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救急業務高度化推進検討会 第3回>ディЛルзントロル
ᢇᕆᬺോ㜞ᐲൻផㅴᬌ⸛ળ ╙㧟࿁ࡔ࠺ࠖࠞ࡞ࠦࡦ࠻ࡠ࡞ᬺㇱળ ᰴ ╙ ᣣᤨ㧦ᐔᚑ㧞㧞ᐕ㧝㧝㧥ᣣ㧔Ἣ㧕 㧝㧟ᤨ㧜㧜ಽ㨪㧝㧡ᤨ㧜㧜ಽ ႐ᚲ㧦ਃ⇟↸↪ળ⼏ᚲ 㙚㧝㓏 㧭ળ⼏ቶ 㧝 㐿 ળ 㧞 ⼏ 㗴 ࡆ࠺ࠝ༄㗡㏜ߦߟߡ ᢇᕆ㓌ຬߩᢎ⢒╬ߦߟߡ ߘߩઁ 㧟 㐽 ળ ޣ㈩Ꮣ⾗ᢱޤ ⾗ ᢱ ╙㧟࿁ࡔ࠺ࠖࠞ࡞ࠦࡦ࠻ࡠ࡞ᬺㇱળ ᬌ⸛⾗ᢱ ᷝ㧝 ᢇᕆᢇ჻ߩ᳇▤ᝌ▤ߦߟߡ 㧔┻ਛᆔຬឭ㧕 ᷝ㧞 ∛㒮೨ᢇ⼔ߦ߅ߌࠆ᳇▤ᝌ▤ߩోᕈߣ⏕ታᕈߩะ㧔ᬮࠝࡉࠩࡃឭ㧕 ᷝ㧟 ᢇ჻ߩᜂ߁ᓎഀߣᢎ⢒ 㧔┻ਛᆔຬឭ㧕 ᷝ㧠 ᢇᕆ㓌ຬߩౣᢎ⢒ࠍߋࠆ㗴ߦߟߡߩ⚛ឬ 㧔ᯅᧄᆔຬឭ㧕 ෳ⠨㧝 ᒙὐߪߎߎߛ 㧔ᢇᕆᢇᎺ⎇ୃᚲ⾗ᢱ㧕 ᐔᚑ㧞㧝ᐕᐲᢇᕆᬺോ㜞ᐲൻផㅴᬌ⸛ળ ࡔ࠺ࠖࠞ࡞ࠦࡦ࠻ࡠ࡞ᬺㇱળ ᭴ᚑຬ 㧔ච㖸㗅ޔᢘ⒓⇛㧕 ጤ↰ ᄥ 㧔ᥓᄢቇᴺቇㇱᢎ㧕 㥱⮮ ⧷৻ 㧔᧲੩ᶖ㒐ᐡෳ㧕 ㋈Ꮉ ᱜਯ 㧔⥄ᴦක⑼ᄢቇᢇᕆකቇᢎቶᢎ㧕 ┻ਛ ࠁ߆ࠅ 㧔ᢇᕆᝄ⥝⽷࿅ᢇᕆᢇᎺ⎇ୃᚲᢎ㧕 ┙Ꮉ ศᦶ ၯ₹⋵ᶖ㒐㒐ἴ⺖⺖㐳㧕 ᯅᧄ 㓶ᄥ㇢ 㧔᧙ᨋᄢቇ✚ว╷ቇㇱᢎ㧕 ᐔጊ ብผ 㧔ጘ㒂⋵ஜᐽㇱක≮ᛛ⋙㧕 ᑝ⍹ ᤘ 㧔ਅ㑐Ꮢᶖ㒐ዪ⼊㒐⺖㐳㧕 ᧄ ᕺ 㧔㐳ፒᏒᶖ㒐ዪ⼊㒐⺖㐳㧕 ㊁ ৻⌀ 㧔ጊᒻ⋵┙ਛᄩ∛㒮ᢇᢇᕆࡦ࠲⸻≮ㇱㇱ㐳㧕 ٤ᮮ↰ 㗅৻ᦶ 㧔Ꮢ┙႓∛㒮㒮㐳㧕 ࠝࡉࠩࡃ ਛ㊁ 㧔ෘ↢ഭ⋭කዪᜰዉ⺖ᢇᕆක≮ኾ㐷ቭ㧕 ᬮ ⌀ੑ 㧔⋵┙ᐢፉ∛㒮ᢇᢇᕆࡦ࠲㧕 ٤㧦ᐳ㐳 ╙㪊࿁䇸䊜䊂䉞䉦䊦䉮䊮䊃䊨䊷䊦ᬺㇱળ䇹 ᐔᚑ㪉㪉ᐕ㪈㪈㪐ᣣ䋨Ἣ䋩㪈㪊㪇㪇䌾㪈㪌㪑㪇㪇 ਃ⇟↸↪ળ⼏ᚲળ⼏ቶ䇭䌁ળ⼏ቶ ᮮ ↰ ᐳ 㐳 䂾 䂾 䂾 䂾 ጤ↰ᆔຬ 㥱⮮ᆔຬ ㋈Ꮉᆔຬ ┻ਛᆔຬ ┙Ꮉᆔຬ ᯅᧄᆔຬ ᐔጊᆔຬ ᑝ⍹ᆔຬ 䋨ઍ䋩ർ᳁ ᧄᆔຬ ㊁ᆔຬ 䂾 䂾 䇭䇭ᬮ㩷කᏧ 䇭䇭䋨䉥䊑䉱䊷䊋䊷䋩 䂾 ਛ㊁ኾ㐷ቭ 䂾 䂾 䂾 䂾 䂾 䇭 䇭 Ḵ ญ ኾ 㐷 ቭ 䇭 㩷 㐿 ቶ 㐳 䂾 䂾 䂾 ോዪ 䂾䈲ற⡬Ꮸ䇮ή䈚 ⾗ᢱ ᐔᚑ䋲䋱ᐕᐲ ᢇᕆᬺോ㜞ᐲൻផㅴᬌ⸛ળ ╙3࿁䊜䊂䉞䉦䊦䉮䊮䊃䊨䊷䊦ᬺㇱળ ⾗ ᢱ ᐔᚑ䋲䋲ᐕ䋱䋱䋹ᣣ䋨Ἣ䋩 ✚ ോ ⋭ ᶖ 㒐 ᐡ ╙䋲࿁ᬺㇱળ䈪䈘䉏䈢ਥ䈭ᗧ䋨䋱䋩 䂾 ᢇᕆ䈮㑐䈜䉎⹏ଔ䊶ಽᨆ䈮䈧䈇䈩 㽲 ᔃ⢖ᯏ⢻ᱛ்∛⠪䈮䈍䈔䉎⚦⺞ᩏ䋨䉡䉿䉺䉟䊮⛔⸘䉕ᵴ↪䈚䈢⺞ᩏ䋩䈮䈧䈇䈩 䊶 ᱫᓽ䈏䈅䉎்∛⠪䉕៝ㅍ䈜䉎䈎䈬䈉䈎䈲䇮ၞ䈮䉋䈦䈩䈳䉌䈧䈐䈏䈅䉍䇮↢ሽ₸╬ 䈱⚿ᨐ䈮ᓇ㗀䈚䈩䈇䉎䈫⠨䈋䉌䉏䉎䇯࿁䈱⺞ᩏ䈪ታᘒ䉕ᛠី䈜䉎䈖䈫䈲㊀ⷐ䈪䈅䉎䇯 䊶 ኅᣖ╬䈏ᢇಣ⟎䉕ᦸ䉁䈭䈎䈦䈢႐ว䇮ᢇᕆ㓌䈏䈬䈉ኻᔕ䈜䈼䈐䈎䈲䇮㔍䈚䈇㗴䈪䈅 䉍䇮ᛒ䈇䉕ᘕ㊀䈮䈜䈼䈐㗄⋡䇯ᢇಣ⟎䉕䈚䈢䈎䈬䈉䈎䈪䈲䈭䈒䇮䇸ᢇಣ⟎䉕ᦸ䉁䈭䈎䈦 䈢ኅᣖ╬䈏㪈ੱ䈪䉅䈇䈢䈎䈬䈉䈎䇹䉕⡞䈇䈩䈇䉎䉅䈱䈪䈅䉎䈖䈫䉕ᢛℂ䈚䈩䈍䈒ᔅⷐ䈏䈅䉎䇯 䊶 䌐䌁ㅪ៤䈮䈧䈇䈩䈲䇮ᓟ䈘䉌䈮䇮⹏ଔᣇᴺ╬䇮ᬌ⸛䈚䈩䈇䈒ᔅⷐ䈏䈅䉎䈱䈪䈲䈭䈇䈎䇯 㽳 ၞ䈮䈍䈔䉎ో்∛⠪䉕ኻ⽎䈫䈚䈢⺞ᩏ䈮䈧䈇䈩 䊶 ៝ㅍవ䈱ㆬቯℂ↱䈲䇮ⶄᢙ࿁╵䈪䈲䈭䈒䇮䇸ਥ䈢䉎ℂ↱䇹䈮䈚䈿䉌䈭䈔䉏䈳䇮㓸⸘䊶ಽᨆ 䈏࿎㔍䈫䈭䉎䈖䈫䈏⠨䈋䉌䉏䉎䇯 䊶 ᢇᕆ㓌䈏ᵈ⋡䈚䈢்∛⠪䈱∝⁁䈫ක≮ᯏ㑐䈪⸻ᢿ䈘䉏䈢∔∛䈫䈱㑐ଥ䉇䇮㜞ᐲ䈭ක≮ 䈏ᔅⷐ䈭்∛⠪䉕៝ㅍ䈱Ბ㓏䈪ᢇᕆ㓌䈏䈬䈱⒟ᐲ್ᢿ᧪䈢䈎╬䈮䈧䈇䈩ᛠី䊶ಽᨆ 䈜䉎䈖䈫䈪䇮ᓟ䈱ⷰኤᣇᴺ䉇ᢎ⢒䈱䈅䉍ᣇ╬䈮䈧䈭䈕䉌䉏䉎䈱䈪䈲䈭䈇䈎䇯 䊶 ࿁䈱⺞ᩏ⚿ᨐ䈲䇮ฦㇺᐭ⋵䈪៝ㅍ䈶ฃ䉏䈱ታᣉၮḰ䉕╷ቯ䈚䈩䈇䈒䈪䇮ෳ ⠨䈫䈭䉎䊂䊷䉺䈮䈭䉎䈱䈪䈲䈭䈇䈎䇯 1 ╙䋲࿁ᬺㇱળ䈪䈘䉏䈢ਥ䈭ᗧ䋨䋲䋩 䂾 ᢇᕆ㓌ຬ䈱ᢎ⢒╬䈮䈧䈇䈩 䊶 ᢇᕆᢇ჻䈱ౣᢎ⢒䈮䈧䈇䈩䈲৻ቯ䈱ᣇ㊎䈏␜䈘䉏䈩䈇䉎䈏䇮ᢇᕆᢇ჻䈣䈔䈪䈲䈭 䈒䇮ᢇᕆ㓌ో䈮ኻ䈜䉎ᢎ⢒䈱లታ䉕࿑䈦䈩䈇䈒ᔅⷐ䈏䈅䉎䈱䈪䈲䈭䈇䈎䇯 䊶 ో࿖⊛䈮⾰䈱㜞䈇ᢇᕆᬺോ䉕⏕䈚䈩䈇䈒䈢䉄䈮䇮ᔅⷐ䈭ᢎ⢒䉇⸠✵䈱ᣇᴺ╬䈮䈧䈇 䈩␜䈚䇮ᐩ䈕䉕࿑䈦䈩䈇䈒ᔅⷐ䈏䈅䉎䈱䈪䈲䈭䈇䈎䇯 䊶 ᶖ㒐ᯏ㑐䈮䈍䈔䉎ᢎ⢒䈱䈅䉍ᣇ䈮䈧䈇䈩䈲䇮ቴⷰ⊛䊂䊷䉺䉅〯䉁䈋䇮䈘䉌䈮ᤨ㑆䉕 䈎䈔䈩⼏⺰䉕ᷓ䉄䈩䈲䈬䈉䈎䇯 䊶 ்∛⠪䈱ⷰኤ䉇ᚻᛛ䈏ㆡಾ䈎䈬䈉䈎╬䈮䈧䈇䈩䈲䇮කቇ⊛䈎䉌䈱⹏ଔ䈏ᔅⷐ䈫䈭 䉎䈱䈪䈲䈭䈇䈎䇯 䂾 䊎䊂䉥༄㗡㏜䈮䈧䈇䈩 䊶 ᳇▤ᝌ▤䈱ᚻᛛ䈮䈱䉂⌕⌒䈜䉎䈫䇮㕖Ᏹ䈮ല䈭ౕེ䈪䈅䉎䈫䈇䈋䉎䈱䈪䈲䈭䈇䈎䇯 䊶 䊎䊂䉥༄㗡㏜䈱ᵴ↪䉕ᔨ㗡䈮⟎䈇䈢䊃䊧䊷䊆䊮䉫䈏ᔅⷐ䈪䈲䈭䈇䈎䇯 䊶 ⇣‛㒰䈮ะ䈎䈭䈇䈖䈫䈮䈧䈇䈩䈲⇐ᗧ䈏ᔅⷐ䈪䈲䈭䈇䈎䇯 䊶 ⁁䈪䇮ක≮ᯏ㑐䈮ᐢ䈒᥉䈚䈩䈇䉎䉅䈱䈪䈲䈭䈒䇮䊎䊂䉥༄㗡㏜䈱∛㒮ታ⠌䈱䉕 ⏕䈜䉎䈖䈫䈏࿎㔍䈭ၞ䉅䈅䉎䈖䈫䈲䇮ᔨ㗡䈮⟎䈇䈩䈍䈒ᔅⷐ䈪䈅䉎䈱䈪䈲䈭䈇䈎䇯 2 ᧄᣣ䈱ᬌ⸛⺖㗴╬䈮䈧䈇䈩 䋱 䊎䊂䉥༄㗡㏜䈮䈧䈇䈩 㶎 ೨࿁䈎䉌䈱ᒁ䈐⛯䈐㗄 䋲 ᢇᕆ㓌䈱ᢎ⢒䈮䈧䈇䈩 䋳 ⺞ᩏ䈱ㅴ⁁ᴫ䈮䈧䈇䈩 䋨䋱䋩 ᔃ⢖ᯏ⢻ᱛ்∛⠪䉕ኻ⽎䈫䈚䈢⺞ᩏ䋨ో࿖䋩 䋨䋲䋩 ో்∛⠪䉕ኻ⽎䈫䈚䈢⺞ᩏ䋨ၞ䋩 䊶 ᄢ㒋Ꮢ 䊶 ዊጊ䊶⧐⾐ 䊶 ႓Ꮢ䋨㶎Ꮢ䈱⁛⥄ᬺ䋩 3 ᢇᕆᢇ჻䈱ታᣉ䈜䉎᳇▤ᝌ▤䈮䈧䈇䈩 ᳇▤ᝌ▤䈱ᬺോ䊒䊨䊃䉮䊷䊦 䇸ᢇᕆᢇ჻䈱᳇▤ౝ䉼䊠䊷䊑䈮䉋䉎᳇⏕䈱ታᣉ䈮ଥ䉎䊜䊂䉞䉦䊦䉮䊮䊃䊨䊷䊦䈱లታᒝൻ 䈮䈧䈇䈩䇹䋨ᐔᚑ䋱䋶ᐕ䋳䋲䋳ᣣઃ䈔ᶖ㒐ᢇ╙䋵䋸ภ䊶කᜰ⊒╙䋰䋳䋲䋳䋰䋷䋱ภ䊶ᶖ㒐ᐡᢇᕆᢇഥ⺖㐳 䊶ෘ↢ഭ⋭කዪᜰዉ⺖㐳ㅢ⍮䋩 䇼᳇▤ᝌ▤䈱ㆡᔕ䈫⠨䈋䉌䉏䉎䉬䊷䉴䇽 ਅ⸥䈱⁁ᘒ䈱ᔃ⢖ᯏ⢻ᱛᖚ⠪䈱䈉䈤䇮䊤䊥䊮䉭䉝䊦䊙䉴䉪䇮㘩㐽㎮ᑼ䉣䉝䉡䉢䉟 䈪᳇⏕䈏䈪䈐䈭䈇䉅䈱 㽲 ⇣‛䈮䉋䉎⓸ᕷ䈱ᔃ⢖ᯏ⢻ᱛ 㽳 䈠䈱ઁ䇮ᜰዉක䈏ᔅⷐ䈫್ᢿ䈚䈢䉅䈱 䇼᳇▤ᝌ▤䈱ㆡᔕᄖ䈫䈭䉎䉬䊷䉴䇽 㽲 ⁁ᴫ䈎䉌㗖㜑៊்䈏ᒝ䈒⇼䉒䉏䉎 㽳 㗡ㇱᓟዮ࿎㔍 㽴 㐿ญ࿎㔍䈫⠨䈋䉌䉏䉎 㽵 ༄㗡㏜ᝌ࿎㔍 㽶 ༄㗡㏜ᝌᓟ༄㗡ዷ㐿࿎㔍 㽷 䈠䈱ઁ䈱ℂ↱䈪ჿᏪ⏕࿎㔍 㽸 ᤨ㑆䉕ⷐ䈜䉎䇮䉅䈚䈒䈲ⷐ䈜䉎䈫⠨䈋䉌䉏䉎 㽹 䈠䈱ઁᜂᒰᢇᕆᢇ჻䈏᳇▤ᝌ▤ਇㆡ䈫⠨䈋䈢 4 ༄㗡㏜䈮䈧䈇䈩䋨䋱䋩 ༄㗡㏜䋺 䋭᳇▤ᝌ▤䉇ญ⣧ౝ䈱⇣‛㒰╬䈱䈢䉄䇮༄㗡䉕ዷ㐿䈜䉎㓙䈮↪䈇䉎ౕེ䇯 䋭䊑䊧䊷䊄䈱ᒻ䈮䉋䉍䇮⋥ဳ䇮ᦛဳ䈮ಽ㘃䈘䉏䉎䇯 ⋥ဳ䋺 䊚䊤䊷ဳ䇮䉡䉞䉴䉮䉲䊮ဳ ╬ ᦛဳ䋺 䊙䉾䉨䊮䊃䉾䉲䊠ဳ ╬ 䋭ᝌ▤ᣉⴕ⠪䈱ⷞὐ䈎䉌༄㗡䉁䈪䈱⋥✢⊛ⷞ㊁䉕⏕䈚䇮ჿ㐷䉕䇸⋥ធ䇹ⷞ䈜䉎䇯 䊚䊤䊷ဳ 䊙䉾䉨䊮䊃䉾䉲䊠ဳ ĺ ㄭᐕ䇮䊎䊂䉥༄㗡㏜䈫䈳䉏䉎䇮↹䉕䊝䊆䉺䈪䉎䈖䈫䈏᧪䉎༄㗡㏜䈏᥉䇯 5 ༄㗡㏜䈮䈧䈇䈩䋨䋲䋩 ⒳ 㘃 ⋥ធჿ㐷ⷞဳ ⎬ᕈ༄㗡㏜ 㑆ធჿ㐷ⷞဳ ⎬ᕈ༄㗡㏜ 䉼䊠䊷䊑⺃ዉ ᯏ⢻䉕䈜䉎 㑆ធჿ㐷ⷞဳ ⎬ᕈ༄㗡㏜ ․ ᓽ ⠨ ຠฬ䇮ㅧ䊜䊷䉦 䊶ᝌ▤ᣉⴕ⠪䈱ⷞὐ䈎䉌༄㗡䉁 䊶䊑䊧䊷䊄䈱ḧᦛㇱಽ䉇 䈪䈱㑆䈮⋥✢⊛ⷞ㊁䉕⏕䈜䉎 㐿ญ㒢䈭䈬䈮䉋䉍ⷞ 䈖䈫䈪䇮ჿ㐷䉕⋥ធⷰኤ䈜䉎䇯 ᕈ䈏ૐਅ䈜䉎႐ว 䊶ⷞ㊁䈏⏕䈘䉏䈢႐ว䈲䉼䊠䊷 䈏䈅䉎䇯 䊑╬䈏ᝌ▤䈚䉇䈜䈇䇯 䊶䊑䊧䊷䊄䈏․ᱶ䈭ᒻ⁁ 䊶ჿ㐷䈎䉌ᢙcm䈱⟎䈎䉌ⷰኤ 䉕䈚䈩䈇 䉎䈢䉄䇮᳇▤ 䈪䈐䇮༄㗡䈱ⷞᕈ䈏䉋䈇䇯 ᝌ▤ᤨ䈮䉼䊠䊷䊑䈱ⷺ ᐲ䉕ᱜ䈚䈭䈏䉌ᝌ 䈜䉎ᔅⷐ䈏䈅䉎䇯 䊶ჿ㐷䈱ⷞᕈ䉕ᜬ䈚䈧䈧䇮䉼 䊠䊷䊑⺃ዉᯏ⢻䈏䈅䉎䈢䉄䇮ᝌ ▤䈱ᚑഞ₸䉕ะ䈘䈞䉎䇯 䂾 Trueview 䋺TRUPHATEK 䂾 䊐䉜䉟䊋䊷䊎䊠䊷䊎䊂䉥༄㗡㏜ 䋺䊐䉜䉟䊋䊷䊁䉾䉪 䂾 䉪䊷䊂䉾䉪䊎䊂䉥䊤䊥䊮䉯䉴䉮䊷䊒䊘䊷䉺䊑䊦VLP100 䋺ᄢකකེᩣᑼળ␠ 䂾 Glide scope ® 䋺Verathon® Corporate 䂾 STROZ ® video Laryngoscope 䋺KARL STROZ 䂾 Ctrach 䋺LMA 䂾 Airtraq ® 䋺Prodol Meditec 䂾 䉣䉝䉡䉢䉟䉴䉮䊷䊒AMS-S100 䋺䊕䊮䉺䉾䉪䉴 6 䊎䊂䉥༄㗡㏜䈮䈧䈇䈩䋨䋱䋩 䊎䊂䉥༄㗡㏜䋺 㑆ធჿ㐷ⷞဳ 䋭ᓥ᧪䈱༄㗡㏜䈮㒝ዻ䈘䉏䈢ౝⷞ㏜䉇䌃䌃䌄䊝䊆䉺䉕䈚䈩ធ⌒䊧䊮䉵䉇ౝ⤳䊝䊆 䉺䇮䈅䉎䈇䈲ᄖㇱ䊝䊆䉺䈪䇸㑆ធ⊛䇹䈮ⷰኤ䈪䈐䉎䇯 䋭༄㗡䈱ⷞᕈ䈲ᓥ᧪䈱༄㗡㏜䈮Ყ䈼䈩䇮⪺䈚䈒ᡷༀ䈜䉎䈫⸒䉒䉏䈩䈇䉎䇯 7 䊎䊂䉥༄㗡㏜䈮䈧䈇䈩䋨䋲䋩 ᢇᢇᕆ჻䈱᳇▤ౝ䉼䊠䊷䊑䈮䉋䉎᳇⏕䈱ታᣉ䈮ଥ䉎䊜䊂䉞䉦䊦䉮䊮䊃䊨䊷䊦 䈱లታᒝൻ䈮䈧䈇䈩䋨ᶖ㒐ᢇ╙㪌㪏ภකᜰ⊒╙㪇㪊㪉㪊㪇㪎㪈ภᐔᚑ㪈㪍ᐕ㪊㪉㪊ᣣ䋩 䋱䋮කᏧ䈎䉌䈱ౕ⊛ᜰ␜䊶ᜰዉ䈱లታ 䋲䋮䊒䊨䊃䉮䊷䊦䈮ᴪ䈦䈢ታᣉ 䋳䋮ᚲⷐ䈱⍮⼂䈱⠌ᓧ 䋴䋮ᓟᬌ⸽䈱⏕┙╬ ᳇▤ᝌ▤䈱ᬺോ䊒䊨䊃䉮䊷䊦 䋭 ᝌ▤䈱⒳䈲ձ᪽ᦟ䉕↪䈇䈢Ⴚᙻɦኺӝሥ䈮㒢ቯ䈜䉎䇯 䋭 ᳇▤䉼䊠䊷䊑䈏ᱜ䈚䈒ᝌ䈘䉏䈩䈇䉎䈎⏕䈜䉎䈢䉄એਅ䈱4䈧䈱ᣇᴺ䉕ⴕ䈉䇯 1䋩 Ⴚᙻɦ䈪ჿᏪ䉕䉼䊠䊷䊑䈏䈋䉎䈱䉕⏕䈜䉎䇯 2䋩 ᳇▤ᝌ▤ᓟ䇮⋥䈤䈮ᔃ䉦ㇱ䇮ਔਛ⣠ਅ⣼䊶೨⢷ㇱ䉕⡬ข䈜䉎䇯 3䋩 ᳇ੑ㉄ൻ⚛ᬌ⍮ེ䉕ⵝ⌕䈜䉎䇯 4䋩 㘩ᝌ▤ᬌ⍮ེ䉕ⵝ⌕䈜䉎䇯 䋨ᐔᚑ14ᐕᐲෘ↢ഭ⑼ቇ⎇ⓥ䇸ᢇᕆᢇ჻䈮䉋䉎․ቯⴕὑ䈱ౣᬌ⸛䈮㑐䈜䉎⎇ⓥ䇹ႎ๔ᦠ䋩 8 ᢇᕆ㓌䈱ᢎ⢒䈮䈧䈇䈩䋨䋱䋩 䂾 ᢇᕆ㓌ຬ䈱ᢎ⢒䈮䈧䈇䈩 ో࿖⊛䈮৻ቯ䈱⾰䈱ᢇᕆᬺോ䉕⏕䈜䉎䈢䉄䈮䇮ᢇᕆᢇ჻䈱䉂䈭䉌䈝 ᢇᕆ㓌ో䈮䈍䈔䉎ᢎ⢒䈱లታᒝൻ䈏ᔅⷐ䈪䈲䈭䈇䈎䇯 䇼⸠✵╬䈮㑐ㅪ䈜䉎ㅢ⍮╬䇽 ᢇᕆᬺോታᣉၮḰ䋨ᤘ䋳䋹ᐕ䋳䋳ᣣઃ䈔⥄ᶖ↲ᢎ⊒╙䋶ภ䋩 ╙䋷᧦ ᶖ㒐㐳䈲䇮㓌ຬ䈮ኻ䈚䇮ᢇᕆᬺോ䉕ⴕ䈭䈉䈮ᔅⷐ䈭ቇⴚ䈶ᛛ⢻䉕⠌ᓧ䈘䈞䉎䈢 䉄䇮Ᏹ䈮ᢎ⢒⸠✵䉕ⴕ䈉䉋䈉䈧䈫䉄䈭䈔䉏䈳䈭䉌䈭䈇䇯 ╙䋲䋶᧦ ᶖ㒐㐳䈲䇮․ᱶ䈭ᢇᕆ䈱⊒↢䈚䈢႐ว䈮䈍䈔䉎ᢇᕆᬺോ䈱ታᣉ䈮䈧䈇䈩䈱 ⸘↹䉕╷ቯ䈚䈩䈍䈒䉅䈱䈫䈜䉎䇯 䋲 ᶖ㒐㐳䈲䇮Ფᐕ䋱࿁એ೨㗄䈮ቯ䉄䉎⸘↹䈮ၮ䈨䈒⸠✵䉕ⴕ䈉䉅䈱䈫䈜䉎䇯 9 ᢇᕆ㓌䈱ᢎ⢒䈮䈧䈇䈩䋨䋲䋩 䂾 ᢇᕆ㓌ຬ䈱ᢎ⢒⸠✵䈱లታ䇮ᒝൻ䈮䈧䈇䈩䋨ᤘ䋶䋰ᐕ䋴䋸ᣣઃ䈔 ᶖ㒐ᢇ╙䋳䋲ภ䋩䋨ᛞ䋩 䊶 ㇺᐭ⋵䈮䈍䈇䈩䈲䇮ᶖ㒐ቇᩞ䈶▤ਅᶖ㒐ᧄㇱ䈱⡯႐䈮䈍䈔䉎ᢇᕆ㓌ຬᢎ⢒̪䈱ታ❣䇮ലᨐ╬䉕䈸䉁䈋䉎䈫䈫 䉅䈮▤ਅᶖ㒐ᧄㇱ䈫䉅චಽද⼏䉕ⴕ䈦䈢䈪䇮ᢇᕆ㓌ຬᢎ⢒䈮ଥ䉎⋧䈱ᓎഀಽᜂ䈫ᢎ⢒⋡⊛䉕⏕䈮䈚䇮ో䈫 䈚䈩ᢛวᕈ䈱䈫䉏䈢ᢎ⢒䉲䉴䊁䊛䉕᭴▽䈜䉎䉋䈉ദ䉄䉎䈖䈫䇯 ̪ ᢇᕆ㓌ຬ䈱⾗ᩰขᓧ⻠⠌ 䊶 කᏧળ䇮ᢇᕆකቇળ╬䈫䈱ㅪ៤ᒝൻ䇮ᶖ㒐ᄢቇᩞ䈻䈱⸘↹⊛ᵷ㆜䇮ㆡછ⠪ฬ★䈱ᚑ╬䈮䉋䉍䇮ᢇᕆ㓌ຬᢎ⢒ 䈱ᜰዉ⠪䈱⏕䇮ⷐ⺧䈮ദ䉄䉎䈖䈫䇯 䊶 ᢎ⢒䈱৻ㇱ䉕කᏧ╬䈱ᄖㇱ⻠Ꮷ䈮ଐ㗬䈜䉎႐ว䈮䈲䇮೨䈮⻠⠌䈱⿰ᣦ䇮䉦䊥䉨䊠䊤䊛䈱✬ᚑ䇮⻠⟵ౝኈ䈱⺞ ᢛ䇮ലᨐ᷹ቯ䈱ታᣉᣇᴺ╬䈮䈧䈇䈩චಽද⼏䉕ⴕ䈇䇮ᢎ⢒ലᨐ䈏䈏䉎䉋䈉㈩ᘦ䈜䉎䈫䈫䉅䈮䇮ᓟ䈮䉅䇮ฃ⻠⠪ 䈎䉌䈱ᗧ䇮ⷐᦸ╬䉕ෳ⠨䈮䈚䈩એᓟ䈱ᢎ⢒ᣇ㊎䈮䈧䈇䈩ᬌ⸛䈜䉎䈭䈬䈱ᣇ╷䉕⻠䈝䉎䈖䈫䈏ᦸ䉁䈚䈇䈖䈫䇯 䊶 ᶖ㒐ቇᩞ䈮䈍䈔䉎ᢇᕆ㓌ຬᢎ⢒䈱ലᨐ䉕䈕䉎䈢䉄䇮ታᛛ䇮⎇ⓥ䇮ⷞ⡬ⷡᢎ⢒╬䈱ᢎ⢒ᣇᴺ䉕䈪䈐䉎䈣䈔 ข䉍䉏䉎䈫䈫䉅䈮䇮䈖䉏䉌䈮↪䈇䉎ᢎ᧚․䈮ᔃ⢖䈠↢⸠✵↪ੱᒻ䈶ⷞ⡬ⷡᢎ᧚䈱⸘↹⊛ᢛ䈮ദ䉄䉎䈖䈫䇯 䊶 ㇺᐭ⋵䈮䈍䈇䈩䇮ᶖ㒐ቇᩞ䈮䈍䈔䉎ౣᢎ⢒䈫⡯႐䈮䈍䈔䉎ౣᢎ⢒䈫䈱ᓎഀಽᜂ䉕⏕䈮䈚䇮䈠䉏䈡䉏䈏⋧䉁䈦 䈩ലᨐ䉕䈕䉎䉋䈉㈩ᗧ䈜䉎䈖䈫䇯 䊶 ᶖ㒐ᧄㇱ䈏ⴕ䈉⡯႐䈮䈍䈔䉎ౣᢎ⢒̪̪䈮䈧䈇䈩䈲䇮ᢇᕆ㓌ຬ䈱⾗⾰䇮⢻ജ䇮ᢇᕆᖚ⠪䈱േะ╬䉕䈸䉁䈋䈩䇮ᢎ ⢒⋡ᮡ䉕⏕䈮䈚䇮ᐕ㑆ᢎ⢒⸘↹䉕䈢䈩䉎䈭䈬䈚䈩䇮Ⓧᭂ⊛䈎䈧⸘↹⊛䈮ታᣉ䈜䉎䈖䈫䇯䈖䈱႐ว䈮䈍䈇䈩䇮ㇺᐭ ⋵䈲䇮ዊⷙᮨᶖ㒐ᧄㇱ䈮䈍䈇䈩䉅ലᨐ⊛䈭ౣᢎ⢒䉕ⴕ䈉䈖䈫䈏䈪䈐䉎䉋䈉䈮䇮⻠Ꮷ䈲ᜰዉ⠪䈱ᢷᣓ䇮วห䈪ౣᢎ ⢒䉕ⴕ䈉႐ว䈱⺞ᢛ╬䈱ភ⟎䉕⻠䈝䉎䉋䈉ദ䉄䉎䈖䈫䇯 ̪̪ ᢇᕆᬺോታᣉၮḰ╙䋷᧦䈮ቯ䉄䉌䉏䈩䈇䉎ᢎ⢒⸠✵ 䊶 ᶖ㒐ቇᩞ䈏ⴕ䈉ౣᢎ⢒䈮䈧䈇䈩䈲䇮䈠䈱ᵄലᨐ䉕⠨ᘦ䈚䈩ᜰዉ⠪ⷐ⺧䉕㊀ὐ䈮ታᣉ䈜䈼䈐䈪䈅䉍䇮ᢇᕆ㓌ຬ䈱 ౣᢎ⢒⺖⒟䈏ᧂ⸳⟎䈱ᶖ㒐ቇᩞ䈮䈅䈦䈩䈲䇮䈠䈱⸳⟎䈮Ⓧᭂ⊛䈮ข䉍⚵䉃䈖䈫䇯 10 ᢇᕆ㓌䈱ᢎ⢒䈮䈧䈇䈩䋨䋳䋩 䂾 ᢇᕆ㓌ຬ⾗ᩰขᓧ⻠⠌䈠䈱ઁᢇᕆ㓌ຬ䈱ᢎ⢒⸠✵䈱లታᒝൻ䈮䈧䈇䈩 䋨ᐔᚑరᐕ䋵䋱䋸ᣣઃ䈔 ᶖ㒐ᢇ╙䋵䋳ภ䋩䋨ᛞ䋩 ╙䋲 છ䈱ᢇᕆ㓌ຬ䈮ኻ䈜䉎ᢎ⢒⸠✵㑐ଥ 䋲 ᶖ㒐ᯏ㑐䈮䈍䈇䈩䉅䇮ᧄㇱන䈲⟑ᚲන䈮ၮ␆⊛ᛛⴚ䈱ᓳ⠌ᾫ⸠✵䉇ᣣ䇱䈱ᢇᕆ᩺䉕ᵴ↪䈚䈢 ⎇ⓥ䉕ⴕ䈉䈭䈬䇮⡯႐䈱․ᕈ䉕䈇䈎䈚䈢ᢎ⢒⸠✵䈮ഃᗧ䈫Ꮏᄦ䉕䈖䉌䈚䇮䈠䈱Ⓧᭂ⊛䈎䈧⸘↹⊛䈭ታᣉ䈮ദ䉄䉎䈖䈫䇯 䋨ਛ⇛䋩 䋳 ᶖ㒐ቇᩞ䈶ᶖ㒐ᯏ㑐䈮䈍䈇䈩䈲䇮䈇䈮දജ䈚䇮ᐔ⚛䈎䉌䇮ᢇᕆ㓌ຬ䈱ᢎ⢒⸠✵䈮ଥ䉎⋧䈱ᓎഀಽᜂ䉇䈖 䉏䈮ၮ䈨䈒ᢎ⢒⸠✵䈱ౝኈ䇮ᣇᴺ╬䈮䈧䈇䈩ද⼏䉇ᗧ឵䈏䈪䈐䉎႐䈱⸳⟎䉕࿑䉍䇮䈠䉏䈡䉏䈏⋧䉁䈦䈩ో䈫 䈚䈩ᢛวᕈ䈱䈫䉏䈢♽⊛䈭ᢎ⢒⸠✵䈏ലᨐ⊛䈮ታᣉ᧪䉎䉋䈉ദ䉄䉎䈖䈫䇯 䂾 ᡷᱜᶖ㒐ᴺ 䋨ᤘ䋲䋳ᐕᴺᓞ╙䋱䋸䋶ภ䋩䋨ᐔᚑ䋲䋱ᐕ䋵䋱ᣣᡷᱜ䋩䋨ᛞ䋩 ╙䋳䋵᧦䈱䋵 䋲 ታᣉၮḰ䈮䈍䈇䈩䈲䇮ㇺᐭ⋵䈱ၞ䈲ක≮䉕ឭଏ䈜䉎䈱⁁ᴫ䉕⠨ᘦ䈚䈩ㇺᐭ⋵䈱ၞ䉕ಽ䈔䈩ቯ䉄䉎 ၞ䈗䈫䈮䇮ᰴ䈮ឝ䈕䉎㗄䉕ቯ䉄䉎䉅䈱䈫䈜䉎䇯 ৻ ்∛⠪䈱ᔃり╬䈱⁁ᴫ䋨એਅ䈖䈱㗄䈮䈍䈇䈩䇸்∛⠪䈱⁁ᴫ䇹䈫䈇䈉䇯䋩䈮ᔕ䈛䈢ㆡಾ䈭ක≮䈱ឭଏ䈏ⴕ䉒䉏䉎䈖 䈫䉕⏕䈜䉎䈢䉄䈮ක≮ᯏ㑐䉕ಽ㘃䈜䉎ၮḰ ੑ ೨ภ䈮ឝ䈕䉎ၮḰ䈮ၮ䈨䈐ಽ㘃䈘䉏䈢ක≮ᯏ㑐䈱ಽ䈶ᒰಽ䈮ᒰ䈜䉎ක≮ᯏ㑐䈱ฬ⒓ ਃ ᶖ㒐ᯏ㑐䈏்∛⠪䈱⁁ᴫ䉕⏕䈜䉎䈢䉄䈱ၮḰ ྾ ᶖ㒐ᯏ㑐䈏்∛⠪䈱៝ㅍ䉕ⴕ䈍䈉䈫䈜䉎ක≮ᯏ㑐䉕ㆬቯ䈜䉎䈢䉄䈱ၮḰ ᶖ㒐ᯏ㑐䈏்∛⠪䈱៝ㅍ䉕ⴕ䈍䈉䈫䈜䉎ක≮ᯏ㑐䈮ኻ䈚்∛⠪䈱⁁ᴫ䉕વ㆐䈜䉎䈢䉄䈱ၮḰ ೨ੑภ䈮ឝ䈕䉎䉅䈱䈱䈾䈎䇮்∛⠪䈱ฃ䉏䈮㑐䈜䉎ᶖ㒐ᯏ㑐䈫ක≮ᯏ㑐䈫䈱㑆䈱วᗧ䉕ᒻᚑ䈜䉎䈢䉄䈱ၮḰ 䈠䈱ઁ்∛⠪䈱ฃ䉏䉕ⴕ䈉ක≮ᯏ㑐䈱⏕䈮⾗䈜䉎㗄 ৾ ೨ฦภ䈮ឝ䈕䉎䉅䈱䈱䈾䈎䇮்∛⠪䈱៝ㅍ䈶்∛⠪䈱ฃ䉏䈱ታᣉ䈮㑐䈚ㇺᐭ⋵䈏ᔅⷐ䈫䉄䉎㗄 11 ෳ⠨䋺ᶖ㒐ᴺᡷᱜ ታᣉၮḰᔨ࿑ ٤ ᶖ㒐ᯏ㑐㧔ᢇᕆ㓌㧕 ٤ ක≮ᯏ㑐 ⏕㧔ⷰኤ㧕 ޣ㧟ޤ ㆬቯ ޣ㧠ޤ વ㆐ 㧔ฃᾖળ㧕 ޣ㧡ޤ ක≮ᯏ㑐 ࠬ࠻ ಽ㘃ಽߩ ⸳ቯ ޣ㧞ޤ ޣ㧝ޤ ޔ ޣ㧞ޤ ฃนุ ࿁╵╬ ฃක≮ᯏ㑐߇ㅦ߿߆ߦ ቯߒߥ႐วߩኻᔕ ޣ㧢ޤ ߘߩઁ ޣ㧢ޤ ޔ ޣ㧣ޤ ̪⇟ޣภޔߪޤฦၮḰࠍቯߡࠆᶖ㒐ᴺ╙㧟㧡᧦ߩ㧡╙㧞㗄ߩฦภࠍ␜ߔޕ ޣ㧝╙ޤ㧝ภ㧔ಽ㘃ၮḰ㧕 ்∛⠪ߩ⁁ᴫߦᔕߓߚಽ㘃ߩ╷ቯ ޣ㧞╙ޤ㧞ภ㧔ක≮ᯏ㑐ࠬ࠻㧕 ಽ㘃ߦᔕߓක≮ᯏ㑐ߩฬ⒓ࠍౕ⊛ߦ⸥タ ޣ㧟╙ޤ㧟ภ㧔ⷰኤၮḰ㧕 ்∛⠪ߩ⁁ᴫߩⷰኤߩၮḰ ޣ㧠╙ޤ㧠ภ㧔ㆬቯၮḰ㧕 ක≮ᯏ㑐ߩㆬቯߩၮḰ ޣ㧡╙ޤ㧡ภ㧔વ㆐ၮḰ㧕 ⷰኤߦၮߠߚ்∛⠪ߩ⁁ᴫߩવ㆐ߩၮḰ ޣ㧢╙ޤ㧢ภ㧔ฃක≮ᯏ㑐⏕ၮḰ㧕 ක≮ᯏ㑐ߩㆬቯ߇࿎㔍ߥ႐วߩኻᔕ ߘߩઁක≮ᯏ㑐ࠍ⏕ߔࠆߚߩၮḰ ޣ㧣╙ޤ㧣ภ㧔ߘߩઁၮḰ㧕 ߘߩઁᔅⷐߥၮḰ 12 ᢇᕆ㓌ຬ䈮䉋䉎ᔕᕆಣ⟎䈫ᢇᕆᢇ჻䈮䉋䉎ᢇᕆᢇಣ⟎ 丵㉄丩丱䷱个ᶧ䷚↪䶑䶫㕒⣂〝⏕䶺䶫䷍䶺ベᶧ 丵㘩㐽㎮ᑼ䷧䷡䷥䷦䷣䵿丨丩丱䷱䷡个丝䷸䷮䶿᳇ ▤ౝ一两丶丕䶷䷔䷗᳇⏕ 丵䷡丈丫三丩丱䷚↪䶑䶫⮎䶺ᛩਈ 丵♖⑼㗔ၞ䶺ಣ⟎ 丵ዊఽ⑼㗔ၞ䶺ಣ⟎ 丵↥ᇚੱ⑼㗔ၞ䶺ಣ⟎ 丵⥄Ꮖᵈ䶙น⢻䶶䷧专丌且丩丱䶷䷔䷗ ䷧专丌且丩丱ᛩਈ 丵ඨ⥄േᑼ㒰⚦േེ䶷䷔䷗㒰⚦േ 丵⡬⸻ེ䶺↪䶷䷔䷗ᔃ㖸丵ๆ㖸䶺⡬ข 丵ⴊ⸘䶺↪䶷䷔䷗ⴊ䶺᷹ቯ 丵ᔃ㔚⸘䶺↪䶷䷔䷗ᔃᜉേ䶺ⷰኤ䶿ᔃ㔚࿑વㅍ 丵㋢ሶ丵ๆᒁེ䶷䷔䷗ຜ㗡丵ჿ㐷ㇱ䶺⇣‛䶺㒰 丵⚻㥦䷧䷡䷥䷦䷣䶷䷔䷗᳇⏕ 丵丐个䷸䷩䷬䷶丠丶䷾丶䶷䷔䷗ⴊਛ㉄⚛㘻ᐲ䶺᷹ ቯ 丵䷶並丂䷮丐丱七䶺↪䶷䷔䷗ⴊ䶺ᜬ䶿ਅ⢇䶺 ࿕ቯ 丵⥄േᑼᔃ丝丂䷴丶䷷ེ䶺↪䶷䷔䷗ᄖᑼ⢷㛽 ㄼᔃ丝丂䷴丶䷷䶺ᣉⴕ 丵․ቯቛ≮ᴺ⛮⛯ਛ䶺்∛⠪䶺ಣ⟎䶺⛽ᜬ 丵ญ⣧ౝ䶺ๆᒁ 丵⚻ญ䷧䷡䷥䷧䷣䶷䷔䷗᳇⏕ 丵丏丂䷯丝䷸䷮䶷䷔䷗ੱᎿๆ 丵㉄⚛ๆེ䶷䷔䷗㉄⚛ᛩਈ 丵⥄േᑼ㒰⚦േེ䶷䷔䷗㒰⚦േ 丵↪ᚻᴺ䶷䷔䷗᳇⏕ 丵⢷㛽ㄼᔃ丝丂䷴丶䷷ 丵᳇็䶚ㄟ䷋ᴺ䶷䷔䷗ੱᎿๆ 丵ㄼᱛⴊ 丵㛽᛬䶺࿕ቯ 丵与䷣丟丩丂䷮ᴺ䶿⢛ㇱณᛂᴺ䶷䷔䷗⇣‛䶺㒰 丵᷷ 丵ᔅⷐ䶶䶺⛽ᜬ䵿㕒䶺⛽ᜬ䵿᷷ 䍃 丵ๆᢙ丵ᗧ⼂⁁ᘒ丵㗻⦡䶺ⷰኤ ⣂ᜉ 䂾ᢇᕆᢇ჻ᴺ ╙43᧦ ᢇᕆᢇ჻䈲䇮ஜᏧഥ↥Ꮷ⋴⼔Ꮷᴺ ╙31᧦╙䋱㗄䈶╙32᧦䈱ⷙቯ䈮䈎䈎䉒䉌䈝䇮⸻≮䈱ഥ䈫䈚䈩 ᢇᕆᢇಣ⟎䉕ⴕ䈉䈖䈫䉕ᬺ䈫䈜䉎䈖䈫䈏䈪䈐䉎䇯䋨䋲䋨⇛䋩䋩 ╙44᧦ ᢇᕆᢇ჻䈲䇮කᏧ䈱ౕ⊛䈭ᜰ␜䉕ฃ䈔䈭䈔䉏䈳䇮ෘ ↢ഭ⋭䈪ቯ䉄䉎ᢇᕆᢇಣ⟎䉕ⴕ䈦䈩䈲䈭䉌䈭䈇䇯 䋨䋲䋨⇛䋩䋩 䂾 ᶖ㒐ᴺ ╙䋲᧦╙䋹㗄 ᢇᕆᬺോ䈫䈲䇮䊶䊶䊶䋨ਛ⇛䋩䊶䊶䊶்∛⠪ 䈱䈉䈤䇮කോᯏ㑐䈠䈱ઁ䈱႐ᚲ䈻✕ᕆ䈮៝ㅍ䈜䉎ᔅⷐ䈏䈅䉎䉅 䈱䉕䇮ᢇᕆ㓌䈮䉋䈦䈩䇮ක≮ᯏ㑐䋨ෘ↢ഭ⋭䈪ቯ䉄䉎ක≮ ᯏ㑐䉕䈇䈉䇯䋩䈠䈱ઁ䈱႐ᚲ䈮៝ㅍ䈜䉎䈖䈫䋨்∛⠪䈏කᏧ䈱▤ ℂਅ䈮⟎䈎䉏䉎䉁䈪䈱㑆䈮䈍䈇䈩䇮✕ᕆ䉇䉃䉕ᓧ䈭䈇䉅䈱䈫䈚 䈩䇮ᔕᕆ䈱ᚻᒰ䉕ⴕ䈉䈖䈫䉕䉃䇯䋩䉕䈇䈉䇯 䂾ᢇᕆᬺോታᣉၮḰ 䂾ᢇᕆ㓌ຬ䈱ⴕ䈉ᔕᕆಣ⟎╬䈱ၮḰ කᏧ䈱ౕ⊛ ᜰ␜ 䋨․ቯⴕὑ䋩 කᏧ䈱൮⊛䈭ᜰ␜䋨ᢇᕆᢇ჻䋩 කᏧ䈮䉋䉎ᜰዉ䊶ഥ⸒䋨ᢇᕆ㓌ຬ䋩 ৻⥸ੱ䈪䉅น⢻ ᢇᕆᢇ჻䈏ታᣉน⢻䈭ಣ⟎ ᢇᕆ㓌ຬ䈏ታᣉน⢻䈭ಣ⟎ ෳ⠨䋺ᢇᕆ㓌䈱ᢎ⢒ᤨ㑆䈫ታᣉน⢻䈭ᔕᕆಣ⟎╬䈮䈧䈇䈩 ᢎ⢒ ᢇᕆ㓌ຬ 㪈 ᢇᕆ㸇⺖⒟ୃੌ⠪ ታᣉน⢻䈭ᔕᕆಣ⟎ 䊶⥄േᑼ㒰⚦േེ䈮䉋䉎㒰⚦േ 䊶↪ᚻᴺ䈮䉋䉎᳇⏕ 䊶⢷㛽ㄼᔃ䊙䉾䉰䊷䉳 䊶᳇็䈐ㄟ䉂ᴺ䈮䉋䉎ੱᎿๆ 䊶ㄼᱛⴊ 䊶㛽᛬䈱࿕ቯ ᶖ㒐ᯏ㑐䈮ዞ⡯ᓟ䈮ᶖ㒐ቇᩞ䈮䈍䈇䈩䇮 䊶䊊䉟䊛䊥䉾䉪ᴺ䈍䉋䈶⢛ㇱณᛂᴺ䈮䉋䉎⇣‛䈱㒰 䋱䋳䋵ᤨ㑆એ䈱ᢎ⢒䉕ฃ䈔䈢⠪ 䊶᷷䊶⣂ᜉ䊶ๆᢙ䊶ᗧ⼂⁁ᘒ䊶㗻⦡䈱ⷰኤ 䊶ᔅⷐ䈭䈱⛽ᜬ䇮㕒䈱⛽ᜬ䇮᷷ ⠨ ৻⥸ੱ䈪䉅ታᣉน⢻ 䊶ญ⣧ౝ䈱ๆᒁ 䊶⚻ญ䉣䉝䉡䉣䉟䈮䉋䉎᳇⏕ 䊶䊋䉾䉪䊶䊙䉴䉪䈮䉋䉎ੱᎿๆ 䊶㉄⚛ๆེ䈮䉋䉎㉄⚛ᛩਈ 䋱䈏ታᣉ᧪䉎ᔕᕆಣ⟎ ᢇᕆ㸈⺖⒟ୃੌ⠪ 㪉 ᢇᕆᮡḰ⺖⒟ୃੌ⠪ 㪊 ᢇᕆᢇ჻ ᶖ㒐ᯏ㑐䈮ዞ⡯ᓟ䈮ᶖ㒐ቇᩞ䈮䈍䈇䈩䇮 ᢇᕆ㸇⺖⒟䈱⾗ᩰ䉕䈜䉎䉅䈱䈏䇮䈘䉌 䊶⡬⸻ེ䈱↪䈮䉋䉎ᔃ㖸䊶ๆ㖸䈱⡬ข 䊶ⴊ⸘䈱↪䈮䉋䉎ⴊ䈱᷹ቯ 䈮䋱䋱䋵ᤨ㑆એ䈱ᢎ⢒䉕ฃ䈔䈢⠪ 䊶ᔃ㔚࿑䈱↪䈮䉋䉎ᔃᜉേ䈱ⷰኤ䈍䉋䈶ᔃ㔚࿑વㅍ 䊶㋢ሶ䊶ๆᒁེ䈮䉋䉎ຜ㗡䊶ჿ㐷ㇱ䈱⇣‛䈱㒰 䊶⚻㥦䉣䉝䉡䉣䉟䈮䉋䉎᳇䈱⏕ 䊶䊌䊦䉴䉥䉨䉲䊜䊷䉺䈮䉋䉎ⴊਛ㉄⚛㘻ᐲ䈱᷹ቯ ᶖ㒐ᯏ㑐䈮ዞ⡯ᓟ䈮ᶖ㒐ቇᩞ䈮䈍䈇䈩䇮 䊶䉲䊢䉾䉪䊶䊌䊮䉿䈱↪䈮䉋䉎ⴊ䈱ᜬ䈍䉋䈶ਅ⢇䈱࿕ቯ 䊶⥄േᑼᔃ䊙䉾䉰䊷䉳ེ䈱↪䈮䉋䉎⢷㛽ㄼᔃ䊙䉾䉰䊷䉳 䋲䋵䋰ᤨ㑆એ䈱ᢎ⢒䉕ฃ䈔䈢⠪ 䈱ᣉⴕ 䊶․ቯቛ≮ᴺ⛮⛯ਛ䈱்∛⠪䈱ಣ⟎䈱⛽ᜬ 㽲㩷䋲䈱⾗ᩰ䉕䈜䉎⠪䈏䇮䋵ᐕએ䉁䈢 䈲䋲䋬䋰䋰䋰ᤨ㑆એ䈱ᢇᕆᬺോ䈮ᓥ䈚 䈢ᓟ䇮㩷ෘ↢ഭ⋭䈏ᜰቯ䈜䉎ቇᩞ䈮䈍 䈇䈩䋸䋳䋵䌾䋱䋬䋰䋰䋰ᤨ㑆䈱㩷ᢇᕆᢇ჻ 㙃ᚑᚲ䈪䈱ᢎ⢒ 㩷 㽳ෘ↢ഭ⋭䈏ᜰቯ䈜䉎ኾ㐷ቇᩞ䊶ᄢቇ 㩿䋲䌾䋴ᐕ㪀 කᏧ䈮䉋䉎ᜰዉ䊶ഥ ⸒䋨ᢇᕆ㓌ຬ䋩 කᏧ䈱൮⊛䈭ᜰ ␜䋨ᢇᕆᢇ჻䋩 䋲䈏ታᣉ᧪䉎ᔕᕆಣ⟎ 䊶♖⑼㗔ၞ䈱ಣ⟎ 䊶ዊఽ⑼㗔ၞ䈱ಣ⟎ 䊶↥ᇚੱ⑼㗔ၞ䈱ಣ⟎ 䊶⥄Ꮖᵈ䈏น⢻䈭䉣䊏䊈䊐䊥䊮䋨䉝䊄䊧䊅䊥䊮䋩䈮䉋䉎䉣 䊏䊈䊐䊥䊮ᛩਈ 䊶ඨ⥄േᑼ㒰⚦േ䈮䉋䉎㒰⚦േ 䊶㉄䊥䊮䉭䊦ᶧ䉕↪䈇䈢㕒⣂〝⏕䈱䈢䉄䈱ャᶧ 䊶㘩㐽㎮ᑼ䉣䉝䉡䉢䉟䇮䊤䊥䊮䉭䉝䊦䊙䉴䉪䇮᳇▤ౝ䉼䊠䊷䊑 කᏧ䈱ౕ⊛ᜰ␜ 䈮䉋䉎᳇⏕ 䋨․ቯⴕὑ䋩 㽲䉁䈢䈲㽳䈱ᓟ䇮࿖ኅ⹜㛎䈮วᩰ䈚䈢⠪ 䊶䉝䊄䊧䊅䊥䊮䉕↪䈇䈢⮎䈱ᛩਈ 㸣 㶎䇮ᣂⷙ䈱ᢇᕆ㓌ຬ䈲ᢇᕆᮡḰ⺖⒟ୃੌ⠪䉁䈢䈲ᢇᕆᢇ჻ 14 ᢇᕆ㓌䈱ᢎ⢒ ᢇᕆᬺോ⻠⠌⺖⋡䋨ᢇᕆᮡḰ⺖⒟䋩 ᤨ㑆ᢙ ⑼䇭䇭䇭䇭䇭䇭䇭䇭䇭⋡ ᄢ ਛ ᢇᕆᬺോ䈱✚⺰䈶කቇ⺰ ᢇᕆᬺോ䈶ᢇᕆකቇ 䈱ၮ␆㫖㫖㫖㫖㫖 ᔕᕆಣ⟎䈱✚⺰㫖 ⸃೬䊶↢ℂ ␠ળ㓚䊶␠ળ 㪌 㪈㪇 ⷰኤ 㪉㪌 ᬌᩏ 㪈㪇 ᔕᕆಣ⟎✚⺰ 㪈㪇 ᔕᕆಣ⟎ฦ⺰ 㪉㪇 ᔃ⢖ᱛ 㪏 㪈㪇 䉲䊢䉾䉪䊶ᓴⅣਇో 㪌 ᗧ⼂㓚ኂ 㪌 ⴊ 㪌 ৻⥸ᄖ் ․ᱶ∛ᘒᔕᕆಣ⟎ 㪊㪇 ᢇᕆታോ䈶㑐ଥᴺⷙ ᢇᕆක≮㩷䊶ἴኂක≮ ∛ᘒᔕᕆಣ⟎ 㪌 ᢎ⢒⸠✵╬䈮䉋䉎ౣᢎ⢒ 㪉㪌 㗡ㇱ䇮㗪ᬁ䋨㗪㜑䋩៊் 㪌 ᾲ்䇮㔚᠄∝ 㪊 ਛᲥ 㪊 ṃ᳓ 㪊 ⇣‛䋨᳇䊶ᶖൻ▤䋩 㪊 ዊఽ䇮ᣂ↢ఽ 㪌 㜞㦂⠪ 㪌 ↥ᇚੱ⑼∔ᖚ䊶↥ᦼ 㪌 ♖㓚ኂ 㪌 䈠䈱ઁ䈱ഃ்䈱ಣ⟎╬ 㪌 㪊㪌 ታ⠌䈶ⴕ ✚䇭䇭䇭䇭䇭䇭䇭䇭⸘ 㪉㪌㪇 15 ᢇᕆ㓌䈱ᢎ⢒⸠✵䈮䈧䈇䈩 䋨䋱䋩 ታᣉਥ 䊶 ᶖ㒐ᧄㇱ䋯ᶖ㒐ቇᩞ䋯䊜䊂䉞䉦䊦䉮䊮䊃䊨䊷䊦ද⼏ળ䋯ක≮ᯏ㑐 ╬ 䋨䋲䋩 ౝኈ 䊶 ㇱ㓌ㆇ↪䋯ᢇ䋯៝ㅍ䋯ゞౝ▤ℂ䋯ធㆄ䋯ⷰኤ䋯ᔕᕆಣ⟎ ╬ 䋨䋳䋩 ⹏ଔ⠪ 䊶 ᢇᕆᜰዉଥ䋯⼊㒐ᜂᒰ⠪䋯කᏧ ╬ 䋨䋴䋩 ⷙᮨ 䊶 ᣣᏱᬺോ䈱ਛ䈪䈱⸠✵䋯ᄢⷙᮨ⸠✵ ╬ 䋨䋵䋩 ᒻᘒ 䊶 ᐳቇ䋯ታ⠌䋯ੱᒻ⸠✵䋯࿑⸠✵䋯ታ⸠✵䋯ᓟᬌ⸽ ╬ 16 ᢇᕆ㓌䈱ᢎ⢒⸠✵䈱 䂾 ႐ᢎ⢒ 䊶 ᢇᕆ㓌㐳䊶ᢇᕆᜰዉଥ䈎䉌䈱ᜰዉ 䂾 ᓟᬌ⸽䊶∝ᬌ⸛ળ 䊶 ᶖ㒐ᧄㇱ䋯ක≮ᯏ㑐䋯䊜䊂䉞䉦䊦䉮䊮䊃䊨䊷䊦ද⼏ળ䋯ో࿖ᢇᕆ㓌ຬ䉲䊮䊘䉳䉡䊛 䂾 ੱᒻ䉇ᮨᡆᖚ⠪䉕䈦䈢⸠✵ 䊶 ᚻᛛ䈱⸠✵ 䊶 ⷰኤ䈱⸠✵ ෳ⠨䋺 OSCE䋨Objective Structured Clinical Examination䋻ቴⷰ⊛⥃ᐥ⢻ജ⹜㛎䋩 ᛛ⢻䊶ᘒᐲ䉕ቴⷰ⊛䈮⹏ଔ䈜䉎⥃ᐥ⢻ജ⹜㛎 䂾 ✚ว⸠✵ 䊶 ᄙᢙ்∛⠪⊒↢䉕ᗐቯ䈚䈢⸠✵䇮ἴኂ⸠✵䇮╬ ̪ ᄢⷙᮨ⸠✵䈱ਛ䈪䇮䊑䊤䉟䊮䊄䈪ታ⸠✵䉕ⴕ䈇䇮ᢇᕆᜂᒰ⠪䈣䈔䈪䈭䈒䇮⼊㒐 ᜂᒰ⠪䉇කᏧ╬䈱⹏ଔ䉕ታᣉ䈚䈩䈇䉎ᶖ㒐ᧄㇱ䈅䉍䇯 ෳ⠨䋺 䊜䊂䉞䉦䊦䊤䊥䊷 ක≮㑐ଥ⠪╬䈪✬䈘䉏䈢䉼䊷䊛䈪ᮨᡆᖚ⠪╬䈻䈱ኻᔕ 䈱ㆡಾᕈ䉇ㄦㅦᕈ䉕┹䈉 17 ෳ⠨䋺᳇▤ᝌ▤⹏ଔ ᳇ ▤ᝌ▤⹏ଔ 䊋䉾䉫䊶䊋䊦䊑䊶䊙䉴䉪 䇭↪ᚻ᳇⏕䈲ലᨐ⊛䈎 䇭䊙䉴䉪䊐䉞䉾䊃䈲⏕ታ䈎 䇭䊋䉾䉫䉕䈜ᒝ䈘䈲ㆡಾ䈎 䇭ๆ᳇ᤨ㑆䈮䋲⑽䈎䈔䈩䈇䉎䈎 䇭឵᳇⁁ᘒ䉕ᱜ䈚䈒ᛠី䈪䈐䈩䈇䉎䈎 ⇣‛㒰䈲ㆡಾ䈎 ౣ᳇⏕䈲ㆡಾ䈎 ᜰ␜ⷐ⺧䈱ౝኈ䈲ᱜ⏕䈎 ኅᣖ䈻䈱⺑䈲ㆡಾ䈎 ᳇▤ᝌ▤䊒䊨䊃䉮䊷䊦 䇭ో䈪⏕ታ䈮ᝌ▤䈪䈐䉎႐ᚲ䈻⒖േ䈚䈢䈎 䇭‛ຠ䈱Ḱ䈲ቢో䈎 䇭䇭༄㗡㏜ 䇭䇭᳇▤䉼䊠䊷䊑 䇭䇭䉴䉺䉟䊧䉾䊃 䇭䇭䉦䊐↪㪈㪇䌭䌬䉲䊥䊮䉳 䇭䇭⡬⸻ེ 䇭䇭᳇▤䉼䊠䊷䊑࿕ቯ↪ౕ 䇭䇭᳇▤䉼䊠䊷䊑⟎⏕↪ౕ 䇭༄㗡ዷ㐿䈫᳇▤ᝌ▤ 䇭䇭䉴䊆䉾䊐䉞䊮䉫䊘䉳䉲䊢䊮䈲ㆡಾ䈎 䇭䇭䌃䌐䌒ਛᢿ䈱䉺䉟䊚䊮䉫䈲ᱜ䈚䈇䈎 䇭䇭䉶䊥䉾䉪ᴺ䉕ᜰ␜䈚䈢䈎 䇭䇭㐿ญ䈲චಽ䈎 䇭䇭༄㗡㏜䈪⥠䈲චಽ䈮䉋䈔䉌䉏䈩䈇䉎䈎 䇭䇭༄㗡⬄䈱⏕䈲䈪䈐䈩䈇䉎䈎 䇭䇭ჿ㐷䈏䈬䉏䈒䉌䈇䈋䉎䈎ᛠី䈪䈐䈩䈇䉎䈎 㪰㪼㫊 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 㪥㫆 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䇭䇭ჿ㐷䈎䉌⋡䉕㔌䈘䈝᳇▤䉼䊠䊷䊑䉕ฃ䈔ข䈦䈢䈎 䇭䇭᳇▤䉼䊠䊷䊑䉕䉴䊛䊷䉵䈮ㅴ䉄䈩䈇䉎䈎 䇭䇭䉴䉺䉟䊧䉾䊃䉕ᛮ䈒䉺䉟䊚䊮䉫䈲ᱜ䈚䈇䈎 䇭䇭᳇▤䉼䊠䊷䊑䉕䈚䈦䈎䉍ᛠᜬ䈚䈩䈇䉎䈎 䇭䇭䉦䊐䈱䉣䉝䈲ᱜ䈚䈒䉏䈢䈎 䇭䇭᳇▤䉼䊠䊷䊑䈱ᷓ䈘䈲ㆡಾ䈎 䇭ᝌ▤⟎䈱⏕䈫࿕ቯ 䇭䇭䋵ὐ⡬⸻ᴺ䈱ᚻ㗅䈲ㆡಾ䈎 䇭䇭⢷㛽ㄼᔃ⤳䊙䉾䉰䊷䉳ౣ㐿䈱ᤨᦼ䈲ᱜ䈚䈇䈎 䇭䇭᳇▤䉼䊠䊷䊑ౝ䈱⚿㔺䈲⏕䈚䈢䈎 䇭䇭᳇▤䉼䊠䊷䊑䈱ᷓ䈘䈲ㆡಾ䈎࿕ቯ䈲ㆡಾ䈎 䇭䇭⟎⏕↪ౕ䈮䉋䉎ੑᰴ⏕䉕䈚䈢䈎 䇭ᝌ▤࿎㔍䈻䈱ኻᔕ 䇭䇭䌃䌐䌒䈱ਛᢿ䈲㪊㪇⑽એౝ䈪䈅䈦䈢䈎 䇭䇭ჿ㐷䈏䈋䈭䈇䈫䈐䈲䌃䌐䌒䈮ᚯ䈦䈢䈎 䇭䇭ჿ㐷䈏䈋䈮䈒䈇ᤨ䌂䌕䌒㪧ᴺ䉕⹜䉂䈢䈎 䇭䇭䉴䉺䉟䊧䉾䊃䈱ᦛ䈏䉍䉕Ꮏᄦ䈚䈢䈎 䇭䇭䋲࿁ᄬᢌ䈚䈢䈫䈐䈠䈱ઁ䈱᳇⏕ᴺ䈮䈚䈢䈎 䇭䇭㘩ᝌ▤䈣䈦䈢䈫䈐䈮䈜䈓䈮᳇䈨䈇䈢䈎 䇭䇭᳇▤䉼䊠䊷䊑䉕ᛮ䈚䈢䈫䈐ᩮ䈲ᱜ䈚䈎䈦䈢䈎 ᳇▤ᝌ▤ᓟ䈱䌃䌐䌒 䇭䊥䉱䊷䊋䊷䉕ઃ䈔䈩㪈㪇㪇䋦㉄⚛䈪឵᳇䈚䈩䈇䉎䈎 䇭䊋䉾䉫䉕䈜ᒝ䈘䈲ㆡಾ䈎 䇭ੱᎿๆ䈱࿁ᢙ䈲䋵⑽䈗䈫䈎 䇭ๆ᳇ᤨ㑆䈮䋲⑽䈎䈔䈩䈇䉎䈎 䇭⢷㛽ㄼᔃ⤳䊙䉾䉰䊷䉳䈫䈲㕖หᦼ䈎 ⥄Ꮖᔃᜉౣ㐿ᓟ䈱ੱᎿๆ 䇭ๆ࿁ᢙ䈲䋴䌾䋵⑽䈗䈫䈎 䇭⚻⊹⊛㉄⚛㘻ᐲ䉕䊝䊆䉺䊷䈚䈢䈎 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 䂔 㒰⚦േ䊶᳇▤ᝌ▤ ᢇᕆᢇ჻ᮡḰ䊁䉨䉴䊃ㅊ 18 ෳ⠨䋺᳇▤ᝌ▤䉲䊅䊥䉥䈱ታ ᝌ▤ੱᒻ䈮ኻ䈜䉎᳇▤ᝌ▤䈱ᚻᛛ䈮චಽ⠌ᾫ䈚䈢䉌䇮䉲䊅䊥䉥䉕↪䈇䈩᳇▤ ᝌ▤䊒䊨䊃䉮䊷䊦䈮ၮ䈨䈇䈢್ᢿ䈫᳇▤ᝌ▤ᚻᛛ䉕⛔ว䈚䈩ታ〣䈜䉎⸠✵䉕ⴕ 䈉䇯ᦨೋ䈱䈉䈤䈲䇮․ቯ䈱䉲䊅䊥䉥䉕ⷡ䈋䈩ᱜ⏕䈮ታᣉ䈜䉎䈖䈫䈏⋡ᮡ䈫䈭䉎䇯 ᣢ⍮䈱䉲䊅䊥䉥䉕㗴䈭䈒䈪䈐䉎䉋䈉䈮䈭䈦䈢䉌䇮䉟䊮䉴䊃䊤䉪䉺䊷䈮ᦨೋ䈱ᗐቯ 䈣䈔䉕ᢎ䈋䈩䉅䉌䈇䉲䊅䊥䉥䉕㐿ᆎ䈚䇮ᄌൻ䈜䉎䉲䊅䊥䉥䈮ኻᔕ䈚䈩ㆡಾ䈭ಣ⟎ 䉕ᣉⴕ䈜䉎⸠✵䉕ⴕ䈉䇯 䋨ਛ⇛䋩 ⹏ଔ䉕↪䈇䈩䇮䉲䊅䊥䉥ታᣉ⠪䉕⹏ଔ䈚䈩䇮ᡷༀ䈜䈼䈐ὐ䈮䈧䈇䈩䊐䉞䊷䊄 䊋䉾䉪䈜䉎䈖䈫䈏㊀ⷐ䈪䈅䉎䇯䈖䈱䉋䈉䈭ᚻᴺ䈮䉋䉍ᚑ❣䉕䈧䈔䉎䈖䈫䉕OSCE (Objective Structured Clinical Examination)䈫䈇䈉䇯䉲䊅䊥䉥䈱ㅴⴕᓎ䈪䈅䉎䉟䊮䉴 䊃䊤䉪䉺䊷䈫⹏ଔ⠪䈲છ䈜䉎䈖䈫䉅䈪䈐䉎䈏䇮ಽᜂ䈚䈢䈾䈉䈏䉋䉍ᱜ⏕䈭⹏ଔ䈏 น⢻䈫䈭䉎䇯 䇼䋱䇽 㪎㪇ᱦ䈱↵ᕈ䇯䊧䉴䊃䊤䊮䈪㘩ਛ䈮ๆ࿎㔍䈫䈭䉍ᢇᕆゞⷐ⺧䇯႐⌕ᤨ䇮ᔃ⢖ᱛ⁁ᘒ䈪ᔃ 㔚࿑䈲ή⣂ᕈ㔚᳇ᵴേ䇯䌃䌐䌒䉕㐿ᆎ䈜䉎䈏឵᳇ਇ⦟䇯༄㗡㏜䈮䉋䉎༄㗡ዷ㐿䇮䊙䉩䊦㋢ሶ䈪ຜ 㗡䈱⡺ 䉕㒰䈚឵᳇䈏น⢻䈫䈭䉎䇯⋥ㄭ䈱ක≮ᯏ㑐䉁䈪㪊㪇ಽ䈎䈎䉎䈱䈪ᜰ␜ⷐ⺧䈚䇮᳇▤ᝌ▤ 䈱ᜰ␜䉕ฃ䈔䉎䇯ᢇᕆゞౝኈᓟ䇮䈫䈒䈮㗴䈭䈒᳇▤ᝌ▤䉕ⴕ䈇឵᳇⦟ᅢ䈫䈭䉍ᜰዉක䈻ႎ๔䇮 ක≮ᯏ㑐䈻៝ㅍ㐿ᆎ䇮៝ㅍਛ䈮ᔃᜉ䈱䉂ౣ㐿䈚⢷㛽ㄼᔃ⤳䊙䉾䉰䊷䉳䉕ਛᱛ䈚䈢䇯 㒰⚦േ䊶᳇▤ᝌ▤ ᢇᕆᢇ჻ᮡḰ䊁䉨䉴䊃ㅊ 19 ෳ⠨䋺ᢇᕆᢇ჻䈮䉋䉎⮎ᛩਈ∛㒮ታ⠌㆐⋡ᮡ ᢇᕆᢇ჻䈱⮎ᛩਈ䈱ታᣉ䈱䈢䉄䈱⻠⠌䈶ታ⠌ⷐ㗔䈮䈧䈇䈩䋨ᐔᚑ17ᐕ䋳䋱䋰ᣣઃ䈔කᜰ⊒╙0310002ภ䋩 20 ᢎ⢒✵ᤨ╬䈮䈍䈔䉎䉼䉢䉾䉪㗄⋡䋨ᢇᕆᢇᎺ⎇ୃᚲ䋩 㶎ๆ䊶⣂ᜉ䈱⏕䈶᳇⏕ 㶎⢷㛽ㄼ ๆ䊶⣂ᜉ䈱⏕䈶᳇⏕ ᚻ䈱⟎䈲ᱜ⏕䈎 ╙䋵ᜰ䈏ਅ㗶䈮䈎䈎䈦䈩䈇䉎䈎 䊙䉴䉪䉕䈘䈋䉎ᜰ䈱⟎䈲ㆡಾ䈎 ਅ㗶ᚻᛛ䋨╙䋱ᜰ䉕ᡰὐ䋩䈲ㆡಾ䈎 ᜰవ䈱ᒁ䈐䈕䈲ㆡಾ䈎 ടᤨ䈮⣨䈲ု⋥䈮䈭䈦䈩䈇䉎䈎 ടᤨ䈮⢀䈲ᦛ䈏䈦䈩䈇䈭䈇䈎䋨ඨり䈱㊀䈲↪䈚䈩䈇䉎䈎䋩 ⣨䈱ᚯ䉍䋨ㄼ䈱⸃㒰䋩䈲ㆡಾ䈎 㗪ㇱㆊિዷ䈮䈭䈦䈩䈇䈭䈇䈎 䊥䉵䊛䈲䈰䋱䋰䋰࿁㪆ಽ䈎 ⢷ㇱ䈱േ䈐䈮ᵈⷞ䈚䈩䈇䉎䈎 ᷓ䈘䋴䋙䈎䉌䋵䋙䈮䈭䈦䈩䈇䉎䈎 㗪േ⣂⸅⍮▎ᚲ䈲ㆡಾ䈎 㶎㕒⣂〝⏕ 䉼䊞䊮䊋䊷䈱లႯ䈱ᣇᴺ䈫䉼䊞䊮䊋䊷లႯ㊂䋨⚂ඨಽ䋩䈲ㆡಾ䈎 㶎ੱᎿๆ ታᣉ⟎䈲ㆡಾ䈎䋨േ╬ᗧ⼂䈚䈩ᵈⷞ䈚䈩䈇䉎䈎䋩 ㅍ᳇ᤨ䈱䊥䊷䉪䈲䈭䈇䈎 䉣䉝ᛮ䈐䈲ㆡಾ䈎 㚟ⴊᏪ䈱ⵝ⌕䊶⸃䈲ㆡಾ䈎 ⓫ೝㇱ䋨ⴊ▤ⴕ䋩䉕⏕䈚䈢䈎 ⓫ೝㇱ䉕ᶖᲥ䈚䈢䈎 ㅍ᳇ᤨ⢷ㇱ䈱േ䈐䉕ᵈⷞ䈚䈩䈇䉎䈎 ⇐⟎㊎䈱ᜬ䈤ᣇ䈲ㆡಾ䈎 ⢷ㇱ䈱䈏⏕䈪䈐䉎චಽ䈭឵᳇㊂䈎 ⊹⤏䉕ᒁ䈦ᒛ䉎ᜰవ䈱⟎䈲ㆡಾ䈎 ㅍ᳇㊂䈲䈾䈿৻ቯ䈎䋨䋶࿁એ䋩 ⓫ೝⷺᐲ䈲ㆡಾ䈎䋨䈰㪈㪌䌾㪉㪇ᐲ䋩 ㅍ᳇䈱㑆㓒䈲৻ቯ䈎䋨䋶⑽䈮䋱࿁䋩 ⴊᶧ䈱䊋䉾䉪䊐䊨䊷䉕⏕䈚䈢ᓟ䇮⇐⟎㊎䈱ⷺᐲ䉕ᵻ䈒䈚䇮ᢙ䊚䊥䋨䋱䌾䋲䋘䋩ㅴ䉄䈢䈎 䊋䉾䉫䊙䉴䉪䈱㗻㕙䈻䈱䈚ઃ䈔䈲䈭䈇䈎 䊋䉾䉫䉕㣐ឞ䉂䈮䈚䈩ㅍ᳇䈚䈩䈇䈭䈇䈎 ᄖ╴ᝌ⋥೨䉁䈪䊁䊮䉲䊢䊮䉕䈎䈔䈩䈇䉎Უᜰ䉕േ䈎䈚䈩䈇䈭䈇䈎 ౝ╴䉕ᜬ䈚䇮ᄖ╴వ┵ㄼ䈶⟎䈲ㆡಾ䈎 ౝ╴䈱ᑄ᫈䈲ㆡᱜ䈎 ㅍ᳇䈲䈰䋱⑽䈎 䊋䉾䉫䈲᳓ᐔ䈮䈢䉏䈩䈇䉎䈎 䊤䉟䊮ធ⛯ᓟ䉪䊧䊮䊜䉕ో㐿䈚䇮Ṣਅ䈶⓫ೝㇱ䈎䉌䈱ṳ䉏╬䉕⏕䈚䈩䈇䉎䈎 Ᏹ䈮ో䈪ᷡẖ䈭ᠲ䉕ᔃ䈏䈔䈢䈎 21 ᢇᕆᢇ჻䈱ᵴ↪ ᢇᕆᢇ჻䈱ౣᢎ⢒䈮ଥ䉎∛㒮ታ⠌䋺 ∛㒮ታ⠌䈱⚦⋡䇸∛㒮ㆬቯ䈱䈢䉄䈱್ᢿ⢻ജ䇹 ∔ᖚ ᔅ㗇ઁⷡᚲ ૐᔃᜉ ᔃਇో 㝠ⴊ ᕆᕈ∝⟲ ᔃ╭㓚ኂ ᔃ㔚࿑⇣Ᏹ વዉ㓚ኂ 㗻㕙⚻㤗∽ Ꮍ∝⁁ ⣖තਛ ⣖ㅴ∝⁁ หⷞ ౕ⊛ಣ⟎ ⴊૐਅ ᧃ᪳ᓴⅣਇో ഥๆ䇭䇭䇭 㗪㕒⣂ᔶᒛ 䇭▤ℂ ⢷ㇱ⡬⸻䊤㖸 䊏䊮䉪䈱ᵃᴜ⁁∷ 䌓䌔⇣Ᏹ ᔃቶᕈਇᢛ⣂ ቶᕈਇᢛ⣂ ᚱቶ䊑䊨䉾䉪㸇ᐲ ᚱቶ䊑䊨䉾䉪㸈ᐲ ᚱቶ䊑䊨䉾䉪㸉ᐲ ᧃ᪳ᕈ䈫䈱 䊁䊮䊃∛ᄌ 䊁䊮䊃ਅ∛ᄌ ⷞᐥ∛ᄌ ㆇേ㤗∽ ⸒⺆㓚ኂ ⍓ሹਇห ỗ䈚䈇㗡∩ ỗ䈚䈇ཌྷฯ ▤ℂ䇭䇭䇭 䇭ㆊ឵᳇ 㜑⤑ೝỗ∝⁁ ᳇▤ᡰ⁜⓰ 㓚ኂ ⥌ᱫ⊛༎ᕷ ⢖⢩ᵹਇో ᕆᕈ⣻∝ ⣻⤑ೝỗ∝⁁ ᶋ⣲ 䉝䊅䊐䉞䊤䉨䉲䊷 ᄖ் ᳇㐽Ⴇ ഥๆ䇭䇭䇭 䇭▤ℂ䇭䇭 䇭䇭䉴䉪䉞䊷䉳 ⢖⢩ๆ㖸䈱ૐਅ 䊮䉫 ༥ჿ ๆ᳇ᑧ㐳 䂾 ᢇᕆᢇ჻䈫䈇䈉䈣䈔䈪䈭䈒䇮㜞ᐲ䈭ⷰ ኤജ䇮⥃ᯏᔕᄌ䈱್ᢿജ䇮⊛⏕䈭ᜰዉജ ╬䉕䉅䈦䈢䇮ᜰዉ⠪䈫䈚䈩䈱⢒ᚑ䉅ᔅⷐ䈫⠨ 䈋䉌䉏䉎䇯 ഥๆ ☼⤑ㇱ⣲⣘ ᳇▤ᡰ⁜⓰ ᓴⅣ⯯⣕ ⭄㤗∐ ૐ᷷ ṃ᳓ 㔚᠄䊶ᾲ் ਛᲥ ዊఽ⑼ᢇᕆ ∨ᡨ ↥ᇚੱ⑼ᢇᕆ ή᳇⢖ ᳇⢷ 〡∩ ╭ᕈ㒐ᓮ ⣺㔀㖸ᶖᄬ ᳇ᑧ㐳 ᳇䈱䊤㖸 䂾 ∛㒮ታ⠌╬䈪ᓧ䈢⍮䉕ᵴ䈎䈚䇮ᢇᕆ㓌 䈱⾰䈱ะ䈮䈇䈎䈮ㆶర䈪䈐䉎䈎䈏⺖㗴䇯 ▤ℂ ᷷ ಽᇂ䋨䋳䋩 䈠䈱ઁ↥ᇚੱ⑼ ᢇᕆ 䊐䊧䉟䊦䉼䉢䉴䊃 ⊹ਅ᳇⣲ ⣄㜑៊் ቇ䊶ഥ ᔃ䉺䊮䊘䊅䊷䊂 ✕ᒛᕈ᳇⢷ ᖚ㥏㖸 ᵈ䋨䋱䋩༄㗡ዷ㐿䈫䈲䇮༄㗡⬄⼱䈮༄㗡㏜䈱䊑䊧䊷䊄వ┵䉕ㅴ䈘䈞䈩༄㗡⬄䉕ᜬ䈤䈕䉎ⴕὑ䉕䈇䈉䇯 ᵈ䋨䋲䋩༄㗡ዷ㐿䈱䉂䈱ⴕὑ䈪䉅᳇▤ᝌ▤䈫ห᭽䈭㪠㪚䉕ᔅⷐ䈫䈜䉎䇯 ᵈ䋨䋳䋩ಽᇂታ⠌䈮䈲䇮ಽᇂ䈱ഥ䇮⢝⋚ಣ⟎䇮⤯Ꮺ⚿⚤䇮ᣂ↢ఽ䈱ๆ⹏ଔ䉕䉃 㐽Ⴇᕈ䉲䊢䉾䉪 22 ៝ㅍ䈶ฃ䉏䈱ታᣉၮḰ䈮䈍䈔䉎PDCA䉰䉟䉪䊦䈫ᢎ⢒⸠✵ Plan 䂾 ⸠✵⋡ᮡ䈱⸳ቯ ⁁䉕ᛠី䈚 ታᣉၮḰ䉕 ╷ቯ Act 䂾 ታᣉၮḰ䉕ᔨ㗡䈮⟎䈇䈢 ⸠✵䈱╷ቯ䇮ታᣉ Do ታᣉၮḰ䈱 ᡷༀ䊶ᔅⷐ䈭 ᗧౕ↳ ታᣉၮḰ䉕 ታⴕ Check ታᣉၮḰ䈱 ታᣉ⁁ᴫ䈱⺞ ᩏ䊶ಽᨆ䈮ၮ 䈨䈒⹏ଔ 䂾 ᡷༀ䈜䈼䈐ὐ╬䇮⺖㗴䈱 䋨ᓟᬌ⸽䋩 23 ்∛⠪䈱៝ㅍ䈫ฃ䉏䈮㑐䈜䉎⺞ᩏ䈮䈧䈇䈩 䇼ኻ ⽎䇽 㽲 ో࿖ ᔃ⢖ᯏ⢻ᱛ்∛⠪䉕ኻ⽎䈫䈚䈢⺞ᩏ ᢇᕆ៝ㅍ䈘䉏䈢ᔃ⢖ᯏ⢻ᱛ்∛⠪ 䋨㶎 ᣢሽ䈱䇸䉡䉿䉺䉟䊮᭽ᑼ䇹䈮ၮ䈨䈒⺞ᩏ䈮⺞ᩏ㗄⋡䉕ઃട䋩 㽳 ၞ䋨ᄢ㒋Ꮢ䇮႓Ꮢ䇮ᩔᧁ⋵ዊጊ䊶⧐⾐䋩 ⺞ᩏᯏ㑐ౝ䈮ᢇᕆ៝ㅍ䈘䉏䈢ో்∛⠪ 䇼ᦼ㑆䇽 㽲 ᐔᚑᐕᣣ㨪ᐔᚑᐕᣣ㧔੍ᓟ╬ߪ৻ࡨᓟ 㽳 ᐔᚑᐕᣣ㨪ᐔᚑᐕᣣ㧔੍ᓟ╬ߪ৻ㅳ㑆ᓟ㧕 䇼࿁⁁ᴫ䇽 㽲 㪈䉬੍ᓟ䉕䉄࿁ਛ䋨ᦨ⚳㪉㪈㪌ᣣ䋩 㽳 䊶 ᄢ㒋Ꮢ⚦⺞ᩏ 䊶 ᩔᧁ⋵ዊጊ䊶⧐⾐ ᶖ㒐ᯏ㑐 ⚂㪈㪊㪃㪊㪇㪇ઙ ක≮ᯏ㑐 ⚂ 㪎㪃㪍㪇㪇ઙ ᶖ㒐ᯏ㑐 ⚂ 㪎㪉㪇ઙ ක≮ᯏ㑐 ⚂ 㪏㪊㪇ઙ 24 24 ᔃ⢖ᯏ⢻ᱛ்∛⠪䉕ኻ⽎䈫䈚䈢⺞ᩏ 䌎䌯䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭⊒↢ᐕᣣ䇭䇭䇭䇭䇭ᐕ䇭䇭䇭䇭ᣣ㩷㩷㩷㩷ᕈ䇭䇭䂔↵䇭䂔ᅚ䇭䇭䇭ᐕ㦂 䇭䇭䇭㩷䌐䌁ㅪ៤䈱ή䇭㩷䇭䇭䇭䂔䈅䉍䇭䂔䈭䈚 ᢇᕆᢇ჻ਸ਼ゞ䇭䂔䈅䉍䇭䂔䈭䈚䇭䇭䇭කᏧ䈱ਸ਼ゞ䇭䂔䈅䉍䇭䂔䈭䈚䇭䇭䇭කᏧ䈱䋲ᰴᢇಣ⟎䇭䂔䈅䉍䇭䂔䈭䈚 䋱䋮ᔃᱛ䈱⋡᠄䇭 䇭䇭䂔㩷⋡᠄䇮䉁䈢䈲㖸䉕⡞䈇䈢䇭䇭䇭䇭䇭䇭ᤨ䇭䇭䇭ಽ 䇭䇭䂔㩷ኅᣖ䇭䇭䇭㩷䂔㩷䈠䈱ઁ䈱䊋䉟䉴䉺䊮䉻䊷䋨䂔ੱ䇭䂔ห䇭䂔ㅢⴕੱ䇭䂔䈠䈱ઁ䋩 䇭䇭䂔㩷ᶖ㒐㓌䇭䇭䂔㩷ᢇᕆ㓌䋨䂔ᢇᕆᢇ჻㓌䋩䇭 䇭䇭䂔㩷ᣢ䈮ᔃ⢖ᯏ⢻ᱛ䋨⊒ᤨ䋩 䋲䋮䊋䉟䉴䉺䊮䉻䊷䌃䌐䌒䇭䇭䂔㩷䈅䉍䇭䋨䂔ᔃ⤳䊙䉾䉰䊷䉳䇭䂔ੱᎿๆ䇭䂔Ꮢ᳃╬䈮䉋䉎㒰⚦േ䋩䇭䂔㩷䈭䈚䇭䇭䇭䇭 䇭䇭䊋䉟䉴䉺䊮䉻䊷䌃䌐䌒䉁䈢䈲Ꮢ᳃╬䈮䉋䉎㒰⚦േ㐿ᆎᤨೞ䇭䇭䇭䇭䇭ᤨ䇭䇭䇭ಽ䇭䇭䇭䂔⏕ቯ䇭䂔ផቯ䇭䂔ਇ 䇭䇭䂔㩷ญ㗡ᜰዉ䈅䉍 䋳䋮ೋᦼᔃ㔚࿑ᵄᒻ 䇭䇭䂔㩷䌖䌆䋨ᔃቶ⚦േ䋩䇭䇭䇭䇭䇭䂔㩷㪧㫌㫃㫊㪼㫃㪼㫊㫊㩷㪭㪫䋨ή⣂ᕈᔃቶ㗫ᜉ䋩㩷䇭䇭䇭䇭䂔㩷䌐䌅䌁䋨ή⣂ᕈ㔚᳇⊛ᵴേ䋩 䇭䇭䂔㩷ᔃ㕒ᱛ䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䂔㩷䈠䈱ઁ䋨䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䋩 䋴䋮ᢇᕆᢇಣ⟎╬䈱ౝኈ 䇭䇭䂔㩷㒰⚦േ䋨䂔ੑ⋧ᕈ䇭䂔න⋧ᕈ䋩䇭䇭䇭䇭ೋ࿁㒰⚦േታᣉᤨೞ䇭䇭䇭䇭䇭ᤨ䇭䇭䇭ಽ䇭ᣉⴕ࿁ᢙ䇭䇭䇭䇭䇭䇭䇭䇭࿁ 䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭ታᣉ⠪䇭䂔ᢇᕆᢇ჻䇭䂔ᢇᕆ㓌ຬ䇭䂔ᶖ㒐⡯ຬ䇭䂔䈠䈱ઁ 䇭䇭䂔㩷᳇⏕䇭䇭䇭䂔㩷․ቯⴕὑౕེ↪䋨䇭䂔䌌䌍䇭䇭䂔㘩㐽㎮ᑼ䉣䉝䉡䉢䉟䇭㩷䂔᳇▤ౝ䉼䊠䊷䊑䇭䋩䇭 䇭䇭䂔㩷㕒⣂〝⏕䇭 䇭䇭䂔㩷⮎ᛩਈ䇭䇭䇭䇭䇭ೋ࿁ᛩਈᤨೞ䇭䇭䇭䇭䇭ᤨ䇭䇭䇭ಽ䇭ᛩਈ࿁ᢙ䇭䇭䇭䇭䇭䇭䇭䇭࿁ 䋵䋮ᤨ㑆⚻ㆊ䇭䇭 ⷡ⍮䇭䇭䇭ᤨ䇭䇭䇭ಽ㩷⌕䇭䇭䇭ᤨ䇭䇭䇭ಽ䇭䇭ធ⸅䇭䇭䇭ᤨ䇭䇭䇭ಽ䇭䌃䌐䌒㐿ᆎ䇭䇭䇭ᤨ䇭䇭䇭ಽ䇭∛㒮ኈ䇭䇭䇭ᤨ䇭䇭䇭ಽ 䋶䋮ᔃᱛ䈱ផቯේ࿃ 䇭䇭䂔㩷ᔃේᕈ䋺䂔⏕ቯ䇭䂔㒰ᄖ⸻ᢿ䈮䉋䉎ᔃේᕈ ಣ⟎࿎㔍 ኾ㐷ᄖ කᏧਇ ೋ⸻ 䋨䈎䈎䉍䈧䈔 ක䈭䈚䋩 ℂ↱ਇ 䈠䈱ઁ ⸘ 䇭䇭䂔㩷㕖ᔃේᕈ䋺䂔⣖ⴊ▤㓚ኂ䇭䂔ๆེ♽∔ᖚ䇭䂔ᖡᕈ⣲≌䇭䂔ᄖ࿃ᕈ䇭䂔䈠䈱ઁ䋨䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䋩 䋷䋮ォᏫ䈶੍ᓟ 䊶∛㒮ኈ೨䈱ᔃᜉౣ㐿䇭䂔䈅䉍䇭䂔䈭䈚䇭ೋ࿁ᔃᜉౣ㐿ᤨೞ䇭䇭䇭䇭䇭ᤨ䇭䇭䇭ಽ 䇭䇭䂔 䋱䊱੍ᓟ䇭䋨࿁╵䋺䂔䈅䉍䇭䂔䈭䈚䋩 䇭䇭䂔 䋱䊱↢ሽ䇭䂔䇭䈅䉍䇭䂔䇭䈭䈚 䂾䇭⣖ᯏ⢻䉦䊁䉯䊥䊷䋨䌃䌐䌃䋩 䇭䇭䂔䇭 䇭 㪚㪧㪚㪈ᯏ⢻⦟ᅢ䇭䇭䇭䂔䇭 䇭 㪚㪧㪚㪉ਛ╬ᐲ㓚ኂ䇭䇭䇭䂔䇭 䇭 㪚㪧㪚㪊㜞ᐲ㓚ኂ 䇭䇭䂔䇭 䇭 㪚㪧㪚㪋ᤀ⌧䇭䇭䇭㩷㩷䇭䇭䂔䇭 䇭 㪚㪧㪚㪌ᱫ䇮䉅䈚䈒䈲⣖ᱫ 䂾䇭ోりᯏ⢻䉦䊁䉯䊥䊷䋨䌏䌐䌃䋩 䇭䇭䂔䇭 䇭 㪦㪧㪚㪈ᯏ⢻⦟ᅢ䇭䇭䇭䂔䇭 䇭 㪦㪧㪚㪉ਛ╬ᐲ㓚ኂ䇭䇭䇭䂔䇭 䇭 㪦㪧㪚㪊㜞ᐲ㓚ኂ 䇭䇭䂔䇭 䇭 㪦㪧㪚㪋䇭ᤀ⌧䇭䇭䇭䇭㩷㩷䂔䇭 䇭 㪦㪧㪚㪌䇭ᱫ䇮䉅䈚䈒䈲⣖ᱫ 䊔䉾䊄ḩᐥ 䋸䋮႐⊒ᤨ㑆䇭䇭䇭䇭䇭ᤨ䇭䇭䇭䇭ಽ䇭䋨ᢇᕆゞ䈏േ䈐䈚䈢ᤨ㑆䋩 䋹䋮ᾖળ࿁ᢙ㩷㩷㩷㩷㩷㩷䇭䇭䇭䇭䇭㩷㩷㩷㩷㩷䇭䇭䇭࿁䇭䋨䋱∛㒮䈮ⶄᢙ䈇ว䉒䈞䈢႐ว䉅䋱࿁Ფ䈮⸘䋩 㪈㪇䋮ฃ䈮⥋䉌䈭䈎䈦䈢ℂ↱䈗䈫䈱ઙᢙ ᚻⴚਛ䇮 ᖚ⠪ኻᔕਛ 㪈㪈䋮៝ㅍవක≮ᯏ㑐䇭䇭䇭䇭䇭䇭䇭ೋᦼ䇭䇭䇭䇭ੑᰴ䇭䇭䇭䇭ਃᰴ䇭䇭䇭䋨䂾䈪࿐䉃䋩 㪈㪉䋮ኅᣖ䈶㑐ଥ⠪䈏்∛⠪䈻䈱ᢇᕆᢇಣ⟎╬䉕ᦸ䉁䈭䈇ᣦ䇮⸒䉒䉏䈢᩺䇭䂔ᒰ䇭䇭䂔㕖ᒰ䇭 㪈㪊䋮ᱫᓟ⎬⋥䈲ᱫ⇼䈇╬䈏䈅䈦䈢᩺䇭䇭䇭䇭㩷㩷㩷䇭䇭䇭㩷㩷㩷䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭䇭㩷䇭䇭㩷䂔ᒰ䇭䇭䂔㕖ᒰ䇭 25 ᷝ䋱 ᢇᕆᢇ჻䈱 ᳇▤ᝌ▤䈮䈧䈇䈩 ᢇᕆᢇᎺ⎇ୃᚲ ┻ਛ䉉䈎䉍 ጊ৻ 䌁䌗䌓䈱ὐ䈫ᰳὐ ὐ ᰳὐ 䋱䋩 㗡㗖ㇱਛ㑆࿕ቯ䈪䇮 䋱䋩 ᝌ▤એᄖ䈱 ᝌ▤䈜䉎䈖䈫䈏䈪䈐䉎น⢻ᕈ ญ⣧ౝᠲ䈮䈲ਇㆡ 䋲䋩 ༄㗡㏜䈮䉋䉎᳇▤ᝌ▤䈮 Ყ䈼ᚻᛛ䈏ኈᤃ 䊶 ⇣‛㒰ᠲਇน⢻ 䊶 㘩ᝌ▤ᤨ䈱⏕ਇน 䋳䋩 ᝌ▤࿎㔍∝䈮ኻᔕน⢻ ∛㒮೨ᢇ⼔䈮䌁䌗䌓䈲↪䈪䈅䉎䇯 1 ᳇▤ᝌ▤∝ᢙ䋨2008ᐕ䋩 ർᎺᏒ ᐢፉᏒ ጟᏒ 䌔⋵᧲ㇱ 㪐㪏ਁ 㪈㪈㪎ਁ 㪈㪋㪋ਁ 㪉㪋㪅㪌ਁ 47,795 48,048 56,934 8,545 䌃䌐䌁ઙᢙ 852 761 841 250 ᢇᕆᢇ჻ᢙ 135 212 104 49 ᝌ▤ቯᢇᕆᢇ჻ᢙ 䋨ታ䋩 18 21 33 40 ᳇▤ᝌ▤∝ᢙ 11 25 58 100 ੱญ ᢇᕆേઙᢙ ቯᢇᕆᢇ჻ᢙ䈅䈢䉍䈱 䋱ᐕ㑆䈱᳇▤ᝌ▤∝ᢙ䈲䋱࿁એਅ 2 ᳇▤ᝌ▤ᢙ䈫㘩᳇⇣‛∝ᢙ䈱Ყセ ർᎺᏒ䋨ੱญ⚂ਁੱ䋩 2006ᐕ 2007ᐕ 2008ᐕ 45,238 46,040 46,795 䌃䌐䌁ઙᢙ 778 810 852 ᳇▤ᝌ▤∝ᢙ 䋲䋲 䋱2 11 㘩᳇⇣‛∝ᢙ 187 218 212 ᢇᕆേઙᢙ 3 㪈 㪇㪈 㪐 㪌ᱦ 㪏 㪌ᱦ 㪎 㪌ᱦ 㪍 㪌ᱦ 㪌 㪌ᱦ 㪋 㪌ᱦ 㪊 㪌ᱦ 㪉 㪌ᱦ 㪈 㪌ᱦ ᱦએ 㪐 㪈㪄 㪏 㪈㪄 㪎 㪈㪄 㪍 㪈㪄 㪌 㪈㪄 㪋 㪈㪄 㪊 㪈㪄 㪉 㪈㪄 㪈 㪈㪄 㪋㪌 㪋㪇 㪊㪌 㪊㪇 㪉㪌 㪉㪇 㪈㪌 㪈㪇 㪌 㪇 㪇 㪄㪌 ᐕ㦂㘩᳇⇣‛∝ᢙ䋺ർᎺᏒ 㪉㪇㪇㪏ᐕ 㪉㪇㪇㪎ᐕ 㪉㪇㪇㪍ᐕ 4 ⇣‛㒰䈮䈲༄㗡ዷ㐿䈲ᔅ㗇 㽲 ᳇▤ᝌ▤∝䉋䉍䉅⇣‛㒰䈱ᔅⷐ䈭 ∝ᢙ䈱ᣇ䈏䈲䉎䈎䈮ᄙ䈇䇯 㽳 ⇣‛䈲㜞㦂⠪䈫ᐜఽ䈮ᄙ䈇䇯 㜞㦂ൻ䈏ㅴ䉃␠ળ䈪䈲 ༄㗡ዷ㐿ᚻᛛ䈏ή↪䈮䈭䉎䈖䈫䈲䈭䈒䇮 䉃䈚䉐↪䈪䈅䉎䇯 5 ጟ⋵ᐔᚑ 20ᐕᐲᝌ▤ታ⠌ ᢇᕆᢇ჻ 21ฬ 11∛㒮 䋱䋩␠ળ⊛䈭㕙 ታ⠌ᦼ㑆 17䌾99ᣣ 䋨ᐔဋ 48.0ᣣ䋩 䋲䋩ታᛛ㕙 ታ⠌∝ᢙ 30䌾37 ∝ 䋨ᐔဋ 31.0 ∝䋩 IC ᣉⴕ∝ᢙ 37.6 ∝ IC หᗧ∝ᢙ 32.4 ∝ IC หᗧ₸ 89.2 䋦 ᚑഞ₸ 97.6 䋦 䋽 ᚑഞ∝䋯ታ⠌∝ 䋨 30 ∝ᚑഞ䈜䉎䉁䈪䈮 ᔅⷐ䈫䈚䈢∝ᢙ 31.0䋩 6 ᢇᕆᢇ჻䈱༄㗡㏜䈮䉋䉎᳇▤ᝌ▤ Learning Curve 7 ᳇▤ᝌ▤learning curve ኻ⽎䋺䊧䉳䊂䊮䊃 Konrad et al,1998.Anesth Analg 䋦䈱⠌ᾫᐲĺᔅⷐ 䋦䈱⠌ᾫᐲĺᔅⷐ 8 ↢䊝䊂䊦䈮䉋䉎䉲䊚䊠䊧䊷䉲䊢䊮ᢎ⢒䈱ലᨐ ↢䈮䉋䉎ታ⠌ 䉲䊚䊠䊧䊷䉲䊢䊮ᢎ⢒ 35 57 䋦䈱⠌ᾫ ĺ 䋦䈱⠌ᾫ ĺ ቇ⠌⠪ ᢇᕆᢇ჻䈱᳇▤ᝌ▤㪣㪼㪸㫉㫅㫀㫅㪾㩷㪺㫌㫉㫍㪼 㪇㪅㪐 㪇㪅㪏 㪇㪅㪎 㪇㪅㪍 ᚑഞ₸ ↢䊝䊂䊦ታ⠌ 䋫 කቇ⊛ᢎ⢒ 㪇㪅㪌 ┙䈤䈅䈏䉍䉕ㅦ䈒䈚䇮 ㆐ᤨ㑆䉕⍴❗䈜䉎 ┙䈤䈅䈏䉍䉕ㅦ䈒䈚䇮 㪇㪅㪋 㪇㪅㪊 㪇㪅㪉 ㆐ᤨ㑆䉕⍴❗䈜䉎 㪇㪅㪈 㪇 㪇 㪌 㪈㪇 㪈㪌 㪉㪇 ∝ᢙ 㪉㪌 㪊㪇 㪊㪌 9 10 11 12 13 14 15 ᷝ㧞 ∛㒮೨ᢇ⼔䈮䈍䈔䉎᳇▤ᝌ▤䈱 ోᕈ䈫⏕ታᕈ䈱ะ ⋵┙ᐢፉ∛㒮 ᢇᢇᕆ䉶䊮䉺䊷 ᬮ ⌀ੑ 7KHRXWRIKRVSLWDOHVRSKDJHDODQGHQGREURQFKLDO LQWXEDWLRQVSHUIRUPHGE\HPHUJHQF\SK\VLFLDQV Timmermann A, et al. Anesth Analg 2007; 104:619-23 䊶∛㒮೨ᢇ⼔䈮䈍䈔䉎᳇▤ᝌ▤ 㪈㪋㪐 䊶ᢇᕆೋ≮ක䈏᳇▤ᝌ▤ታᣉ 䊶 ⢖ᝌ▤䋺㪈㪇㪅㪎䋦䋬㘩ᝌ▤䋺㪍㪅㪎䋦 1 ᢇᕆ႐䈪䈱᳇ઃ䈎䉏䈭䈇㘩ᝌ▤ ᝌ▤ታᣉ⠪ ∝ᢙ 㘩ᝌ▤㩿㩼㪀 㪢㪸㫋㫑㩷㪼㫋㩷㪸㫃㪅㩷 䊌䊤䊜䊂䉞䉾䉪 㪈㪇㪏 㪈㪍㪅㪎 㪡㪼㫄㫄㪼㫋㫋 㪼㫋㩷㪸㫃㪅㩷 䊌䊤䊜䊂䉞䉾䉪 㪈㪇㪐 㪈㪈㪅㪐 㪡㫆㫅㪼㫊㩷㪼㫋㩷㪸㫃㪅㩷 䊌䊤䊜䊂䉞䉾䉪 㪉㪇㪏 㪌㪅㪏 㪪㫀㫃㫍㪼㫊㫋㫉㫀 㪼㫋㩷㪸㫃㪅㩷 䊌䊤䊜䊂䉞䉾䉪 㪈㪌㪊 㪐㪅㪇 ᢇᕆೋ≮ක 㪈㪋㪐 㪍㪅㪎 㪫㫀㫄㫄㪼㫉㫄㪸㫅㫅 㪼㫋㩷㪸㫃㪅 2 3UHKRVSLWDODLUZD\PDQDJHPHQW$SURVSHFWLYHHYDOXDWLRQ RIDQDHVWKHVLDWUDLQHGHPHUJHQF\SK\VLFLDQV Timmermann A, et al. Resuscitation 2006; 70:179-85 䊶∛㒮೨ᢇ⼔䈮䈍䈔䉎᳇▤ᝌ▤∝䋨㫅㪔㪈㪃㪈㪇㪍䋩 䊶㤗㈮⑼ක䋬ᢇᕆක䋬㓸ਛᴦ≮ක䈏᳇▤ᝌ▤ታᣉ 䊶㪛㪘㪤䋨㪛㫀㪽㪽㫀㪺㫌㫃㫋㩷㪘㫀㫉㫎㪸㫐㩷㪤㪸㫅㪸㪾㪼㫄㪼㫅㫋㪀䋺㪈㪋㪅㪏䋦 䊶㪚㫆㫉㫄㪸㪺㫂ಽ㘃 㪊ᐲએ䋺㪈㪐㪅㪉䋦 䊶䋳࿁એ䈱⹜ⴕ䋺㪋㪅㪊䋦 䊶᳇▤ᝌ▤ᄬᢌ䋺㪉䋦 3 3UHKRVSLWDODLUZD\PDQDJHPHQW$SURVSHFWLYHHYDOXDWLRQ RIDQDHVWKHVLDWUDLQHGHPHUJHQF\SK\VLFLDQV Timmermann A, et al. Resuscitation 2006; 70:179-85 4 3UHKRVSLWDODLUZD\PDQDJHPHQW$SURVSHFWLYHHYDOXDWLRQ RIDQDHVWKHVLDWUDLQHGHPHUJHQF\SK\VLFLDQV Timmermann A, et al. Resuscitation 2006; 70:179-85 5 Procedural experience with out-of-hospital endotracheal intubation. Wang HE, et al. Crit Care Med 2005; 33:1718-21 䊶☨࿖䋬䊕䊮䉲䊦䊋䊆䉝Ꮊ 䊶㪉㪇㪇㪊ᐕ㪈䌾㪈㪉 䊶∛㒮೨ᢇ⼔⠪䋺㪌㪃㪉㪋㪌ฬ 䊶∛㒮೨᳇▤ᝌ▤∝ᢙ䋺㪈㪈㪃㪋㪏㪋 䊶䋱ੱ䈅䈢䉍䈱᳇▤ᝌ▤∝ᢙ䋺㪈䋨ਛᄩ୯䋩 䊶᳇▤ᝌ▤∝ᢙ䈏㪉࿁એਅ䋾㪍㪎䋦 䊶᳇▤ᝌ▤∝䈭䈚䋾㪊㪐䋦 6 䉣䉝䊃䊤䉾䉪䋬䉣䉝䉡䉢䉟䉴䉮䊷䊒䋬 䊙䉾䉨䊮䊃䉾䉲䊠༄㗡㏜䈱Ყセ 䋭ᢇᕆᢇ჻䈮䉋䉎ᬌ⸛䋭 7 ኻ⽎ ᝌ▤ታᣉ⠪䋺᳇▤ᝌ▤ㅊട⻠⠌ਛ䈱ᢇᕆᢇ჻ 㪉㪍ฬ 䊙䊈䉨䊮䋺㪟㪼㪸㫉㫋㪪㫀㫄㫤㩷㪋㪇㪇㪇䋨㪣㪸㪼㫉㪻㪸㫃䋩 ᐥઔ⥁䋬䉴䊆䉾䊐䉞䊮䉫䊘䉳䉲䊢䊮 8 ᣇᴺ 䃂 㪘㪫㪨䈫㪘㪮㪪䈱ታᛛᜰዉ䋨䈠䈱ᓟ䈱✵⠌䈲છᗧ䋩 䃂 ታᛛᜰዉ䈱 ⠉ᣣ䋨೨ᦼ䋩 䈫 㪈ㅳ㑆ᓟ䋨ᓟᦼ䋩 䈮⹜㛎 䃂 㪘㪫㪨䋬㪘㪮㪪䋬㪤㪣䉕↪䈇䈩᳇▤ᝌ▤䋨ήὑ䈱㗅䋩 䃂 ᝌ▤ᤨ㑆 䊶㪫㪈䋺ౕེᝌ䌾ჿ㐷ⷞ 䊶㪫㪉䋺ౕེᝌ䌾䉦䊐䈱ჿ㐷ㅢㆊ 䊶㪫㪊䋺ౕེᝌ䌾⢷ㇳ 䃂 ᝌ▤䈱㔍ᤃᐲ䋺㪭㫀㫊㫌㪸㫃㩷㪘㫅㪸㫃㫆㪾㩷㪪㪺㪸㫃㪼䋨㪭㪘㪪䋩 䋨㪇䌾㪈㪇㪇㫄㫄䋺ኈᤃ䌾࿎㔍䋩 䃂 ฦౕེ䈱ᅢ䉂䈱㗅䋨ᓟᦼ⹜㛎⚳ੌᓟ䈮⺞ᩏ䋩 䃂 ⛔⸘䋺㪘㪥㪦㪭㪘䋬㪢㫉㫌㫊㫂㪸㫃㪄㪮㪸㫃㫃㫀㫊㩷㫋㪼㫊㫋䋬ኻᔕ䈱䈅䉎㫋 ᬌቯ 䋨㪧 㪓㪇㪅㪇㪌䉕ᗧ䋩 9 ᝌ▤ᤨ㑆䋨೨ᦼ䋩 㪌㪇 ATQ AWS ᝌ▤ᤨ㑆 㪋㪇 ML (mean㫧SD) 㪊㪇 㪉㪇 䋨⑽䋩 㪈㪇 㪇 T1 T2 䊶㪉࿁⋡䈱⹜ⴕ䈪ᚑഞ䈚䈢䉅䈱䈏㪘㪫㪨䋬㪘㪮㪪䈪ฦ㪈ฬ 䊶㪫㪉㪄䌔㪈䋬㪫㪊㪄㪫㪉䈮䈲ౕེ㑆䈮Ꮕ䉕䉄䈭䈎䈦䈢䋮 T3 P YV0/ 10 ᝌ▤ᤨ㑆䋨ᓟᦼ䋩 㪌㪇 ATQ AWS ᝌ▤ᤨ㑆 㪋㪇 ML (mean㫧SD) 㪊㪇 㪉㪇 䋨⑽䋩 㪈㪇 㪇 T1 T2 䊶䈜䈼䈩ೋ࿁⹜ⴕ䈪ᚑഞ 䊶T2-䌔1䋬T3-T2䈮䈲ౕེ㑆䈮Ꮕ䉕䉄䈭䈎䈦䈢䋮 T3 PP YV$:6 YV೨ᦼ 11 䈬䈱ㆊ⒟䈏ᄌൻ䈚䈢䈎䋿䋨೨䊶ᓟᦼᲧセ䋩 ౕེᝌ䌾ჿ㐷ⷞ 䋨㪫㪈䋩 㪊㪇 ჿ㐷ⷞ䌾䉼䊠䊷䊑ᝌ 䋨㪫㪉䋭㪫㪈䋩 㪊㪇 16 16 䉼䊠䊷䊑ᝌ䌾⢷ㇳ 䋨㪫㪊䋭㪫㪉䋩 㪊㪇 16 16 ⚻ㆊᤨ㑆 16 㪉㪇 㪉㪇 䋨⑽䋩 㪈㪈㪇 㪈㪇 㪈㪇 㪇 㪇 㪇 $74 $:6 0/ $74 䋨ฦౕེ䈱䉫䊤䊐 Ꮐ䋺೨ᦼ䋬ฝ䋺ᓟᦼ䋩 $:6 16 16 16 $74 $:6 0/ 㪉㪇 0/ P YV೨ᦼ 12 㔍ᤃᐲ ࿎㔍 㪈㪇㪇 ATQ AWS ML 㪏㪇 (mean㫧SD) 㪍㪇 VAS (mm) 㪋㪇 㪉㪇 ኈᤃ 㪇 ೨ᦼ ᓟᦼ P YV$740/P YV೨ᦼ 13 ᅢ䉂䈱㗅 ATQ AWS ML ᅢ 㪈 㗅 㪉 㪊 䋨ੱ䋩 ATQ AWS ML P $74YV$:6YV0/ 14 䉣䉝䊃䊤䉾䉪䋬䉣䉝䉡䉢䉟䉴䉮䊷䊒䋬 䊙䉾䉨䊮䊃䉾䉲䊠༄㗡㏜䈱Ყセ 䋭⎇ୃක䈮䉋䉎ᬌ⸛䋭 15 ኻ⽎ ᝌ▤ታᣉ⠪䋺᳇▤ᝌ▤䈱⥃ᐥ⚻㛎䈏䈭䈇ೋᦼ⎇ୃක㪉㪇ฬ ኻ⽎∝䋺⸥⎇ୃක䈏᳇▤ᝌ▤䉕ታᣉ䈜䉎ᚻⴚᖚ⠪㪊㪇㪇 㒰ᄖ∝䋺ⴚ೨䈮᳇▤ᝌ▤࿎㔍䈏੍᷹䈘䉏䈢∝ 16 ᣇᴺ 䃂 䊙䊈䉨䊮䈮䉋䉎೨✵⠌ 䃂 ⎇ୃක䈏㪤㪣䈪༄㗡ዷ㐿䈚䋬㪚㫆㫉㫄㪸㪺㫂ಽ㘃䉕⹏ଔ 䃂 ⎇ୃක䈏㪘㪫㪨䋬㪘㪮㪪䋬㪤㪣䈱䈇䈝䉏䈎䈪᳇▤ᝌ▤ታᣉ 䃂 ᳇▤ᝌ▤ᤨ㑆䋺ౕེᝌ䌾᳇▤䉼䊠䊷䊑䈱ჿ㐷ㅢㆊ 䃂 㪈㪉㪇⑽એ⚻ㆊ䈚䈢႐ว䈲䊙䉴䉪឵᳇ᓟ䈮ౣ⹜ⴕ 䃂 㪉࿁䈱⹜ⴕ䈪䉅᳇▤ᝌ▤䈪䈐䈭䈇႐ว䈲ਇน 䃂 ೋ࿁䈎䉌㪌࿁⋡䈱᳇▤ᝌ▤䈮䈧䈇䈩ᬌ⸛ 䃂 ᳇▤ᝌ▤䈱ᚑุ䋬⹜ⴕ࿁ᢙ䋬ᚲⷐᤨ㑆䋬ว૬∝䉕Ყセ 䃂 ⛔⸘䋺㪘㪥㪦㪭㪘䋬㪩㪼㫇㪼㪸㫋㪼㪻㩷㫄㪼㪸㫊㫌㫉㪼㩷㪘㪥㪦㪭㪘䋬㪢㫉㫌㫊㫂㪸㫃㪄㪮㪸㫃㫃㫀㫊㩷㫋㪼㫊㫋 䋨㪧 㪓㪇㪅㪇㪌䉕ᗧ䋩 17 ⚿ᨐ 㪘㪫㪨 㪘㪮㪪 㪤㪣 㩿㫅㪔㪈㪇㪇㪀 㩿㫅㪔㪈㪇㪇㪀 㩿㫅㪔㪈㪇㪇㪀 㪤㪣䈱㪚㫆㫉㫄㪸㪺㫂ಽ㘃 㪈 㪈 㪈 㪚㫆㫉㫄㪸㪺㫂ಽ㘃 㪈 㪈 㪈* 㪓㪇㪅㪇㪇㪇㪈 ᚑഞ₸䋨䋦䋩 㪏㪌 㪐㪏㪏 † 㪎㪏 㪓㪇㪅㪇㪇㪇㪈 ᐔဋ⹜ⴕ࿁ᢙ䋨࿁䋩 㪈㪅㪊 㪈㪅㪈㪈 † 㪈㪅㪊 㪇㪅㪇㪇㪇㪉 ᳇▤ᝌ▤ᤨ㑆䋨⑽䋩 㪏㪊㫧㪏㪉 㪋㪎㫧㪋㪎㪎 㪐㪋㫧㪐㪇 㪓㪇㪅㪇㪇㪇㪈 * YV YV$74$:6 † † YV$740/ Y 㪧୯ 㪇㪅㪍㪎 median䋬mean㫧SD ᖚ⠪⢛᥊䋺⟲㑆Ꮕ䈭䈚 18 ᚑഞ₸䈱⚻ᤨ⊛ᄌൻ 㪘㪫㪨 㪘㪮㪪 㪤㪣 㩿㩼㪀 㩿㩼㪀 㩿㩼㪀 㪈 㪏㪇 㪐㪌 * 㪍㪇 㪇㪅㪇㪉㪌 㪉 㪏㪇 㪈㪇㪇 㪏㪇 㪇㪅㪈㪇㪉 㪊 㪏㪌 㪈㪇㪇 㪏㪇 㪇㪅㪈㪉㪍 㪋 㪏㪌 㪐㪌 㪏㪌 㪇㪅㪌㪊㪎 㪌 㪐㪌 㪈㪇㪇 㪏㪌 㪇㪅㪈㪌㪐 Attempts 㪧୯ YV * YV0/ 19 ᳇▤ᝌ▤ᤨ㑆䈱Ყセ * P YV$740/ Intubation Time (sec) 㪉㪇㪇 㪈㪍㪇 㪈㪉㪇 㪏㪇 * 㪋㪇 㪇 ATQ AWS ML 20 ᳇▤ᝌ▤ᤨ㑆䈱⚻ᤨ⊛ᄌൻ Intubation Time (sec) 㪈㪋㪇 LS ATQ AWS 㪈㪉㪇 㪈㪇㪇 㪏㪇 * 㪍㪇 NS. 㪋㪇 㪉㪇 㪈 㪉 㪊 Attempts 㪋 㪌 * P YV0/ 21 ⹜ⴕ࿁ᢙ䈱Ყセ 㪘㪫㪨 㪘㪮㪪 㪤㪣 㩿㫅㪔㪈㪇㪇㪀 㩿㫅㪔㪈㪇㪇㪀 㩿㫅㪔㪈㪇㪇㪀 㪈࿁⋡䈪ᚑഞ 㪎㪋 㪐㪇 * 㪍㪍 㪉࿁⋡䈪ᚑഞ 㪈㪈 㪏* 㪈㪉 ਇᚑഞ 㪈㪌 㪉* 㪉㪉 *P YV$740/ 22 ว૬∝䈱Ყセ 㪘㪫㪨 㪘㪮㪪 㪤㪣 㪧୯ 㩿㫅㪔㪈㪇㪇㪀 㩿㫅㪔㪈㪇㪇㪀 㩿㫅㪔㪈㪇㪇㪀 㘩ᝌ▤ 㪌 㪈 㪋 㪇㪅㪉㪍 ⴊ 㪎 㪉 㪋 㪇㪅㪉㪉 ຜ㗡∩ 㪉㪍 㪉㪇 㪉㪊 㪇㪅㪍㪇 ༥ჿ 㪈㪋 㪈㪏 㪈㪊 㪇㪅㪌㪐 23 䉣䉝䉡䉢䉟䉴䉮䊷䊒䈱⠌ᾫᦛ✢䈱ᬌ⸛ 䋭㤗㈮⑼ኾ㐷ක䈫⎇ୃක䈱Ყセ䋭 24 ኻ⽎ ኻ⽎∝䋺ᛚ⻌䈱ᓧ䉌䉏䈢੍ቯᚻⴚᖚ⠪㪉㪌㪇 㒰ᄖ∝䋺ⴚ೨䈮᳇▤ᝌ▤࿎㔍䈏੍᷹䈘䉏䈢∝ ᝌ▤ታᣉ⠪䋺㪘㪮㪪䈱⥃ᐥ↪⚻㛎䈏䈭䈇කᏧ㪉㪌ฬ 䋨Macintosh༄㗡㏜䈮䉋䉎᳇▤ᝌ▤䈲⠌ᓧᷣ䉂䋩 㤗㈮⑼ኾ㐷ක㪈㪇ฬ 㪭㪪㪅 ⎇ୃක䋨ೋᦼ䋬ᓟᦼ䋩㪈㪌ฬ 25 ᣇᴺ 䃂 䊙䊈䉨䊮䈮䉋䉎㪘㪮㪪䈱೨✵⠌ 䃂 ฦⵍ㛎⠪䈏㪈㪇∝䈝䈧㪘㪮㪪䈮䉋䉍᳇▤ᝌ▤ታᣉ 䃂 ฦⵍ㛎⠪䈱㪈∝⋡䈎䉌㪈㪇∝⋡䉁䈪䉕ᬌ⸛ 䃂 ᬌ⸛㗄⋡䋺᳇▤ᝌ▤䈱ᚑุ ⹜ⴕ࿁ᢙ ᳇▤ᝌ▤ᤨ㑆䋨㪘㪮㪪ᝌ䌾᳇㪚㪦㪉ᬌ䋩 䃂 ⛔⸘ᬌ⸛䋺ኻᔕ䈱䈭䈇㫋ᬌቯ䋬㪤㪸㫅㫅㪄㪮㪿㫀㫋㫅㪼㫐㩷㫋㪼㫊㫋 䋨㪧 㪓㪇㪅㪇㪌䉕ᗧ䋩 26 ⚿ᨐ ⎇ୃක ᜰዉක 㩿㫅㪔㪈㪌㪇㪀 㩿㫅㪔㪈㪇㪇㪀 㤗㈮ᱧ䋨ᐕ䋩 㪇㪅㪉㫧㪇㪅㪊 㪐㪅㪎㫧㪌㪅㪈 㪓㪇㪅㪇㪇㪇㪈 ᚑഞ₸䋨䋦䋩 㪈㪇㪇 㪈㪇㪇 㪄 ⹜ⴕ࿁ᢙ䋨࿁䋩 㪈㪅㪈㫧㪇㪅㪊 㪈㪅㪇㫧㪇㪅㪉 㪇㪅㪇㪎 ᳇▤ᝌ▤ᤨ㑆䋨⑽䋩 㪋㪊㫧㪈㪏 㪋㪈㫧㪈㪏 㪇㪅㪋㪏 㪧୯ mean㫧SD 27 䉣䉝䉡䉢䉟䉴䉮䊷䊒䈱⠌ᾫᦛ✢ Intubation Time (sec) 㪏㪇 㪎㪇 㫄㪼㪸㫅㫧㪪㪛 㪍㪇 㪌㪇 䃂 䃂 䃂 䃂 䃂 䃂 㪋㪇 䃂 䃂 䃂 䃂 㪊㪇 㪉㪇 㪇 㪉 㪋 㪍 㪏 Cumulative Experience (n) 㪈㪇 28 ⠌ᾫᦛ✢䈱Ყセ Intubation Time (sec) 㪏㪇 Stuff Anesthesiologists 㪎㪇 㫄㪼㪸㫅㫧㪪㪛 㪍㪇 㪌㪇 䃂 䃂 䃂 䃂 䃂 㪋㪇 NS. 䃂 䃂 䃂 䃂 䃂 㪊㪇 㪉㪇 Residents 㪇 㪉 㪋 㪍 㪏 Cumulative Experience (n) 㪈㪇 29 ᳇▤ᡰ䊐䉜䉟䊋䊷ᝌ▤䈱⠌ᾫᦛ✢ Intubation Time (sec) 㪊㪇㪇 Johnson C, et al. J Clin Anesth 1989; 1:344-9 䊶䊧䉳䊂䊮䊃㪋ฬ 㪉㪋㪇 䊶䊐䉜䉟䊋䊷ᝌ▤ᧂ⚻㛎 㪈㪏㪇 㪈㪉㪇 㪍㪇 㪇 䂹䂹 䂹 䂹 䂹 䂹 䂹䂹䂹 䂹 㪈㪇 㪘㪮㪪䈱⠌ᾫᦛ✢ 䋨ᐢፉᄢቇ∛㒮䋬⎇ୃක㪈㪌ฬ䋩 㪉㪇 Cumulative Experience (n) 30 䊑䊤䊷䊄༄㗡㏜䈱⠌ᾫᦛ✢ Shulman GB, et al. Anesthesiology 2003; 98:615-20 Intubation Time (sec) 㤗㈮⑼ක 㪊㪍ฬ 䂹 䊎䊂䉥䉲䉴䊁䊛 㪈㪍ฬ 䂦 ⋥ⷞ 㪉㪇ฬ 䂹 䂹 䂹 䂹 …• 㪘㪮㪪䈱⠌ᾫᦛ✢ 䋨ᐢፉᄢቇ∛㒮䋬⎇ୃක㪈㪌ฬ䋩 䂹 䂹 ‥‧ 䃂 䂹 䂹 䂹 ‥• 31 ⚿⺰ 䉣䉝䉡䉢䉟䉴䉮䊷䊒䈱ዉ䈮䉋䉍䋬∛㒮೨ᢇ⼔ 䈮䈍䈔䉎᳇▤ᝌ▤䈱ోᕈ䈫⏕ታᕈ䉕ะ䈘 䈞䉎䈖䈫䈏ᦼᓙ䈪䈐䉎䋮 32 ᷝ䋳 ᢇ჻䈱ᜂ䈉ᓎഀ䈫ᢎ⢒ ᢇᕆᢇᎺ⎇ୃᚲ ┻ਛ䉉䈎䉍 ጊ৻ ⦟⾰䈎䈧ㆡಾ䈭ක≮䉕ឭଏ䈜䉎䈢䉄䈱 ∛㒮೨ᢇ⼔䈱ᓎഀ 䊶 ᖚ⠪䈏 䊶 ᯏ⢻䈮ᔕ䈛䈢ක≮ᯏ㑐䈪 䊶 ㆡಾ䈭ක≮䉕ฃ䈔䉌䉏䉎䉋䈉䈮 䊶 ⊒↢႐䈎䉌ㄦㅦ䈮៝ㅍ䈜䉎 䊶 ක≮䈱᥉䈶ะ 䊶 කᏧ䈱ᜰ␜䈱ਅ 䊶 ක≮㑐ଥ⠪䈫䈱ㅪ៤ All Rights reserved by K.Kohriyama 䇸ᢇᕆᢇಣ⟎䇹 䈱ታᣉ䋨ᬺ䋩 1 ᶖ㒐ᴺ䈱ᡷᱜ䈮䉋䉎 ㇺᐭ⋵䈱ද⼏ળ䈱ታᣉၮḰ䈮ၮ䈨䈒 ㆬቯ䈫៝ㅍ 䈮ᔅⷐ䈭䉅䈱䈲䇮 ᢇᕆ㓌䈱 㽲்∛⠪ⷰኤ⢻ജ 㽳ක≮ᯏ㑐䈮ኻ䈚்∛⠪䈱⁁ᴫ䈱ႎ๔⢻ജ 䉅䈤䉐䉖䈖䉏䈮ട䈋 ᢇᕆ႐䈍䉋䈶៝ㅍㅜਛ䈮䈍䈔䉎↢䈱ෂᯏ࿁ㆱ 䈮ኻᔕ䈚䈩ㆡಾ䈭ಣ⟎䉕ⴕ䈉⢻ജ䉅ᔅⷐ䈪䈅䉎䇯 2 ∛㒮೨ᢇ⼔䈪ᢇᕆᢇ჻䈏ᜂ䈉䋲䈧䈱ᓎഀ 䊚䊆䊄䉪䉺䊷 䈮䈅䉌䈝䋣䋣 කቇ⊛䈮⾰䈱㜞䈇䇸៝ㅍ䇹 㽲 ㆡಾ䈭៝ㅍవቯ 䋫 ㄦㅦ䈭⊒ 䊶 ⷰኤ 䊶 ක≮ᯏ㑐䈱ᯏ⢻ಽൻ All Rights reserved by K.Kohriyama 㽳 ∝⁁䈱⪺䈚䈇ᖡൻ㒐ᱛ ↢䈱ෂ㒾࿁ㆱ 䊶 䈖䉍䈋䉎ᘒ䈏ಽ䈎䉎 䊶 ᔅⷐ䈭ⷰኤ 䊶 ㆡಾ䈭ಣ⟎ 䊶 ක≮ᯏ㑐䈫䈱ㅪ៤ 3 ᢇᕆ㓌䈏ീᒝ䈜䈼䈐䈖䈫 㽲䌃䌐䌁ኻᔕ 㽳䌃䌐䌁䈮䈚䈭䈇䈢䉄䈱ኻᔕ 䉁䈪㽲䈮ኻ䈚䌂䌌䌓䊶㒰⚦േ䊶䉝䊄䊧䊅䊥䊮䊶᳇▤ᝌ ▤䈭䈬䈏ⴕ䉒䉏䈩䈐䈢䇯 䈏䇮䌁䌃䌓䊶㜞ᐲ䊑䊨䉾䉪䉕䉃ᓢ⣂䊶䉲䊢䉾䉪䊶ๆਇ ో䊶⣖තਛ䈭䈬䈱↢䈱ෂᯏ⊛⁁ᴫ䉕࿁ㆱ䈚䇮䌃䌐 䌁䈮䈚䈭䈇䈢䉄䈱ᢎ⢒䉅ᔅⷐ䇯 4 ᢇ჻䈮䉋䉎ⷰኤ • • • • • • ๆ ᓴⅣ ᔃ㔚࿑䊝䊆䉺䊷䈱ⷰኤ 䊐䉤䊷䉦䊦䊶䉰䉟䊮䈱ⷰኤ ᄖ்䈱ⷰኤ 䈠䈱ઁ䈱ઁⷡᚲ 5 ᢇᕆᢇ჻䈏ⴕ䈉ಣ⟎ • • • • • • • • • • ㉄⚛ᛩਈ ਅ㗶䈮䉋䉎᳇⏕ 䌂䌖䌍 䋨ഥๆ ੱᎿๆ䋩 ⚻㥦䊶⚻ญ䉣䉝䉡䉣䉟 ᷷䊶಄ළ ▤ℂ ⓸ᕷ䈱⸃㒰 ๆᒁ䊶༄㗡㏜ᠲ ో⣄ᩇ࿕ቯ ᳇䊂䊋䉟䉴䈮䉋䉎᳇⏕ ․ቯⴕὑ䋨㒰⚦േ䊶᳇▤ᝌ▤䊶䉝䊄䊧䊅䊥䊮ᛩਈ䊶㕒⣂〝⏕䋩 6 ㆱ䈔䉌䉏䈭䈇ၞセᏅ䋨ᮮ↰⃰䉋䉍䋩 䋨䋦䋩 䋨⑽䋩 100 1200 1000 80 800 60 600 40 400 20 200 20000 40000 60000 80000 100000 ៝ㅍઙᢙⷙᮨ䈫㒰⚦േታᣉ₸ 10000 20000 30000 40000 50000 ៝ㅍઙᢙⷙᮨ䈫㒰⚦േታᣉ䉁䈪䈱ᤨ㑆 7 ᕆᕈ∝⟲䈱ⷰኤ㗄⋡⚻㛎⁁ᴫ 䋭 ⚻㛎ᐕᢙ 䌖䌳 㓌៝ㅍઙᢙ 䋭 䋨䋦䋩 100 ో࿖ᐔဋ 1091ઙ䋯ᐕ 90 80 70 ⚻㛎ᐕᢙ 60 50 㓌៝ㅍઙᢙ 40 30 20 10 4 5 10 ᐕએ 1500 ઙએ 3䌾5ᐕ 500 䌾 1000 ઙ 3 5 䌾 10 ᐕ 1000 䌾 1500 ઙ All Rights reserved by K.Kohriyama 2 1䌾3ᐕ 100 䌾 500 ઙ 1 100 ઙએਅ 1 ᐕᧂḩ 0 8 ฦ∔ᖚ䈮䈍䈇䈩ᢇᕆᢇ჻䈏䇸ⷰኤ䈚䈢䈖䈫䈏䈅䉎䇹䈫 ታᗵ䈚䈩䈇䉎㑐ㅪ㗄⋡ ᕆᕈ∝⟲ ⣖තਛ ㊀∝༎ᕷ ᕆᕈ⣻∝ 䉝䊅䊐䉞䊤䉨䉲䊷 ᄖ் ૐ᷷ ṃ᳓ ዊఽ䈱ᕆᕈ∔ᖚ ಽᇂ 0 All Rights reserved by K.Kohriyama 20 40 60 80 100 䋨䋦䋩 9 㗪േ⣂⸅⍮ 21ᐕᐲ⮎ㅊട⻠⠌610ฬ ⸠✵೨ ⸠✵ᓟ 㪇㪅㪉㩼 㪈㪏㪅㪈㩼 㪏㪈㪅㪐㩼 วᩰ ਇวᩰ 㪐㪐㪅㪏㩼 วᩰ ਇวᩰ 10 ਅ㗶ᚻᛛ 21ᐕᐲ⮎ㅊട⻠⠌610ฬ ⸠✵೨ ⸠✵ᓟ 㪈㪅㪍㩼 㪈㪊㪅㪏㩼 㪐㪏㪅㪋㩼 วᩰ ਇวᩰ 㪏㪍㪅㪉㩼 วᩰ ਇวᩰ 11 䌂䌖䌍䈪⢷䈏䈏䉎䈣䈔䈱឵᳇㊂䈎 21ᐕᐲ⮎ㅊട⻠⠌610ฬ ⸠✵೨ ⸠✵ᓟ 㪇㪅㪌㩼 㪈㪐㪅㪍㩼 㪏㪇㪅㪋㩼 วᩰ ਇวᩰ 㪐㪐㪅㪌㩼 วᩰ ਇวᩰ 12 㕒⣂〝⏕ᚻᛛ 21ᐕᐲ⮎ㅊട⻠⠌610ฬ ⸠✵೨ ⸠✵ᓟ 㪉㪎㪅㪏㩼 㪈㪌㪅㪇㩼 㪏㪌㪅㪇㩼 㪎㪉㪅㪉㩼 วᩰ ਇวᩰ วᩰ ਇวᩰ 13 㽲 CPCR వヘ䈎䉌䈱ᜰዉ 䈅 䉍 䈭 䈚 ว ᩰ ਇวᩰ 20 15 68 97 వヘ䈎䉌䈱ᜰዉ䈱ലᕈ 䋽 All Rights reserved by K.Kohriyama 20 88 㬭 15 112 1.7 14 ↢䊝䊂䊦䈮䉋䉎䉲䊚䊠䊧䊷䉲䊢䊮ᢎ⢒䈱ലᨐ ↢䈮䉋䉎ታ⠌ 䉲䊚䊠䊧䊷䉲䊢䊮ᢎ⢒ 35 57 䋦䈱⠌ᾫ ĺ 䋦䈱⠌ᾫ ĺ ቇ⠌⠪ ᢇᕆᢇ჻䈱᳇▤ᝌ▤㪣㪼㪸㫉㫅㫀㫅㪾㩷㪺㫌㫉㫍㪼 㪇㪅㪐 㪇㪅㪏 㪇㪅㪎 㪇㪅㪍 ᚑഞ₸ ↢䊝䊂䊦ታ⠌ 䋫 කቇ⊛ᢎ⢒ 㪇㪅㪌 ┙䈤䈅䈏䉍䉕ㅦ䈒䈚䇮 ㆐ᤨ㑆䉕⍴❗䈜䉎 ┙䈤䈅䈏䉍䉕ㅦ䈒䈚䇮 㪇㪅㪋 㪇㪅㪊 㪇㪅㪉 ㆐ᤨ㑆䉕⍴❗䈜䉎 㪇㪅㪈 㪇 㪇 㪌 㪈㪇 㪈㪌 㪉㪇 ∝ᢙ 㪉㪌 㪊㪇 㪊㪌 15 ᢇᕆᢇ჻䈏ᦨૐ㒢り䈮䈧䈔䉎䈼䈐⍮⼂䈫ᛛ⢻ ᢇᕆᢇ჻ౣᢎ⢒䈱ኻ⽎∛ᘒ 䊶ᕆᕈ∝⟲ 䊶⣖තਛ 䊶㊀∝༎ᕷ 䊶ᕆᕈ⣻∝ 䊶ᄖ ் 䊶䉝䊅䊐䉞䊤䉨䉲䊷 䊶ૐ᷷ 䊶ṃ ᳓ 䊶ዊఽ䈱ᕆᕈ∔ᖚ 䊶ಽ ᇂ 䊶㔚᠄∝䇮ᾲ்䇮ਛᲥ ኻ10ਁੱᒰ䈢䉍䈱∔ᖚᱫ⠪ᢙ ᕆᕈᔃ╭᪪Ⴇ ⯯ⴊᕈᔃ∔ᖚ વዉ㓚ኂ ⣖᪪Ⴇ ⣖ౝⴊ 䈒䉅⤑ਅⴊ ༎ᕷ ㅢ ṃ᳓ ᾍ䊶Ἣἴ╬ ਛᲥ䊶ኂ‛⾰ᦑ㔺 㪉㪍㪍㪅㪐 㪊㪋㪅㪎 㪉㪋㪅㪐 㪈㪎㪅㪉 㪍㪇㪅㪌 㪉㪍㪅㪊 㪈㪈㪅㪊 㪉㪅㪇㩷 㪍㪅㪍 㪋㪅㪎 㪈㪅㪉 㪇㪅㪎 㰮㸔ᗻᖗ ⮒ᙷ 䉪䊝⤑ਅ ⴊ ⣖ౝⴊ 20000 18000 16000 14000 12000 10000 8000 6000 4000 2000 0 0 䋰䌾䋴 䋵䌾䋹 䋱䋰䌾䋱䋴 䋱䋵䌾䋱䋹 䋲䋰䌾䋲䋴 䋲䋵䌾䋲䋹 䋳䋰䌾䋳䋴 䋳䋵䌾䋳䋹 䋴䋰䌾䋴䋴 䋴䋵䌾䋴䋹 䋵䋰䌾䋵䋴 䋵䋵䌾䋵䋹 䋶䋰䌾䋶䋴 䋶䋵䌾䋶䋹 䋷䋰䌾䋷䋴 䋷䋵䌾䋷䋹 䋸䋰䌾䋸䋴 䋸䋵䌾䋸䋹 䋹䋰䌾䋹䋴 䋹䋵䌾䋹䋹 䋱䋰䋰䌾 䉧䊮 ⣖᪪Ⴇ 16 ᢇ჻䈱⸠✵ • ၮᧄ⸠✵ ฦᚲዻ䈮䈍䈔䉎ᡷༀ⸠✵ ਅ㗶 䌂䌖䌍䈮䉋䉎ഥๆ䊶ੱᎿๆ ⢷㛽ㄼ 㒰⚦േེ䈱↪ ో⣄ᩇ࿕ቯ䊶䉦䊤䊷䈱ⵝ⌕ ⇣‛㒰 ᳇▤ℂౕེ 㕒⣂〝⏕ ႎ๔ⷐ㗔 • 䉲䊚䊠䊧䊷䉲䊢䊮⸠✵ 䉲䊅䊥䉥䊃䊧䊷䊆䊮䉫 • ∛㒮ታ⠌ 䊄䉪䉺䊷䉦䊷╬หਸ਼ታ⠌ ၮᧄᚻᛛ䊶ಣ⟎ ∝⁁䈱ⷰኤ ⚻ㆊ • ႐ᵴേ䈱䊐䉞䊷䊄䊋䉾䉪 ᬌ⸽ ∝ᬌ⸛ળ 17 18 19 20 21 22 23 24 ᷝ㧠 䇺ᢇᕆ㓌ຬ䈱ౣᢎ⢒䉕䉄䈓䉎㗴䈮䈧䈇䈩䈱⚛ឬ䇻㩷 ᯅᧄ㓶ᄥ㇢ 㧝㧚 ߩ㗴 ޟౣᢎ⢒↢ޟ ݬ ޠᶦᢎ⢒ޠ 㧞㧚 㧟ߟߩ႐㕙ޠ 㧔Σ㧕ᢇᕆᢇ჻ߩ↢ᶦᢎ⢒ ၮḰࠍల⿷ߒߥࡠࠞ࡞࡞࡞ 㧔Τ㧕ᢇᕆ㓌ຬߩ↢ᶦᢎ⢒ Σ⺖⒟ޔΤ⺖⒟ޔᮡḰ⺖⒟ޔᢇᕆ⑼ ᢇᕆᢇ჻⮎ޔቯ㨪ޔ᳇▤ᝌ▤ቯ㨪⮎ޔ᳇▤ᝌ▤ቯ㨪 ⷰޟኤޟ ߣ ޠၮᧄ⊛ᚻᛛޠ 㧔Υ㧕 ࠍޠࠕ࠾ࡘࠫޟ߇ޠࠕ࠾ࠪޟ⢒ߡࠆ ᢇᕆᵴേ⥄ߦ߹ߟࠊࠆ࠙ࡂ࠙ࡁޟવᛚޠ 㗴⸃ജ㧩ޟ⍮ᕺޠ ⊛ࡌ࡞ 㧦 ᮮᵿᏒᶖ㒐᧲ޔ੩ᶖ㒐ᐡ╬ߢታᣉ ᶖ㒐ᧄㇱࠆߪද⼏ળਥߩ⎇ୃળ ⑳⊛ࡌ࡞ 㧦 ⥄ਥ⊛⎇ୃળ ቇⴚ⎇ⓥ ో࿖ㅪ⛊ળ 㧔ෳ⠨㧕 ᜕Ⓜޟᢇᕆ㓌ຬ⾗ᩰขᓧᓟߩౣᢎ⢒ߦߟߡޠᶖ㒐㒐ἴ 27 ภ㧔2009 ᐕ㧕 ᜕Ⓜޟᢇᕆ㓌ຬߩ⥄ਥ⊛⎇ୃળߩᔅⷐᕈ ࠕࠤ࡞࠲ࡇࠬࡎࡊޠ90 ภ 㧔2009 ᐕ㧕 ෳ⠨䋱 ᒙὐߪߎߎߛ㧍 㧙 ߎࠇ߆ࠄߩ∛㒮೨ᢇ⼔᭴▽ߩߚߦ 㧙 ᢇᕆᝄ⥝⽷࿅ᢇᕆᢇᎺ⎇ୃᚲ ฦ⥄ޔᚻᛛߦߟߡౕ⊛ߦ߇ߢ߈ߡߥߩ߆ࠍ߆ߩ⦟߫ࠇߔ߁ߤޔ ⸃⺑ߒߚߎߩޟᒙὐߪߎߎߛ㧍ࠍޠ㈩Ꮣߒ߹ߔޕ ᓟߩ⸠✵ࠍㅴߡߊਛߢ⾗ߩߎޔᢱࠍෳ⠨ߦ߈ߜࠎߣߒߚᚻᛛࠍりߦߟ ߌ∛ޔ㒮೨ᢇ⼔ߩ႐߳ࡈࠖ࠼ࡃ࠶ࠢߢ߈ࠆࠃ߁ฦ⃰ౝߢදജߒᣣ✵⸠ߩޘ ߦขࠅ⚵ࠎߢߊߛߐޕ 1 ᳇⏕䋨ਅ㗶ᴺ䋩㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 䊐䉜䊷䉴䊃䉮䊮䉺䉪䊃䋨කቇᦠ㒮䋩䉋䉍৻ㇱᛮ☴㩷 䋱㩷 ᚻᛛ䈱⟎䈨䈔㩷 䊶㩷 䊓䊦䉴䉬䉝䊒䊨䊋䉟䉻䊷䇮Ꮢ᳃ᢇഥ⠪䈱ਔᣇ䈏⍮䈦䈩䈍䈒䈼䈐㩷 䊶㩷 ↪ᚻ᳇⏕䈱ਛᔃ㩷 䊶㩷 ో䈩䈱ක≮ᓥ⠪䈮ᔅ㗇㩷 䋲㩷 䊘䉟䊮䊃㩷 䋨䋱䋩 㗪ㇱ䉕ᓟዮ䇮િዷ䈭䈒ⴕ䈉㩷 㹢㩷 㗡ㇱ䈱࿕ቯ䇮ታᣉ⠪䈱ᚻ䈱ቯ㩷 䋨䋲䋩 ਅ㗶䉕⏕ታ䈮㩷 㩷 ⸥䋲ὐ䈏ᱜ䈚䈒ⴕ䈋䉎䈖䈫䉕⺖㗴䈫䈜䉎䇯䈬䈱ᜰ䈪䈬䈖䉕ី䉎䈎╬䈲㗴䈪䈲䈭䈇䇯 䈠䉏䈲䇸ᚻᛛ䇹䈪䈲䈭䈒䇸䈍ᴺ䇹䈪䈅䉎䇯㩷 㽲㩷㩷 ਅ㗶ⷺ䉕䋨ਛᜰ䈪䋩䈧䈔䉎 ԙ Უᜰ䉕ਅ㗶䈮⟎䈒 Ԛ Უᜰ䈪㐿ญ 㽵 ਅ㗶䉕 ਅᱤ䉕ᱤ䉋䉍೨ᣇ 䈮⓭䈘䈞䉎 1 Ԝ ᒻ䉕⛽ᜬ䈚䈢䉁ਛᜰ䉕ዊᜰ䈮⟎឵ 㽷 䊙䉴䉪䉕㗻䈮ኒ⌕ ⋡䈮䈅䈢䉌䈭䈇䉋䈉䈮ᵈᗧ 㽸 Უᜰ䈫␜ᜰ䈪䊙䉴䉪䉕࿕ቯ ㅘ⓹䈮䉅ᵈᗧ䈞䉋 㽹 Უᜰ䇮␜ᜰ䇮ዊᜰ䈱䋳ὐ䈪ᜬ ਛᜰ䇮Ⅳᜰ䈲ਅ㗶㛽䉕シ䈒ᜬ 䋳㩷 ታᣉ䈱㓙䈱⏕㗄 㽲 ⢷ㇳ䈱േ䈐 ᩰ䈎䉌䉂䈩឵᳇㊂䈲ㆡಾ䈎䋿㩷 㹢㩷 ⢷ㇳ䈱േ䈐䇮䊋䉾䉫䈱឵᳇㊂ ᏀฝᏅ䋨⡬⸻䉅ታᣉ䋩 ๆ᳇䈲චಽ䈮䈘䉏䈢ᓟ䈮ⴕ䈦䈩䈇䉎䈎㩷 㩷 㩷 㩷 㩷 ⢷ㇳ䈱േ䈐 ๆ᳇ᤨ㑆䈫᳇ᤨ㑆䈱Ყ䈲䋿 㽳 ឵᳇࿁ᢙ 㽴 䊋䉾䉫䈱ᛶ᛫ 㽵 ㅘ⓹䈱⁁ᘒ ᳇䈮䈉䈒䉅䉍㩷 㩷 㩷 㩷 䊶㩷 ཌྷฯ䈱ή 1 ༄㩷 㗡㩷 ㏜㩷 ᠲ㩷 㩷 ⷐ㩷 㗔㩷 㫊㫅㫀㪽㪽㫀㫅㪾㩷㫇㫆㫊㫀㫋㫀㫆㫅 䈲ㆡಾ䈎㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㗡䈱㜞䈘䈲㊀ⷐ䈪䈜䇯⚂䋸䉶䊮䉼䇮ី䉍䈖䈹䈚䋱ಽ䈪䈜䇯㩷 㩷ᕁ䈦䈩䈇䉎䉋䉍㜞䈇䈎䉅䈚䉏䉁䈞䉖䇯㗡䉕ዋ䈚ᓟዮ䈚䉁䈚䈢 䈎䋿䈖䉏䈏ᱜ䈚䈇㩷 㫊㫅㫀㪽㪽㫀㫅㪾㩷㫇㫆㫊㫀㫋㫀㫆㫅㩷 䈪䈜䇯㩷 㩷 㩷 㩷 㩷 㐿ญ䈲චಽ䈎䋨䉪䊨䉴䊐䉞䊮䉧䊷ᴺ䋩㩷 㩷 㐿ญ䈲㐷ᱤ䈮⽶ᜂ䉕䈎䈔䈭䈇䉋䈉䈮䇮ਅ䈫䉅䈮䈪䈐䉎䈣䈔 ᅏᱤ䈮ᜰ䉕䈎䈔䉁䈜䇯㩷 ᦨ䉅㊀ⷐ䈭䊘䉟䊮䊃䈪䈜䇯䊑䊧䊷䊄䈲ᦛ䈏䈦䈩䈇䉁䈜䇯㩷 䊑䊧䊷䊄䈱ᝌⷺᐲ䈲ㆡಾ䈎䋨వ┵䈏⌀ਅ వ┵䈱䉦䊷䊑䈮䈠䈦䈩િ䈳䈚䈢✢䈏䇮ญ䈱㕙䈫 㪐㪇 ᐲ䈮䈭䉎䉋 䈉䈮⺞ᢛ䈚䉁䈜䇯ⷺᐲ䈏ᵻ䈇䈫䊑䊧䊷䊄䈲ญ⣧ౝ䈮ᵻ䈒䈚䈎 㩷 䉍䉁䈞䉖䇯㩷 䈮ะ䈇䈩䈇䉎䈎䋩㶎࿑ෳᾖ㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 䊑䊧䊷䊄䈱వ┵䉕ฝญⷺ䈎䉌ᝌ䈚䈩䈇䉎 ⷺᐲ䈲 䈎㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㪐㪇 ᐲ䈱䉁䉁ญ⣧ౝ䈮䊑䊧䊷䊄䉕ᝌ䈚䉁䈜䋨䊘䉟䊮䊃 䈲䈖䈖䈮䈅䉍䉁䈜䋩䇯⥠䉕ឃ䈜䉎䈢䉄䈮ฝญⷺ䈎䉌ᝌ䈚䉁 㩷 䈜䇯㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 ⥠䈲චಽ䈮Ꮐ䈻䉋䈔䉌䉏䈩䈇䉎䈎㩷 㩷 㩷 㩷 㩷 㩷 㩷 ༄㗡㏜䈮䈧䈇䈩䈇䉎䊧䊷䊦䋨Ḵ䋩䈲⥠䉕Ꮐ䈮䉋䈔䉎䈢䉄䈱䉅 䈱䈪䈜䇯㩷 䊑䊧䊷䊄䈲ᱜਛ䈮⟎䈚䈩䈇䉎䈎㩷 㩷㩷 䊑䊧䊷䊄䈱䉦䊷䊑䈮ᴪ䈦䈩ㅴ䉄䈩䈇䉎䈎㩷 㩷 䊑䊧䊷䊄䈏ญ⣧ౝ䈮䈦䈢䉌䇮䈖䈖䈎䉌䈲ᚻ㚂䉕䈦䈩༄㗡㏜ 䉕࿁ォ䈘䈞䉁䈜䇯⚿ᨐ⊛䈮䊑䊧䊷䊄䈲䉦䊷䊑䈮䈠䈦䈩ຜ㗡䈻 ㅴ䉖䈪䈇䈐䉁䈜䇯䈅䉎⒟ᐲ䈱ᷓ䈘䉁䈪৻᳇䈮ㅴ䉄䉁䈜䇯༄㗡 ⬄䈱ో䈏䈋䇮䈎䈧༄㗡⬄⼱䈮䈎䈎䉎ᚻ೨䈒䉌䈇䈏䊔䉴 䊃䊘䉳䉲䊢䊮䈪䈜䇯㩷 䊑䊧䊷䊄䈱వ┵䈲ᱜ䈚䈇⟎䈮䈅䉎䈎㩷 㩷 䋨ᵻ䈜䈑䇮ᷓ䈜䈑ਇน䋩㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 ༄㗡⬄⼱䉕䈧䈔䈢䉌䇮䈠䈖䈮䊑䊧䊷䊄䈱వ┵䉕ᱜ䈚䈒䈅䈩䉁 䈜䇯ᚻⴚቶ䈪䈱ᝌ▤ታ⠌䈱㓙䈮䈲ᔃ㔚࿑䊝䊆䉺䊷䈱㖸䈮ᵈ 㩷ᗧ䈚䈩䈒䈣䈘䈇䇯㩷 㩷 䊑䊧䊷䊄䈱వ┵䈎䉌⋡䉕㔌䈚䈩䈇䈭䈇䈎㩷 㩷㩷 䊊䊮䊄䊦䈱ゲ䈱ᣇะ䈻ജ䉕䉏䈩䈇䉎䈎㩷 㩷 䊊䊮䊄䊦䉕䈖䈰䈩䈲䈇䈔䉁䈞䉖䇯䊊䊮䊄䊦䈱ゲᣇะ䉕ᗧ⼂䈚 䈩䈠䈤䉌䈮ജ䉕䈇䉏䉁䈜䇯䉅䈦䈫䉅ෂ㒾䈭ᠲ䈪䈜䇯↢䈪䈲 㩷৻᳇䈮ᔃᜉᢙ䈏䈚䇮ⴊ䉅䈅䈏䉍䉁䈜䇯ㅒ䈮㒰⣂䈎䉌ᔃ㩷 ᱛ䈮⥋䉎䈖䈫䉅䈅䉍䉁䈜䇯ᢇᕆ㓌䈱ᄙ䈒䈲ੱᒻ䈪✵⠌䈚䈩䈇 䉎䈏䉉䈋䈮ജ䈏䉍䈜䈑䈩䈇䉁䈜䇯㩷 㗶ᱤ䉕䊑䊧䊷䊄䈱䈩䈖䈱ᡰὐ䈮䈚䈩䈇䈭 ೋᔃ⠪䈮䈅䉍䈏䈤䈪䈜䇯䊊䊮䊄䊦䈱ゲ䈱ᣇะ䈮ജ䉕䈇䉏䉎䈫 䈇䈎㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 หᤨ䈮䇮ᱤ䈮䈅䈢䈦䈩䈇䈭䈇䈎䉕චಽ䈮ᗧ⼂䈚䈩䈒䈣䈘䈇䇯㗡 㩷䈱⟎䈏ૐ䈇䈫䈉䉁䈒䈇䈐䉁䈞䉖䇯㩷 㩷 ⋡✢䈏ㄭ䈒䈭䈦䈩䈇䈭䈇䈎㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 ᕁ䉒䈝⋡✢䈏ญ䈱䈜䈓ㄭ䈒䈮䈇䈦䈩䈚䉁䈇䉁䈜䇯⋡✢䉕㔌䈚 㩷 Ᏹ䈮ో䈱㔓࿐᳇䉕ᗵ䈛䉏䉎䉋䈉䈮䈚䉁䈚䉊䈉䇯㩷 1 ཱྀ⭍ෆࣈ࣮ࣞࢻࢆᤄධࡍࡿ㝿ࠊ୍᪦Ṇࡉࡏࣈ࣮ࣞࢻࡢඛ➃ࡀཱྀ ⭍㍈ᑐࡋ࡚ᆶ┤࡛࠶ࡿࡇࢆ☜ㄆࡋ࡚ᤄධࡍࡿࠋ 1 㕒㩷 ⣂㩷 〝㩷 ⏕㩷 㩷 ⷐ㩷 㗔 㚟ⴊᏪ䈱ⵝ⌕䈲ㆡᱜ䈎㩷 ක≮ᯏ㑐䈪䈲ᖚ⠪䈱⊹⤏䉕䈲䈘䉁䈭䈇䉋䈉䈮᳇䉕䈧䈔䉁䈜䇯⑳䈲㚟ⴊᏪ䉕ⓨਛ䈪િ䈳䈚䈩䇮⥄ಽ䈱ᜰ䉕䋱ᧄ㩷 䈇䉏䈩䈒䈒䈦䈢ᓟ䈮䇮ᜰ䉕ᛮ䈇䈩䈇䉁䈜䇯㩷 ⓫ೝㇱ䋨ⴊ▤ⴕ䋩䉕⏕䈚䈢䈎㩷 ฝᔃᚱ䉋䉍ૐ䈇⟎䈪ត䈜䈼䈐䈪䈜䇯䈪䈐䉎䈣䈔䉁䈦䈜䈓䈭ⴊ▤䉕ㆬᛯ䈚䉁䈜䇯㩷 ⓫ೝㇱ䉕ᶖᲥ䈚䈢䈎㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 㩷 ⓫ೝㇱ䉕䉄䈢䉌⓫ೝㇱ䉕ਛᔃ䈮ᄖ䈮ะ䈎䈦䈩ዋ䈚ᐢ䉄䈮ᶖᲥ䈚䉁䈜䇯㩷 Ᏹ䈮ᷡẖᠲ䉕ᔃ䈏䈔䈢䈎㩷 䈱ਛ䈮䉎䉅䈱䈪䈜䇯⓫ೝㇱ䈏ᷡẖ䈪䈅䉎䈱䈲䉅䈤䉐䉖䇮ⴊᶧ䈱ᳪᨴ䈏ᦨዊ㒢䈮䈭䉎䉋䈉䈮Ḱ䈏䈪䈐㩷 䈩䈇䉎䈪䈚䉊䈉䈎䋿㩷 ⓫ೝⷺᐲ䈲ㆡᱜ䈎䋨䈰 㪈㪌䌾㪉㪇 ᐲ䋩㶎࿑㽳ෳᾖ㩷 ⓫ೝ䈱㓙䈮䈫䈩䉅㊀ⷐ䈭䈱䈲Ꮐⷫᜰ䈪⓫ೝㇱ䈱⊹⤏䈏േ䈎䈭䈇䉋䈉䈮ᚻ೨䈮シ䈒䈵䈦䈴䉎䈫䈖䉐䈪䈜䇯㩷 ᒙ䈜䈑䉎䈫⓫ೝ䈱㓙䈮ⴊ▤䈏േ䈐䉁䈜䈚䇮ᒝ䈜䈑䉎䈫ᔶᒛ䈏ᶖ䈋䈩䈚䉁䈇䉁䈜䇯⓫ೝ䈜䉎䈫䉄䈢䉌䇮⊹⤏䈱㩷 䈪䈐䉎䈣䈔ㄭ䈒䈪৻ᣤ㊎䉕ᱛ䉄䈩䇮䈠䉏䈎䉌⊹⤏䉕⓫ೝ䈚䉁䈜䇯䉉䈦䈒䉍䈜䈑䉎䈫⓫ೝ䈪䈐䈭䈇䈉䈋䈮ⴊ▤䈏㩷 ㅏ䈕䉁䈜䇯ฝᚻ䈏േ䈎䈭䈇䉋䈉䈮䈬䈖䈎䈮࿕ቯ䈚䈩䈇䉁䈜䈎䋿㩷 ⴊᶧ䈱䊋䉾䉪䊐䊨䊷䉕⏕䈚䈢ᓟ䇮⇐⟎㊎䈱ⷺᐲ䉕ᵻ䈒䈚䇮ᢙ䊚䊥㩿㪈䌾㪉 䊚䊥㪀ㅴ䉄䈢䈎㩷 䊋䉾䉪䊐䊨䊷䈏䈋䈮䈒䈇䈫䈖䉐䈪㊎䉕ᜬ䈦䈩䈇䉁䈞䉖䈎䋿㩷 ᄖ╴䈲ౝ╴䉋䉍ᢙ䊚䊥⍴䈒䈭䈦䈩䈇䉁䈜䇯ᢙ䊚䊥ㅴ䉄䉎䈱䈲ᄖ╴䉕ⴊ▤ౝ䈮䉏䉎䈢䉄䈪䈜䇯ⷺᐲ䈏ᷓ䈇䉁䉁䈣䈫㩷 ⴊ▤䉕⓭䈐ᛮ䈔䉁䈜䇯❫⚦䈭ᚻᛛ䈏ᦸ䉁䉏䉎䈫䈖䉐䈪䈜䇯㩷 ᄖ╴䈱ᩮర䉁䈪ᝌ䈚䈢䈎㩷 ౝ╴䉕ᜬ䈚䇮ᄖ╴వ┵ㄼ䉕䈚䈩䈇䉎䈎㩷 㩷 㩷 㶎࿑㽴ෳᾖ㩷 ᄖ╴వ┵䈲⊹⤏䈎䉌⸅䉏䉎䈖䈫䈏䈪䈐䉁䈜䇯䈚䈦䈎䉍⏕䈚䈢䉌䇮䈠䈱ዋ䈚వ┵䉕ㄼ䈚䉁䈜䇯䈖䉏䈪ㅒᵹ䈲㒖ᱛ㩷 䈪䈐䉁䈜䇯㩷 ౝ╴䈱ᑄ᫈䈲ㆡᱜ䈎㩷 ౝ╴㊎䉕ᛮ䈒೨䈮䇮ᔅ䈝ᑄ᫈႐ᚲ䉕⌒䈪⏕䈚䉁䈜䇯⏕䈪䈐䈢䉌ᛮ䈇䈩䈠䈖䈮ᝥ䈩䉁䈜䇯㩷 ᑄ᫈䈜䉎䈫䈐䈮䇮ਔ⣨䈏䉪䊨䉴䈜䉎䉋䈉䈭ⷐ㗔䈲ෂ㒾䉕䈉䈱䈪ᡷༀ䈏ᔅⷐ䈪䈜䇯㩷 䊤䉟䊮ធ⛯ᓟ䉪䊧䊮䊜䉕ో㐿䈚䇮Ṣਅ䈶⓫ೝㇱ䈎䉌䈱ṳ䉏╬䉕⏕䈚䈩䈇䉎䈎㩷 1 ᅗձ ࢳࣕࣥࣂ࣮ࡢὀពⅬ ᅗղ ✸่ࡢὀពⅬ Ⰻ࠸ ᝏ࠸ 㔪䛸ᣦ䛜ゐ䜜䛭䛖 䛺㊥㞳䛷䛿䛂₩䛃 䛺䛾䛰䟿 ␃⨨㔪ẕᣦࡀ᥋ゐࡋ₩࡞ࡿ㸟 Ⰻ࠸ ᅗճ ඛ➃ᅽ㏕ ゅᗘ 15ࢎ㹼 20r࡛✸่ ࢸࣥࢩࣙࣥࢆࡅࡿ᪉ྥ 1