldlett ¿ h„lst h„lst-æ-mn -æ-mnrl rl « `cih ipîrktinrl îqunpî ¿, dkns le mlbirs ml tiutl prîslehl budknel. Cirsqul cl aiehtnieeldlet lst eirdkc, ck prîslehl budknel lst cl akhtlur dkjlur ml primuhtnie ml pkrtnhucls mkes cl `cih ipîrktinrl. Ck rîmuhtnie mu rnsqul ml hietkdnektnie æ pkrtnr mu plrsieelc rlpisl sur cls pinets sunvkets : • c„utncnsktnie m„ue sks qun plrdlt ml survlncclr qul hbkqul plrsieel pîeîtrket mkes cl `cih lst `nle rlvêtul m„uel tleul spîhnanqul ku `cih lt qul hlccl-hn el plut êtrl utncnsîl le mlbirs mu `cih (hnrhunt kvlh ziel vlstnknrl îcingeîl mu `cih ipîrktinrl) ? • piur ck tleul spîhnanqul spîhnanqul mu plrsiee plrsieelc, lc, cl hitie mint êtrl îvntî mu aknt ml sk akn`cl hkpkhntî ml `krrnârl lt ml sk airtl îdnssnie pkrtnhucknrl, cls tleuls le dktnârls eie tnssîls siet prîaîrk`cls, dkns clur hkpkhntî m„îdnssnie pkrtnhucknrl mint êtrl hieeul. Cls bk`nts minvlet êtrl hbkegîs cirsqu„ncs siet vnsn`cldlet hietkdneîs ? • hbkqul dld`rl ml c„îqunpl pîeîtrket ku `cih mint pirtlr uel hkgiucl hiuvrket hidpcâtldlet ck hblvlcurl lt ue dksqul hiuvrket cl elz lt ck `iuhbl ?

;11  mls hkskquls lt mls hbkdps ndplrdîk`cls siet rlhi rl hidd ddke kemî mîs, s, ml mlvk vket et ks kssu surlr rlr uel `k `krr rrnâ nârl rl 87 cirsqu„ncs siet budnmls ? •  piur tius cls singekets lxpisîs kux prijlhtnies, cl pirt ml cuelttls lst nemnsplesk`cl. C„utncnsktniee ml shk tni shkpbk pbkemrl emrl plut êtr êtrll rlh rlhidd iddkem kemîl îl piur ck pritlhtnie mu pktnlet hiddl hlccl mu hbnrurgnle vns-æ-vns mls kglets hietkdnekets ?=  c„bygnâell mu plrsieelc mint êtrl hirrlhtl, dkns •  c„bygnâe nc akut îvntlr uel miuhbl justl kvket ml pîeîtrlr ku `cih hkr hlccl-hn kugdletl ml dkenârl ndpirtketl ck primuhtnie ml squkdls. C„bygnâel mls dknes lt mls kvketkvket-`rks `rks lst lsslet lssletnlccl nlccl : iegcls hiurts lt priprls, ckvkgl mls dknes æ c„letrîl mkes cl `cih, k`slehl ml `kguls, ml `njiux iu ml dietrl ku pingelt, ckvkgl rîgucnlr mls dknes, utnc ut ncns nskt ktni niee ml mn mnsp spis isnt ntna nass sp spîh îhna nanq nqul ulss sk skes es hietkht piur iuvrnr cls pirtls piur cndntlr cl rnsqul m„nealhtnie dkeupirtîl ? •  ck mnshnpcnel murket c„netlrvletnie (nc akut cndntlr c ndntlr ck hnrhucktnie mls plrsieels murket c„netlrvletnie, hl qun suppisl ck prîpkrktnie hidpcâtl mu dktîrnlc eîhlssknrl, ck cndntktnie mls mîpckhldlets eie nemnsplesk`cls) ? •  ck rîmuhtn rîmuhtnie ie mu eid`rl ml plrsiee plrsieels ls prîsletls ku strnht plrsieelc eîhlssknrl ku `ie mîriucldlet ml c„netlrvletnie ? •  cl rlsplht mls râgcls ml elttiykgl letrl mlux netlrvletnies. •

Elttiykgl ml ane ml `cih Cl elttiykgl letrl cls `cihs mint hidpirtlr, kprâs îvkhuktnie mls mîhblts, cl trkntldlet budnml ml tiutls cls surakhls birnzietkcls. Hl elttiykgl mint êtrl sunvn m„uel pîrniml ml rlpis ml 06 dneutls (skes kuhuel hnrhucktnie) eîhlssknrls æ ck rlmîpisntnie mls pkrtnhucls lt æ c„laanhkhntî mls primunts mîtlrglets-mî mîtlrgl ets-mîsnealh snealhtkets tkets utncn utncnsîs. sîs. \e elttiy elttiykgl kgl spîhnanqul e„lst pks rlhiddkemî kprâs uel netlrvletnie skcl iu hietkdneîl. Ck jiureîl ipîrktinrl mint s„khblvlr pkr cl elttiykgl budnml mîsnealhtket mu sic lt mls surakhls birnzietkcls kvlh ue primunt mîtlrglet-mîsnealhtket vkcnmî.

Hidpirtldlet ml c„îqunpl hbnrurgnhkcl lt mls singekets Cl plrsieelc mint kvinr mls iegcls hiurts lt priprls. Xn c„k`cktnie mu vlrens lst hieslnccîl, c„k`cktnie mls `njiux lst le rlvkehbl nemnsplesk`cl. \e elttiykgl mls iegcls lst nemnsplesk`cl kvket cl prldnlr ckvkgl hbnrurgnhkc ml ck jiureîl. Cl ckvkgl hbnrurgnhkc mls dknes mint murlr ku dines < dneutls, cl rneçkgl mint êtrl laalhtuî dknes le c„knr le pcnket cls hiumls, puns sunvn m„ue sîhbkgl kvlh ue

B. Dngkum lt kc. hbkdp stîrncl. Cl ckvkgl hbnrurg hbnrurgnhkc nhkc plut êtrl prktnquî tnq uî kvl kvlhh uel sic sicutn utnie ie diu diussk ssketl etl ket ketnsl nslptn ptnqul qul hiddl îviquî pcus bkut iu ku diyle ml sicutîs bymrikchiicnquls.8; Mkes cl prldnlr hiddl mkes cl slhiem hks, cl ckvkgl mint murlr ku dines < æ 7 dneutls lt mî`utlr pkr ue `rissk `risskgl gl mls mingts lt mls iegcls kvlh uel `rissl æ uskgl uenqul. Le hks m„utncn m„ut ncnskt sktnie nie ml sic sicutîs utîs bymr bymrikc ikchii hiicnq cnquls uls,, hlt hlttl tl pkrtnl lst laalhtuîl kvlh ue skvie elutrl, hl qun cndntl c„laalt nrrntket. Mkes cls mlux hks, ue rneçkgl lst prktnquî le prleket sine ml cknsslr cls pingelts pcus bkuts lt cls hiumls acîhbns. Cl slhiem tldps hidpirtl ue dksskgl singelux mls pkudls lt mls kvket-`rks kvlh ck sicutnie ketnslptnqul. X„nc s„kgnt m„uel sicutnie diussketl, hl ckvkgl slrk sunvn m„ue rneçkgl lt m„ue sîhbkgl. Mkes cl hks mls sicutîs bymri bym rikc kchi hiic icnq nqul uls, s, cl dk dkss sskg kgll sl slrk rk pi piur ursu sunv nvnn jusqu„ku sîhbkgl spietkeî. Cls sicutîs bymrikchiicnquls iet c„kvketkgl m„uel rîdkelehl lt m„uel dinemrl nrrntktnie hutkeîl. Hlplemket, c„k`slehl ml hicirktnie rlem eîhlssknrl c„kpprletnsskgl ml clur utncnsktnie kane ml el pks dîhieekåtrl c„k`slehl ml pksskgl sur hlrtknels ziels (lspkhls netlrmngn tlrm ngntku tkux, x, `ir `irmm ucek uceknrl nrl mls dkn dknes es lt mls pin pin-gelts). Letrl mlux netlrvletnies kvlh cls sicutnies diussketls hckssnquls, ue ckvkgl hidpclt lst eîhlssknrl. Æ c„nevlrsl, ue ckvkgl « netlrdîmnknrlkccîgî ¿ kux sicutîs bymrikchiicnquls (skes `risskgl kvlh cl skvie elutrl) lst pissn`cl letrl mlux netlrvletnies, hl qun cndntl lehirl c„laalt m„nrrntktnie hutkeîl. Cls gkets minvlet êtrl miu`cîs le irtbipîmnl, hidptl tleu ml ck plrairktnie arîquletl pkr mls nestrudlets pnqukets lt hietiemkets.86 Ck pirisntî aknt qul ck pknrl suplranhnlccl mint êtrl hbkegîl tiutls cls blurls. Cls gkets kssurlet uel pritlhtnie rlcktnvl vns-æ-vns mls hietkdnektnies æ pkrtnr mu pktnlet. Clur rýcl pritlhtlur lst pcus cndntî piur cls kngunccls qul piur cls kglets trkehbkets sndpcls, piur clsqulcs cl pksskgl ku trkvlrs mls mlux hiuhbls ml cktlx kssurl ue hlrtkne « lssuykgl ¿. Ie mint kussn hiesnmîrlr ck plrtl ml pritlhtnie mls gkets æ ck jiehtnie dkehblttl-hkskqul hbnrurgnhkcl mâs qul hlccl-hn lst hietkdneîl pkr mls cnqunmls `nicignquls, hl qun suppisl uel survlncckehl rkpprihbîl ml hlttl ziel cirs mls netlrvletnies. 86 C„utncnsktnie m„ue hbkdp kmbîsna « æ nehnslr ¿ lst rlhiddkemîl. C„ndprîgektnie prîkck`cl m„ue ketnslptnqul nimî k dietrî ck rîmuhtnie mls `khtîrnls hietkdneketls, dkns c„netîrêt sur cl tkux m„NXI e„k pks îtî îtî priuvî priuvî mkes uel îtuml hietrýcîl hietrýcîl le irtbi08,76,>0 pîmnl. C„utncnsktnie ml hbkdps ml `irmurl e„k pks aknt ck prluvl ml sk supîrnirntî mkes uel îtuml hietrýcîl, dkns lccl plut sld`clr cignqul piurr mls net piu netlrv lrvletn letnies ies pri pricieg ciegîls îls (m„ (m„uel uel murî murîll supîrnl sup îrnlurl url æ ; blur blurl) l) æ hie hiemnt mntnie nie qu„ncs sinlet sinlet

Pnsqul nealhtnlux le hbnrurgnl irtbipîmnqul ndprîgeîs m„uel sicutnie ketnslptnqul, hl qun kssurl uel dlncclurl pritlhtnie pkr rîdkelehl. Cls hbkdps ml `irmurl iet ml pcus c„kvketkgl ml cndntlr cl rnsqul ml mîhiccldlet mu hbkdp æ nehnslr, eitkdd eit kddlet let cir cirsqu squll c„n c„netl etlrvle rvletni tniee lst cie ciegul gul iu cirsqu„lccl lst bîdirrkgnqul. C„utncnsktnie mls nrrngktnies ipîrktinrls lst mnshutîl.>> k hieanrdî ck eîhlssntî piur cls îtk`cnssldlets ml sines m„uel i`cngktnie ml sîhurntî ml rîsuctkt. Nc ndpirtl mieh piur cls nestn nestntutnie tutniess ml dlttrl le riutl uel picntnqul hcknrl ml prîvletnie, ml ck aknrl vkcnmlr rîgucnârldlet lt qul hlttl neairdktnie sint khhlssn`cl æ c„lesld`cl mls khtlurs netlrvleket mkes ck prnsl le hbkrgl m„ue pktnlet hbnrurgnhkc.

Neairdktnie mu pktnlet sur cl rnsqul nealhtnlux Ku pcke cîgkc, nc y k i`cngktnie m„uel neairdktnie hcknrl lt netlccngn`cl piur cl pktnlet. Cl prktnhnle mint s„kssurlr qul cl pktnlet k `nle plrçu c„neairdktnie hiehlreket cls rnsquls nealhtnlux lt eitkddlet cl rkppirt `îeîanhl/rnsqul ml c„netlrvletnie. Cl prktnhnle mint nemnqulr qul tiut khtl nevksna/ hbnrurgnhkc hidpirtl ue rnsqul nealhtnlux lt qul tius cls diyles slriet dns le Řuvrl piur le îvntlr

;1> ck survleul le skhbket qul cl rnsqul zîri e„lxnstl pks. Cl missnlr mu pktnlet mint aknrl îtkt ml ck mîcnvrkehl ml c„neairdktnie sur cl rnsqul ipîrktinrl lt eitkddlet nealhtnlux. Vkrdn cls neairdktnies mieeîls ku pktnlet mlvrknt angurlr ck eitnie qul c„nealhtnie le irtbipîmnl plut êtrl rlspiesk`cl : • m„ue mîanhnt aiehtnieelc pkrains pcus sîvârl qul c„kaalhtnie qun kvknt ditnvî c„netlrvletnie ? => > • m„uel surdirtkcntî ? 28,2> • m„uel priciegktnie m„bispntkcnsktnie ? • ml c„k`cktnie mu dktîrnlc lt iu ml ck pritbâsl pkrains ml akçie mîanentnvl ?=> • lt qu„lccl plut justnanlr ml trkntldlets ketn`nitnquls priciegîs plemket pcusnlurs dins.78 Hiehlreket Hiehlre ket cls hie hiesîq sîquleh ulehls ls ml ck sur survle vleul ul m„uel NXI, ie plut lstndlr qu„lccl ihhksnieel ue kcciegldlet kcciegl dlet mu sîjiu sîjiurr ml 0 sldkn sldknels els le diylee diyleel, l, qul cl tkux m„bispntkcnsktnies ntîrktnvls lst miu`cî lt qul cl surhiÿt leglemrî lst ml 866 %.2> \el clttrl plut êtrl rldnsl ku pktnl pktnlet et dkns lccl el prnvl pks m„uel neairdktnie irkcl lt surtiut m„ue letrltnle ku hiurs muqulc cl prktnhnle pr ktnhnle mint s„kssurlr qul cl pktnlet k `nle plrçu cls neairdktnies hiehlreket cl rnsqul m„NXI. Nmîkcldlet, mls anhbls m„neairdktnies minvlet êtrl îdnsls pkr ck Xiahit qun kssurlrk knesn ue « ck`lc qukcntî ¿ punsqul hlccls-hn kuriet îtî vnsîls (lt skes miutl vkcnmîls) pkr cls hidpkgenls m„kssurkehls, cls jurnstls, cls nestkehls irmnekcls, lth.

Vinet airt

Cl `ie sles mint prîvkcinr le hks ml survleul m„uel NXI le mieeket uel neairdktnie ciykcl lt netlccngn`cl ku pktnlet sur sie îtkt lt c„îvicutnie sius si us c„ c„la laal altt mls trk trknt ntld ldle lets ts kp kppc pcnq nquî uîs. s. Ck dlncclurl râgcl lst « el pks k`kemieelr cl pktnle pkt nlett ¿. H„ls H„lstt siu siuvle vlett hlt hlttl tl snt sntukt uktnie nie qun hiemunt æ uel prihîmurl jumnhnknrl, cirsqul cl pktnlet sl slet « càhbî iu tridpî ¿. Hlck e„ldpêhbl pks ml « pksslr ck dkne ¿ sn cl prktnhnle lstndl qul ck prnsl le hbkrgl m„uel NXI mîpkssl sls hidpîtlehls iu cls pissn`ncntîs ml sie îtk`cnssldlet. Hlplemket, cls rknsies ml ck prnsl le hbkrgl pkr ue kutrl prktnhnle minvlet êtrl hcknrldlet lxpcnquîls ku pktnlet sius plnel ml rlhrîlr « ck sntuktnie m„k`kemie ¿ îviquîl pcus bkut. Leane rîgcldletknrldlet, tiutl nealhtnie eisi ei sihi hidn dnkc kcll su surr sn sntl tl ip ipîrk îrkti tinr nrll mi mint nt ak aknr nrll c„i`jlt m„uel mîhck ckrk rkttnie ku HC HCNNE ml c„îtk`cnssldlet.

;76

B. Dngkum lt kc.

Vrîvletnie lt bygnâel Cl rltiur m„neairdktnie kuprâs mu plrsieelc singeket mls lequêtls sur cls îtumls NXI lst siubkntk`cl. Nc ndpcnqul mkvketkgl c„îqunpl lt, le akvirnsket ck mnaausnie ml c„neairdktnie sur ck plrtnelehl mls dlsurls, nc hietrn`ul æ ck rîmuhtnie ml ck arîqulehl mls NXI.02,7=

Pîaîrlehls ;. 0. 8.

=. . ;6. ;;. ;0.

;8.

;=. ;28?;;2:8=7‘20?;;7:;67‘;0. Kck ckrrhi hiee GX GX,, Di Dirrlc lcke kemm CW, Jk Jkaaal O, Vb Vbnc nccn cnps ps PD PD,, @ihkelgrk ]. ]bl usl ia dltbitrlxktl plrniplrktnvlcy ne pktnle pkt nlets ts wnt wntbb rbl rbludk udktin tinmm krt krtbrn brntns tns uem uemlrg lrgine inegg dkj dkjir ir rlpckhldlet surglry.  J Hcne Pbludktic  ;>>1?0:1‘2. Keieydius Keiey dius.. Xurgn Xurgnhkc hkc blcdl blcdltt systl systlds. ds. Blkctb Mlvnhls  ;>>1? 0>=?86>:>2?07: ;0=7‘1?;7: wntb hkutni hkutnie. e.   Nealht 77. Hnrhuc Hnr hucknr knrll rlc rlcktn ktnvl vl ku trk trkntl ntldle dlett ml c„l c„lku. ku. MGX/XM7K MGX/XM7K// XM>>?;8:880‘7. ;7. Hiu Hiumke mkell B. Nea Nealht lhtnie nie eisihidn eisihidnkcl kcl le hbn hbnrur rurgnl gnl irtbiirtbiHbnrr Irt Irtbip bip pîmnqul. ]k`cl rieml ml ck XIAHI].   Plv Hbn Plpkrktrnhl Kppkr Dit  066;?27:702‘8>. ;2. Mlkhi Mlkhiee JD, Vkgcnkri Vkgcnkri KJ, Zlcnhia Zlcnhia X@, X@, Biriwntz Biriwntz BW. BW. VripbyVripbyckhtnh usl ia ketn`nitnhs air prihlmurls katlr titkc jinet rlpckhldlet. J @iel Jinet Xurg _Kd  ;>>1?72:;7>>?06:=60‘7. 06. Mlsp Mlspckhls ckhls E. Nealhtnies Nealhtnies eisihid eisihidnkcls nkcls le hbnrurgnl hbnrurgnl irtbiirtbipîmnqul.   Lehyhc Lehyhc Dîm Hbnr  (Lcslvnlr XKX, Vkrns) Kppkrlnc cihiditlur, ;=-6;1-@-;6, 0666. 0;. Mup Mupie ie D, Cir Cirtkt tkt-Jk -Jkhi` hi` K, Mlspckhl Mlspckhlss E, Gkumnks Gkumnks J, Mkh Mkh-qultt Q, Hkr qul Hkrsle sletn tn B, lt kc. Xlh Xlhiem iemkry kry pri pristb stbltn ltnhh jin jinet et nealhtnie: mnkgeistnh hrntlrnk, trlktdlet.  Dlm Dkc Nealht 066;?8;:;08‘86. 00. Lspl Lsplbkug bkug @, Leglsklt Leglskltlr lr C@, Qiccslt Qiccslt XL, Bkvlcne Bkvlcne CN, CN, Ckeglckem E. Ketn`nitnh pripbyckxns ne titkc bnp krtbripcksty. Plvnlw ia ;6,>6< prndkry hldletlm titkc bnp rlpckhldlets rlpirtlm ti tbl Eirwlgnke krtbripcksty rlgnstlr, ;>27 ti ;>>>7?  ;>>7?7>:6‘21?;=:;6. 0=. Aicne KH, KH, Eirmstrid Eirmstrid GD. GD. Khhnmletkc Khhnmletkc `ciim `ciim hietkht hietkht murneg irtbiplmnh surgnhkc prihlmurls. Nealht Hietric Bisp Lpnmldnic  ;>>7?;2:0==‘1. 0>>? 2>7?0>6?70:0>>‘86=. 02. Bkcly PW, PW, Hucvlr Hucvlr MB, Dirgke Dirgke WD, Wbntl Wbntl JW, Ldirn Ldirn ]G, Biitie ]D. Nmletnayneg pktnlets kt bngb rnso ia surgnhkc wiuemm nealh wiue nealhtnie. tnie. K sndpc sndpcll ductn ductnvkrnk vkrnktl tl nemlx ia pktnle pktnlets ts sushlptn`ncnty kem wiuem hietkdnektnies. Kd J Lpnmldnic ;>2