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MINISTERUL
SNTII
AL REPUBLICII MOLDOVA

2009

A.

A.1. : ..........................................................................................5
A.2. ( 10): N10........................................................................................5
A.3. ....................................................................................................5
A.4. ..................................................................................................................5
A.5. : 2009.....................................................6
A.6. : 2011..................................................6
A.7. , ...............................................6
, ...................................6
A.8. , .....................................................................6
A.9. ............................................................................................8
B.

B.1. .......................................................................9
B.2. .................................10
B.3. ......................10
B.4. (, , ) ..........................11
C.1.

14

C.1.1. .................................14
C.1.2. ...............................15
C.2. ,

16

C.2.1. ........................................................................................16
C.2.2. ...............................................................................................................17
C.2.3. ..........................................................................17
C.2.4. ..................................................................................17
C.2.5. ..........................................................................................................18
C.2.5.1. ...................................................................................................................18
C.2.5.2. ....................................................................................18
C.2.5.3. .............................................................................20
C.2.5.4. ........................................................................................22
C.2.5.5. ..................................................................................22
C.2.5.6. ...................................................................23
2

C.2.5.7. ...................................................................................................................23
C.2.5.7.1. ...........................................................................23
C.2.5.7.2. .....................................................24
C.2.5.8. ...............................................................................27
C.2.5.9. .........................................................................27
C.2.5.10. ............................................................................28
C.2.6. .........................................................28
2.6.1. ..........................................................28
2.6.2. ......................................28
2.6.3. .........................................................................29
2.6.4. ...............................................................................................30
2.6.5. ....................................................................31
2.6.6. ...................................................................32
C.2.7. ...................................................................................................................33
D. ,

34
D.1. ..............................................................34
D.2. ..............................................34
D.3. - ..................................................................34
D.4. : (, )
(, , )......................................................35
E.

38

39

1. ....................................................................................39
2. .....................................................40
3.
, .................................................................41
4. .................................42
5. ......................43
Anexa 6. .....................................................43

44

HBs

-HBc
-HBs
-VHC
-VHD

K/DOQI

...

B
B
C
D
-

(Kidney Disease Outcome Quality Initiative)



-




-






(systemic inflammatory response
syndrome)
,
, ,




-


( ),


(, ).

. ,
,
.

, .
4

A.
A.1. :

:
1. ( );
2. - ;
3. (, );
4. ( 2)
( 2)
:
5. ( 13);
6. ( );
: .
:
7. (, , )
( ; ; , ,
1,2,3);
8.
(;
; );
9. K/DOQI, 2002;
10. .
:
, Escherichia coli
(), . B, .
, Staphylococcus
aureus (), . . . . . . II . (K/DOQI, 2002).
, .
(, ),
Enterococcus faecalis Citrobacter (),
. . . . .
(26.06.2008). (27.06.2008).
(27.06.2008). .
(30.06.2008). 2- , , .
. III . (K/DOQI, 2002).

A.2. ( 10): N10


A.3.

( );
(/ , );
(, , , );
(, , , );
, , , ,
.

A.4.


;
;
;
.
5

A.5. : 2009
A.6. : 2011
A.7. ,

,
,


;
,
,

;
, -, ,


,
,

,
/


A.8. ,


[9,19,42]. ( ), ,
.
[43]. (
)
[43,46].
, . ( ) ,
( 0,5 ) [42,46].
[19,46].
[43, 46].
.
[19,46].
[43].
( )
6

[43]. ,
.
() /
,
3- < 60 / / 1,73 2 3 (
) [19].
III [10,19]. ()
, . 140 mm Hg / . 90 mm Hg.
:
[19].
-
().
[19,40]. , 1
, .
( ) [19,38,40,46]
105 (
), 104 ( 5%
/ + ; ), 103
; ;
.
(, , ,
, ) [19,43].

/ / [5,12]. : .
(): 2 ( 1). +
[5,12]. : +
/ ( 2). : 2- / [12,41]. :
+ ( ),
[5,12].
( ): < 90 mm Hg < 70 mm Hg
40 mm Hg / 2
[5,12]. : ,
,
, [5,10,12].
1.

(1992, 2008) [1,5,10,12,41]

o
> 38,3 C < 36oC
90/

20/ /
PaCO2 32 mm Hg
12 x 109/
4 x 109/
> 10%

> 38,5 C < 35oC (,


) ( )
> 2 30
( ,
)
> 2
(
)
/
> 10%
o

2. SOFA(septic organ function alteration)(2000, 2008) [1,5,12]


/


70 mm Hg 90 mm Hg
40 mm Hg 2
1 ( N)
0,5 // 2N
44,2 /


( PaO2/FiO2) 250
() 2N ()34 /

( 2 ) .
100,000 x 109/ 50%

(3 ) 1,5 60
pH 7,3 BE 5,0 / 1,5 N

(> 7,7 /)

/ 2
. . 15 (, , )
: N , , ,
, pH , BE ,
; C , ,
, .
, 2008 .
SOFA (2008) (2008).

A.9.
,

[9,10,19].
( ),

.
, .
. 1,5 ,
. - 10 : 1 [16,19].
65 [16].
: , ,
, , , ,
[19,43,46]. Escherichia coli
(75-95%), Staphilococcus saprophyticus (5-20%),
Enterobacteriacea ( Klebsiella spp., Proteus spp.
Pseudomonas aeruginosa,
) [9,10,19,43].
- .
.
, , ,
1%. , 200,000 250,000
, [16,19,42].
.

, .
8

B.
B.1.
()
1.

C.2.2. C.2.3.

2.

C.2.2. C.2.3.

3
C.2.4
4.
C.2.5.1-C.2.5.5.
C.1.1.

5.
C 2.5.7.
C.1.1

6.
C. 2.5.6.
7.
C 2.5.9.
C.1.1.
8.
C. 2.5.7.1., C.2.5.10.
C.1.1.

()

( )

( 2),
( 6 7)

( 3)

( 7)

(
11,14,15),

( 4)


( 2 5)


( 6, 7,
1,2,3)

( 4)
( )

(
) ( 11, D.1.)
( 11,14,15)



( 7)




( C.1.1., 17, 18)


( C.1.1., 11,14,15)
( 12)
9

B.2. ( )
()
1.
C.2.5.
C.1.1.

2.
C 2.5.7.

3.

C. 2.5.6.

()


( )

( 6)
( 7, 1,2,3)



( ) ( 11,

D.1.)

B.3. (, , , )
()
I
1.

C.2.2. C.2.3.

2.

C.2.2. C.2.3.

3.
C.2.4

()
II

( )
III

( 2),
( 6 7)

( 3)

( 7)

(
11,14,15),

( 4)


( 2 5)

10

4.
C.2.5.1.-C.2.5.5.
C.1.1
I
5.
C 2.5.7.
C.1.1.

6.
C. 2.5.6.
7.
C 2.5.9.
C.1.1.
8.
C. 2.5.7.1., C.2.5.10.
C.1.1


( 6)

( 7, 1,2,3)
( 4)
( )
II
III


;

( 11, D.1.).

.

( 11,14,15, C.1.1.).

(
).
( 7).


;

( C.1.1., 17,18).

.
( C.1.1.,
11,14,15);
( 12).

B.4. (, , )

()
1.

C.2.2. C.2.3.

()

( )


( C.1.1.,
3,4,5,6, 8)
( 4)
( 9-15,
9-11)
11

2.

C. 2.5.5. C.2.5.7.

I
3.
C.2.5.1-C.2.5.5.,
C.2.7.

C.1.1 -C.1.2.

4.
C 2.5.7. C.2.7.
C.1.1 C.1.2.

;
;

,
.
II


/

( 13)


;
;

.


( 7);
( 8);
( 16).

III

( 6)
( 7)
( 4)
( 1,2,3)
,
( 1,8, 3,5,6),
( 13), ( 20-30)

( 4)
( )

,
( ) ( 11,
- D.1.)
( 10)
( 9)
( 9-15, 11)
( 10)
( 20),
( 21), ( 22),
( 23);
( 24-29, C.1.2.)

12

5.
C 2.5.9.
C.1.1.
6.

C.2.5.8.


( C.1.1., 17 18)

( 16)

13

C.1.
C.1.1.
, ,
-

( 6,7)
(tabelul 4)


( 2)

( 1 2) ;
(
),
( 2), ( 13)


/
/

. ;
./.

( 8,11)

.
. .


( 8,11)

( 10)


( 10)


( 12 13)

( 16)


( 11)

,
,

, ,
( 14 15, 12)

3 ( 18):
; ,

14

C.1.2.

( 27)
,
3


( 28,

-)

.
( I-II -)

.
( III-IV -)

( 11,29)

1

( 1,2,3)

( 2)

( 11,29)

+
antibioticoterapie + TC de control
( 11,27,29, 4)
[21,22,25]
: ,
, ,
, .
3-
(, ).

.
15

C.2. ,
C.2.1.
1. [9,10,19,39,40,42,46,50,54]
:
(
);
( 2) ( ,
).
:
;
;

(,
).
:
();
:
- ( );
- - ( );
- ;
- () ;
- () ( ).
:
- ;
- ;
- .
( 3):
;
;
.
:
:
- - (Escherichia coli, Proteus spp., Klebsiella pneumoniae,
Pseudomonas aeruginosa, Enterobacter, Citrobacter .);
- - (Staphylococcus spp., Streptococcus spp., Enterococcus spp.);
- .
;
;
, .
:
: 48
;
: 24 .
3. [5,12,14,41]

+
., ,

(= )
.

: /

16

C.2.2.
2. [9,10,19,38,40,42,46,50,54]

;
(,
, - , .)
(, ,
, , , );
: , .;
/ ;
(, ,
);
: , .

C.2.3.
3. [9,10,19,39,40,47,54]

;
( 5, 11);
( )
, , ,
. ;
.
;
, ;
;
(. );
( 14,
15).

4. [9,10,19,38,54]

( C.1.1.) /;
, ( 11)
;
,
(, ) ( 10);
( 14-15);
( 12).

C.2.4.
5. [9,10,19,39,40,54]

( 2);
( ) (, );
( ) ( 6
7) : ,
, ;
( )
( 6 7) , ,
, , .
17

C.2.5.
C.2.5.1.
6. [9,10,19,38,42,50,54]

( 2);
(, , , , ,
);
, (.
, ) /
;
,
.

(
).
(, , , , ,
, , , ,
) ( 1 2);
(, , ,
- , );

: , ( )
/ ;
, :
( 3), (
( 1 2)), .

C.2.5.2.

18

7. [9,10,19,39,46,54]
/
( 2);
( 2) ,
;
( ):
, , , ,
( );
: ,
,
, ,
( , / ),
(, ), ,
, ;
():
, , , , , , ,
( 1 2);
: (- ), ;
: () ( );
, ,
( , , ,
, ).

19

C.2.5.3.
4. [2,8,9,10,19,24,26,29,45,38,40,44,45,46,54]

( 5 / , 8 / ); (
,,
); ,
; (
, ); ,
( . );
( ); , ().
- , . ,
,
.
(> 80%) . ( 50%)
,
( 5%) .
3- ,

3- .

< 1 /,

.
,

( > 500 ).

, ,
,,
. , ,
( ).
, ( ), (), ,

(, ) ( ), , .
,,

( ), , , (
), (

), , ( ).
.

20

. ,
- .

, ,
.
,

AgHBs, anti-HBs, anti-VHC, anti-HBc IgG+M, anti-VHD ( ),


, ; Rh ( );
( )
.
.
, , , ,
(, ).
.

,
, ,

, K .
.
()
, ,
, ,
, ,
, (, , ,
.),
, ,
.
/ (. , ,

. .)
, ,

, ,
(, .)
. - ,
, , - ; ,
,
/ .
.. ( ). ..

/ .

, ,


,
: , , .
: O ,

21

C.2.5.4.
8. [2,8,19,24,26,29,39,44,48,50,54]

( 2);
( 6);
( 7);
( 4):
, ();
() / .
( 4).
:
: ,
, ,
, ,
(, , , .),
,
, ;
: ,
;
: ,
, ; .. , : ,
/ .
( ). ..
/ .

C.2.5.5.
5.
[19,29,38,39,42,54]


(3-5 )



(1-2 )


,

6.
[19,40,50]

3-




22

C.2.5.6.
7. [10,19,20,39,54]


/



/
,
(
: , .).
(

),
.
8. [12,19,20,38,51]




;
(.
.);
.

C.2.5.7.
C.2.5.7.1.
9. [9, 19,39,54]

= + (
, ) + ( 0,5 ).
5oC ( 25oC)
1oC ( 37oC) 0,5-1 /.
- 0,5-1,0 /.
(,
, ), ,
. ,
, , , ,
(, , , , ),
, , , , , , .
25-30 //, , 35 //,
.
1-1,2 //.
(0,8 //).
0,7-1,0 //, 1/3
( ).
4-5 //, .
( ).
3-5 / / .
(, , ).
. 0,5 x 3 / 400 ,
1-2 / .
23

10. [10,19,40,54]
/


( 17)


( C.1.1.)

( C.1.1.)
: .
+ 3
, , .

C.2.5.7.2.
9. [9,10,19,39,40]


( 10)
( 11)

,
( 12 13)
( 14)
( 15)
( ) ( 11)

( 12)
11. [10,12,20,41,51]


(, . , ,
, , .
0,9% 5%), (,
, ), (
), ( 11).

(), (. ), (),
().

40% + ( , 1 4
) + (2,4% - 200 ..) +
10% 5% + -
(, 1-2 x 3-4 /).
: /

10. [19,40,42,43,46,47]

( )
( C.1.1.);
(, .);
/ ( , -
);
,
( );
(, , ).
24

11. [10,12,19,36,38,39,41,47,54]
,
;
(, , ): 7-10 :
(500 x 2 /)
/ (160/800 x 2 /)
/ (500/125 x 3 /): .
:
PNA (, 3): 7-10 :
, (2- ): 1,0 x 4 / 1,0 x 4 /
1,0 x 4 / 200 200
0,9% 1,0 x 2 .
(, 3): 14 :
: 2,0 x 3-4 / 1,0 x 4
/ 1,0 x 4 / 1,0 x 2 /
1,0 x 2 / + 200 200
0,9% 0,25 x 3 / 3-5 / (
).
(, 3): 21 :
( / )
:
- 2,0 x 2 / 2,0 x 2 / + 200
400 200 0,9%;
- + 0,5 + 0,5 x 4 /;
- / 1000 / 200 x 4 / 2,0
x 2 / + 0,25 x 3 / 3-5 /.
:
- ():
, 0,5 - 1,0 200 0,9% x 2 /;
Pseudomonas aeruginosa: .. 4 / 0,5 x4 /
0,25x3 / +
(. + , 1000 + 200 ) x 4 /;
: 0,5% 100 x 2 /.
:
200 x 2 / 100 1 3 .

25

12. [9,10,19,38,47,54]
:
: 100 x 3 ;
0,5 x 3-4 /.
:
: 30 1 3- /,
10 x 2 /;
: 75 3 3- /,
50 x 3 /;
: 50% - 2 3-4- /.
:
: 50 1 3- /, 100 x 3 /.
.
13. [10,19,55]


3 ;
3
;
1-2 . (0,04) x 3 / ( );

: 2% - 2 x 3-4 /
../.. 0,2% - 1 .. x 3-4 / (-
).

14. [9,10,38,54]

.
( 2-3 ).
2-3 .
:
5% - 2 .. 200 500 0,9%
5%. 5-7-10 .
:
-, 0,4, 1 ./;
, 0,1, 1 . x 3 / ;
.
15. [7,10,32,38,54]

/ ;
10-14 ;
;
, ;
, ;
: , , .
: . ;
: Turiones Pini,
Gemmae Populi, Folium et Radix Althaea, Althaea rosea, Folium Betulae
26

12. [10,38,52,54]

;
;
;
;
;
/ .

(,
);
II (, );
(:
, );
(, ).

C.2.5.8.
16. [19,38,40,46,50]
(/ );
. (/ );
III-IV . ( );
V . ( );
(
);

;
,
( 8,11) , (+ 1 ) .

C.2.5.9.
17. [10,19,38,50]
( C.1.1.)
( C.1.1. C.1.2., 20-30)
( C.1.1., 9-15,
9-12):
( 9 10);
,
( 8,11);

( 9,
4, C.1.1.);
( C.1.1, 10);
(
);
3 ( 18)
.

27

18. 3 [19,38,40,54]
( 19);
/ (
2);
;
: , , /, , ;
: , ( ), ,
, / , K+, Na+, Ca2+;
: , , , .

C.2.5.10.
19. [9,19,38,47,50,54]
;
;
, ;

;
,
;
.

C.2.6.
2.6.1.
20. [17,27,54,55]

:
: 1 : 1 1 : 4 ;
Escherichia coli ( 50%), Klebsiella
pneumoniae, - , -
;
;

(, , )
/ , ;
( 50%)
.

, (
);
;
.

;

;
+ 25% ;
.

2.6.2.

28

21. [4,19,31,34,37,54]



;
;
3-5 ;
, ,
, ,
, .

:
, ;
,
;

.

;
( 11).
,
, III IV ,
.

2.6.3.

29

22. [11,13,19,30,35,36,53]
:
2% , 23% ;
;
, ,
, .
:
;
;
,
- ;

- ..
. 48-72
.
:
. :
. ;
(/ );
- (,
). ,
( + ) ()
I-III () (, ,
, );
, ,
/ (7 );

( 11) ( ).

2.6.4.
23. [10,18,19,23,49,54]

-
;
, ,
( ) (4-10) .

3 ;

.
;
, ,
.

;
: , III-IV ,
;

.
30

2.6.5.
24. . [15,20,28]

,

, ,
.
:
,
(90%) (75%), (
80-90%) ( 10-20%)
Escherichia coli Proteus mirabilis,
, ;
;
45-65 , : - 1 : 3-4.
25. . [2,33,44,48]

, , ,
2- ;
, :
, . (
, ). 50%
, ;
,
. ,
, . ;
..
( : ),
. 80%
: ,
, , ;

, (
-) 0 75 UH, 10 - 30 UH:
I ;
II . ;
III . ,
- - ( 20% )
.

31

26. [20,28,33]


(1-18% - );
.

;

( , .)

2.6.6.
27. [3,20,22]

, ,
/ .
,
. , ,
, 2- , ;
: E. coli, Kl.
pneumoniae, Aerobacter aerogenes, Proteus, Citrobacter, Enterobacter,
Acinetobacter, Pseudomonas aeruginosa, Streptococcus Faecalis, Salmonella;
(85%-96% );
: ,
, , , , .
50-60 , : - 1:1,8.
28. . [2,21,22,25,44,48]
,
. . 100%. - 40%;
, ,
.
. - .
;
: , , ,
, , .
40-60% ;

.
( -, ):
I ;
II ;
III A ;
III B ;
IV / .

32

29. [21,22,25]
C.1.2. ..
: III (.
, 2-4 /) (4 /)
( 0,4-0,8/ 2 ) (. 3-5
//, 1 ) (1 / 2 );
.
( ).
. 24 .
.
4-7 ;


.
.

C.2.7.
13. [9,10,19,20,38,40,42,46,50,54]

: -;
: ( ), ( ), ,
(),
();
: ,
, ;
: ()
,
(, ,
.);
: / ,
per arrosio.
:
( ), ,
, / / ;
( III .);
().

33

D. ,

D.1.

,
, , ,
.
:
: (. 30
, 10); (. 0,1% - 1
, , 2), e (. 1%1, , 5), (. 75 3 ,
, 5), ( 0,9%
5%, 500 , 2), (.
, 40 /, 10), , , (
).
:
D.2. / ;
.
:


:
: D.1
:
, , ,

-
34

:

( )
( )
, , ,
, , , .
:
: D.1.
: D.4. (
)
: D.4. (
)
: D.4.
: D.4.
: D.4.
:
- (, , , )
( , ,
)

-

35

:

( )
( :
, )
( )
,
:
, ;
( ) , , , ,
; , :
, , , , ;
( ) ; , : ,
, , ;
Rh , AgHBs, anti-HBs, antiVHC, anti-HBc IgG+M, anti-VHD, , ;
: - ; , :
,
;
- , ; , :
, , ,

(, )
:
-
- ( )
-
(, )
:
.. (
)

:
()

36

:
: D.1
:
: ( 1,0 )
( 1,0 )
: ( 0,5 1,0
) ( 0,5 1,0
)
: ( 500
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43


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46