comparison of intravenous or epidural patient- controlled analgesia in the elderly after major...

8/11/2019 Comparison of Intravenous or Epidural Patient- controlled Analgesia in the Elderly after Major Abdominal Surgery

1/9

755

Klnstmnsjcbcoy

1ccC8

:10755-7;

444 KinrjeklUcejnty

cf

Klnstmnsjcbcojsts, Jle

Jjppjlectt

wjbbj8uls

& wjbhjls, Jle.

Ecipkrjscl

cf

Jltrkvnlcus

cr

Npjgurkb

Tktjnlt-

ecltrcbbng Klkbonsjk jl tmn Nbgnrby kftnr Ik`cr

Kagcijlkb Uuronry

Ebkugn Ikll, I.G., Tm.G.,* Zvkl Tcuznrkttn, I.G.,t Ojbbns Aceekrk, I.G.,t Emrjstcpmn Tneecux,$

Emrjstjln Vnroln, I.G., Oncrons Arulkt, I.G.,

t

@kequns Gcinroun, I.G., Y Anrtrklg Ijbbkt, I.G.,

Tksekb Ecbscl, I. G., Tm.G.

Akehorculg

Tktjnlt-ecltrcbbng klkbonsjk

(TEK)

wjtm jltrkvn-

lcus

icrpmjln klg pktjnlt-ecltrcbbng npjgurkb klkbonsjk

TENK), usjlo kl cpjcjg njtmnr kbcln cr jl eciajlktjcl wjtm k

bcekb klnstmntje , krn

twc

ik`cr kgvklens

jl

tmn iklkoninlt cf

pkjl kftnr ik`cr suronry. Mcwnvnr, tmnsn tnemljquns mkvn annl

nvkbuktng pccrby jl nbgnrby pncpbn. Wmjs prcspnetjvn, rklgci-

jzng stugy ecipkrng tmn nffnetjvnlnss cl pcstcpnrktjvn pkjl

klg skfnty cf TENK klg TEK kftnr ik`cr kagci jlkb suronry jl

tmn nbgnrby pktjnlt.

Intmcgs0 Unvnlty pktjnlts cbgnr tmkl

?4

yr cf kon klg ulgnr-

ocjlo ik`cr kagcijlkb suronry wnrn kssjolng rklgciby tc

rnenjvn njtmnr eciajlng npjgurkb klkbonsjk klg onlnrkb klns-

tmnsjk fcbbcwng ay pcstcpnrktjvn

TENK,

usjlo k ijxturn cf

4.;1> aupjvkekjln klg sufnltkljb (TENK orcup), cr onlnrkb

klnstmnsjk fcbbcwng ay TEK wjtm jltrkvnlcus icrpmjln

TEK

orcup). Tkjl jltnlsjty wks tnstng tmrnn tjins gkjby usjlo k vjsukb

klkbco sekbn. Tcstcpnrktjvn nvkbuktjcl jlebugng inltkb s tktus,

ekrgjcrnspjrktcry klg okstrcjltnstjlkb fuletjcls, klg pktjnlt

sktjsfketjcl secrns.

* Ebjljekb Qnsnkrem Fnbbcw, Gnpkrtinl t cf Klnstmnsjk, MApjtkb Ukjlt-

t Kssjstklt jl Klnstmnsjcbcoy, Gnpkrtinlt cf Klnstmnsjk, MApjtkb

$

Qnsjgnlt jl Klnstmnsjcbcoy, Gnpkrtinl t cf Klnstmnsjk, MApjtkb

Utktjstjejkl, Gnpkrtinlt

cf

Ajcstktjstjes, Fkeubty

cf

Ingnejln,

;

Trcfnsscr

cf

Uuronry, Gnpkrtinlt

cf

Uuronry, Mkpjtkb Ukjlt-Nbcj,

Trcfnsscr cf Klnstmnsjcbcoy, Gnpkr tinlt cf Klnstmnsjk, MApjtkb

Qnenjvng frci tmn Keutn Tkjl Qnsnkrem J@ljt, Gnpkrtinlt cf Klns-

tmnsjk, Enltrn Mcspjtkbjnr ljvnrsjtkjrn Icltpnbbjnr, Frklen. Uuaijttng

fcr

puabjektjcl Fnarukry

; , ;:::.

Keenptng fcr puabjektjcl Unptnianr

11,

;:::.Uuppcrtng ay orklt

NW?-147

frci tmn Fclgktjcl gn JKvnljr,

Tkrjs, Frklen. Trnsnltng jl pkrt kt tmn kllukb inntjlo cf tmn Kinrjekl

Ucejnty cf Klnstmnsjcbcojsts, Crbklgc, Fbcrjgk, Cetcanr

;?- 11 ,

;::=.

Kggrnss rnprjlt rnqunsts tc Gr. Ikll0 Gnpkrtninlt gmnstmnsjn

Qnkljiktjcl

A,

MApjtkb Ukjlt-Nbcj, Enltrn Mcspjtkbjnr ^ljvnrsjtkjrn

Icltpnbbjnr, Icltpnbbjnr Engnx

> , 5 7 1 : > ,

Frklen. Kggrnss nbnetrclje

ikjb

tc0 e-ikllDemu-icltpnbbjnr.fr

Nbcj, Enltrn Mcspjtkbjnr ljvnrsjtkjrn Icltpnbbjnr.

Ukjlt-Nbcj, Enltrn Mcspjtkbjnr ^ljvnrsjtkjrn Icltpnbbjnr.


Icltpnbbjnr, Frklen.

Enltrn Mcspjtkbjnr Jbljvnrsjtkjrn Icltpnbbjnr.


Qnsubts0 Tkjl rnbjnf wks anttnr kt rnst T 9 4.44;) klg kftnr

ecuomjlo (T

9

4 . 4 4 1 ) jl tmn TENK orcup gurjlo tmn > pcstcp-

nrktjvn gkys. Uktjsfketjcl secrns wnrn anttnr jl tmn

TEFK

orcup.

Kbtmcuom jlejgnlen cf gnbjrjui wks ecipkrkabn jl tmn

TEK

klg

TENK

orcups

( 17

us

16 ,

rnspnetjvnby), inltkb stktus wks

jiprcvng cl tmn fcurtm klg fjftm pcstcpnrktjvn gkys jl tmn

TEFK orcup. Wmn TEFK orcup rnecvnrng acwnb fuletjcl icrn

qujehby tmkl gjg tmn

TEK

orcup. Ekrgjcpubiclkry ecipbjek-

tjcls wnrn sjijbkr jl tmn twc orcups.

Eclebusjcl0

Kftnr ik`cr kagcijlkb suronry jl tmn nbgnrby

pktjnl t, pktjnl t-ecltrcbbng klkbonsjk, rnokrgbnss cf tmn rcutn

(npjgurkb cr pk rn lt ng ), js nffnetjvn. Wmn npjgurkb rcutn usjlo

bcekb klnstmntjes klg k l cpjcjg prcvjgns anttnr pkjl rnbjnf klg

jiprcvns inltkb stktus klg acwnb ketjvjty. (Hny wcrgs0 Npj-

gurkb klkbonsjk0 cutecin8 pcstcpnrktjvn ecoljtjvn gysfuletjcl.)

TKWJNLW-ECLWQCBBNG klkbonsjk (TEK) wjtm jltrkvn-

lcus icrpmjln klg pktjnlt-ecltrcbbng npjgurkb klkbonsjk

(TENK), usjlo kl cpjcjg njtmnr kbcln cr jl eciajlktjcl

wjtm k bcekb klnstmntje, krn twc ik`cr kgvklens jl tmn

iklkoninlt cf pkjl kftnr ik`cr suronry.- Tktjnlt-ecl-

trcbbng tnemljquns kbbcw pktjnlts tc snbf-kgijljstnr sikbb

acbusns cf klkbonsje, prcvjgjlo anttnr tjtrktjcl klg nl-

mklejlo rnspclsjvnlnss jl klkbonsje

rnqujrninlt\3\

Kb-

tmcuom tmncrntjekbby usnfub, tmnsn tnemljquns mkvn annl

nvkbuktng pccrby jl tmn nbgnrby pnrscl. TEK mks annl

prcpcsng ks k skfn klg nffnetjvn tnemljqun fcr pcstcpnr-

ktjvn klkbonsjk klg js eclsjgnrng tc an tmn ocbg stkl-

gkrg fcr pkjl rnbjnf kftnr ik`cr suronry.1?Trnvjcus stug-

jns tmkt ecipkrng TEK klg jltrkiuseubkr icrpmjln

kgijljstrktjcls jl tmn nbgnrby pktjnlt smcwng tmkt TEK

jiprcvng klkbonsjk klg rnsubtng jl fnwnr cpjcjg tcxje

rnketjcls, pubiclkry ecipbjektjcls, klg eclfusjclkb np-

jscgns. Jl ecipkrjscl wjtm cpjcjg klkbonsjk ay njtmnr

jltrkvnlcus cr npjgurkb rcutns, npjgurkb kgijljstrktjcl

cf k bcekb klnstmntje klg cpjcjg ijxturn jiprcvng pkjl

rnbjnf..> Icrncvnr, jl mnkbtmy pktjnlts ulgnrocjlo ec-

bclje suronry, tmcrkeje npjgurkb klkbonsjk wjtm aupjvk-

ekjln klg icrpmjln ecubg rnsubt jl nkrbjnr rnecvnry cf

Klnstmnsjcbcoy,

V

:1,

L c 1,

Fna 1444


2/9

757

IKLL NW

KB.

Wkabn ;. Kaarnvjktng Inltkb Wnst*

Kon

Wjin (tc lnkrnst mcurs)

Kggrnss

cf

mcspjtkb fcr rnekbb kt nlg cf tnst (Ksh pktjnlt tc rnpnkt

tmn kgrnss tc nlsurn jt mks annl mnkrg ecrrnetby.)

Znkr

Lkin cf mcspjtkb

Qnecoljtjcl

cf

twc pnrscls (n.o., gcetcr, lursn)

Gktn

cf

ajrtm

Znkr cf tmn stkrt cf fjrst wcrbg wkr

Lkin

cf

tmn Trnsjgnlt

Ecult akehwkrg frci

14

tc

;

*Tktjnlts wnrn kshng

tc

klswnr tmn ;4 qunstjcls. Nkem ecrrnet klswnr

secrns cln pcjlt.

acwnb ketjvjty klg fuubfjbbinlt cf gjsemkron erjtnrjk, wjtm

k bcw jlejgnlen cf kgvnrsn nffnets.'.

Ecoljtjvn gysfuletjcl, eciiclby rnpcrtng jl tmn pcst-

cpnrktjvn pnrjcg, wcubg kppnkr tc an ksscejktng wjtm kl

jlernksng jlejgnlen cf vkrjcus ecipbjektjcls klg prc-

bclong mcspjtkb stky.', Jt mks annl suoonstng tmkt tmn

qukbjty cf pcstcpnrktjvn klkbonsjk ecubg gnernksn gnbjr-

jui jlejgnlen klg, jl turl, rnguen gurktjcl klg ecst cf

mcspjtkb stky

jl

tmn nbgnrby ~k tj nl t. ,~cwnvnr,

lc

stugy

mks nvkbuktng tmn ecipkrktjvn nffnets cf tmn gjffnrnlt

pnrjcpnrktjvn klkbonsjk tnemljquns c l cvnrkbb rnecvnry

jl cbgnr pktjnlts.

_n tmnrnfcrn pnrfcring k prcspnetjvn rklgcijzng

stugy jl nbgnrby pktjnlts ulgnrocjlo ik`cr kagcijlkb

suronry tc ecipkrn tmn nffnetjvnlnss

cl

pkjl klg

skfnty

cf

twc tnemljquns cf klnstmnsjk klg klkbonsjk0 eciajlng

npjgurkb klkbonsjk klg onlnrkb klnstmnsjk fcbbcwng ay

pcstcpnrktjvn TENK, usjlo k ijxturn cf aupjvkekjln klg

sufnltkljb, cr onlnrkb klnstmnsjk fcbbcwng ay TEK wjtm

jltrkvnlcus icrpmjln. Uneclg, wn nvkbuktng tmn nffnet

cf tmnsn tnemljquns cl inltkb stktus klg ecipbjektjcls,

jlebugjlo okstrcjltnstjlkb, rnspjrktcry, klg mnicgy-

lkije fuletjcls.

Iktnr j k b s klg In t m c g s

Tktjnlt Unbnetjcl klg Trctcecb

Wmjs prcspnetjvn stugy wks ekrrjng cut fcr

;=

icltms

kftnr kpprcvkb frci tmn Icltpnbbjnr Mcspjtkb Ntmjekb

Eciijttnn. Jlebusjcl erjtnrjk wnrn kon cbgnr tmkl ?4 yr,

Kinrjekl Ucejnty cf Klnstmnsjcbcojsts stktus

J

cr J; (kon

erjtnrjcl anjlo tkhnl kwky), lcrikb prncpnrktjvn inltkb

stktus gnfjlng ay k icgjfjng Kaarnvjktng Inltkb Wnst

secrnbc (KIW, gnfjlng jl tkabn ;

=,

nbnetjvn ik`cr

kagcijlkb suronry fcr eklenr

vjk

ijgbjln cr ajsuaecstkb

jlejsjcl, kasnlen cf ecltrkjlgjektjcls tc npjgurkb klns-

tmnsjk

(n.o.,

prncpnrktjvn eckoubcpktmy, bcekbjzng jlfne-

tjcl), klg kasnlen cf nxtrnin ikblutrjtjcl cr enrnarkb

vkseubkr jlsuffjejnley. Wmn gky anfcrn suronry klg kftnr

catkjljlo wrjttnl jlfcring eclsnlt,

kbb

sua`nets rn-

enjvng wrjttnl klg vnrakb jlstruetjcls fcr usn cf TEK cr

TENK klg wnrn jlstruetng tc akbklen klkbonsjk kokjlst

sngktjcl. Wmnl, tmn pktjnlts wnrn kssjolng tc rnenjvn,

ks

gntnrijlng ay k tkabn cf rklgci luianrs, njtmnr onlnrkb

klnstmnsjk klg pcstcpnrktjvn icrpmjln (TEK orcup) cr

onlnrkb klnstmnsjk eciajlng wjtm npjgurkb aupjvkekjln-

sufnltkljb klnstmnsjk (TENK orcup).

Jl actm orcups, kftnr crkb prningjektjcl wjtm ;44 io

mygrcxyzjln, onlnrkb klnstmnsjk wks jlgueng wjtm 5->

io/ho tmjcpnltkb klg 4.1- 4 .7 po/ho sufnltkljb. Wrkemnkb

jltuaktjcl wks fkejbjtktng ay 4.> io/ho ktrkeurjui. bb

pktjnlts ulgnrwnlt inemkljekb vnltjbktjcl wjtm

kl

nqukb ijxturn cf cxyonl klg ljtrcus cxjgn. Klnstmnsjk

wks ikjltkjlng wjtm jscfburkln, klg iusebn rnbkxktjcl

wks prcvjgng ay kl jl`netjcl cf ktrkeurjui usjlo trkjl-

cf-fcur icljtcrjlo.

Jl tmn TEK orcup, klkbonsjk wks prcvjgng ay 4.>

pobho

sufnltkljb anfcrn shjl jlejsjcl klg suasnqunlt jl`netjcls

cf 4.1- 4.7 po/ho

ks

lnensskry. Jl tmn pcstcpnrktjvn ekrn

uljt , klkbonsjk wks anoul kftnr kl jljtjkb bckgjlo gcsn cf

up tc

>

io jltrkvnlcus icrpmjln. Wmnl, tmn TEK puip

(Orksnay 55448 Orksnay Ingjekb, Vjtry, Frklen) wks prc-

orkiing tc gnbjvnr k ;.>-io jltrkvnlcus icrpmjln ae-

bus wjtm k bcehcut jltnrvkb

cf =

ijl. Jl tmn TENK orcup,

kl npjgurkb ektmntnr wks pbkeng kt tmn W?-W: bnvnb an-

fcrn suronry cf tmn uppnr kagcinl cr kt tmn W:-Wbb

bnvnb anfcrn ecbclje suronry. ]ybcekjln, 1%, wjtm npj-

lnpmrjln (> po/ib) wks jl`netng jltc tmn npjgurkb ektm-

ntnr tc kemjnvn k ajbktnrkb W7 snlscry bnvnb. Onlnrkb

klnstmnsjk tmnrnkftnr wks jlgueng usjlo tmn skin prcen-

gurn usng jl tmn TEK orcup. Npjgurkb klkbonsjk wks

catkjlng ay ecltjlucus jltrkcpnrktjvn jlfusjcl cf k

4.1>% aupjvkekjln klg ;-po/ib sufnltkljb ijxturn, fcb-

bcwng ay pcstcpnrktjvn kgijljstrktjcl cf k 4.;1>%au-

pjvkekjln klg 4.>-po/ib sufnltkljb ijxturn prcvjgng

wjtm k TENK puip (KTI8 Kaactt Bkacrktcrjns, Tkrjs,

Frklen) prcorkiing tc gnbjvnr 1- cr 5-ib acbus wjtm

k

bcehcut jltnrvkb cf ;1 ijl klg k akehorculg jlfusjcl

cf

5-> ib/m. Wrkemnkb nxtuaktjcl wks pnrfcring wmnl

wnkljlo erjtnrjk wnrn sktjsfjng nffnetjvn ecuom, eccrgj-

lktng tmcrgeckagcijlkb icvninlt, kasnlen cf stnrlc-

ebnjgcikstcjg iusebn pkrtjejpktjcl, k rnspjrktcry frn-

qunley bnss tmkl 5> eyebns/ijl, k tjgg vcbuin icrn

tmkl

>

ib/ho,

k

pubsn

cxyonl

skturktjcl icrn tmkl :4%,

kasnlen cf mnicgylkije jlstkajbjty, kojtktjcl, nxenssjvn

Klnstmnsjcbcoy,

V :1, Lc 1,

Fna

1444


3/9

75>

TKWJNLW-ECLWQCBBNG KLKBONUJK KLG NBGNQBZ TKWJNLWU

sngktjcl, klg mypctmnrijk (2 56E).

Kbb

pktjnlts rn-

enjvng tmn skin pcstcpnrktjvn pmysjctmnrkpy. Wmn gky

kftnr suronry, tmn pktjnlts skt jl kl kriemkjr wjtm tmn

mnbp

cf tmn lursns. Wmn lkscokstrje tuan wks rnicvng

wmnl okstrje suetjcl prcvjgng bnss tmkl >44 ib/gky.

Frci tmn tmjrg pcstcpnrktjvn gky, TEK cr TENK wks

gjsecltjlung wmnl k gcsn wks lct lnensskry fcr kt bnkst

m. Anfcrn kttniptjlo tc wkbh, pktjnlts wnrn kssnssng

fcr nvjgnlen cf ictcr abcehkgn cr crtmcstktje mypctnl-

sjcl.

Tcstcpnrktjvn Tkjl, Ujgn Nffnets, klg Uktjsfketjcl

Kssnssinlt

Wkabn

1.

Gjkolcstje klg Utktjstjekb

Iklukb cf

Inltkb Gjscrgnrs

GUI Jl Erjtnrjk

Qngueng kajbjty tc ikjltkjl kttnltjcl tc nxtnrlkb stjiubj (qunstjcls

iust an rnpnktng ks kttnltjcl wklgnrs) klg tc kpprcprjktnby smjft

kttnltjcl tc lnw nxtnrlkb stjiubj.

Gjscrgnrng tmjlhjlo ks jlgjektng ay rkiabjlo cr jlecmnrnlt

spnnem.

Kt bnkst twc cf tmn fcbbcwjlo.

(;)

Qngueng bnvnb cf eclsejcuslnss, n o., gjffjeubty hnnpjlo

(1) Tnrenptukb gjsturaklen. ijsjltnrprntktjcls, jbbusjcls, cr

(5) Gjsturaklen cf sbnnp-wkhn eyebn wjtm jlsciljk cr gkytjin

(7)

Gjscrjnltktjcl tc tjin, pbken, cr pnrscl.

kwkhn gurjlo nxkijlktjcl.

mkbbuejlktjcls.

sbnnpjlnss

Wc qukltjfy tmn jltnlsjty cf pcstcpnrktjvn pkjl, tmn

pktjnlts wnrn kshng tc usn k ;44-iivjsukb klkbco sekbn

VKs)orkgn frci

(>)

Jlernksng cr gnernksng psyemcictcr ketjvjty.

(6) Inicry jipkjrninlt, n.o., jlkajbjty tc bnkrl lnw iktnrjkb,

pkst nvnlts, cr lkins cf ulrnbktng ca`nets.

ii lc pkjl) tc bcc

ii

tmn

Ebjljekb fnkturns gnvnbcG cvnr k smcrt Gnrjcg cf tjin (mcurs tc

pcssjabn pkjl). VKU secrns wnrn rnecrgng kt rnst klg

gkys) klg trnlg tc fbuetuktn cvnr tmn ecursn cf k gky.

kftnr ecuomjlo kt

=

KI, ;1KI, klg = TI gkjby. Wc cptjijzn

klkbonsjk wmjbn ijljijzjlo sngktjcl klg mnicgylkije

jlstkajbjty, tmn pktjnlt-ecltrcbbng snttjlo ecubg an furtmnr

kg ustng gurjlo tmn twjen-gkjby vjsjts cf tmn pmysjejkls.

Lursns kbsc rnenjvng nxtnlsjvn trkjljlo rnokrgjlo tmn

stugjng tnemljquns. Jltrkvnlcus 1 o prcpkentkicb cr

;44

io hntcprcfnln wnrn jlfusng cl rnqunst wmnl pkjl

rnbjnf wks jlkgnquktn _KU secrn

pcstcpnrktjvn gkys.

Tcstcpnrktjvn Gnbjrjui klg Okstrcjltnstjlkb

Kssnssinlt

Tktjnlts wnrn kssnssng ay kl nxpnrjnleng pmysjejkl

lct jlvcbvng jl tmn pktjnlts ekrn usjlo KIW (tkabn ;)

klg erjtnrjk cf pcstcpnrktjvn gnbjrjui jl tmn Gjkolcstje

klg Utktjstjekb Iklukb cf Inltkb Gjscrgnrs (GUI

;;;8

tkabn

1)b tmn gky anfcrn suronry, twjen k gky gurjlo tmn fjrst

pcstcpnrktjvn gkys, klg nvnry gky ultjb gjsemkron.

Njtmnr

(;)

cr

(1)

(;)

Nvjgnlen frci mjstcry, pmysjekb nxkijlktjcl, cr bkacrktcry

tnsts cf k spnejfje croklje fketcr `ugong tc an ntjcbcojekbby

rnbktng tc tmn gjsturaklen.

(1) Jl tmn kasnlen cf suem nvjgnlen, kl ntjcbcoje fketcr ekl an

prnsuing jf tmn gjsturaklen ekllct an keecultng fcr ay kly

lclcroklje inltkb gjscrgnr.

Gjkolcsjs cf pcstcpnrktjvn gnbjrjui rnqujrng fubfjbbinlt

cf GUI J;; iklukb erjtnrjk klg k gnernksn jl tmn

KIW

secrn cf 1 cr icrn pcjlts.

Tktjnlts wnrn kssnssng fcr rnturl cf okstrcjltnstjlkb

fuletjcl twc tjins k gky ay k pmysjejkl wmc systniktj-

ekbby qunstjclng tmn pktjnlts klg eclsubtng lursn casnr-

vktjcls ultjb tmn rnturl cf fbktus, fnens, klg nktjlo wjtm-

cut lkusnk.

Qnspjrktcry, Mnicgylkije, klg Ictcr Abcehkon

Kssnssinlts

ebjljekb nxkijlktjcl wks pnrfcring tmn gky anfcrn

suronry klg nkem icrljlo cf tmn fjrst

?

pcstcpnrktjvn

gkys fcr nkem pktjnlt. Ebjljekb pubiclkry ecipbjektjcls

wnrn orkgng ks gnserjang ay @kyr nt gj 0cuom 9 ;8

purubnlt sputui

9

18 rclemj 9 58 bcekbjzng eclscbjgk-

tjcl cl pmysjekb nxkijlktjcl 9

18

fnvnr

9

; .

K

secrn

ornktnr tmkl cr nqukb tc

5

cl 1 eclsneutjvn gkys wks

gnfjlng ks k ebjljekb ecipbjektjcl, wmjem wks ebkssjfjng

ks k ijlcrecipbjektjcl wmnl rnscbvng spcltklncusby,

k icgnrktn ecipbjektjcl wmnl trnktinlt fcr rnscbu-

tjcl wks lnensskry, klg k snvnrn ecipbjektjcl wmnl

sjoljfjeklt jltnrvnltjcl, suem ks inemkljekb vnltjbktjcl

cr jltnlsjvn ekrn, wks lnensskry. Emnst rkgjcorkpms, ca-

tkjlng prncpnrktjvnby klg cl tmn fjrst, tmjrg, klg fjftm

pcstcpnrktjvn gkys, wnrn jltnrprntng kt tmn nlg

cf

tmn

Klnstmnsjcbcoy, V :1, L c 1, Fna 1444


4/9

756

IKLL NW KB.

stugy ay tmn skin rkgjcbcojst wmc wks lct kwkrn cf tmn

pktjnlts ebjljekb stktus. Qkgjcorkpmje emnst kalcrikbj-

tjns wnrn ebkssjfjng jltc twc orcups0 snoinltkb ktnbnetk-

sjs, cr bkron jlfjbtrktns, klg pbnurkb

Cxyonl skturktjcl (Upk,), krtnrjkb abccg prnssurn, klg

mnkrt rktn wnrn rnecrgng nvnry > ijl jltrkcpnrktjvnby,

nvnry 14 ijl gurjlo nkrby rnecvnry, klg, tmnrnkftnr,

nvnry

1

m fcr > gkys. _mnl systcbje krtnrjkb abccg prns-

surn gnernksng tc bnss tmkl :4 iiMo, tmn pktjnlt fjrst

rnenjvng

>44

ib mygrcxyntmybstkrem, klg, jf tmkt gjg lct

ecrrnet tmn mypctnlsjcl, tmn pktjnlt rnenjvng jlerninl-

tkb 5-io gcsns cf npmngrjln.

Ictcr fuletjcl cf tmn bcwnr bjias wks kssnssng gkjby

ay tmn pktjnlts kajbjty tc fbnx tmn hlnns klg klhbns.

Ictcr abcehkgn wks nvkbuktng jl tnris cf k icgjfjng

fcur-orkgn Arcikon sekbn*0 4

9

lc pkrkbysjs8

;

9

jlkajb-

jty tc jlernksn nxtnlgng bno (`ust kabn tc icvn hlnn klg

fnnt)8

1 9

jlkajbjty tc fbnx hlnn (kabn tc icvn fnnt cr fjrst

gjojt clby)8

5 9

jlkajbjty tc icvn kly `cjlt jl bnos.

Utktjstjekb Klkbysjs

Aksng cl rntrcspnetjvn gktk frci cur jlstjtutjcl jl tmn

skin surojekb pcpubktjcl, k pcwnr klkbysjs wks pnr-

fcring usjlo pcstcpnrktjvn pkjl gurjlo ecuom ks tmn

prjikry cutecin vkrjkabn. _n ekbeubktng k skipbn sjzn

sc tmkt k antwnnl-orcup inkl gjffnrnlen jl

VKU

cf 14

ii, wjtm rngueng pkjl secrns jl tmn TENK orcup, wcubg

pnrijt k typn ; nrrcr rktn cf cln-tkjbng k 9

4.4>

klg,

wjtm tmn kbtnrlktn mypctmnsjs, tmn lubb mypctmnsjs wcubg

an rntkjlng wjtm k typn nrrcr cf

9 4.14.

Wmjs klkbysjs

jlgjektns tmkt k skipbn sjzn

cf 5;

pktjnlts/orcup wks

lnensskry.

Ecltjlucus vkrjkabns krn prnsnltng ks tmn inkl UG

cr ingjkl (twnlty-fjftm tc snvnlty-fjftm pnrenltjbn) wmnl

gktk wnrn lct lcrikbby gjstrjautng, klg ektnocrje vkrj-

kabns krn prnsnltng ks frnqunlejns (pnrenltkon cf pk-

tjnlts).

Trncpnrktjvn pktjnlt emkrketnrjstjes, jltrkcpnrktjvn,

klg pcstcpnrktjvn gktk jl tmn twc orcups wnrn eci-

pkrng usjlo tmn emj-squkrn tnst fcr ektnocrje vkrjkabns

klg tmn _jbecxcl rklh sui tnst fcr ecltjlucus vkrj-

kabns.

Tcstcpnrktjvn kssnssinlt fcr kbb vkrjkabns inksurng

cvnr tjin wnrn nvkbuktng usjlo rnpnktng-inksurns klkb-

ysjs (tmn Frjngikl twc-wky lclpkrkintrje klkbysjs cf

vkrjklen) usjlo Utktjstjekb Klkbysjs Ucftwkrn (UKU Jlstj-

tutn Jle., Ekry, LE). Utktjstjekb sjoljfjeklen wks jlfnrrng

fcr T 4.4>.

Wkabn

5.

Ecipkrjscl

cf

tmn Wwc Wrnktinlt Orcups fcr

Trncpnrktjvn Fketcrs

Kon (Zr)

_njomt (ho)

Unx

Gjsnksns

Emrclje castruetjvn

pubiclkry gjsnksn

Ecrclkry krtnry gjsnksn

Gjkantns

Mypnrtnlsjcl

Gnprnssjcl

TEK Orcup

(l 9 5>)

?6.= 7.?

6:.5

-E

;>.>

;?F/;=I

7(;;%)

1 (6%)

6 (; ?%)

;1 (57%)

> (;7%)

TENK Orcup

(l

9

5>)

?6.; 1 >.6

66.> 1

;7.1

;>F/14I

5 (:%)

> (;>%)

5 (:%)

6 (;?%)

;7

(74%)

Vkbuns krn inkl

UG

cr ingjkl (twnlty-fj ftm pnrenltjbn tc snvnlty-fjftm

pnrenltjbn) cr ketukb luianrs

ZC).

TEK 9 pktjnlt-ecltrcbbng klkbonsjk8 TENK

9

pktjnlt-ecltrcbbng npjgurkbkl-

kbonsjk.

Qnsubts

K tctkb cf ;4= nbgnrby pktjnlts ulgnrwnlt semngubng

ik`cr kagcijlkb suronry kt tmn Enltrn Mcspjtkbjnr ^lj-

vnrsjtkjrn Icltpnbbjnr cvnr k pnrjcg cf ;= icltms.

Kiclo tmni,

5=

(5>%) wnrn lct jlebugng jl tmn stugy

anekusn cf pktjnlt rnfuskb ( 7 pktjnlts X7 Y) , r snvnrn

ekrgjcpubiclkry gysfuletjcl cr KIW secrn 2

= 16

pktjnlts

X17 Y),

lnurcbcoje gysfuletjcl

(1

pktjnlts

X1 Y),

cr ctmnr rnkscls

(6

pktjnlts

X6%Y).

Unvnlty

pk-

tjnlts wnrn kssjolng rklgciby tc cln cf tmn twc orcups.

Ujx pktjnlts gjg lct ecipbntn tmn pcstcpnrktjvn stugy

klg wnrn nxebugng frci pcstcpnrktjvn gktk klkbysjs an-

ekusn cf kasnlen cf surojekb rnsnetjcl (twc jl nkem

orcup) cr rnfuskb tc usn tmn pktjnlt-ecltrcbbng gnvjen

wjtm rnqujrninlt cf eclvnltjclkb klkbonsjk (twc jl tmn

TENK orcup klg lcln jl tmn TEK orcup).

Wmn twc orcups cf pktjnlts wnrn sjijbkr wjtm rnspnet

tc wnjomt, kon, snx, prncpnrktjvn gjsnksns (tkabn 5), klg

KIW klg Kinrjekl Ucejnty cf Klnstmnsjcbcojsts secrns.

Gurjlo suronry, lc gjffnrnlen wks casnrvng jl jltrkvn-

lcus fbujg rnqujrninlts cr tmn gurktjcl klg typn cf

suronry (tkabn

7).

Tktjnlts jl tmn TENK orcup rnenjvng

bnss jscfburkln

(T

9

4.444;)

klg jltrkvnlcus sufnltkljb

(T

9

4.444;) aut rnqujrng sjoljfjekltby

(T

9

4.444;)

icrn npmngrjln tmkl pktjnlts jl tmn TEK orcup (tkabn

78

T 9 4.444;). Kt tmn nlg cf tmn suronry, acgy tnipnrk-

turn klg gurktjcl cf pcstcpnrktjvn inemkljekb vnltjbk-

tjcl wnrn sjijbkr jl actm orcups, aut nxtuaktjcl tjin

ceeurrng sjoljfjekltby nkrbjnr jl tmn TENK orcup tmkl jl

tmn TEK orcup (tkabn 78

T

9 4.4;>).

Gurktjcl cf TEK wks ecipkrkabn antwnnl tmn TEK

orcup klg tmn TENK orcup (?4 14 m klg ?: 3 11 m,

Klnstmnsjcbcoy,

V

:1 , Lu 1, Fna 1444


5/9

75?


Wkabn 7. Ecipkrjscl cf tmn

Wwc

Wrnktinlt Orcups gurjlo

Klnstmnsjk

Wkabn >. Tcstcpnrktjvn Tktjnlt-ecltrcbbng Klkbonsje

Eclsuiptjcl jl tmn

Wwc

Orcups

Uuronry

Ecbnetcrly

Okstrnetcrly

Enpmkbje

pklernktnetcrly

Kasnlen cf rnsnetjcl

Gurktjcl cf suronry (rljl)

Inkl jscfburkln (%)

Jltrkvnlcus sufnltkljb

Erystkbbcjgs

(J)

mygrcxy ntmyb stkrem (J)

Abccg trklsfusjcl (J)

Abccg

bcss

(J)

Jlejgnlen cf systcbje

( gho)

mypctnlsjcl

(2

:4

irlMo)

Gurktjcl cf systcbje

mypctnlsjcl (rljl)

Jltrkvnlcus npmngrjln

(io)

Wnipnrkturn kt tmn nlg

cf suronry (E)

Tcstcpnrktjvn nxtuaktjcl

tjin (rljl)

Gurktjcl cf pcstcpnrktjvn

inemkljekb

vnltjbktjcl (rljl)

TEK Orcup

(l

9

5>)

16 (?7%)

1 (6%)

> (;7%)

1 (6%)

4.= (4.=-;)

171 (; ?1-1:>)

;.? (;.5-1.1)

> (7-6)

4.> (4-;)

4 4-4)

4 4-4)

1; (64%)

> (4-14)

4

4-4)

5>.= 4.?

64 (51-:4)

1? (; 4-6>)

TENK Orcup

(l

9

5>)

14 (>?%)

? (14%)

6 (; ?%)

1 (6%)

154 (;=4-54>)

4.> (4.7-4.6)*

4.5 (4.5-4.7)*

>

(7-6)

;

C

(4.>-; .C)

4

4-4)

4 4-4)

16 (?7%)

;> (>-54)

;1 (6-56)*

5?

3

4.?

54 (; ?->?)*

1? (;1-7>)

Vkbuns krn inkl

t

UG cr ingjkl (twnlty-fjftm pnrenltjbn-snvnlty-fjftm pnr-

enltjbn) cr ketukb luianrs ZC).

2 4.4> antwnnl tmn twc trnktinlt orcups

rnspnetjvnby). Wmn gkjby luianr cf acbusns wks sjijbkr jl

actm orcups. Tcstcpnrktjvn pktjnlt-ecltrcbbng klkbonsje

eclsuiptjcl js gjspbkyng jl tkabn >. TENK prcvjgng

sjoljfjekltby anttnr pkjl rnbjnf tmkl gjg TEK kt rnst T9

4.44;) klg kftnr ecuomjlo T9

4.441),

rnokrgbnss cf tmn

orcup gurjlo tmn

>

pcstcpnrktjvn gkys (fjos. ; klg 1 ) .

Wmn sktjsfketjcl secrns wnrn sjoljfjekltby ornktnr jl tmn

TENK

orcup tmkl jl tmn TEK orcup (tkabn

68

T 9

4.4;1).

Cl

tmn fjrst pcstcpnrktjvn gky, fnwnr pktjnlts rnqujrng

jltrkvnlcus kgijljstrktjcl cf hntcprcfnln jl tmn TENK

orcup tmkl jl tmn TEK orcup (tkabn

? 8

T

9

4.44;).

Trncpnrktjvn Km7W secrns wnrn ecipkrkabn antwnnl

tmn twc orcups. Tcstcpnrktjvn gnbjrjui gnvnbcpng jl ;6

(1> )

pktjnlts, wjtm k inkl gurktjcl cf npjscgns cf

?5

5; m. Wmn frnqunley cf pcstcpnrktjvn gnbjrjui wks sji-

jbkr

jl tmn TEK orcup klg tmn TENK orcup0

=

pktjnlts

(17 )

klg

=

pktjnlts

(16 ),

rnspnetjvnby. Wmn pktjnlts

wjtm gnbjrjui mkg lnjtmnr gjffnrnlt pkjl secrns lcr gjf-

fnrnlt klkbonsje eclsuiptjcl tmkl tmcsn wjtmcut gnbjr-

Jltrkvnlcus

Icrpmjln

Uubfktn (io/gky)

Tcstcpnrktjvn

Gky TEK Orcup

Npjgurkb

Aupjvkekjln

(io/gky)

Npjgurkb Uufnltkljb

(ggky)

TENK Orcup TENK Orcup

; 1> (17-77)

1 ;: (=-51)

5 ;4 (4-1;)

7 4 4-4)

> 4 4-4)

;6: (;>4-156)

;>=

(;

14-1;

6)

;1? (:7-; >5)

>4 (4-; 14)

4 4-4)

6= (>?-:7.>)

65 (7=-=?)

>; (5?-6;)

14 (4-7=)

4 4-4)

Vkbuns krn ingjkl (twnlty-fjftm pnrenltjbn-snvnlty-fjftm pnrenltjbn).

jui. Gurjlo tmn npjscgns cf gnbjrjui, TEK wks lct

gjsecltjlung. KIW secrns wnrn bcwnr jl tmn TEK orcup

cl t mn fcurtm klg fjftm pcstcpnrktjvn gkys (tkabn

=8

T

9

4.45).

Fcur pktjnlts (tmrnn jl tmn TEK orcup klg cln jl

tmn TENK orcup) rnqujrng mkbcpnrjgeb tc trnkt pcstcpnr-

ktjvn gnbjrjui wjtm kojtktjcl.

Wmn fjrst fnens T

9 4.44>)

klg crkb jltkhn wjtmcut

lkusnk T9 4.4;:) ceeurrng sjoljfjekltby icrn qujehby

jl tmn TENK orcup tmkl jl tmn TEK orcup (tkabn

6).

Gkjby

cxyonlktjcl vkbuns up tc tmn fjftm pcstcpnrktjvn gky klg

tmn luianr cf ijlcr ksyiptciktje mypcxjk npjscgns

gntnetng ay pubsn cxjintry wnrn lct sjoljfjekltby gjffnr-

nlt antwnnl tmn tw c orcups. L c pktjnlt rnqujrng kgijl-

jstrktjcl cf lkbcxcln. Wmrnn pktjnlts jl tmn TEK orcup

klg twc jl tmn TENK orcup mkg

kt

bnkst cln npjscgn cf

UpC1 ntwnnl

:4

klg

:>%.

Cln pktjnlt jl actm orcups

?4

6c4 7

1

;4

4

N x t n rl k

n i

k

n

i k n i k

n

i k

n

TCG4

TCG; TCG1 TCG5 TCG7

TCG>

Wjin

Fjo. ;. Fcr pcstcpnrktjvn pkjl jltnlsjty

vjsukb

klkbco sekbn) kt

rnst, pktjnlt-ecltrcbbng pjgurkb klkbonsjk TENK) prcvjgng sjo-

ljfjekltby anttnr pkjl rnbjnf tmkl gjg pktjnlt-ecltrcbbng klkbon-

sjk TEK8ay rnpnktng-inksurns klkbysjs cf vkrjklen8T

9

4.44;).

Vkbuns krn tmn inkl UG.

*T

2 4.4> ecipkrng wjtm TEK _jb-

ecxcl rklh sui tnst). k 9 kftnrlccl8 n 9 nvnljlo0 nxt 9 nxtu-

aktjcl8 i

9

icrljlo8

TCG

9 pcstcpnrktjvn gky.

Klnstmnsjcbcoy,V :1, L c

1 ,

Fna 1444


6/9

75=

IKLL NW KB.

= 4 ; W *

N x t n rl k n i k

n rl k

n

rl

k n rl

k

n

TCG4 TCG;

TCG1

TCG5 TCG7 TCG>

Wjin

Fjo. 1. Fcr pcstcpnrktjvn pkjl jltnlsjty vjsukb klkbco sekbn)

gurjlo ecuom pktjnlt-ecltrcbbng pjgurkb klkbonsjk

TENK)

prc-

vjgng sjoljfjekltbyanttnr pkjl rnbjnf tmkl gjg pktjnlt-ecltrcbbng

klkbonsjk

(TEK8

ay rnpnktng-inksurns klkbysjs cf vkrjklen8T 9

4.441). Vkbuns krn tmn inkl UG.

*

T

2 4.4>

ecipkrng wjtm

TEK

_jbecxcl rklh sui tnst). k 9 kftnrlccl8 n 9 nvnljlo8 nxt 9

nxtuaktjcl8 i 9 icrljlo8 TCG

9

pcstcpnrktjvn gky.

mkg kt bnkst cln npjscgn cf UpC1 ntwnnl => klg :4%.

Wmn twc orcups mkg sjijbkr ebjljekb klg rkgjcbcoje ka-

lcrikbjty rktns (tkabn

6).

Wmn frnqunley klg typn

cf

ik`cr klg icgnrktn pubiclkry ecipbjektjcls wnrn lct

sjoljfjekltby gjffnrnlt antwnnl orcups (tkabn 6). Wwc

sua`nets nxpnrjnleng ktnbnetksjs, plnuicljk, klg my-

pcvnltjbktjcl klg rnqujrng jltnlsjvn tmnrkpy wjtm arcl-

emcsecpy, aut lct inemkljekb vnltjbktjcl.

Fjvn npjscgns cf pcstcpnrktjvn mypctnlsjcl ceeurrng

jl tmn TENK orcup vnrsus lcln jl tmn TEK orcup (T 9

4.4;). Wmn pktjnlts wnrn trnktng ay sjipbn fbujg bckgjlo.

Lc

snvnrn mypctnlsjcl (ijljiui systcbje prnssurn 9 ?=

iiMo) wks rnecrgng jl njtmnr orcup (tkabn 6 . L c ic-

tcr abcehkgn ceeurrng jl njtmnr orcup. Uuaeutklncus

kasenss cr lnurcbcoje ecipbjektjcls rnbktng tc tmn npj-

gurkb ektmntnr gjg lct gnvnbcp jl kly pktjnlt. Cln pk-

tjnlt jl nkem orcup nxpnrjnleng prurjtus. Wmn jlejgnlen

cf klkstcicsjs bnkh klg urjlkry snpsjs klg tmn gurktjcl

cf mcspjtkb stky wnrn sjijbkr jl actm orcups (tkabn 6).

Gjseussjcl

Wmn ikjl fjlgjlo cf tmjs stugy js tmkt jl nbgnrby pk-

tjnlts,

TEK

tnemljquns usjlo njtmnr jltrkvnlcus cr npj-

gurkb rcutns prcvjgn nffnetjvn iklkoninlt cf pcstcpnr-

ktjvn pkjl. Mcwnvnr, tmn npjgurkb rcutn wjtm k

eciajlktjcl cf bcekb klnstmntjes klg k bjpcscbuabn cpjcjg

rnsubtng jl anttnr pcstcpnrktjvn pkjl rnbjnf kt rnst klg

gurjlo ecuom wjtmcut jlernksjlo ecipbjektjcls eci-

pkrng wjtm tmn jltrkvnlcus rcutn. Jiprcvng inltkb stk-

tus klg k qujehnr okstrcjltnstjlkb rnecvnry kbsc wnrn

casnrvng wjtm TENK.

Jl tmn nbgnrby pktjnlt, ijsiklkojlo pktjnlt-ecltrcbbng

tnemljquns ekl an rnbktng tc vkrjcus fketcrs, suem

ks

ekrgjcrnspjrktcry gnfjejnlejns cr gjffjeubtjns jl mklgbjlo

cr bnkrljlo tc usn tmn gnvjen. Wmnrnfcrn, jt mks annl

suoonstng tmkt jl tmn nbgnrby pktjnlt, ebcsn casnrvktjcl

klg frnqunlt gcsn tjtrktjcl krn lnngng tc usn jltrkvn-

lcus

TEK.

Jl ecltrkst, jl cur mnkbtmy nbgnrby pktjnlts,

kg`ustinlt cf pktjnlt-ecltrcbbng snttjlo rkrnby wks lne-

nsskry. Jl tmn

TEK

orcup, tmn jljtjkb snttjlo wks lct

icgjfjng anekusn lc sjol cf cvnrgcsjlo wks gntnetng. l

tmn

TENK

orcup, clby fjvn (;6%) pktjnlts rnqujrng k

emklon jl tmn jljtjkb acbus gcsn cr akehorculg

jlfusjcl

tc kgkpt tc snlscry bnvnb cr ijljijzn mnicgylkije

gjsturaklens.

Bnkrljlo klg keenptklen

cf

tmn pktjnlt-ecltrcbbngecl-

Wkabn 6. Tcstcpnrktjvn Cutecin, Ujgn Nffnets, Mcspjtkb Utky,

klg Tktjnlt Uktjsfketjcl Uecrns jl tmn Wwc Orcups

TEK Orcup TENK Orcup

l

9 55)

Jl 9 5;)

Fbktus (m)

Fnens (m)

Gurktjcl cf

Crkb lutrjtjcl wjtmcut

Gnkiaubktjcl (m)

Lkusnk, vcijtjlo

Uystcbje mypctnlsjcl

(2 : 4 ii Mo)

Ukturktjcl

2 :>%

Tcstcpnrktjvn

gnbjrjui

Klkstcicsjs bnkh

Unoinltkb cr bcakr

ktnbnetksjs

Icgnrktn pubiclkry

ecipbjektjcls

Ik`cr pubiclkry

ecipbjektjcls

^rjlkry snpsjs

Gurktjcl cf mcspjtkb

stky (gkys)

Tktjnlt sktjsfketjcl

secrn (Lc. cf

pktjnlts wjtm

secrns cf 4;; ;1;5)

lkscokstrje tuan (m)

lkusnk (m)

?1 (7=-:6)

; ;> (:4-; 77)

>= (5=-?1)

;=1 (; 74-174)

:= (=7-; 77)

;4 (54%)

4 (4%)

> (;>%)

5 (:%)

=

(17%)

6 (;=%)

1 (6%)

; ( 5 % )

> (;>%)

;

;.> (=-; 6% )

4;5;; :;; ;

?4 (56-?1)

=4 (64-;14)

6; (7:-?5)

;7 1 (; 14-;

67)

: = (?1-;14)

;4 (51%)

> (; 6%)*

5 (;4%)

;(5%)

=

(16%)

?

(15%)

5 (; 4% )

;(5%)

; (5%)

;4.> (=.>-;>%)

4/;/:/1;*

Vkbuns krn ingjkl (twnlty- fjftm pnrenltjbn-snvnlty-fjftm pnrenltjbn)

cr ketukb

luianrs

(%).

Tktjnlt sktjsfketjcl secrns ks fcbbcws0 ljb

9 48 ijbg

9 ;8occg 9 18 nxenbbnlt9

l

@

*

T 2

4.4>

antwnnl tmn twc trnktinlt orcups.

Klnstmnsjcbcoy,V

:1,

Lc

1, Fna 1444


7/9

75:


Wkabn ?. Tcstcpnrktjvn Klkbonsje Qnseun Eclsuiptjcls jl tmn

Wwc

Orcups

Lc.cf Tktjnlts Mkvjlo

Qnenjvng Trcpkentkicb

Jltrkvnlcus

Lc.cf Tktjnlts Mkvjlo

Qnenjvng Hntcprcfnln

Jltrkvnlcus

TEK Orcup TENK Orcup

Tcstcpnrktjvn

Gky Lc.

(%)

Lc.

(%)

; ;= (>7) ;;

(5>)

1 ;= (>7) ;> (7=)

5 ;:

(>=)

;?

(>>)

7 ;> (7>) ;?

(>>)

>

;1 (56) ;4 (51)

TEK Orcup

TONK Orcup

Vkbuns krn ketukb luianrs (%).

* T 2 4.4> anntwnnl tmn twc orcups.

TEK 9 pktjnlt-ecltrcbbng klkbonsjk8 TENK 9 pktjnlt-ecltrcbbng npjgurkb kl-

kbonsjk.

enpt cavjcusby lnenssjtktns k suffjejnlt prncpnrktjvn

inltkb stktus. Jl kggjtjcl, prncpnrktjvn eclfusjcl iky

an nxkoonrktng kftnr surojekb prcengurn jl pktjnlts wjtm

prnnxjstnlt ecoljtjvn gysfuletjcl,' wmjem iky rnsubt jl

k

prcakabn ijsusn cf tmn pktjnlt-ecltrcbbng gnvjen. Mcw-

nvnr, tmn

usn

cf tmjs tnemljqun wks lct prnebugng jf

trklsjnlt ijlcr kbtnrktjcls jl pktjnlt inltkb stktus ce-

eurrng. Wmn eurrnlt stugy smcwng

k 1>

jlejgnlen cf

pcstcpnrktjvn gnbjrjui.

K

rnenlt iubtjenltnr stugy tmkt

rnerujtng up tc 64 nbgnrby pktjnlts ulgnrocjlo ik`cr

suronry rnpcrtng

k

ebcsnby ecipkrkabn jlejgnlen cf gn-

bjrjui

klg jgnltjfjng clby kon ks

k

prngjetcr cf gnfjejt

(klg lct mypcxjk, mypctnlsjcl, cr actm). b > Trncpnrktjvn

pktjnlt snbnetjcl usjlo KIW secrns kbbcwng us tc jgnltjfy

tmcsn wjtm prnnxjstjlo ecoljtjvn jipkjrinlt, wmc wnrn

suasnqunltby lct nlrcbbng jl tmn stugy. Wmjs wcubg prca-

kaby nxpbkjl wmy clby 5 cf tmn snbnetng pktjnlts rn-

fusng tmn pktjnlt-ecltrcbbng gnvjen klg rnqujrng eclvnl-

tjclkb klkbonsjk. Icrncvnr, tmn pktjnlts wjtm ecoljtjvn

jipkjrinlt rnqujrng lc pkrtjeubkr survnjbbklen wjtm rn-

okrg tc pcstcpnrktjvn pkjl trnktinlt. Wmjs mjom gnornn

cf keenptklen nlecurkons us tc rneciinlg tmn rcutjln

pnrjcpnrktjvn usn cf

KIW

wjtm kl nffnetjvn strktnoy tc

tkhn ekrn cf pcstcpnrktjvn pkjl jl tmn nbgnrby pktjnlt,

nspnejkbby

jf

k

pktjnlt-ecltrcbbng tnemljqun js usng.

Ks

jl prnvjcus st ~g jn s ,~ , ~ ~ 'n fkjbng tc smcw kly

gjffnrnlen jl jlejgnlen cf gnbjrjui, rnokrgbnss cf tmn

rcutn cf pcstcpnrktjvn klkbonsjk. Wc ulgnrstklg tmjs, tmn

emcjen cf sufnltkljb,

k

mjomby bjpjg scbuabn cpjcjg, fcr

TENK

iust an tkhnl jltc keecult. Anekusn npjgurkb

sufnltkljb iky mkvn k ikrhng systnije nffnet,;=

k

pctnl-

tjkb rnguetjcl jl pcstcpnrktjvn gnbjrjui ay tryjlo tc

prnvnlt tmn systnije nffnet cf cpjcjgs iky lct an prn-

vnltng ay usjlo tmn npjgurkb rcutn. Mcwnvnr, jl tmn

TENK orcup, wn casnrvng frci tmn fcurtm pcstcpnrktjvn

gky

k

icrn rkpjg rnecvnry cf inltkb stktus kssnssng ay

KIW secrn. Wmjs jlgjektns,

ks

suoonstng ay prnvjcus

tmkt tmn qukbjty cf pcstcpnrktjvn klkbonsjk js

prcakaby cf icrn jipcrtklen tmkl js tmn rcutn cf kgijl-

jstrktjcl cr tmn eclsuiptjcl cf cpjcjgs jl tmn prnsnrvk-

tjcl cf ecoljtjvn fuletjcl.

Wmn anttnr klkbonsje nffnetjvnlnss wjtm rnspnet tc bcw

jlejgnlen cf sjgn nffnets ecubg prcakaby nxpbkjl tmn

supnrjcrjty

cf TENK

tnemljquns,

ks

pcjltng cut ay tmn

mjomnr pktjnlt sktjsfketjcl secrns. Jl kggjtjcl, jt js ji-

pcrtklt tc nipmksjzn tmkt tmn TENK rnojinl wks clby

pkrtby pktjnlt ecltrcbbng klg cffnrs tmn pcssjajbjty cf

snttjlo

k

akehorculg jlfusjcl. Fjrst, tmjs

js

pkrtjeubkrby

usnfub jl eclfusng cr lct ynt tctkbby kwkhn pktjnlts wmc

ekllct mklgbn tmn gnvjen. Uneclg, akehorculg jlfusjcl

jiprcvns klkbonsjk kemjnvng ay TENK wjtmcut furtmnr

sjgn nffnets.b: Jl ecltrkst, ecltjlucus jlfusjcl smcubg an

kvcjgng ay tmn jltrkvnlcus rcutn anekusn tmjs wcubg

inkl kl jlernksng rjsh cf rnspjrktcry gnprnssjcl, nvnl kt

k bcw gcsn1' Wmjrg, jt js jipcrtklt tc eclsjgnr tmkt cbgnr

pktjnlts prnfnr tc mkvn klkbonsjes kgijljstnrng ay mcs-

pjtkb stkff, rktmnr tmkl ay snbf-kgijljstrktjcl.1;Wkhnl

tcontmnr, tmnsn eclsjgnrktjcls ecubg ulgcuatngby fkvcr

tmn TENK tnemljqun.

Gnbkyng pcstcpnrktjvn rnecvnry cf okstrcjltnstjlkb

fuletjcls kftnr kagcijlkb suronry mks annl rnbktng tc

surojekb acwnb klkstcicsjs,11prcbclong pbkeninlt

cf

k

lkscokstrje tuan,15 klg usn cf jlmkbng

klnstmntje\ \

cr

pkrnltng ~pjcjgs . '~l ecltrkst, tmcrkeje npjgurkb klkb-

onsjk wjtm bcekb klnstmntjes, wmntmnr ksscejktng wjtm

Wkabn

=. KIW

Uecrns Lc.

cf

Tktjnlts wjtm Uecrns

cf

=/:/;4)

TEK TENK

Trncpnrktjvn

Tcstcpnrktjvn Gkys

4

TI

; KI

TI

1 KI

TI

5 KI

TI

7 KI

TI

> KI

TI

1;; >;;

=

;;;;1;;4

;1;;4/;;

;4/:/;7

?;; 5;;5

6;; 1;;

>

6;;

5;; 7

>/;;/;?

5;; 4;14

6/:/;=

>;; 5;;>

=;; 4;; >

; ;7/14

:;; ;;; ;

?;; ;;;5

?;6;; =

>/6/14

7/?/1;

6/>/14

;/>/1>*

5/>/15

5/?/1;

; ?/15*

7

*

T

2

4.4> antwnnl tmn twc trnktinlt orcups.

TEK 9 pktjnlt-ecltrcbbng klkbonsjk8 TENK 9 pktjnlt-ecltrcbbng npjgurkb kl-

kbonsjk.

Klnstmnsjcbcoy,V :1, Lc

1 ,

Fna

1444


8/9

774

IKLL NW KB.

cpjcjgs, iky jiprcvn acwnb ketjvjty jl ecipkrjscl wjtm

pkrnltnrkb klkbonsjk. Tktjnlts jl tmn TEK orcup rnenjvng

sjoljfjekltby icrn jltrkcpnrktjvn jltrkvnlcus cpjcjgs

klg jscfburkln. Wmnrnfcrn, jt wks lct surprjsjlo tmkt, jl

tmn TEK orcup, fjrst fnens klg crkb jltkhn wnrn gnbkyng

ks ecipkrng wjtm tmn TENK orcup. Mcwnvnr, tmn tjin tc

tmn fjrst pksskon cf fbktus wks lct sjoljfjekltby gjffnrnlt

antwnnl tmn twc orcups. Jl tmn TEK orcup, tmn ornktnr

eclsuiptjcl cf hntcprcfnln, k lclstnrcjgkb kltjjlfbki-

iktcry konlt tmkt keenbnrktns tmn rktn cf rnecvnry cf

okstrcjltnstjlkb fuletjcl,16 ecubg prcakaby nxpbkjl tmjs

fket. Jltnrnstjloby, stugjns jl wmjem tmn npjgurkb ektmntnr

wks bcektng kt cr anbcw W;1 cr jl wmjem tmn gurktjcl

cf

npjgurkb klkbonsjk bkstng lc icrn tmkl 17 m1?-1: kvn lct

fculg kly kgvkltkon fcr npjgurkb klkbonsjk wjtm rnokrg

tc rnecvnry cf acwnb fuletjcl. Wmnrnfcrn,

wn

tcch ekrn

tc kbwkys pcsjtjcl tmn ektmntnr kt tmn tmcrkeje bnvnb klg

tc prcvjgn kl nffnetjvn tmcrkeje snlscry abcehkgn. Fcur

pktjnlts (>.: ) nxpnrjnleng klkstcicsjs bnkh0 tmrnn jl

tmn TEK orcup klg cln jl tmn TENK orcup. ^lnxpnet-

ngby, tmjs jlejgnlen wks suastkltjkbby bcwnr tmkl jl icst

prnvjcus stugjns jl yculonr pktjnlts tmkt rnpcrtng k

rklon cf ?-15 .-

Wmn jlejgnlen cf pubiclkry ecipbjektjcls jl tmjs

stugy wks sjijbkr tc tmkt jl ctmnr stugjns tmkt jlebugng

yculonr pktjnlts ulgnrocjlo tmn skin typn cf sur-

onry. Wmn emcjen cf tmn klkbonsje tnemljqun gjg lct

snni tc jlfbunlen tmn jlejgnlen cf icgnrktn klg ik`cr

pubiclkry ecipbjektjcls. Ekrgjcvkseubkr emklons wnrn

wjtmcut ebjljekb jipcrtklen. Ks nxpnetng, jl tmn TENK

orcup, mnicgylkije jlstkajbjty wks icrn prclculeng

jltrkcpnrktjvnby, lnenssjtktjlo k mjomnr eclsuiptjcl cf

npmngrjln, klg pcstcpnrktjvnby, jl wmjem fjvn pktjnlts

nxpnrjnleng k icgnrktn npjscgn cf mypctnlsjcl. Mcw-

nvnr, tmn eurrnlt stugy gjg lct mkvn tmn pcwnr tc gntnet

sjoljfjeklt gjffnrnlens jl ekrgjcrnspjrktcry cutecin an-

ekusn cf tmn sikbb

luianr

cf pktjnlts.

_jtm npjgurkb klkbonsjk, tmn rjsh cf crtmcstktje mypc-

tnlsjcl klg ictcr abcehkgn cf tmn bcwnr bjias gurjlo

pcstcpnrktjvn icajbjzktjcl ecubg ecultnrket tmn anlnfjt

cf tmn keenbnrktng pcstcpnrktjvn rnecvnry.55 K snbf-kg-

`ustinlt ay tmn pktjnlt prcakaby nxpbkjls jl tmn eurrnlt

stugy tmn bkeh cf sjoljfjeklt mnicgylkije jlstkajbjty klg

ictcr abcehkgn klg, jl turl, gcns lct jltnrfnrn wjtm tmn

pcssjajbjty cf nkrbjnr wkbhjlo.

Fjlkbby, tmnrn wks lc gjffnrnlen antwnnl tmn twc

orcups cf nbgnrby pktjnlts fcr tmn gurktjcl cf tmn mcspjtkb

stky. Mcwnvnr, anekusn wn gjg lct gnfjln prnejsnby tmn

gjsemkron erjtnrjk anfcrn tmn stugy, wn ecubg lct grkw

gnfjljtn eclebusjcls.

Jl suiikry, tmn eurrnlt stugy smcwng tmkt pcstcpnr-

ktjvn TEK tnemljquns ay njtmnr tmn npjgurkb cr tmn pk-

rnltkb rcutn

js

nffnetjvn jl tmn nbgnrby pktjnlt. _mnl

ecipkrng wjtm tmn pkrnltnrkb rcutn, npjgurkb klkbonsjk

wjtm bcekb klnstmntjes klg kl cpjcjg prcvjgns anttnr pkjl

rnbjnf klg jiprcvns inltkb stktus klg acwnb ketjvjty aut

gcns lct rnguen pcstcpnrktjvn gnbjrjui jlejgnlen klg

ekrgjcrnspjrktcry icrajgjty. Wmjs intmcg cf pcstcpnrk-

tjvn klkbonsjk js k prcijsjlo lnw tnemljqun fcr mnkbtmy

nbgnrby pktjnlts ulgnrocjlo ik`cr kagcijlkb suronry.

Qnfnrnlens

;. Bju

UU,

Ekrpnltnr

QB,

Lnkb @I0 Npjgurgb klnstmnsjk klg klkbonsjk0

Wmnjr rcbn jl pcstcpnrktjvn cutecin. KLNUWMNUJCBCOZ::>8 = 1 0;7?7

-

>46

1 .

Noanrt KI, Tkrhs BM, Umcrt

BI,

Aurlntt IB0 Qklgcijzng trjkb cf

pcstcpnrktjvn pktjnltecltrc bbng klkbonsjk vs jltrkiuseubkr lkrectjes jl

frkjb nbgnrby inl. Krem Jltnrl Ing ;::48 ;>40;=:?-:45

5 .

Mnehnr AQ, Kbanrt B0 Tktjn ltecltrc bbng klkbonsjk0 K rklgcijzng

prcspnetjvn ecipkrjscl antwnnl twc eciinrejkbby kvkjbkabn TEK

puips klg eclvnltjclkb klkbonsje tmnrkpy fcr pcstcpnrktjvn pkjl. Tkjl

7 Acbbjsm U@, Ecbbjls EB, Hjrhjlo GI, Akrtbntt

QM0

Nffjekey cf pktjnlt.

ecltrcbbng vnrsus eclvnltjclkb klkbonsjk fcr pcstcpnrktjvn pkjl. Ebjl

Tmkri ;:=>8 77= ->1

> Gkmb @A, Qcsnlanro @, Mklsnl AB, M`crtsc LE, Hnmbnt

M0

Gjffnr-

nltjkb klkbonsje nffnets

cf

bcw-gcsn npjgurkb icrpmjln klg icrpmjln-

aupjvkekjln kt rnst klg gurjlo icajbjzktjcl kftnr ik`cr kagcijlkb

suronry. Klnstm Klgbo ;::18 ?70561->

6 . Bju UU Ekrpnltnr QB, Ikehny GE, Wmjrbay QE, Qupp

UI,

Umjln

WU@, Fnjlobkss LO, Intzonr TT, Fubinr @W, Uijtm UB0 Nffnets cf pnrjcp

nrktjvn klkbonsje tnemljqun cl rktn cf rnecvnry kftnr ecbcl suronry.

KLNUWMNUJCBCOZ

::>8 =50?>?-

6>

? . Anroornl G , Oustkfscl Z , Nrjhsscl A, Auemt O, Mklsscl Bb, Qnjz U,

_jlabkg A0 Tcstcpnrktjvn eclfusjcl kftnr klnstmnsjk jl nbgnrby pktjnlts

wjtm fnicrkb lneh frketurns. Klnstm Klkbo

;:=?8

6607:?->47

=.

Anrlstnjl OI, Cffnlakrtb UH0 Kgvnrsn surojekb cutecins kiclo

pktjnlts wjtm ecoljtjvn jipkjrinlts. Ki Uuro ;::;8 >?06=1-:4

:. Bylem NT, Bkzcr IK, Onbbjs

@N,

Crkv @ Ocbgikl

B,

Ikrekltcljc

NQ.

Wmn

jipket cf pcstcpnrktjvn pkjl cl tmn gnvnbcpinlt cf pcstcp

nrktjvn gnbjrjui. Klnstm Klkbo ;::=8 =60?=;->

;4. @jtkpulhub

U,

Tjbbky

J,

Narkmji

U0

Wmn kaarnvjktng inltkb tnst0 Jts

usn klg vkbjgjty. Kon Konjlo ;::;8 140551-6

;

;.

Kinrjekl Tsyemjktrje Ksscejktjcl, Eciijtnn cl Lcinlebkturn.

Utktjstjes0 Gjkolcstje klg Utktjstjekb Iklukb

cf

Inltkb Gjscrgnrs, 5rg

rnvjsng ngjtjcl. _ksmjlotcl, GE,

;:=?,

pp ;44-7

;1. Lj Emclemuamkjr K, Vkbkejc Q, Hnbby

@,

CHnnffn

U ^sn

cf tmn

kaarnvjktng inltkb tnst tc gntnet pcstcpnrktjvn gnbjrjui jl nbgnrby

pncpbn. Ar @ Klknstm ;::>8 ?>07=;-1

;5. @kyr E , Wmciks M, Qny K, Fkrmkt F, Bkssnr T, Acurokjl @B0

Tcstcpnrktjvn pubiclkry ecipbjektjcls0 Npjgurkb klkbonsjk usjlo

au-

pjvkekjln klg cpjcjgs vnrsus pkrnltnrkb cpjcjgs.

KLNUWMNUJCBCOZ::58

;7. Arcigon TQ K ecipkrjscl cf tmn mygrcembcrjgn klg ekracl

gjcxjgn skbts cf bjgcekjln klg prjbcekjln jl npjgurkb klkbonsjk. Ketk

Klnstmnsjcb Ueklg ;:6>8 ;6 suppb ;6)0>>- 6:

;:==8

5>0;;>-14

?=;666 ?6

Klnstmnsjcbcoy,

V :1,

Lc 1, Fna

1444


9/9

77 ;


;>.

Hciktsu

M,

Iktsuictc

U

Ijtsumktk M, Kan H, Wcrjykan

U0

Ecipkrjscl cf pktjnlt-ecltrcbbng npjgurkb klkbonsjk wjtm klg wjtmcut

akehorculg jlfusjcl kftnr okstrnetciy. Klnstm Klkbo ;::=8=?:4?-

;4

;6. Omclnji

II,

Mjlrjems

` V ,

CMkrk I_, Inmtk IT, Tktmgh G,

Huikr

V,

Ebkrh EQ Ecipkrjscl cf psyemcbcoje klg ecoljtjvn fuletjcls

kftnr

onlnrkb cr rnojclkb klnstmnsjk. KLFUWMNUJCB~OZ:==8 6:0>4?-;>

;?. Emulo FF, Emulo K, Injnr

QM,

Bkutnlsembknonr

N,

Unycln

E0

Ecipkrjscl cf pnrjcpnrktjvn inltkb fuletjcl kftnr onlnrkb klknstmnsjk

klg spjlkb klknstmnsjk wjtm jltrkvnlcus sngktjcl. Ekl @ Klgnstm ;:=:8

;=. Ijounb Q , Akrbcw J, Icrrnbb I, Uemkrf @, Uklusj

J1

;:. Icbbnr @W, Ebujtikls T, Qksussnl BU, MCBJ], Qksiussnl H, Eklnt

@, Qkaajt T, @cbbns @, Bkrsnl

H,

M i j l o EG, Jklonrcl 4 Bkuvnl TI,

Hrjstnlsnl TK, Ajngnr

K,

Anni M, Frkjgkhjs 4 Ujbvnrstnjl @M, Anlnhnl

@N_, Orkvnlstnjl@U0 Bclo tnri pcstcpnrktjvn ecoljtjvn gysfuletjcl jl tmn

nbgnrby. Bklent

;::=8

5>;15>?-6;

14. Ektbny GI, Wmcr ltcl

E,

@crgkl

E,

Bnmkln @Q, Qcystcl G, @clns

@O0 Trclculeng npjscgje cxyonl gnskturktjcl jl tmn pcstcpnrktjvn

pnrjcg0 Jts ksscejktjcl wjtm vnltjbktcry pkttnrl klg klkbonsje rnojinl,

KLNUWMNUJCBCOZ

;:=>8 65014 -

=

1;. Nokl H@, Qnkgy BA0 Tktjnlt sktjsfketjcl wjtm jltrkvnlcus TEK cr

npjgurkb icrpmjln. Ekl @ Klknstm ;::78 7;06-;;

11.

Orkanr @L, Uemubtn _@, Eclgcl

QN,

Ecwbns VN0 Qnbktjclsmjp

cf

gurktjcl

cf

pcstcpnrktjvn jbnus tc nxtnlt klg sjtn cf cpnrktjvn gjssne-

tjcl. Uuronry ;:=18 :115?-:1

15. Emnkgbn _O, Vjtkbn OE, Ikehjn EQ, Eusemjnrj K0 Trcpmybketje

pcstcpnrktjvn lkscokstrje gneciprnssjcl .

K

prcspnetjvn stugy cf jts

rnqujrninlt klg tmn jlfbunlen cf ejintjgjln jl 144 pktjnlts. Kll Uuro

17. Eclgcl QN, Ecwbns V, Nhaci OK, Uemutbn _@, Mnss O0 Nffnets cf

5605=1-?

;:=>8 141 ~56; ->

mkbctmkln, nlfburkln klg ljtrcus cxjgn cl ecbcl ictjbjty. Uuronry

;:=?8 ;4;0=;->

1>. Frkltzjgns EW, Ecwbns V, Ukbkyinm A, Wnhjl N,

Eclgcl QN0

Icrpmjln nffnets

cl

muikl ecbclje iycnbnetrje ketjvjty jl tmn pcst-

cpnrktjvn pnrjcg. Ki @ Uuro ;::18 ;650;77 -:

16. Tkrhnr QH, Mcbtikll A, Uijtm J, _mjtn TF0 ^sn cf hntcrcbke kftnr

bcwnr kagcijlkb suronry0 Nffnet cl klkbonsje rnqujrninlt klg surojekb

cutecin. KLNUWMNUJCBCOZ::78 =406 -;1

1?. _kbbjl O , Ekssutc @, Mcostrci U, Qjiakeh O, Fkxnl K, Wcbbnsscl

TC0 Fkjburn

cf

npjgurkb klnstmnsjk tc prnvnlt pcstcpnrktjvn pkrkbytje

jbnus. KLNUWMNUJCBCOZ:=68 6>01:1-?

1=. M`crtsc LE, Lnuikll T, Frcsjo

F,

Klgnrsnl W, Bjlgmkrg K,

Qcocl

N,

Hnmbnt M0

K

ecltrcbbng stugy cl tmn nffnet

cf

npjgurkb

klkbonsjk wjtm bcekb klknstmntjes klg icrpmjln cl icrajgjty kftnr

kagcijlkb suronry. Ketk Klknstmnsjcb Ueklg ;:=>8 1:0?:4

-6

1 : . Hklkzj ON, Wmcipscl

@U,

Acshcvshj LK0 Nffnet cf npjgurkb kl-

kbonsjk cl pcstcpnrktjvn jbnus kftnr jbnkb pcuem-klkb klkstcicsjs. i

Uuro ;::68 6107::->41

54.

Qcuffnt F, Mky @I, Vkemnr

A,

Fjlonrmut

K,

Fbkiklt

Z ,

Iktmcl

E ,

Okjlklt K0 Eurktjvn rnsnetjcl fcr bnft ecbclje ekrejlcik0 Mnijecbne-

tciy vs snoinltkb ecbnetciy. K prcspnetjvn, ecltrcbbng, iubtjenltnr

trjkb. Gjs Ecbcl Qnetui ;::78 5?06>;-:

5;. Arngtikll QG nrgnl

ML,

Wnjemikll

_,

Icnehn MT, Hljnsnb

A, Akntonl

Q,

Wnehbnlauro K0 Npjgurkb klkbonsjk jl ecbclje suronry0

Qnsubts cf k rklgcijzng prcspne tjvn stugy. Ar @ Uuro ;::48??065= 71

51.

Kjthnlmnkg

KQ,

_jsmkrt

M Z ,

Arcwl GK0 Mjom spjlkb lnrvn abceh

fcr bkron acwnb klkstcicsjs. Ar @ Klknstm ;:?=8

>40

;??- =5

55. Erkwfcrg NI, Icjljemn U, Craknh @, A`nrrui

M,

Hnmbnt M0

Crtmcstktje mypctnlsjcl gurjlo pcstcpnrktjvn ecltjlucus tmcrkeje npj-

gurkb aupjvkekjln-icrpmjln jl pktjnlts ulgnrocjlo kagcijlkb suronry.

Klnstm Klkbo ;::68 =50;41=-51

Klnstmnsjcbcoy,

V :1, L c

1, Fna 1444

comparison of intravenous or epidural patient- controlled analgesia in the elderly after major...

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