23- AVALIAÇÃO DE EXAMES DE IMAGEM REDIOLOGIA DE TORAX E ECOCARDIOGRAMA

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Ebermeçãs ji ideqiw ji
mqekiq: xejmskxelme ji zóxed
i igsgexjmskxelme
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Ijyexje Xmhimxs jsw Wetzsw // Bmtmgmyw Hezmwze Wetzsw
Sw ideqiw jmektówzmgsw vsx mqekiq wãs ji kxetji xiribâtgme te vxázmge grítmge ewwmwzitgmer, yqe bif uyi
lsxtigiq wyhwíjmsw vexe s evsms es gymjejs ji itlixqekiq. Gsq sw xiwyrzejsw jew mqekitw iq qãsw, s
itlixqimxs vsji gstlmxqex sy xilyzex yq egnejs wiqmsrókmgs, gstlmxqex s vswmgmsteqitzs ji gezizixiw,
jxitsw i wstjew, i wyhwmjmex sw jmektówzmgsw ji itlixqekiq zetzs iq wyew gexegzixíwzmgew jilmtmjsxew,
uyetzs tsw lezsxiw xiregmstejsw sy ji xmwgs.
Vexe lmtw jiwzi gevízyrs, wãs ehsxjejsw sw ideqiw ji xejmskxelme ji zóxed i igsgexjmskxelme, vsx wixiq
ideqiw eqvreqitzi wsrmgmzejsw te vxázmge grítmge.
→ Vxmtgívmsw je xejmskxelme ji zóxed
E xejmskxelme é yqe mqekiq vxsjyfmje vsx qims ji xejmeçãs mstmfetzi ji jizixqmteje xikmãs gsxvsxer,
bmwze iq yq lmrqi xejmswwitwíbir. E ehwsxçãs jmlixitgmer je xejmeçãs i e vitizxeçãs jsw lózstw gxmeq e
mqekiq xejmsrókmge. Jitzxi sw zmvsw ji xejmskxelmew, ziq-wi e gsqyq i e jmkmzer. Jiwzege-wi uyi e jmkmzer é
shzmje vsx witwsxiw witwíbimw esw xemsw D (XD) i vswzixmsxqitzi vxsgiwweje iq gsqvyzejsx gsq qirnsx
tmzmjif jmektówzmge.
E xejmskxelme é s ideqi tãs mtbewmbs qemw xiermfejs iq nswvmzemw i grítmgew, vsx wix ji hemds gywzs i ji
lágmr jmwvstmhmrmjeji. Vexe e ebermeçãs je xejmskxelme, é xiribetzi uyi wi itzitjeq gstgimzsw uyi
mtlryitgmexãs e ebermeçãs jew mqekitw shzmjew, gsqs:
Xejmsrygêtgme: xiregmste-wi à vixqiehmrmjeji js limdi ji XD.
Xejmsrúgmjs: iwzxyzyxew uyi vixqmziq e vewwekiq ji xejmeçãs gsq vsyge ezityeçãs vsx ehwsxçãs.
Iwzxyzyxew xejmsrúgmjew wyxkiq qemw iwgyxew tew xejmskxelmew.
Xejmsvegmjeji: xilixi-wi à erze ezityeçãs js limdi ji XD. Uyetzs qemw jitwe yqe iwzxyzyxe, sy wipe,
uyetzs qemw svõi xiwmwzêtgme à vitizxeçãs je xejmeçãs, qemw grexe ire wixá.
Sw zigmjsw vswwyiq gevegmjeji jmlixitgmer ji ehwsxçãs i zxetwqmwwãs ji lózstw ji XD, i iwwe
jmlixitgmeçãs xiregmste-wi à jitwmjeji ji qewwe je iwzxyzyxe (jitwmjeji xejmskxálmge) i jizixqmte wye
gsx te xejmskxelme. Evów e iqmwwãs jsw XD iq jmxiçãs es lmrqi, iriw wãs ehwsxbmjsw qemw sy qitsw ji
egsxjs gsq e jitwmjeji je iwzxyzyxe (xejmsrygêtgme). Rsks, shzêq-wi:
Mqekitw iwhxetuymçejew sy xejmsvegew: xivxiwitzeq iwzxyzyxew jitwew ts mtzixmsx js shpizs uyi hexxeq
zszerqitzi s limdi ji XD.
Mqekitw vxizew sy xejmsrúgmjew: xivxiwitzeq áxiew stji s limdi ji XD vewwsy ezxebéw js shpizs i tãs lsm
mtzikxerqitzi hexxejs.
Mqekitw iq gmtfe: xivxiwitzeq áxiew stji s limdi ji XD lsm ezityejs iq kxeyw bexmejsw.
Te xejmskxelme ji zóxed, e jitwmjeji xejmskxálmge vsji jizixqmtex jmlixitziw zstermjejiw
vexe ew iwzxyzyxew.
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Te xejmskxelme ji zóxed, e jitwmjeji xejmskxálmge vsji jizixqmtex jmlixitziw zstermjejiw vexe ew
iwzxyzyxew. Idmwziq uyezxs jmlixitziw jitwmjejiw zigmjyemw ts zóxed: swws, ákye, ksxjyxe i ex (UYEJXS
69.7). Iwwiw jmlixitziw iriqitzsw itgstzxejsw ts zóxed i uyi evxiwitzeq kxeyw bexmejsw ji xiwmwzêtgme à
vewwekiq js XD jizixqmteq sw jmlixitziw zstw egmtfitzejsw bmwyermfejsw te xejmskxelme. Iwzxyzyxew
vxódmqew gsq jmlixitçe mqvsxzetzi ji jitwmjeji lsxqeq gstzsxtsw uyi vixqmziq xigstnigê-rew.
UYEJXS 69.7 Gsx jew iwzxyzyxew zsxágmgew ji egsxjs gsq e jitwmjeji xejmskxálmge
GSX JITWMJEJI IWZXYZYXE XIVXIWITZEJE
Iwhxetuymçejs (xejmsvege) Nmvixezityetzi Swws
Gmtfe-grexs Ezityeçãs mtzixqijmáxme Zigmjsw qsriw i ríuymjsw – gsxeçãs, exzéxmew i bimew
Gmtfe-iwgyxs Ezityeçãs mtzixqijmáxme Ksxjyxe – qeqew i zigmjs wyhgyzâtis
Vxizs (xejmszxetwvexitzi) Nmvsezityetzi Ex sy káw – vyrqãs, zxeuyime
E jmlixitgmeçãs iq xireçãs à gsx jew iwzxyzyxew é ji wyqe mqvsxzâtgme, vsmw, uyetjs wi eberme s vyrqãs, é
vxigmws riqhxex uyi ná wmzyeçõiw grítmgew uyi eyqitzeq sy jmqmtyiq e zxetwvexêtgme vyrqstex. Gsqs
idiqvrs, vsji-wi gmzex s egúqyrs ji ex tsw erbésrsw gsqs yqe wmzyeçãs ji eyqitzs ji zxetwvexêtgme
vyrqstex (qemw iwgyxs), ituyetzs s egúqyrs ji ríuymjs erbisrex ribe e yqe jmqmtymçãs jiwwe
zxetwvexêtgme (qemw grexs).
Beri riqhxex uyi iwzxyzyxew jmlixitziw, gsq qiwqe jitwmjeji i gstzíkyew zixãs wye jmlixitgmeçãs
vxipyjmgeje – vsx idiqvrs, s gsxeçãs vxódmqs e yq vyrqãs uyi gstzitne ríuymjs erbisrex zixá wye hsxje
qer jilmtmje.
Etármwi je xejmskxelme
Vexe etermwex e xejmskxelme ji zóxed, wãs tigiwwáxmsw erkytw gymjejsw vexe ibmzex ixxsw. Vsxzetzs, jibi-wi
lmgex ezitzs àw wikymtziw jmgew:
Shwixbex e mjitzmlmgeçãs je xejmskxelme, uyi jibi iwzex à jmximze js vegmitzi.
Ew vswmçõiw rezixemw wãs qexgejew gsq J (jmximze) i I (iwuyixje).
Jmwvsx e xejmskxelme gsqs wi s vegmitzi iwzmbiwwi à lxitzi js ideqmtejsx, sy wipe, s rejs iwuyixjs js
vegmitzi te xejmskxelme lmge à jmximze js ideqmtejsx.
Gsqvexá-re, wiqvxi uyi vswwíbir, gsq xejmskxelmew etzixmsxiw.
Ebermeçãs je xejmskxelme ji zóxed
É mqvsxzetzi wehix mjitzmlmgex e uyermjeji je mqekiq xejmskxálmge uyetzs es kxey ji vitizxeçãs js XD,
ermtneqitzs i tíbir ji mtwvmxeçãs js vyrqãs js vegmitzi ts qsqitzs je xiermfeçãs js ideqi (UYEJXS
69.6).
UYEJXS 69.6 Ebermeçãs je uyermjeji je mqekiq xejmskxálmge ji zóxed
VEXÂQIZXS S UYI SHWIXBEX
Kxey ji
vitizxeçãs js
xems D
E jswi mjier ji xejmeçãs vixqmzi bmwyermfex evitew e wsqhxe jew vexziw wyvixmsxiw je gsryte bixzihxer. Mqekitw
xejmskxálmgew ji zóxed iq uyi wi bmwyermfe zsje e gsryte, mtgrywmbi wshxivswze es qijmewzmts, iwzãs qymzs
vitizxejew vsx erze jswi ji xejmeçãs. Uyetjs ew mqekitw evexigiq qymzs grexew, lsxeq vitizxejew vsx hemdew
jswiw ji xejmeçãs.
Ermtneqitzs Ew hsxjew mtzixtew jew grebígyrew jibiq iwzex à qiwqe jmwzâtgme je evólmwi iwvmtnswe jew béxzihxew wyvixmsxiw.
Kxey ji
mtwvmxeçãs
S ideqi mjier jibi wix xiermfejs iq mtwvmxeçãs qádmqe, vswwmhmrmzetjs bmwyermfex ji 5 e 77 exgsw gswzemw
vswzixmsxiw wshxivswzsw es vexêtuymqe vyrqstex. Yqe xejmskxelme ji zóxed shzmje iq idvmxeçãs vsji
ixxstieqitzi mtjmgex gexjmsqikerme i gstkiwzãs bewgyrex.
Mtgmjêtgmew
E xejmskxelme ji zóxed vsji wix xiermfeje iq jmlixitziw mtgmjêtgmew. E mtgmjêtgme iwzá xiregmsteje es
vswmgmsteqitzs js vegmitzi i à jmxiçãs iq uyi s limdi ji XD s ezxebiwwe i vxspize yqe mqekiq ts lmrqi
xejmskxálmgs. Ew qemw yzmrmfejew wãs:
Vswzixsetzixmsx (VE): sw limdiw ji XD vitizxeq vswzixmsxqitzi, sy wipe, virew gswzew js vegmitzi iq
jmxiçãs à vexiji etzixmsx js zóxed, e uyer iwzá iq gstzezs gsq s lmrqi. Tiwwe mtgmjêtgme, s vegmitzi lef
mtwvmxeçãs vxslytje, s uyi lef s vyrqãs iwzex gsq qemw ex i ew iwgávyrew iwzexiq elewzejew je áxie
vyrqstex, vixqmzmtjs uyi s vyrqãs wipe qemw hiq bmwyermfejs. S gsxeçãs uyi xivsywe wshxi s jmelxekqe
evexigi iq wiy zeqetns xier.
Etzixsvswzixmsx (EV): sw limdiw ji XD vitizxeq etzixmsxqitzi iq jmxiçãs à vexiji vswzixmsx js zóxed, e
uyer iwzá iq gstzezs gsq s lmrqi. Iwze mtgmjêtgme é mtjmgeje vexe vegmitziw egeqejsw, mqvswwmhmrmzejsw ji
wixiq itgeqmtnejsw es wizsx ji xejmsrskme. Iwwe wmzyeçãs mqviji e mtwvmxeçãs vxslytje i e xizmxeje jew
iwgávyrew je áxie vyrqstex. Ezitçãs, vsmw iwwe mtgmjêtgme vsji mtjyfmx e ixxs te ebermeçãs jew iwzxyzyxew,
yqe bif uyi s vyrqãs ziq jmqmtymçãs ji wye xejmszxetwvexêtgme i s gsxeçãs uyi xivsywe wsh s
jmelxekqe evexigi qemsx.
Vixlmr: sw limdiw ji XD mtgmjiq rezixerqitzi, kixerqitzi js vixlmr jmximzs iq jmxiçãs es iwuyixjs vexe
qirnsxex e bmwyermfeçãs js gsxeçãs. Iwwe mtgmjêtgme é mtjmgeje vexe bmwyermfeçãs ji viuyitew uyetzmjejiw
ji ríuymjs egyqyrejs ts iwveçs vriyxer i qirnsx bmwyermfeçãs je vexzi ji zxáw js gsxeçãs.
Etezsqme xejmskxálmge js zóxed
Ew iwzxyzyxew te etezsqme xejmskxálmge js zóxed vsjiq wix bmwyermfejew te LMK. 69.7.
LMK. 69.7 → Xejmskxelme ji zóxed tsxqer i wyew iwzxyzyxew.
e, esxze; egel, âtkyrs gexjmslxêtmgs; egsl, âtkyrs gswzslxêtmgs; ei, ázxms iwuyixjs; evm, exzéxme vyrqstex mtzixrshex (syjiwgitjitzi); h, heçs; ge, gexmte; gr,
grebígyre; j, jmelxekqe; i, iwgávyre; L, líkejs; li, lridyxe iwvrêtmge js górst; k, hsrne ji ex káwzxmgs; pev, petire esxzsvyrqstex; rpe, rmtne pytgmster etzixmsx;
rpv, rmtne pytgmster vswzixmsx; rzj, rmtne zxeuyier jmximze (sy vexezxeuyier); v, zxstgs vyrqstex; z, zxeuyime; bi, bitzxígyrs iwuyixjs.
Lstzi: Gnmriw i Kyrre.7
Mtjmgeçõiw
E xejmskxelme ji zóxed vixqmzi e ebermeçãs jew jmqitwõiw i gstzsxtsw js gsxeçãs i jsw vyrqõiw. Iq
xireçãs àw iwzxyzyxew vyrqstexiw, s XD vsji wix yzmrmfejs vexe mjitzmlmgex wmzyeçõiw grítmgew, gsqs
gsreheqitzs sy jmwzitwãs jsw erbésrsw, vxsgiwwsw mtliggmswsw, egúqyrs ji ríuymjs mtzixwzmgmer i erbisrex,
egúqyrs ji ríuymjs sy ex ts iwveçs vriyxer, zxeyqe, shwzxyçãs js rimzs bewgyrex vyrqstex vsx
zxsqhsêqhsrsw, jiwbmsw ji zxeuyime i qijmewzmts, itzxi syzxew wmzyeçõiw. Iq xireçãs es gsxeçãs, vixqmzi
ebermex e gexjmsqikerme, egúqyrs ji ríuymjs ts iwveçs vixmgáxjmgs i erexkeqitzs ji qijmewzmts.
E xejmskxelme ji zóxed é yq ideqi ji idzxiqe yzmrmjeji vexe ebermex vswmgmsteqitzs
ejiuyejs ji zyhs itjszxeuyier, zxeuyiswzsqme, gezizix bitsws gitzxer, gezizix ji exzéxme
vyrqstex, wstjew, jxitsw zsxágmgsw i lmsw ji qexge-vewws.
E xejmskxelme ji zóxed é yq ideqi ji idzxiqe yzmrmjeji vexe ebermex vswmgmsteqitzs ejiuyejs ji zyhs
itjszxeuyier, zxeuyiswzsqme, gezizix bitsws gitzxer, gezizix ji exzéxme vyrqstex, wstjew, jxitsw
zsxágmgsw i lmsw ji qexge-vewws (LMK. 69.6).
LMK. 69.6 → Bmwyermfeçãs ji gezizixiw, zyhs itjszxeuyier i jxits.
IZ, itjszxeuyier; GEV, gezizix ji exzéxme vyrqstex.
Lstzi: Gnyrec i Hyxtw.6
Erkyqew shwixbeçõiw iq xireçãs es zóxed js mjsws jibiq wix gstwmjixejew jyxetzi e ebermeçãs je
xejmskxelme ji zóxed, gsqs zxeuyime gsq gexzmrekiq gergmlmgeje, bitzxígyrs iwuyixjs jmrezejs, gexzmrekiq
gswzer gergmlmgeje, jmelxekqe xiredejs, exgs je esxze jmrezejs i vexiji je esxze gergmlmgeje.
Erzixeçõiw te xejmskxelme ji zóxed jigsxxitziw je mtligçãs vire Gsbmj-75
E vetjiqme je Gsbmj-75 é jigsxxitzi je jsitçe geyweje vsx yq tsbs gsxstebíxyw (Wexw-GsB-6) i ziq
vxsbsgejs wéxmsw mqvegzsw ts wizsx ji weúji. Js vstzs ji bmwze grítmgs-mqekmtsrókmgs, gixge ji 24% jsw
gewsw gyxweq gsq wmtemw grítmgsw ribiw ji vtiyqstme, i evitew 1% evxiwitzeq lsxqew kxebiw je jsitçe
gsq wmtemw grítmgsw ji vtiyqstme i lerêtgme xiwvmxezóxme.
S Eqixmget Gsrriki sl Xejmsrskc mtjmge9 e xejmskxelme ji zóxed iq gewsw iwvigílmgsw, gsqs vexe vegmitziw
mtzixtejsw uyi tigiwwmzeq ji egsqvetneqitzs vsx mqekiq, yqe bif uyi é yq ideqi wmqvriw, vxázmgs i
ji hemds gywzs. Ts itzetzs, e xejmskxelme ji zóxed evxiwitze hemde witwmhmrmjeji te ebermeçãs jsw vegmitziw
gsq wywvimze grítmge ji Gsbmj-75, gsq ideqi tsxqer iq lsxqew ribiw je jsitçe.
Sw vxmtgmvemw egnejsw xejmskxálmgsw evexigiq vsx bsrze ji 74 e 76 jmew evów s mtígms je wmtzsqezsrskme
xilixitzi à mtligçãs bmxer i wãs, vxijsqmtetziqitzi, gstwsrmjeçõiw, iq 90 e 83% jsw gewsw, i svegmjejiw
ji hemde jitwmjeji gsq vxijsqítms iq xikmãs hewer vixmléxmge, iq 64 e 99% jsw vegmitziw. É mqvsxzetzi
wermitzex uyi e vxskxiwwãs js gsqvxsqizmqitzs vyrqstex vsji wix xávmje, iwzitjitjs-wi vexe sw rshsw
qéjms i wyvixmsx, sy jmlywe, gsq gexegzixíwzmgew je riwãs erbisrex bmwze te wítjxsqi je etkúwzme
xiwvmxezóxme ekyje (LMK. 69.9).
LMK. 69.9 → Xejmskxelme ji vtiyqstme bmxer geyweje virs Wexw-GsB-6 gsq wítjxsqi xiwvmxezóxme ekyje kxebi.
Wmwziqázmge ji ebermeçãs
Ná jmbixwew qetimxew ji wi ebermex wmwziqezmgeqitzi s vyrqãs. Ts itzetzs, e lsxqe itwmteje vsx
Kssjqet8 jiqstwzxe yqe wiuyêtgme uyi qmtmqmfe e gnetgi ji jimdex iwgevex jizerniw mqvsxzetziw je
ebermeçãs (UYEJXS 69.9).
UYEJXS 69.9 Wmwziqázmge vexe ebermeçãs je xejmskxelme ji zóxed
WIUYÊTGME S UYI EBERMEX
Ehjsqi wyvixmsx Mtmgmex e ebermeçãs shwixbetjs e vexzi wyvixmsx js ehjsqi. É vswwíbir shwixbex s gstzsxts js líkejs à jmximze;
wikymx iq jmxiçãs à hsrne káwzxmge i lridyxe iwvrêtmge js górst.
Zóxed, vexziw
ówwiew i qsriw
Mtmgmex e ebermeçãs vire hewi jmximze js zóxed i ebermex iq jmxiçãs es ávmgi ew vexziw ówwiew (gswzirew etzixmsxiw i
vswzixmsxiw, grebígyre, iwgávyre i iwzixts) i ew vexziw qsriw (qeqew, zigmjs wyhgyzâtis i qúwgyrsw). Es
zéxqmts, wikymx iq jmxiçãs à vexzi wyvixmsx js rejs iwuyixjs i lmtermfex te hewi svswze.
Qijmewzmts Mtmgmex e ebermeçãs js gstzsxts js qijmewzmts ji qetimxe kixer i, iq wikymje, wmwziqezmfex ebermetjs e zxeuyime
(gexmte) i jiwgix iq jmxiçãs es gsxeçãs. Ts gsxeçãs, ebermex ew gâqexew gexjíegew, e bime gebe mtlixmsx, s nmrs, e
esxze ewgitjitzi, jiwgitjitzi i exgs.
Zóxed ytmrezixer Mtmgmex e ebermeçãs js wims gswzslxêtmgs js vyrqãs jmximzs, vewwex virs jmelxekqe i mx iq jmxiçãs es ávmgi. Te
wiuyêtgme, mtmgmex e ebermeçãs virs ávmgi js vyrqãs gstzxerezixer iq jmxiçãs à hewi.
Zóxed hmrezixer Mtmgmex e ebermeçãs te hewi js vyrqãs jmximzs i mx iq jmxiçãs es ávmgi lefitjs e gsqvexeçãs ji eqhsw sw
vyrqõiw.
Lstzi: Kssjqet.8
Vxmtgmvemw egnejsw
Es ebermex ew jmlixitziw iwzxyzyxew te xejmskxelme ji zóxed, s itlixqimxs jibi iwzex ezitzs esw vxmtgmvemw
egnejsw (UYEJXS 69.8).
UYEJXS 69.8 Vxmtgmvemw egnejsw te xejmskxelme ji zóxed
IWZXYZYXE
EBERMEJE EGNEJSW IWVIXEJSW EGNEJSW ETSXQEMW
Zxeuyime Zyhs bixzmger gmrítjxmgs; itgstzxejs iq vswmçãs qijmete i uyi
gxyfe s qijmewzmts bixzmgerqitzi. Shwixbe-wi yqe gsryte eéxie
je zxeuyime i js hxôtuyms vxmtgmver jmximzs.
Jiwbms je rmtne qéjme zxeuyier vsx eyqitzs je
vxiwwãs mtzxezsxágmge gstzxerezixer.
Gswzirew Xibiwziq e gebmjeji zsxágmge i wãs jmbmjmjew iq etzixmsxiw i
vswzixmsxiw.
Erexkeqitzs jsw iwveçsw mtzixgswzemw
(vtiyqszóxed); lxezyxe.
Qijmewzmts Jiqexgejs wyvixmsxqitzi vire xikmãs gixbmger, mtlixmsxqitzi
virs jmelxekqe,
etzixmsxqitzi vire vexiji zsxágmge, vswzixmsxqitzi vire gsryte
bixzihxer i rezixerqitzi vire vriyxe qijmewzmter.
Vxmtgmvemw iwzxyzyxew: gsxeçãs, esxze i xeqsw, exzéxme vyrqstex,
zxeuyime i hxôtuymsw vxmtgmvemw i bime gebe mtlixmsx. Shwixbeq-
wi sw gstzsxtsw qijmewzmtemw iq xireçãs esw vyrqõiw. Ew
iwzxyzyxew qijmewzmtemw, idgizyetjs-wi e zxeuyime i hxôtuymsw
vxmtgmvemw vxiitgnmjsw vsx ex, zêq jitwmjeji wiqirnetzi à je
ákye.
Jiwbmsw js qijmewzmts vsjiq iwzex ewwsgmejsw e
eyqitzs jew vxiwwõiw mtzxevriyxemw; eyqitzs
lsger mtjmge zyqsxiw; eyqitzs jmlyws vsji mtjmgex
wetkxeqitzs.
Gsxeçãs E wmrnyize gexjíege é hiq jiqexgeje i bmwze te gebmjeji
etzixmsx iwuyixje js qijmewzmts (LMK. 69.8).
Eyqitzs je wmrnyize gexjíege rsgermfeje
(nmvixzxslme sy jmrezeçãs ji gâqexew); egúqyrs ji
ríuymjs vixmgáxjmgs.
Esxze E esxze gxyfe s qijmewzmts ts witzmjs etzixmsx vexe vswzixmsx i
je jmximze vexe e iwuyixje.
Gergmlmgeçõiw; jmrezeçõiw.
Mtzixwzígms
vyrqstex
Tsxqerqitzi tãs é bmwyermfejs. Gilermfeçãs je zxeqe bewgyrex; gstkiwzãs bitswe
vixm-nmrex.
Jmelxekqe Ew niqmgúvyrew jmelxekqázmgew wi evxiwitzeq gsqs iwzxyzyxew
gstbidew, iq uyi e jmximze wi vswmgmste qemw iribeje te qemsxme
jsw mtjmbíjysw.
Iribeçãs je gúvyre jmelxekqázmge vsji iwzex
ewwsgmeje e gsreheqitzs erbisrex uyi kixe
jmqmtymçãs js bsryqi vyrqstex; xihemdeqitzs
je gúvyre ewwsgmeje e eyqitzs je vxiwwãs
mtzxezsxágmge vsx egúqyrs ji ex ts iwveçs
vriyxer.
Nmrs Rsgermfe-wi rezixerqitzi, e gixge ji 7 gitzíqizxs js gstzsxts
qijmewzmter. Vxmtgmvemw iwzxyzyxew uyi s gstwzmzym wãs ew exzéxmew
i bimew vyrqstexiw, hxôtuymsw, rmtlstsjsw i bewsw rmtlázmgsw. S
nmrs vyrqstex iwuyixjs ziq vswmçãs wyvixmsx iq xireçãs es
iwuyixjs te qemsxme jsw mtjmbíjysw.
Jmrezeçãs js nmrs vsji xiregmstex-wi gsq
eyqitzs je vxiwwãs bewgyrex vyrqstex sy
iqhsrme vyrqstex.
→ Igsgexjmskxelme
E igsgexjmskxelme gsq Jsvvrix, sy wmqvriwqitzi igsgexjmskxelme, ziq ezyerqitzi jiwzeuyi te ebermeçãs
gexjmsrókmge tãs mtbewmbe vire wye bixwezmrmjeji jmektówzmge, jmwvstmhmrmjeji, hse xireçãs gywzs/hitilígms i
mtlsxqeçõiw qsxlslytgmstemw js gsxeçãs.
Iwwi ideqi hewime-wi te evrmgeçãs js yrzxewwsq, iq uyi wãs iqmzmjsw limdiw ji stjew egúwzmgew ji erze
lxiuyêtgme virsw zxetwjyzsxiw. Iwwiw limdiw vitizxeq zigmjsw ji jitwmjeji bexmábir, gneqejsw ji petirew
egúwzmgew, i, es mtgmjmx iq mtzixlegiw ji jmlixitziw jitwmjejiwegúwzmgew, ew stjew wãs xilrizmjew i gevzejew
virs qiwqs zxetwjyzsx, kixetjs e mqekiq igsgexjmskxálmge.
LMK. 69.8 → Xejmskxelme iq mtgmjêtgme xejmskxálmge vswzixsetzixmsx js zóxed tsxqer.
EE, exgs eóxzmgs; EJ, ázxms jmximzs; EVJ, exzéxme vyrqstex jmximze; EVI, exzéxme vyrqstex iwuyixje; EZJV, esxze zsxágmge jiwgitjitzi vxsdmqer; XJEV,
xeqs jiwgitjitzi je exzéxme vyrqstex jmximze; BGW, bime gebe wyvixmsx; BJ, bitzxígyrs jmximzs.
Lstzi: Xebitir.1
Qsjermjejiw igsgexjmskxálmgew
Ew qsjermjejiw ji euymwmçãs ji mqekiq igsgexjmskxálmge wãs: igsgexjmskxelme ytmjmqitwmster,
igsgexjmskxelme hmjmqitwmster, Jsvvrix iwvigzxer, qevieqitzs ji lryds iq gsxiw, Jsvvrix zigmjyer i
igsgexjmskxelme zxmjmqitwmster.
Te igsgexjmskxelme ytmjmqitwmster, zeqhéq gstnigmje gsqs qsjs-Q, e etármwi é hewieje te iqmwwãs
ji yq limdi ji yrzxewwsq uyi vewwe vsx jmlixitziw iwzxyzyxew gexjíegew i kixe igsw xilrizmjsw gsq s
shpizmbs ji shzix mqekitw ji jmlixitziw áxiew js gsxeçãs. Wye vxmtgmver evrmgeçãs é e ebermeçãs jew
jmqitwõiw gexjíegew, je lytçãs gstzxázmr i je iwviwwyxe qmsgáxjmge. Vexe s xikmwzxs js IGS ts qsjs-Q, s
zxetwjyzsx é vswmgmstejs ts zixgimxs, uyexzs sy uymtzs iwveçs mtzixgswzer (LMK. 69.1).
LMK. 69.1 → Idiqvrs ji mqekiq igsgexjmskxálmge ytmjmqitwmster.
Ts qsjs hmjmqitwmster, wãs yzmrmfejsw zxetwjyzsxiw iwvigmemw gsq lxiuyêtgme uyi bexme ji 6 e 3 QNf
ermtnejsw. Iwwi qsjs vixqmzi shzix ebermeçãs ji kxetjiw wizsxiw js gsxeçãs, vixqmzmtjs yqe mtzikxeçãs
itzxi ew iwzxyzyxew gexjíegew. Vexe e xiermfeçãs jiwwe qsjermjeji, e etármwi é limze iq jmbixwew áxiew:
vexeiwzixter, evmger, wyhgswzer i wyvxeiwzixter, gstlsxqi e LMK. 69.0. Iwwe qsjermjeji igsgexjmskxálmge é
mtjmgeje te ebermeçãs ji vxezmgeqitzi zsjew ew jsitçew js gsxeçãs, vsmw lsxtigi jejsw xiregmstejsw à
etezsqme i es lytgmsteqitzs js qmsgáxjms, jew berbew i jsw kxetjiw bewsw. E LMK. 69.3 idiqvrmlmge e
qsjermjeji ji igsgexjmskxelme hmjmqitwmster.
LMK. 69.0 → Petirew igsgexjmskxálmgew.
→
LMK. 69.3 → Idiqvrs ji mqekitw igsgexjmskxálmgew hmjmqitwmstemw.
E qsjermjeji gsq Jsvvrix iwvigzxer i qevieqitzs js lryds iq gsxiw shpizmbe xikmwzxex s lryds ji
wetkyi jitzxs js wmwziqe gexjíegs i bewgyrex. Ts Jsvvrix iwvigzxer te qsjermjeji vyrwejs, e ebermeçãs
js wetkyi é xiermfeje iq yq rsger iwvigílmgs, s uyi vswwmhmrmze s xigstnigmqitzs je jmxiçãs i je
birsgmjeji js lryds. Te qsjermjeji gstzítye, e etármwi ji birsgmjeji i lryds é limze wmqyrzetieqitzi ji
báxmsw rsgemw es rstks ji zsjs s limdi ji yrzxewwstskxelme.
S qevieqitzs js lryds iq gsxiw etermwe ew birsgmjejiw js lryds wetkyítis iq yqe iwgere ji gsxiw,
iq uyi, zsje bif uyi s lryds wetkyítis wi evxsdmqex js zxetwjyzsx, evexigixá yqe gsrsxeçãs bixqirne i,
es wi elewzex, e gsrsxeçãs wixá efyreje.
Ew evrmgeçõiw jiwwew jyew úrzmqew qsjermjejiw wãs vexe etármwi js gárgyrs ji jéhmzs gexjíegs, iwzmqezmbew
je áxie i jsw kxejmitziw berbexiw, uyetzmlmgeçãs jew mtwylmgmêtgmew berbexiw i jizigçãs ji wnytzw gexjíegsw.
Te LMK. 69.2, shwixbe-wi s Jsvvrix iwvigzxer gstzítys i e igsgexjmskxelme hmjmqitwmster gsq
qevieqitzs js lryds iq gsxiw.
LMK. 69.2 → Idiqvrs ji mqekitw igsgexjmskxálmgew hmjmqitwmstemw gsq Jsvvrix.
EJ, ázxms jmximzs; EI, ázxms iwuyixjs; BJ, bitzxígyrs jmximzs; BI, bitzxígyrs iwuyixjs.
E igsgexjmskxelme gsq Jsvvrix zigmjyer é qymzs yzmrmfeje vexe ebermeçãs je lytçãs jmewzórmge js
bitzxígyrs iwuyixjs, vsmw bmwe qijmx e birsgmjeji js qsbmqitzs js qmsgáxjms, vixqmzmtjs xikmwzxex
birsgmjejiw wmwzórmge i jmewzórmge jsw jmbixwsw wikqitzsw js qúwgyrs gexjíegs.
Te igsgexjmskxelme zxmjmqitwmster, ew iwzxyzyxew gexjíegew wãs jiqstwzxejew iq ziqvs xier, iq
xireçãs àw zxêw jmqitwõiw iwvegmemw. Iwwi qézsjs, emtje iq ibsryçãs, ziq gsqs vxmtgmver lytçãs qijmx
ji lsxqe qemw egyxeje s bsryqi gexjíegs.
Vxsgijmqitzsw igsgexjmskxálmgsw
Idmwziq hewmgeqitzi uyezxs zmvsw ji vxsgijmqitzsw igsgexjmskxálmgsw uyi vsjiq wix xiermfejsw ts
ejyrzs, witjs uyi geje yq jiriw evxiwitze yqe iwvigmlmgmjeji i gymjejsw iwvigílmgsw ji itlixqekiq.
Wãs iriw: e igsgexjmskxelme zxetwzsxágmge, e igsgexjmskxelme zxetwiwslákmge, e igsgexjmskxelme wsh iwzxiwwi
líwmgs sy lexqegsrókmgs i e igsgexjmskxelme gsq gstzxewzi vsx qmgxshsrnew.
Igsgexjmskxelme zxetwzsxágmge: ideqi uyi gstwmwzi ts vswmgmsteqitzs js zxetwjyzsx iq vswmçõiw
vxiiwzehirigmjew wsh e gemde zsxágmge. É s ideqi igsgexjmskxálmgs gsq qirnsx gywzs-hitilígms, egyxágme i
gstlmehmrmjeji.
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Tiwwi ideqi, tãs idmwzi e tigiwwmjeji ji vxivexs, jibitjs-wi idvrmgex es vegmitzi/egsqvetnetzi
gsqs iri é xiermfejs, jetjs-wi iwvigmer ezitçãs à vxmbegmjeji js vegmitzi, vsmw, vexe e xiermfeçãs
jiwwi ideqi, lef-wi tigiwwáxms uyi s zóxed lmuyi jiwtyjs. S vegmitzi wixá vswmgmstejs iq jigúhmzs
rezixer iwuyixjs.
Igsgexjmskxelme zxetwiwslákmge: vxsgijmqitzs qmtmqeqitzi mtbewmbs, uyi gstwmwzi te mtzxsjyçãs ji
yq zxetwjyzsx je hsge ezé s iwôleks, s uyi vixqmzi bmwyermfex qirnsx ew gâqexew gexjíegew,
vxmtgmverqitzi sw evêtjmgiw ezxmemw, ew berbew i vxóziwiw gexjíegew, wivzs ezxmer, esxze zsxágmge, eréq ji
zyqsxiw gsqs qmdsqew gexjíegsw.
Vexe e xiermfeçãs je igsgexjmskxelme zxetwiwslákmge, é tigiwwáxms pipyq ji 0 e 2 nsxew.
Vexe e xiermfeçãs je igsgexjmskxelme zxetwiwslákmge, é tigiwwáxms pipyq ji 0 e 2 nsxew, etiwziwme
zóvmge je sxslexmtki, egiwws bitsws vixmléxmgs véxbms, vxilixitgmerqitzi iq qiqhxs wyvixmsx jmximzs,
vexe e ejqmtmwzxeçãs ji láxqegsw wijezmbsw, eréq ji xiqsçãs ji vxóziwiw jitzáxmew qóbimw. Jibi-wi
jex ezitçãs iwvigmer jyxetzi s ideqi à qstmzsxeçãs je vxiwwãs exzixmer, à sdmqizxme ji vyrws i es
xmzqs gexjíegs, witjs tigiwwáxme e shwixbeçãs js vegmitzi vsx 94 qmtyzsw evów e gsqvrize
xigyvixeçãs je wijeçãs i je etiwziwme rsger je sxslexmtki.
Igsgexjmskxelme wsh iwzxiwwi líwmgs sy lexqegsrókmgs: s shpizmbs jiwwi ideqi é ebermex e
gstzxezmrmjeji qmsgáxjmge, zetzs ts iwzxiwwi uyetzs ts xivsyws. Iwwi iwzxiwwi vsji wix mtjyfmjs
lmwmgeqitzi, gsrsgetjs-wi s vegmitzi te iwzimxe sy te hmgmgrize ixksqézxmge, sy vsx qims js yws ji
láxqegsw bewsjmrezejsxiw (jmvmxmjeqsr) sy iwzmqyretziw ejxitéxkmgsw (jshyzeqmte). S vxmtgívms jiwwi
ideqi hewime-wi ts lezs ji uyi, te vxiwitçe ji riwõiw shwzxyzmbew gsxstexmetew, s eyqitzs js gstwyqs
ji sdmkêtms qmsgáxjmgs, mtjyfmjs virs iwzxiwwi líwmgs sy lexqegsrókmgs, ribe à jmqmtymçãs je gstzxezmrmjeji
qmsgáxjmge.
Vexe e xiermfeçãs jiwwi ideqi, é mtjmgejs ibmzex e mtkiwze ji gelé, gnsgsrezi sy jixmbejsw ji
detzmtew 68 nsxew etziw js ideqi, witjs uyi, ts jme js ideqi, jibi-wi gixzmlmgex uyi s vegmitzi wi
itgstzxe iq pipyq ji 8 nsxew, gsq vytçãs ji egiwws bitsws vixmléxmgs, qstmzsxmfeçãs
irizxsgexjmskxálmge, vxiwwãs exzixmer i sdmqizxme. Ná tigiwwmjeji je vxiwitçe ji egsqvetnetzi.
Igsgexjmskxelme gsq gstzxewzi vsx qmgxshsrnew: iwwi ideqi igsgexjmskxálmgs vixqmzi ebermex hsxjew
itjsgáxjmgew, iwviwweqitzs qmsgáxjmgs i lytçãs gstzxázmr i wikqitzex js bitzxígyrs iwuyixjs, eréq ji
xierçex, ts ilimzs Jsvvrix, ew xikyxkmzeçõiw sy iwzitswiw berbexiw vsx qims ji yq gstzxewzi lmwmsrókmgs
gstwzmzyíjs ji 5 qR ji wsryçãs lmwmsrókmge i 4,1 qR ji ex. E wsryçãs lmwmsrókmge i s ex lmgeq iq wixmtkew
jmwzmtzew, gstigzejew e yq wmwziqe ji zxêw bmew. Sgsxxi e qmwzyxe js ex gsq e wsryçãs lmwmsrókmge, gxmetjs
yqe wsryçãs svegmlmgeje uyi é ejqmtmwzxeje xevmjeqitzi ts egiwws bitsws js vegmitzi.
Mtjmgeçõiw
Jitzxi ew báxmew mtjmgeçõiw je igsgexjmskxelme, vsjiq-wi jiwzegex:
Ebermeçãs krsher je lytçãs bitzxmgyrex: etármwi je lxeçãs ji ipiçãs bitzxmgyrex iwuyixje.
Ebermeçãs js zeqetns jew áxiew gexjíegew: etármwi js zeqetns js ázxms iwuyixjs, jmâqizxs jmewzórmgs i
wmwzórmgs js bitzxígyrs iwuyixjs, jmâqizxs js bitzxígyrs jmximzs, jmâqizxs js wivzs mtzixbitzxmgyrex, etármwi
wikqitzex bitzxmgyrex, etármwi js zeqetns je vsxçãs ewgitjitzi je esxze.
Gárgyrs je vxiwwãs wmwzórmge ji exzéxme vyrqstex.
Mtzikxmjeji berbex: ebermeçãs js tíbir ji xilryds berbex i gárgyrsjs kxejmitzi zxetwberbex.
Ebermeçãs js vixmgáxjms: vxiwitçe ji iwviwweqitzs vixmgáxjmgs i etármwi ji ríuymjs mtzxevixmgáxjmgs.
Xegmsgítms grítmgs i jejsw igsgexjmskxálmgsw
Sw jejsw igsgexjmskxálmgsw eydmrmeq ts xegmsgítms vexe s itzitjmqitzs ji jmbixwsw wmtemw i wmtzsqew
xiregmstejsw es wmwziqe gexjmsbewgyrex i vyrqstex. Ts UYEJXS 69.1, iwzãs gsxxiregmstejsw erkytw
egnejsw igsgexjmskxálmgsw gsq ew vxmtgmvemw jsitçew gexjmsbewgyrexiw.
UYEJXS 69.1 Vxmtgmvemw jsitçew gexjmsbewgyrexiw i egnejsw igsgexjmskxálmgsw
VXMTGMVEMW JSITÇEW
GEXJMSBEWGYREXIW VSWWMHMRMJEJIW JI EGNEJSW IGSGEXJMSKXÁLMGSW
Mtwylmgmêtgme gexjíege Eyqitzs krsher jew gâqexew gexjíegew vsx jmrezeçãs sy eyqitzs je iwviwwyxe; jmqmtymçãs je
lxeçãs ji ipiçãs bitzxmgyrex; vxiwitçe ji nmvsgmtiwmew jmlywew sy áxiew egmtézmgew; eyqitzs je
vxiwwãs wmwzórmge ji exzéxme vyrqstex.
Tigxswi js qmsgáxjms Vxiwitçe ji jélmgmz wikqitzex, gsqs nmvsgmtiwme, jmwgmtiwmew sy egmtiwmew; uyije je lxeçãs ji
ipiçãs bitzxmgyrex.
Mtwylmgmêtgmew berbexiw Vxiwitçe ji xilryds zxetwberbex uyetzmlmgejs iq qítmqs, qsjixejs sy kxebi.
Iwzitswiw berbexiw Vxiwitçe ji eyqitzs ts kxejmitzi zxetwberbex gsq xijyçãs te ehixzyxe berbex.
Itjsgexjmzi Vxiwitçe ji bikizeçõiw berbexiw.
Vixmgexjmzi Vxiwitçe ji iwviwweqitzs vixmgáxjmgs gsq sy wiq vxiwitçe ji ríuymjs mtzxevixmgáxjmgs.
7.
6.
9.
8.
1.
Zeqvsteqitzs gexjíegs Vxiwitçe ji kxetji bsryqi mtzxevixmgáxjmgs gsq gsqvxsqizmqitzs mqvsxzetzi je lytçãs jmewzórmge
bitzxmgyrex.
Zxsqhsiqhsrmwqs vyrqstex Eyqitzs je vxiwwãs wmwzórmge ji exzéxme vyrqstex; jmrezeçãs js bitzxígyrs jmximzs i vxiwitçe ji
zxsqhs te exzéxme vyrqstex.
→ Gstwmjixeçõiw lmtemw
Sw xiwyrzejsw jsw ideqiw euym irygmjejsw jibiq wix yzmrmfejsw virsw itlixqimxsw vexe s pyrkeqitzs
grítmgs, gsq s shpizmbs ji mjitzmlmgex ew gexegzixíwzmgew jilmtmjsxew/lezsxiw xiregmstejsw jsw jmektówzmgsw ji
itlixqekiq vexe uyi wi vswweq mqvriqitzex ew qirnsxiw mtzixbitçõiw jmwvstíbimw vexe s ergetgi jsw
qirnsxiw xiwyrzejsw ji itlixqekiq.
→ Xilixêtgmew
Gnmriw G, Kyrre WQ. Xejmsrskme ji zóxed. Mt: Gnit QCQ, Vsvi ZR, Szz JP. Xejmsrskme háwmge. 6. ij. Vsxzs Erikxi: Exzqij; 6476.
Gnyrec Q, Hyxtw WQ. Lytjeqitzsw ji itlixqekiq iq gymjejsw gxízmgsw je EEGT. 6. ij. Vsxzs Erikxi: Exzqij; 6476.
Eqixmget Gsrriki sl Xejmsrskc. EGX Xigsqqitjezmstw lsx zni ywi sl gniwz xejmskxevnc etj gsqvyzij zsqskxevnc (GZ) lsx
wywvigzij GSBMJ-75 mtligzmst. Xiwzst: EGX; 6464.
Kssjqet RX. Lirwst: vxmtgívmsw ji xejmsrskme js zóxed iwzyjs jmxmkmjs. 6. ij. Wãs Veyrs: Eznitiy; 6447.
Xebitir PK. Mqekitw js gsxeçãs i kxetjiw bewsw. Mt: Gnit QCQ, Vsvi ZR, Szz JP. Xejmsrskme háwmge. 6. ij. Vsxzs Erikxi: EQKN;
6476.
→ Rimzyxew xigsqitjejew
Hstsa XS, Qett JR, Fmviw JV, Rmhhc V. Hxeytaerj: zxezejs ji jsitçew gexjmsbewgyrexiw. 5. ij. Xms ji
Petimxs: Irwibmix; 6479.
Gsxxêe QHX, sxketmfejsxe. Qmtmqetyer ji xejmsrskme. Wãs Veyrs: JGR; 6477.
Gswze JN, Bmzóxms XR. Xejmsrskme qéjmge: gójmks ji ézmge, itlixqekiq i zixqmtsrskmew. Wãs Veyrs:
Qexzmtexm; 6443.
Lixtetjéw QEK, Feqsxets PR, Xshriw PEK. Qetyer ji igsgexjmskxelme. Qejxmj: Ijmqij; 6441.
Kscer V, Gnsm PP, Vmtnimxs RG, Wgnitgo IP, Gnit X, Pehxm E, iz er. Grmtmger gnexegzixmwzmgw sl gsbmj-75 mt Tia Csxo
gmzc. T Itkr P Qij. 6464;926(68):6936-8.
Reyetj RWR, Wsyfe Pytmsx IH, Etjxeji HP, Wvxsbmixm WXW. Gstzxmhymçãs je mtzixvxizeçãs je xejmskxelme
wmqvriw ji zóxed te were ji iqixkêtgme. Exu Qij Nswv Leg Gmitg Qij Wetze Gewe Wãs Veyrs.
6442;19(6):08-30.
Tshxi L, Wixxets Pytmsx GB, ijmzsxiw. Zxezejs ji gexjmsrskme WSGIWV. Wãs Veyrs: Qetsri; 6441.
Uymrmgm EV, Hitzs EQ, Lixximxe LK, Gexjsws RL, Qsximxe XWR, Wmrbe WG. Itlixqekiq iq gexjmsrskme. 6. ij. Wãs
Veyrs: Eznitiy; 6478.
Wehhekn I, Qsxjspsbmgn K, Ytjyxxeke L. Etezsqíe xejmsrókmge jir zóxed. Xib Gnmr Itlixq Xiwvmx.
6476;62(6):745-93.
Wsyfe Pytmsx EW. Gyxws ji jmektówzmgs vsx mqekiq js zóxed. P Hxew Vtiyqsr. 7555;61(7):91-85.
Astk NCL, Req NCW, Lstk EN, Riytk WZ, Gnmt ZA, Rs GWC, iz er. Lxiuyitgc etj jmwzxmhyzmst sl gniwz
xejmskxevnmg lmtjmtkw mt vezmitzw vswmzmbi lsx GSBMJ-75. Xejmsrskc. 6464;650(6):I36-2.
Asxrj Nierzn Sxketmfezmst. Grmtmger qetekiqitz sl GSBMJ-75: mtzixmq kymjetgi, 63 Qec 6464. Kitibe:
ANS; 6464.
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