C\u00e2u 1: Tr\u00ecnh b\u00e0y t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n b\u1eb1ng Glucose m\u00e1u ?<\/p>\n
A – Gi\u1ea3m glucose m\u00e1u:<\/p>\n
N\u1ed3ng \u0111\u1ed9 glucose m\u00e1u \u1edf ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng 0,8 \u2013 1,2 g\/l.<\/p>\n
Gi\u1ea3m glucose m\u00e1u khi n\u1ed3ng \u0111\u1ed9 d\u01b0\u1edbi 0,8g\/l.<\/p>\n
1. Nguy\u00ean nh\u00e2n:<\/p>\n
– Cung c\u1ea5p thi\u1ebfu : kh\u1ea9u ph\u1ea7n h\u1eb1ng ng\u00e0y thi\u1ebfu v\u1ec1 l\u01b0\u1ee3ng.<\/p>\n
– R\u1ed1i lo\u1ea1n kh\u1ea3 n\u0103ng h\u1ea5p thu glucid:<\/p>\n
+ thi\u1ebfu enzym ti\u00eau th\u1ee5 c\u1ee7a t\u1ee5y v\u00e0 ru\u1ed9t<\/p>\n
+ Gi\u1ea3m di\u1ec7n t\u00edch h\u1ea5p thu c\u1ee7a ru\u1ed9t: c\u1eaft \u0111o\u1ea1n ru\u1ed9t, t\u1eafc ru\u1ed9t, vi\u00eam ru\u1ed9t\u2026.<\/p>\n
+ Gi\u1ea3m qu\u00e1 tr\u00ecnh phosphoryl h\u00f3a \u1edf t\u1ebf b\u00e0o th\u00e0nh ru\u1ed9t: ng\u1ed9 \u0111\u1ed9c, vi\u00eam ru\u1ed9t m\u1ea1n t\u00ednh.<\/p>\n
+ Thi\u1ebfu b\u1ea9m sinh enzym galactose uridyl tranferase (ru\u1ed9t) n\u00ean galactose (\u0111\u01b0\u1eddng s\u1eefa) kh\u00f4ng \u0111\u01b0\u1ee3c chuy\u1ec3n th\u00e0nh glucose. Tr\u1ebb kh\u00f4ng ch\u1ecbu \u0111\u01b0\u1ee3c s\u1eefa, n\u00f4n sau khi b\u00fa, ti\u00eau ch\u1ea3y, suy dinh d\u01b0\u1ee1ng.<\/p>\n
– R\u1ed1i lo\u1ea1n kh\u1ea3 n\u0103ng d\u1ef1 tr\u1eef:<\/p>\n
+ Gan gi\u1ea3m kh\u1ea3 n\u0103ng d\u1ef1 tr\u1eef glucid: Gan l\u00e0 kho d\u1ef1 tr\u1eef c\u1ee7a c\u01a1 th\u1ec3. Trong c\u00e1c b\u1ec7nh l\u00fd c\u1ee7a gan: vi\u00eam gan, x\u01a1 gan\u2026 th\u00ec glucose m\u00e1u gi\u1ea3m.<\/p>\n
+ Thi\u1ebfu b\u1ea9m sinh m\u1ed9t s\u1ed1 enzym \u1edf gan nh\u01b0: phosphorylase, amylo -1-6- glucosidase l\u00e0m \u1ee9 \u0111\u1ecdng glycogen ho\u1eb7c s\u1ea3n ph\u1ea9m tho\u00e1i h\u00f3a d\u1edf dang( dextrin gi\u1edbi h\u1ea1n) g\u00e2y h\u1ea1 glucose khi \u0111\u00f3i.<\/p>\n
+ Gan gi\u1ea3m kh\u1ea3 n\u0103ng t\u00e2n t\u1ea1o glucid t\u1eeb c\u00e1c s\u1ea3n ph\u1ea9m kh\u00e1c c\u0169ng nh\u01b0 l\u00e0m gi\u1ea3m l\u01b0\u1ee3ng glucose m\u00e1u<\/p>\n
– T\u0103ng m\u1ee9c ti\u00eau th\u1ee5: ti\u00eau th\u1ee5 glucid trong t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u00f2i h\u1ecfi ti\u00eau th\u1ecb n\u0103ng l\u01b0\u1ee3ng c\u1ee7a c\u01a1 th\u1ec3: co c\u01a1, run (ch\u1ed1ng r\u00e9t), s\u1ed1t k\u00e9o d\u00e0i<\/p>\n
– R\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a c\u1ee7a h\u1ec7 th\u1ea7n kinh, n\u1ed9i ti\u1ebft: c\u01b0\u1eddng ph\u00f3 giao c\u1ea3m. \u1ee9c ch\u1ebf giao c\u1ea3m. Gi\u1ea3m c\u00e1c n\u1ed9i ti\u1ebft t\u1ed1 c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m t\u0103ng glucose m\u00e1u ho\u1eb7c t\u0103ng ti\u1ebft insulin.<\/p>\n
– Th\u1eadn gi\u1ea3m kh\u1ea3 n\u0103ng t\u00e1i h\u1ea5p thu glucose. Nguy\u00ean nh\u00e2n :do r\u1ed1i lo\u1ea1n qu\u00e1 tr\u00ecnh phosphoryl h\u00f3a \u1edf t\u1ebf b\u00e0o \u1ed1ng th\u1eadn ( b\u1ea9m sinh ).<\/p>\n
Ngo\u00e0i ra, b\u1ec7nh u t\u1ebf b\u00e0o beta c\u1ee7a \u0111\u1ea3o t\u1ee5y (u \u1edf th\u00e2n t\u1ee5y) t\u0103ng ti\u1ebft insulin g\u00e2y h\u1ea1 \u0111\u01b0\u1eddng m\u00e1u k\u1ecbch ph\u00e1t. b\u1ec7nh th\u01b0\u1eddng n\u1eb7ng, d\u1ec5 b\u1ecb h\u00f4n m\u00ea do nh\u1eefng c\u01a1n h\u1ea1 glucose m\u00e1u.<\/p>\n
2. Bi\u1ec3u hi\u1ec7n v\u00e0 h\u1eadu qu\u1ea3 :<\/p>\n
– Thi\u1ebfu G6P trong t\u1ebf b\u00e0o, k\u00edch th\u00edch n\u00e3o g\u00e2y c\u1ea3m gi\u00e1c \u0111\u00f3i.<\/p>\n
– Run tay ch\u00e2n, tim nhanh, v\u00e3 m\u1ed3 h\u00f4i : do k\u00edch th\u00edch giao c\u1ea3m.<\/p>\n
– Ru\u1ed9t t\u0103ng co b\u00f3p ( c\u1ed3n c\u00e0o ), d\u1ea1 d\u00e0y t\u0103ng ti\u1ebft d\u1ecbch, m\u1eaft hoa, r\u00e3 r\u1eddi ch\u00e2n tay c\u00f3 th\u1ec3 b\u1ecb x\u1ec9u.<\/p>\n
– Khi glucose m\u00e1u gi\u1ea3m n\u1eb7ng (<0,6g\/l) \u00e0 t\u1ebf b\u00e0o thi\u1ebfu n\u0103ng l\u01b0\u1ee3ng \u00e0 c\u00e1c ch\u1ee9c ph\u1eadn b\u1ecb r\u1ed1i lo\u1ea1n nh\u1ea5t l\u00e0 TB n\u00e3o, tim...ng\u01b0\u1eddi b\u1ec7nh say s\u1ea9m c\u00f3 th\u1ec3 h\u00f4n m\u00ea. Tr\u01b0\u1eddng h\u1ee3p gi\u1ea3m glucose m\u00e1u n\u1eb7ng, \u0111\u1ed9t ng\u1ed9t c\u00f3 th\u1ec3 co gi\u1eadt, h\u00f4n m\u00ea, ch\u1ebft.\n\nB \u2013 T\u0103ng glucose m\u00e1u :\n\nKhi l\u01b0\u1ee3ng glucose m\u00e1u tr\u00ean 1,2g\/l.\n\n1. Nguy\u00ean nh\u00e2n : th\u01b0\u1eddng ng\u01b0\u1ee3c v\u1edbi t\u00ecnh tr\u1ea1ng gi\u1ea3m Glucose m\u00e1u.\n\n- X\u1ea3y ra trong v\u00e0 sau b\u1eefa \u0103n, nh\u1ea5t l\u00e0 khi \u0103n nhi\u1ec1u disaccarid v\u00e0 monosaccarid.\n\n- Gi\u1ea3m thi\u00eau th\u1ee5 : tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu oxy ( ng\u1ea1t, g\u00e2y m\u00ea )\n\n- H\u01b0ng ph\u1ea5n th\u1ea7n kinh, nh\u1ea5t l\u00e0 h\u1ec7 giao c\u1ea3m ( t\u1ee9c gi\u1eadn, h\u1ed3i h\u1ed9p ).\n\n- U n\u00e3o, trung t\u00e2m \u03b2 k\u00e9m nh\u1ea1y v\u1edbi Insulin .\n\n- B\u1ec7nh n\u1ed9 ti\u1ebft: gi\u1ea3m ti\u1ebft insulin, t\u0103ng ti\u1ebft c\u00e1c hormon \u0111\u1ed1i l\u1eadp, t\u0103ng ho\u1ea1t t\u00ednh insulinase, c\u00f3 kh\u00e1ng th\u1ec3 ch\u1ed1ng insulin.\n\n2. H\u1eadu qu\u1ea3:\n\n- T\u0103ng glucose \u00e0 t\u0103ng \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u g\u00e2y \u0111\u00e1i nhi\u1ec1u, \u0111\u1ed3ng th\u1eddi m\u1ea5t Natri, Kali, \u0111\u1eb7c bi\u1ec7t glucose m\u00e1u qu\u00e1 cao v\u01b0\u1ee3t ng\u01b0\u1ee1ng h\u1ea5p thu c\u1ee7a th\u1eadn \u00e0 g\u00e2y glucose ni\u1ec7u.\n\n- T\u0103ng glucose m\u00e1u do r\u1ed1i lo\u1ea1n n\u1ed9i ti\u1ebft nh\u1ea5t r\u1ed1i lo\u1ea1n Insulin c\u1ee7a TB \u0111\u1ea3o t\u1ee5y \u00e0 r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a Glucose tr\u1ea7m tr\u1ecdng g\u1eb7p trong b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng.\n\nC\u00e2u 2: Tr\u00ecnh b\u00e0y b\u1ec7nh nguy\u00ean, b\u1ec7nh sinh c\u1ee7a b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng do t\u1ee5y ?\n\n- Kh\u00e1i ni\u1ec7m: b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng l\u00e0 t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft do gi\u1ea3m ti\u1ebft ho\u1eb7c gi\u1ea3m s\u1eed d\u1ee5ng Insulin d\u1eabn \u0111\u1ebfn b\u1ec7nh nh\u00e2n ti\u1ec3u nhi\u1ec1u v\u00e0 n\u01b0\u1edbc ti\u1ec3u c\u00f3 \u0111\u01b0\u1eddng (glucose), c\u00f3 th\u1ec3 k\u00e8m ho\u1eb7c kh\u00f4ng k\u00e8m c\u00e1c tri\u1ec7u ch\u1ee9ng \u0103n nhi\u1ec1u, u\u1ed1ng nhi\u1ec1u, g\u1ea7y nhi\u1ec1u.\n\n\u00b7 B\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng do t\u1ee5y ( typ I ):\n\n1. B\u1ec7nh nguy\u00ean:\n\n- Do s\u1ef1 k\u00e9m s\u1ea3n xu\u1ea5t Insulin c\u1ee7a t\u1ebf b\u00e0o beta \u0111\u1ea3o t\u1ee5y.\n\n\u00e8 Gi\u1ea3m Insulin l\u00e0m cho Glucose kh\u00f4ng \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 b\u1edfi insulin qua \u0111\u01b0\u1ee3c m\u00e0ng t\u1ebf b\u00e0o v\u00e0o b\u00ean trong v\u00ec t\u00e1c d\u1ee5ng c\u1ee7a Insulin : gi\u00fap glucose v\u00e0o t\u1ebf b\u00e0o nh\u1edd s\u1ef1 g\u1eafn k\u1ebft c\u1ea3u insulin l\u00ean th\u1ee5 th\u1ec3 c\u1ee7a hormon n\u00e0y tr\u00ean b\u1ec1 m\u1eb7t TB.\n\nT\u1eeb \u0111\u00f3 g\u00e2y gi\u1ea3m G6P n\u1ed9i b\u00e0o v\u00e0 t\u0103ng n\u1ed3ng \u0111\u1ed9 Glucose trong m\u00e1u \u00e0 b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng.\n\n- B\u00eanh c\u00f3 t\u00ednh di truy\u1ec1n r\u00f5 r\u1ec7t, ph\u00e1t b\u1ec7nh t\u1ef1 nhi\u00ean, \u00edt ph\u1ee5 thu\u1ed9c \u0111i\u1ec1u ki\u1ec7n m\u00f4i tr\u01b0\u1eddng.\n\n- C\u00e1c gen li\u00ean quan : HLA \u2013 DR3, HLA \u2013 D4, DQW-8.\n\n- Tu\u1ed5i: xu\u1ea5t hi\u1ec7n s\u1edbm d\u01b0\u1edbi 20 tu\u1ed5i, theo d\u00f5i ch\u1eb7t ch\u1ebd c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n \u1edf 11, 12 tu\u1ed5i \u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm.\n\n- C\u01a1 ch\u1ebf ph\u00e1t b\u1ec7nh : C\u01a1 ch\u1ebf mi\u1ec5n d\u1ecbch,ph\u00e1t hi\u1ec7n trong m\u00e1u BN c\u00f3 kh\u00e1ng th\u1ec3 ch\u1ed1ng TB beta, v\u00e0\/ho\u1eb7c ch\u1ed1ng insulin v\u00e0\/ho\u1eb7c ch\u1ed1ng l\u1ea1i th\u1ee5 th\u1ec3 insulin. C\u00f3 ph\u00e1t hi\u1ec7n m\u1ed9t s\u1ed1 b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng typ1 do nhi\u1ec5m virus (quai b\u1ecb, rubeole ) nh\u01b0ng c\u01a1 ch\u1ebf ch\u01b0a r\u00f5.\n\n- Di\u1ec5n bi\u1ebfn: kh\u1edfi ph\u00e1t nhanh, c\u1ea5p. BN ch\u1ec9 s\u1ed1ng n\u1ebfu \u0111\u01b0\u1ee3c ti\u00eam li\u00ean t\u1ee5c v\u00e0 \u0111\u1ee7 li\u1ec1u insulin. Do v\u1eady typ I c\u00f3 t\u00ean ti\u1ec3u \u0111\u01b0\u1eddng ph\u1ee5 thu\u1ed9c insulin.\n\n2. B\u1ec7nh Sinh:\n\n- Glucose kh\u00f4ng \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 b\u1edfi insulin \u0111\u1ec3 qua m\u00e0ng TB. C\u0169ng thi\u1ebfu Insulin m\u00e0 l\u00e0m gan t\u0103ng c\u01b0\u1eddng tho\u00e1i h\u00f3a glycogen v\u00e0 m\u00f4 m\u1ee1 t\u0103ng huy \u0111\u1ed9ng, gi\u1ea3m t\u1ed5ng h\u1ee3p lipid d\u1eabn \u0111\u1ebfn c\u00e1c bi\u1ec3u hi\u1ec7n :\n\n+ N\u1ed3ng \u0111\u1ed9 glucose m\u00e1u t\u0103ng \u00e0 t\u0103ng \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u k\u00e9o n\u01b0\u1edbc ra kh\u1ecfi TB l\u00e0m BN KH\u00c1T v\u00e0 U\u1ed1ng nhi\u1ec1u. \u0110\u1ed3ng th\u1eddi g\u00e2y qu\u00e1 ng\u01b0\u1ee1ng h\u1ea5p thu c\u1ee7a th\u1eadn \u00e0 \u0111a ni\u1ec7u th\u1ea9m th\u1ea5u: Ti\u1ec3u nhi\u1ec1u v\u00e0 n\u01b0\u1edbc ti\u1ec3u c\u00f3 \u0111\u01b0\u1eddng.\n\n+ Thi\u1ebfu G6P n\u1ed9i b\u00e0o \u00e0 gi\u1ea3m nguy\u00ean li\u1ec7u cho chu tr\u00ecnh Krebs l\u00e0m TB thi\u1ebfu n\u0103ng l\u01b0\u1ee3ng(ATP) \u00e0 d\u1eabn \u0111\u1ebfn c\u1ea3m gi\u00e1c \u0111\u00f3i th\u01b0\u1eddng xuy\u00ean v\u00e0 \u0102n Nhi\u1ec1u.\n\n+ Thi\u1ebfu insulin protein k\u00e9m t\u1ed5ng h\u1ee3p m\u00e0 t\u0103ng tho\u00e1i h\u00f3a ( c\u00e2n b\u1eb1ng nito \u00e2m t\u00ednh , ng\u01b0\u1eddi b\u1ec7nh mau g\u1ea7y , suy ki\u1ec7t . \u0110\u1ed3ng th\u1eddi pentose ng\u01b0ng tr\u1ec7 ( thi\u1ebfu G6P ) \u00e0 t\u1ed5ng h\u1ee3p lipid ch\u1eadm l\u1ea1i ho\u1eb7c ng\u1eebng trong khi lipid b\u1ecb huy \u0111\u1ed9ng \u00e0 t\u0103ng lipid m\u00e1u v\u00e0 ng\u01b0\u1eddi b\u1ec7nh G\u1ea7y nhi\u1ec1u.\n\n\u00b7 Bi\u1ebfn ch\u1ee9ng v\u00e0 h\u1eadu qu\u1ea3 :\n\n- Nhi\u1ec5m khu\u1ea9n : \u0111\u01b0\u1eddng m\u00e1u cao v\u00e0 suy gi\u1ea3m \u0111\u1ec1 kh\u00e1ng t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho VSV: li\u00ean c\u1ea7u, t\u1ee5 c\u1ea7u, tr\u1ef1c khu\u1ea9n lao...ph\u00e1t tri\u1ec3n. BN ti\u1ec3u \u0111\u01b0\u1eddng th\u01b0\u1eddng b\u1ecb m\u1ee5n nh\u1ecdt, lo\u00e9t ho\u1ea1i t\u1eed, lao ph\u1ed5i...\n\n- Nhi\u1ec5m toan, nhi\u1ec5m \u0111\u1ed9c : Nhi\u1ec5m acid chuy\u1ec3n h\u00f3a (cetonic m\u00e1u ), nhi\u1ec5m \u0111\u1ed9c, gi\u1ea3m kali m\u00e1u, m\u1ea5t n\u01b0\u1edbc.\n\n- X\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch do t\u0103ng Cholesterol m\u00e1u ( do t\u00edch t\u1ee5 Cholesterol l\u1edbp \u00e1o trong \u0111\u1ed9ng m\u1ea1ch l\u00e0m x\u01a1 c\u1ee9ng th\u00e0nh m\u1ea1ch ).\n\n- Suy ki\u1ec7t to\u00e0n th\u00e2n, nhi\u1ec5m acid \u00e0 c\u00f3 th\u1ec3 h\u00f4n m\u00ea v\u00e0 t\u1eed vong.\n\n- Vi\u00eam \u0111a d\u00e2y th\u1ea7n kinh do bao myelin b\u1ecb tho\u00e1i h\u00f3a\u00e0 gi\u1ea3m truy\u1ec1n xung TK v\u00ec v\u1eady BN ti\u1ec3u \u0111\u01b0\u1eddng \u00edt c\u00f3 c\u1ea3m gi\u00e1c khi d\u1eabm tr\u00fang \u0111inh, v\u1eadt nh\u1ecdn \u00e0 th\u01b0\u1eddng ph\u1ea3i mang d\u00e9p trong nh\u00e0.\n\nC\u00e2u 3 : Nguy\u00ean nh\u00e2n, h\u1eadu qu\u1ea3 c\u1ee7a c\u00e1c lo\u1ea1i r\u1ed1i lo\u1ea1n cholesterol m\u00e1u ?\n\nA- Gi\u1ea3m cholesterol m\u00e1u:\n\n\u00b7 Nguy\u00ean nh\u00e2n :\n\na) Th\u1ee9c \u0103n thi\u1ebfu cholesterol\n\nb) Th\u1ee9c \u0103n nhi\u1ec5m khu\u1ea9n, nhi\u1ec5m \u0111\u1ed9c g\u00e2y t\u1ed5n th\u01b0\u01a1ng gan, h\u1eadu qu\u1ea3 l\u00e0 gi\u1ea3m t\u1ed5ng h\u1ee3p cholesterol, \u0111\u1eb7c bi\u1ec7t l\u00e0 cholesterol este.\n\nc) T\u0103ng ph\u00e2n hu\u1ef7 cholesterol trong c\u01a1 th\u1ec3 (nhi\u1ec5m \u0111\u1ed9c tuy\u1ebfn gi\u00e1p).\n\nd) Do t\u0103ng \u0111\u00e0o th\u1ea3i ra ngo\u00e0i (\u0111i l\u1ecfng)ho\u1eb7c gi\u1ea3m h\u1ea5p thu: l\u1ef5 amip giai \u0111o\u1ea1n \u0111\u1ea7u, vi\u00eam ru\u1ed9t gi\u00e0, base dow.\n\ne) B\u1ea9m sinh do m\u1ed9t gen l\u1eb7n g\u00e2y ra.\n\n\u00b7 H\u1eadu qu\u1ea3:\n\n+Gi\u1ea3m cholesterol m\u00e1u g\u00e2y r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n xung \u0111\u1ed9ng th\u1ea7n kinh v\u00ec cholesterol l\u00e0 m\u1ed9t th\u00e0nh ph\u1ea7n c\u1ea5u t\u1ea1o m\u00e0ng t\u1ebf b\u00e0o.\n\n+Ngo\u00e0i ra c\u00f2n ph\u00e1t sinh thi\u1ec3u n\u0103ng n\u1ed9i ti\u1ebft v\u00ec cholesterol l\u00e0 nguy\u00ean li\u1ec7u \u0111\u1ec3 t\u1ed5ng h\u1ee3p c\u00e1c hormon steroit c\u1ee7a tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn v\u00e0 sinh d\u1ee5c.\n\nB- T\u0103ng cholesterol m\u00e1u:\n\n\u00b7 Nguy\u00ean nh\u00e2n:\n\na) Do \u0103n : \u0103n nhi\u1ec1u th\u1ee9c \u0103n c\u00f3 h\u00e0m l\u01b0\u1ee3ng cholesterol cao (tr\u1ee9ng, n\u00e3o, gan, m\u1ee1 \u0111\u1ed9ng v\u1eadt, vv... ) s\u1ebd d\u1eabn t\u1edbi t\u0103ng cholesterol m\u00e1u.\n\nb) Nh\u1eefng y\u1ebfu t\u1ed1 n\u1ed9i sinh : c\u00f3 th\u1ec3 l\u00e0 axit axetic leuxin, valin, c\u1ed3n etylic,vv... nh\u1eefng ch\u1ea5t n\u00e0y c\u0169ng nh\u01b0 gluxit, protein, m\u1ee1 chuy\u1ec3n ho\u00e1 th\u00e0nh axetyl CoA \u0111\u1ec3 tr\u1edf th\u00e0nh cholesterol.\n\nc) T\u0103ng huy \u0111\u1ed9ng m\u1ee1 d\u1ef1 tr\u1eef (\u0111\u1ed3ng th\u1eddi cholesterol c\u0169ng ra theo) g\u00e2y trong h\u01b0ng ph\u1ea5n th\u1ea7n kinh giao c\u1ea3m, x\u00fac c\u1ea3m m\u1ea1nh, tr\u1ea1ng th\u00e1i Stress. Th\u1ea7n kinh giao c\u1ea3m h\u01b0ng ph\u1ea5n \u0111\u00e3 bi\u1ebfn dehydro cholesterol th\u00e0nh cholesterol. C\u0169ng c\u00f3 th\u1ec3 do nh\u1eefng xung \u0111\u1ed9ng th\u1ea7n kinh \u0111\u00e3 t\u00e1c \u0111\u1ed9ng t\u1edbi s\u1ef1 t\u1ed5ng h\u1ee3p cholesterol \u1edf gan.\n\nd) R\u1ed1i lo\u1ea1n t\u1ed5ng h\u1ee3p axit b\u00e9o v\u00e0 th\u1ec3 xetonic t\u1eeb axit axetoaxetic. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y th\u1ea5y t\u0103ng ho\u1ea1t t\u00ednh men tham gia v\u00e0o t\u1ed5ng h\u1ee3p cholesterol beta \u2013 oxy beta- methyl glutaryl CoA.\n\ne) Gi\u1ea3m oxy ho\u00e1 g\u1eb7p trong thi\u1ebfu oxy c\u00e1c lo\u1ea1i, thi\u1ec3u n\u0103ng tuy\u1ebfn gi\u00e1p, vv... \u0111\u00e3 k\u00ecm h\u00e3m oxy ho\u00e1 cholesterol.\n\n\u00b7 H\u1eadu qu\u1ea3:\n\na) B\u1ec7nh nhi\u1ec5m s\u1eafc v\u00e0ng m\u00e0 \u0111\u1eb7c \u0111i\u1ec3m l\u00e0 \u1ee9 \u0111\u1ecdng cholesterol v\u00e0 cholesterol este \u1edf t\u1ed5 ch\u1ee9c (da, g\u00e2n,vv... ) g\u00e2y t\u0103ng sinh t\u1ebf b\u00e0o li\u00ean k\u1ebft, m\u00e0u v\u00e0ng \u1edf \u0111\u00e2y l\u00e0 do trong th\u00e0nh ph\u1ea7n c\u1ea5u t\u1ea1o c\u00f3 s\u1eafc t\u1ed1 lipocrom cholesterol c\u00f3 th\u1ec3 \u1ee9 \u0111\u1ecdng \u1edf x\u01b0\u01a1ng s\u1ecd, h\u00e0m d\u01b0\u1edbi, x\u01b0\u01a1ng ch\u1eadu (b\u1ec7nh Schuler Chistian).\n\n- \u1ede ng\u01b0\u1eddi gi\u00e0, \u0111\u1ee5c gi\u00e1c m\u1ea1c l\u00e0 do b\u1ec7nh nhi\u1ec5m s\u1eafc v\u00e0ng.\n\nb) Cholesteatose: \u1ee9 \u0111\u1ecdng cholesterol v\u00e0 cholesterol este \u1edf c\u00e1c c\u01a1 quan nh\u01b0 m\u00f4, \u0111\u1eb7c bi\u1ec7t \u1edf gan.\n\n\u00e0 Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, beta lipoprotein v\u00e0 cholesterol t\u1ef1 do x\u00e2m nh\u1eadp v\u00e0o t\u1ebf b\u00e0o gan g\u00e2y x\u01a1 gan.\n\nc) X\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch: trong b\u1ec7nh n\u00e0y, cholesterol \u1ee9 \u0111\u1ecdng trong l\u1edbp d\u01b0\u1edbi n\u1ed9i m\u00f4 c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, c\u00e1c \u0111\u1ed9ng m\u1ea1ch l\u1edbn, \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.\n\n=> C\u01a1 ch\u1ebf g\u00e2y s\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch:<\/p>\n
– L\u00e0 s\u1ef1 t\u00edch \u0111\u1ecdng choles d\u01b0\u1edbi l\u1edbp \u00e1o trong \u0110M\u1ea1ch \u00e0 th\u00e0nh m\u1ea1ch d\u1ea7y l\u00ean \u00e0 l\u1eafng \u0111\u1ecdng calci \u00e0 tho\u00e1i h\u00f3a, lo\u00e9t, s\u00f9i TB n\u1ed9i m\u1ea1c ( do thi\u1ec3u d\u01b0\u1ee1ng ) \u00e0 m\u00f4 x\u01a1 ph\u00e1t tri\u1ec3n t\u1ea1i ch\u1ed7 \u00e0 n\u1ed9i m\u1ea1c th\u00e0nh m\u1ea1ch m\u1ea5t s\u1ef1 tr\u01a1n l\u00e1ng, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho ti\u1ec3u c\u1ea7u b\u00e1m v\u00e0o \u00e0 kh\u1edfi \u0111\u1ed9ng qu\u00e1 tr\u00ecnh \u0111\u00f4ng m\u00e1u, t\u1eafc m\u1ea1ch.<\/p>\n
– Vai tr\u00f2 c\u1ee7a HDL v\u00e0 LDL trong x\u01a1 v\u1eefa th\u00e0nh m\u1ea1ch :<\/p>\n
+ HDL: gi\u00fap v\u1eadn chuy\u1ec3n cholesterol t\u1eeb t\u1ed5 ch\u1ee9c \u0111\u1ebfn c\u00e1c TB gan, c\u00f3 t\u00e1c d\u1ee5ng b\u1ea3o v\u1ec7 th\u00e0nh m\u1ea1ch.<\/p>\n
+ LDL: gi\u00fap v\u1eadn chuy\u1ec3n choles t\u1eeb m\u00e1u \u0111\u1ebfn c\u00e1c m\u00f4.<\/p>\n
C\u00e2u 4: Tr\u00ecnh b\u00e0y bi\u1ec3u hi\u1ec7n, c\u01a1 ch\u1ebf, v\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a r\u1ed1i lo\u1ea1n protid huy\u1ebft t\u01b0\u01a1ng?<\/p>\n
A- Gi\u1ea3m protid huy\u1ebft t\u01b0\u01a1ng:<\/p>\n
\u00b7 Bi\u1ec3u hi\u1ec7n :<\/p>\n
+ L\u00e2m s\u00e0ng: s\u1ee5t c\u00e2n, c\u01a1 teo nh\u1ecf gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c, thi\u1ebfu m\u00e1u, v\u1ebft th\u01b0\u01a1ng l\u00e2u l\u00e0nh, c\u00f3 th\u1ec3 b\u1ecb ph\u00f9. Tr\u1ebb em ch\u1eadm l\u1edbn, ch\u1eadm ph\u00e1t tri\u1ec3n v\u1ec1 th\u1ec3 l\u1ef1 v\u00e0 tr\u00ed tu\u1ec7.<\/p>\n
+ X\u00e9t nghi\u1ec7m: protid huy\u1ebft t\u01b0\u01a1ng gi\u1ea3m. Albumin th\u01b0\u1eddng gi\u1ea3m nhanh v\u00e0 m\u1ea1nh nhi\u1ec1u h\u01a1n so v\u1edbi globulin. T\u1ef7 l\u1ec7 A\/G b\u1ecb \u0111\u1ea3o ng\u01b0\u1ee3c (b\u00ecnh th\u01b0\u1eddng A\/G t\u1eeb 1,2 \u0111\u1ebfn 1,5). T\u1ed1c \u0111\u1ed9 l\u1eafng c\u1ee7a h\u1ed3ng c\u1ea7u t\u0103ng.<\/p>\n
\u00b7 C\u01a1 ch\u1ebf v\u00e0 h\u1eadu qu\u1ea3:<\/p>\n
– Gi\u1ea3m protein huy\u1ebft t\u01b0\u01a1ng d\u1eabn t\u1edbi gi\u1ea3m \u00e1p l\u1ef1c keo c\u1ee7a m\u00e1u, g\u00e2y ra ph\u00f9. Ph\u00f9 ch\u1ec9 xu\u1ea5t hi\u1ec7n khi l\u01b0\u1ee3ng protein huy\u1ebft t\u01b0\u01a1ng gi\u1ea3m r\u00f5 r\u1ec7t (c\u00f3 khi d\u01b0\u1edbi 2,4 g%), v\u00ec trong b\u1ec7nh sinh c\u1ee7a ph\u00f9, ngo\u00e0i t\u00e1c d\u1ee5ng c\u1ee7a \u00e1p l\u1ef1c keo do protein huy\u1ebft t\u01b0\u01a1ng \u0111\u1ea3m nhi\u1ec7m, c\u00f2n nhi\u1ec1u y\u1ebfu t\u1ed1 kh\u00e1c tham gia.<\/p>\n
Trong th\u1ef1c t\u1ebf, cho \u0103n theo m\u1ed9t ch\u1ebf \u0111\u1ed9 thi\u1ebfu protein th\u1ea5y n\u1ed3ng \u0111\u1ed9 protein huy\u1ebft t\u01b0\u01a1ng v\u1eabn b\u00ecnh th\u01b0\u1eddng tuy c\u00f3 ph\u00f9 xu\u1ea5t hi\u1ec7n ; tr\u00e1i l\u1ea1i c\u00f3 tr\u01b0\u1eddng h\u1ee3p protein huy\u1ebft t\u01b0\u01a1ng gi\u1ea3m song kh\u00f4ng c\u00f3 ph\u00f9 k\u00e8m theo, ho\u1eb7c protein huy\u1ebft t\u01b0\u01a1ng gi\u1ea3m r\u1ea5t th\u1ea5p song m\u1ee9c \u0111\u1ed9 ph\u00f9 l\u1ea1i v\u1eeba ph\u1ea3i.<\/p>\n
– Gi\u1ea3m protein huy\u1ebft t\u01b0\u01a1ng g\u00e2y r\u1ed1i lo\u1ea1n v\u1eadn chuy\u1ec3n nhi\u1ec1u ch\u1ea5t : cation (Ca++, Mg++,vv… ), hormon (thyroxin…) bitiamin (\u0111\u1eb7c bi\u1ec7t nh\u00f3m B), bilirubin v\u00e0 nhi\u1ec1u ch\u1ea5t kh\u00e1c, do \u0111\u00f3 g\u00e2y ra m\u1ed9t lo\u1ea1t c\u00e1c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng : n\u1ed5i b\u1eadt l\u00ean h\u00e0ng \u0111\u1ea7u l\u00e0 thi\u1ebfu vitamin.<\/p>\n
Nh\u1eefng bi\u1ec3u hi\u1ec7n s\u1edbm c\u1ee7a gi\u1ea3m protein huy\u1ebft t\u01b0\u01a1ng l\u00e0 r\u1ed1i lo\u1ea1n ho\u1ea1t \u0111\u1ed9ng men chuy\u1ec3n ho\u00e1 gluxit, lipit, v\u00e0 protein; tr\u01b0\u1edbc ti\u00ean l\u00e0 gi\u1ea3m ho\u1ea1t t\u00ednh men kh\u1eed amin, chuy\u1ec3n amin, v\u00e0 t\u1ed5ng h\u1ee3p axit amin (\u0111\u0103c bi\u1ec7t r\u00f5 \u1edf gan), \u1ea3nh h\u01b0\u1edfng t\u1edbi t\u1ed5ng h\u1ee3p protein \u1edf gan v\u00e0 c\u00e1c c\u01a1 quan kh\u00e1c. ho\u1ea1t t\u00ednh men t\u1ea1o ure gi\u1ea3m, n\u00ean ure m\u00e1u gi\u1ea3m, NH3 m\u00e1u t\u0103ng.<\/p>\n
– Khi thi\u1ebfu haptoglobin \u2013 m\u1ed9t lo\u1ea1i alpha 2-globulin \u2013 g\u00e2y r\u1ed1i lo\u1ea1n k\u1ebft h\u1ee3p v\u00e0 v\u1eadn chuy\u1ec3n hemoglobin (do h\u1ed3ng c\u1ea7u b\u1ecb hu\u1ef7, gi\u1ea3i ph\u00f3ng ra), khi\u1ebfn cho hemoglobin b\u1ecb hu\u1ef7, gi\u1ea3i ph\u00f3ng theo n\u01b0\u1edbc ti\u1ec3u.<\/p>\n
– Gi\u1ea3m t\u1ed5ng h\u1ee3p c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u (fibrinogen, brothrombin,vv… ) g\u00e2y r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u.<\/p>\n
– Thi\u1ebfu transferin \u2013 m\u1ed9t lo\u1ea1i beta 1-globulin \u2013 g\u00e2y r\u1ed1i lo\u1ea1n v\u1eadn chuy\u1ec3n s\u1eaft.<\/p>\n
– Gi\u1ea3m t\u1ed5ng h\u1ee3p gamma globulin (kh\u00e1ng th\u1ec3) d\u1ec5 g\u00e2y nhi\u1ec5m tr\u00f9ng v\u00e0 nhi\u1ec5m tr\u00f9ng n\u1eb7ng.<\/p>\n
\u00e0 Gi\u1ea3m protid k\u00e9o d\u00e0i g\u00e2y h\u1eadu qu\u1ea3 : suy dinh d\u01b0\u1ee1ng, c\u00f2i x\u01b0\u01a1ng( tr\u1ebb em ), d\u1ec5 b\u1ecb nhi\u1ec5m khu\u1ea9n, s\u1ee9c \u0111\u1ec1 kh\u00e1ng gi\u1ea3m, n\u0103ng su\u1ea5t lao \u0111\u1ed9ng ch\u00e2n tay v\u00e0 tr\u00ed \u00f3c gi\u1ea3m s\u00fat.<\/p>\n
B- T\u0103ng Protid huy\u1ebft t\u01b0\u01a1ng:<\/p>\n
– R\u1ea5t hi\u1ebfm g\u1eb7p, ch\u1ee7 y\u1ebfu l\u00e0 t\u0103ng gi\u1ea3 do m\u00e1u c\u00f4 \u0111\u1eb7c (m\u1ea5t n\u01b0\u1edbc). Tr\u01b0\u1eddng h\u1ee3p g\u1eb7p th\u1eadt s\u1ef1 l\u00e0 b\u1ec7nh u t\u1ee7y. \u0110\u00f3 l\u00e0 s\u1ef1 ph\u00e1t tri\u1ec3n \u00e1c t\u00ednh c\u1ee7a TB lympho B l\u00e0m l\u01b0\u1ee3ng kh\u00e1ng th\u1ec3 t\u0103ng r\u1ea5t cao trong m\u00e1u, c\u00f3 th\u1ec3 ra c\u1ea3 n\u01b0\u1edbc ti\u1ec3u.<\/p>\n
C- Thay \u0111\u1ed5i th\u00e0nh ph\u1ea7n protid huy\u1ebft t\u01b0\u01a1ng:<\/p>\n
a. Th\u00e0nh ph\u1ea7n protid huy\u1ebft t\u01b0\u01a1ng<\/p>\n
Trong b\u1ec7nh l\u00fd, t\u1ec9 l\u1ec7 c\u00e1c th\u00e0nh ph\u1ea7n protein huy\u1ebft t\u01b0\u01a1ng c\u00f3 th\u1ec3 thay \u0111\u1ed5i<\/p>\n
1) Albumin \u0111\u1ea3m b\u1ea3o 80% \u00e1p l\u1ef1c keo c\u1ee7a m\u00e1u, gi\u1ea3m trong t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p gi\u1ea3m protein huy\u1ebft t\u01b0\u01a1ng nh\u01b0 gi\u1ea3m t\u1ed5ng h\u1ee3p do cung c\u1ea5p kh\u00f4ng \u0111\u1ee7 (\u0111\u00f3i \u0103n), do t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan (x\u01a1 gan), t\u0103ng tho\u00e1i bi\u1ebfn (nhi\u1ec5m tr\u00f9ng ), m\u1ea5t ra ngo\u00e0i (b\u1ec7nh th\u1eadn, r\u1ed1i lo\u1ea1n ti\u00eau ho\u00e1, vv… ).<\/p>\n
2) Alpha globulin t\u0103ng trong t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam c\u1ea5p c\u0169ng nh\u01b0 m\u1ea1n, trong ho\u1ea1i t\u1eed t\u1ed5 ch\u1ee9c (nh\u1ed3i m\u00e1u) hay trong m\u1ed9t s\u1ed1 b\u1ec7nh chuy\u1ec3n ho\u00e1 (th\u1eadn h\u01b0 nhi\u1ec5m m\u1ee1, nhi\u1ec5m b\u1ed9t). Th\u00e0nh ph\u1ea7n n\u00e0y l\u00e0m t\u0103ng \u0111\u1ed9 nh\u1edbt c\u1ee7a m\u00e1u v\u00e0 t\u0103ng t\u1ed1c \u0111\u1ed9 l\u1eafng m\u00e1u.<\/p>\n
3) Beta globulin \u00edt thay \u0111\u1ed5i m\u00e0 ch\u1ec9 th\u1ea5y t\u0103ng khi t\u0103ng m\u1ee1 trong m\u00e1u nh\u01b0 b\u1ec7nh x\u01a1 m\u1ea1ch, t\u1eafc m\u1eadt, th\u1eadn h\u01b0 nhi\u1ec5m m\u1ee1, vv…<\/p>\n
4) Gamma globulin t\u0103ng trong t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u0103ng kh\u00e1ng th\u1ec3 nh\u01b0 nhi\u1ec5m tr\u00f9ng , mi\u1ec5n d\u1ecbch , m\u1eabn c\u1ea3m , x\u01a1 gan, u t\u01b0\u01a1ng b\u00e0o, vv…<\/p>\n
b. H\u1eadu qu\u1ea3: B\u00ecnh th\u01b0\u1eddng c\u00e1c th\u00e0nh ph\u1ea7n protid huy\u1ebft t\u01b0\u01a1ng c\u00f3 m\u1ed9t t\u1ef7 l\u1ec7 t\u01b0\u01a1ng \u0111\u1ed1i c\u00e2n \u0111\u1ed1i nhau nh\u1edd v\u1eady protid huy\u1ebft t\u01b0\u01a1ng lu\u00f4n \u1edf tr\u1ea1ng th\u00e1i ph\u00e2n t\u00e1n \u1ed5n \u0111\u1ecbnh khi s\u1ef1 can b\u1eb1ng n\u00e0y thay \u0111\u1ed5i l\u00e0m m\u1ea5t c\u00e2n b\u1eb1ng \u00e1p l\u1ef1c keo l\u00e0m protid d\u1ec3 b\u1ecb k\u1ebft t\u1ee7a b\u1edfi m\u1ed9t s\u1ed1 mu\u1ed1i. \u0110\u00e2y ch\u00ednh l\u00e0 nguy\u00ean l\u00fd c\u1ee7a m\u1ed9t s\u1ed1 ph\u1ea3n \u1ee9ng.<\/p>\n
– T\u1ed1c \u0111\u1ed9 l\u1eafng c\u1ee7a h\u1ed3ng c\u1ea7u t\u0103ng: trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p gi\u1ea3m protid huy\u1ebft t\u01b0\u01a1ng ( V\u00ec t\u1ef7 tr\u1ecdng huy\u1ebft t\u01b0\u01a1ng gi\u1ea3m trong khi t\u1ef7 trong h\u1ed3ng c\u1ea7u b\u00ecnh th\u01b0\u1eddng n\u00ean h\u1ed3ng c\u1ea7u d\u1ec5 l\u1eafng xu\u1ed1ng).<\/p>\n
C\u00e2u 5: Tr\u00ecnh b\u00e0y r\u1ed1i lo\u1ea1n sinh t\u1ed5ng h\u1ee3p protein do gen \u0111i\u1ec1u h\u00f2a v\u00e0 gen c\u1ea5u tr\u00fac?<\/p>\n
A- R\u1ed1i lo\u1ea1n gen c\u1ea5u tr\u00fac<\/p>\n
Gen c\u1ea5u tr\u00fac mang th\u00f4ng tin quy \u0111\u1ecbnh tr\u00ecnh t\u1ef1 ch\u1eb7t ch\u1ebd c\u1ee7a c\u00e1c acid amin trong m\u1ea1ch polypeptid. Nh\u1eefng sai s\u00f3t trong gen c\u1ea5c tr\u00fac l\u00e0m cho m\u1ed9t acid amin trong gen c\u1ea5u tr\u00fac b\u1ecb thay \u0111\u1ed5i g\u1ecdi l\u00e0 \u0111\u1ed9t bi\u1ebfn gen. trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 nhi\u1ec1u acid amin trong phan t\u1eed polypeptid b\u1ecb thay \u0111\u1ed5i l\u00e0m sai s\u00f3t m\u1ed9t \u0111o\u1ea1n gen c\u1ea5u tr\u00fac ( \u0111\u1ed9t bi\u1ebfn \u0111o\u1ea1n). nh\u1eefng protid \u0111\u01b0\u1ee3c t\u1ed5ng h\u1ee3p ra do s\u1ef1 sai s\u00f3t c\u1ee7a gen c\u1ea5u tr\u00fac tr\u00ean c\u00f3 th\u1ec3 ho\u00e0n to\u00e0n kh\u00f4ng \u0111\u1ea3m nhi\u1ec7m \u0111\u01b0\u1ee3c ch\u1ee9c n\u0103ng c\u1ee7a protid ban \u0111\u1ea7u<\/p>\n
* B\u1ec7nh l\u00fd do r\u1ed1i lo\u1ea1n gen c\u1ea5u tr\u00fac th\u01b0\u1eddng l\u00e0 b\u1ea9m sinh.<\/p>\n
– C\u00e1c b\u1ec7nh l\u00fd r\u1ed1i lo\u1ea1n c\u1ea5u tr\u00fac Hemoglobin:<\/p>\n
+ B\u1ec7nh thi\u1ebfu m\u00e1u h\u1ed3ng c\u1ea7u h\u00ecnh l\u01b0\u1ee1i li\u1ec1m: Acid-amin th\u1ee9 6 trong chu\u1ed7i \u03b2 c\u1ee7a Hb ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng l\u00e0 GAA(glutamin) b\u1ecb thay th\u1ebf b\u1edfi GUA (valin) l\u00e0m cho huy\u1ebft s\u1eafc t\u1ed1 s\u1ebd l\u00e0 HbS. HbS d\u1ec5 b\u1ecb k\u1ebft tinh khi thi\u1ebfu Oxy n\u00ean h\u1ed3ng c\u1ea7u bi\u1ebfn d\u1ea1ng th\u00e0nh h\u00ecnh li\u1ec1m, c\u00f3 s\u1ee9c c\u0103ng b\u1ec1 m\u1eb7t gi\u1ea3m v\u00e0 d\u1ec5 v\u1ee1.<\/p>\n
+ B\u1ec7nh thi\u1ebfu m\u00e1u h\u1ed3ng c\u1ea7u h\u00ecnh bia: Acid-amin th\u1ee9 6 trong chu\u1ed7i \u03b2 \u1edf Hb ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng b\u1ecb thay th\u1ebf b\u01a1i AAA (lysin) v\u00e0 huy\u1ebft s\u1eafc t\u1ed1 l\u00e0 HbC l\u00e0m h\u1ed3ng c\u1ea7u c\u00f3 h\u00ecnh bia v\u00e0 d\u1ec5 v\u1ee1 khi thi\u1ebfu oxy.<\/p>\n
– B\u1ec7nh thi\u1ebfu enzym trong chu\u1ed7i chuy\u1ec3n h\u00f3a: Khi thieeusu enzym n\u00e0o \u0111\u00f3 trong chu\u1ed7i chuy\u1ec3n h\u00f3a s\u1ebd g\u00e2y \u1ee9 \u0111\u1ecdng c\u00e1c s\u1ea3n ph\u1ea9m \u1edf ph\u00eda tr\u01b0\u1edbc v\u00e0 thi\u1ebfu s\u1ea3n ph\u1ea9m \u1edf ph\u00eda sau.<\/p>\n
+ B\u1ec7nh b\u1ea1ch t\u1ea1ng: Thi\u1ebfu enzym tyrosinase n\u00ean kh\u00f4ng h\u00ecnh th\u00e0nh melanin<\/p>\n
+ B\u1ec7nh \u1ee9 \u0111\u1ecdng glycogen \u1edf gan ( Von Gierke): thi\u1ebfu G-6-Phosphatase n\u00ean Glycogen kh\u00f4ng tho\u00e1i h\u00f3a \u0111\u01b0\u1ee3c.<\/p>\n
+ B\u1ec7nh oxalat ni\u1ec7u: Thi\u1ebfu glycintransaminase<\/p>\n
+B\u1ec7nh Alkapton ni\u1ec7u: Thi\u1ebfu h\u00f4mgentisicase<\/p>\n
– B\u1ec7nh b\u1ea9m sinh do thi\u1ebfu \u03b3 globulin, thi\u1ebfu c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u.<\/p>\n
B- R\u1ed1i lo\u1ea1n gen \u0111i\u1ec1u h\u00f2a<\/p>\n
V\u1edbi vi\u1ec7c t\u1ed5ng h\u1ee3p m\u1ed9t ch\u1ea5t hay ki\u1ec5m h\u00e3m n\u00f3, gen \u0111i\u1ec1u h\u00f2a cho ph\u00e9p ho\u1eb7c \u1ee9c ch\u1ebf gen c\u1ea5u tr\u00fac t\u1ed5ng h\u1ee3p s\u1ed1 l\u01b0\u1ee3ng protid th\u00edch h\u1ee3p, \u1edf th\u1eddi \u0111i\u1ec3m th\u00edch h\u1ee3p ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c nhu c\u1ea7u c\u1ee7a c\u01a1 th\u1ec3.<\/p>\n
\u00e0 N\u00ean gen \u0111i\u1ec1u h\u00f2a r\u1ed1i lo\u1ea1n ho\u1ea1t \u0111\u1ed9ng th\u00ec c\u00e1c protid \u0111\u01b0\u1ee3c t\u1ecfng h\u1ee3p ra m\u1ea5t c\u00e2n \u0111\u1ed1i v\u1ec1 t\u1ef7 l\u1ec7, c\u00f3 khi qu\u00e1 th\u1eeba ho\u1eb7c qu\u00e1 thi\u1ebfu, ho\u1eb7c v\u1eabn t\u1ed5ng h\u1ee3p ra m\u1ed9t protid \u0111\u00e3 t\u1eeb l\u00e2u c\u01a1 th\u1ec3 kh\u00f4ng c\u1ea7n.<\/p>\n
– B\u1ec7nh huy\u1ebft s\u1eafc t\u1ed1 F: HbF c\u00f3 \u1edf b\u00e0o thai c\u00f3 hai gen c\u1ea5u tr\u00fac t\u1ed5ng h\u1ee3p hai chu\u1ed7i polypeptid \u03b1 v\u00e0 \u03b3 t\u1ea1o n\u00ean. Hbf tuy r\u1ea5t nh\u1ea1y c\u1ea3m v\u1edbi oxy nh\u01b0ng h\u1ed3ng c\u1ea7u r\u1ea5t d\u1ec5 v\u1ee1.<\/p>\n
Khi tr\u1ebb ra \u0111\u1eddi gen \u0111i\u1ec1u h\u00f2a s\u1ebd ki\u1ec1m h\u00e3m v\u0129nh vi\u1ec5n gen c\u1ea5u tr\u00fac n\u00e0y kh\u00f4ng cho s\u1ea3n xu\u1ea5t HbF. Nh\u01b0ng n\u1ebfu gen \u0111i\u1ec1u h\u00f2a kh\u00f4ng ki\u1ec1m h\u00e3m n\u1ed5i gen c\u1ea5u tr\u00fac chu\u1ed7i \u03b3 th\u00ec HbF v\u1eabn t\u1ed3n t\u1ea1i \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh l\u00e0 b\u1ec7nh l\u00fd<\/p>\n
– B\u1ec7nh huy\u1ebft s\u1eafc t\u1ed1 H: B\u1ed1n chu\u1ed7i \u0111\u1ec1u l\u00e0 beta<\/p>\n
– B\u1ec7nh huy\u1ebft s\u1eafc t\u1ed1 Bart : b\u1ed1n chu\u1ed7i peptid c\u1ee7a huy\u1ebft s\u1eafc t\u1ed1 \u0111\u1ec1u l\u00e0 gama<\/p>\n
– B\u1ec7nh ch\u1ee9c nhi\u1ec1u porphyrin trong ph\u00e2n v\u00e0 n\u01b0\u1edbc ti\u1ec3u: Khi ra \u0111\u1eddi v\u00e0 tru\u1edfng th\u00e0nh, gen \u0111i\u1ec1u h\u00f2a kh\u00f4ng k\u00ecm h\u00e3m \u0111\u01b0\u1ee3c gen c\u1ea5u tr\u00fac t\u1ed5ng h\u1ee3p aminolevuninic acid synthetase (enzym t\u1ed5ng h\u1ee3p aminolevuninic \u2013 ti\u1ec1n th\u00e2n c\u1ee7a phorphyrin). Do v\u1eady phorphyrin \u0111\u01b0\u1ee3c t\u1ea1o ra nhi\u1ec1u v\u00e0 \u1ee9 \u0111\u1ecdng l\u1ea1i.<\/p>\n
C\u00e2u 6: Gi\u1ea3i th\u00edch c\u01a1 ch\u1ebf r\u1ed1i lo\u1ea1n ch\u1ee9c ph\u1eadn ch\u1ed1ng \u0111\u1ed9c c\u1ee7a gan?<\/p>\n
B\u1eb1ng nh\u1eefng ph\u1ea3n \u1ee9ng sinh h\u00f3a k\u1ebft h\u1ee3p, gan c\u00f3 kh\u1ea3 n\u0103ng trung h\u00f2a ch\u1ea5t \u0111\u1ed9c h\u00ecnh th\u00e0nh trong c\u01a1 th\u1ec3 ho\u1eb7c t\u1eeb ngo\u00e0i v\u00e0o nh\u01b0 hocmon c\u00e1c \u0111\u1ed9c t\u1ed1 vi khu\u1ea9n, c\u00e1c ch\u1ea5t t\u1eeb \u1ed1ng ti\u00eau h\u00f3a t\u1edbi, c\u00e1c ch\u1ea5t \u0111\u1ed9c l\u00e0 s\u1ea3n ph\u1ea9m c\u1ee7a qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a trong c\u01a1 th\u1ec3.<\/p>\n
\u1ede b\u1ec7nh nh\u00e2n suy gan, ch\u1ee9c n\u0103ng ch\u1ed1ng \u0111\u1ed9c ph\u00e1t sinh r\u1ed1i lo\u1ea1n.<\/p>\n
1. \u0110\u1ed1i v\u1edbi hocmon: \u1ede b\u1ec7nh nh\u00e2n suy gan, hocmon \u01a1strogen kh\u00f4ng b\u1ecb ph\u00e2n h\u1ee7y, n\u00ean th\u01b0\u1eddng th\u1ea5y c\u00e1c hi\u1ec7n t\u01b0\u1ee3ng r\u1ee5ng t\u00f3c, \u0111\u1ecf, teo tinh ho\u00e0n, v\u00fa n\u1edf, d\u00e3n mao m\u1ea1ch, m\u1ea5t k\u00edch th\u00edch d\u1ee5c t\u00ednh\u2026<\/p>\n
Aldosteron v\u00e0 ADH c\u0169ng kh\u00f4ng \u0111\u01b0\u1ee3c gan ph\u00e2n h\u1ee7y g\u00e2y r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a n\u01b0\u1edbc \u0111i\u1ec7n gi\u1ea3i.<\/p>\n
2. \u0110\u1ed1i v\u1edbi ch\u1ea5t m\u00e0u: B\u00ecnh th\u01b0\u1eddng khi ti\u00eam ch\u1ea5t m\u00e0u bengal v\u00e0o m\u00e1u th\u00ec ch\u1eebng m\u1ed9t gi\u1edd sau, t\u1ea5t c\u1ea3 ch\u1ea5t m\u00e0u \u0111\u00f3 \u0111\u01b0\u1ee3c gi\u1eef l\u1ea1i \u0111\u1ec3 \u0111\u00e0o th\u1ea3i theo m\u1eadt, kh\u00f4ng c\u00f2n l\u01b0u h\u00e0nh trong m\u00e1u n\u1eefa.<\/p>\n
V\u1edbi ch\u1ea5t bromosul fopthalein th\u00ec sau 45 ph\u00fat ch\u1ec9 c\u00f2n l\u1ea1i trong m\u00e1u d\u01b0\u1edbi 10% ch\u1ea5t m\u00e0u. Kh\u1ea3 n\u0103ng c\u1ed1 \u0111\u1ecbnh l\u00e0 do h\u1ec7 th\u1ed1ng v\u00f5ng n\u1ed9i m\u00f4 (t\u1ebf b\u00e0o kuppffer) \u0111\u1ea3m nhi\u1ec7m. Khi gan suy, kh\u1ea3 n\u0103ng n\u00e0y gi\u1ea3m n\u00ean s\u1ed1 l\u01b0\u1ee3ng ch\u1ea5t m\u00e0u l\u01b0u h\u00e0nh trong m\u00e1u s\u1ebd c\u00f2n nhi\u1ec1u sau m\u1ed9t th\u1eddi gian quy \u0111\u1ecbnh. \u0110\u00f3 l\u00e0 nguy\u00ean t\u1eafc c\u1ee7a x\u00e9t nghi\u00eam th\u0103m d\u00f2 ch\u1ee9c n\u0103ng gan b\u1eb1ng m\u00e0u.<\/p>\n
3. \u0110\u1ed1i v\u1edbi vi khu\u1ea9n: Ngo\u00e0i kh\u1ea3 n\u0103ng c\u1ed1 \u0111\u1ecbnh vi khu\u1ea9n (nh\u01b0 c\u1ed1 \u0111\u1ecbnh ch\u1ea5t m\u00e0u), gan c\u00f2n c\u00f3 kh\u1ea3 n\u0103ng sinh kh\u00e1ng th\u1ec3 (nh\u1edd \u1edf h\u1ec7 th\u1ed1ng v\u00f5ng n\u1ed9i m\u00f4) \u0111\u1ec3 trung h\u00f2a \u0111\u1ed9c t\u1ed1 v\u00e0 ch\u1ed1ng l\u1ea1i vi khu\u1ea9n.<\/p>\n
\u1ede b\u1ec7nh nh\u00e2n x\u01a1 gan, v\u00e0ng da do nhi\u1ec5m tr\u00f9ng hay nhi\u1ec5m \u0111\u1ed9c n\u1eb7ng, th\u1ea5y kh\u00e1ng th\u1ec3 trong m\u00e1u gi\u1ea3m. Song c\u01a1 th\u1ec3 c\u00f2n c\u1ea3 m\u1ed9t h\u1ec7 v\u00f5ng n\u1ed9i m\u00f4 ngo\u00e0i gan ho\u1ea1t \u0111\u1ed9ng b\u00f9, n\u00ean hi\u1ec7n t\u01b0\u1ee3ng gi\u1ea3m kh\u00e1ng th\u1ec3 kh\u00f4ng th\u1ef1c s\u1ef1 r\u00f5 r\u1ec7t.<\/p>\n
4.\u0110\u1ed1i v\u1edbi c\u00e1c ch\u1ea5t \u0111\u1ed9c: Gan c\u00f3 kh\u1ea3 n\u0103ng chuy\u1ec3n h\u00f3a c\u00e1c ch\u1ea5t \u0111\u1ed9c th\u00e0nh ch\u1ea5t kh\u00f4ng \u0111\u1ed9c hay \u00edt \u0111\u1ed9c. qu\u00e1 tr\u00ecnh gi\u1ea3i \u0111\u1ed9c n\u00e0y l\u00e0 m\u1ed9t qu\u00e1 tr\u00ecnh h\u00f3a h\u1ee3p.<\/p>\n
M\u1ed9t th\u00ed d\u1ee5 \u0111i\u1ec3n h\u00ecnh l\u00e0 qu\u00e1 tr\u00ecnh chuy\u1ec1n amoniac, m\u1ed9t s\u1ea3n ph\u1ea9n r\u1ea5t \u0111\u1ed9c c\u1ee7a kh\u1eed amin, th\u00e0nh ure l\u00e0 m\u1ed9t s\u1ea3n ph\u1ea9m \u00edt \u0111\u1ed9c. Ho\u1eb7c axitbenzoic \u0111\u01b0\u1ee3c h\u00f3a h\u1ee3p v\u1edbi glixin \u0111\u1ec3 cho axit hippuric kh\u00f4ng \u0111\u1ed9c, \u0111\u00e0o th\u1ea3i theo n\u01b0\u1edbc ti\u1ec3u.<\/p>\n
\u00e0 \u0110\u00f3 l\u00e0 c\u01a1 s\u1edf c\u1ee7a x\u00e9t nghi\u1ec7m th\u0103m d\u00f2 ch\u1ee9c n\u0103ng gi\u1ea3i \u0111\u1ed9c c\u1ee7a gan b\u1eb1ng axit benzoic: cho b\u1ec7nh nh\u00e2n u\u1ed1ng 6g Na-benzoat v\u1edbi 2000ml n\u01b0\u1edbc, r\u1ed3i t\u1ea5p trung n\u01b0\u1edbc ti\u1ec3u trong 4h sau, b\u00ecnh th\u01b0\u1eddng ph\u1ea3i thu \u0111\u01b0\u1ee3c 3g axit huppuric, n\u1ebfu \u00edt h\u01a1n l\u00e0 gan suy.<\/p>\n
5. \u0110\u1ed1i v\u1edbi c\u00e1c thu\u1ed1c: B\u1ec7nh nh\u00e2n suy gan kh\u00f4ng u\u1ed1ng \u0111\u01b0\u1ee3c nhi\u1ec1u thu\u1ed1c ng\u1ee7, thu\u1ed1c an th\u1ea7n, d\u1ec5 b\u1ecb nhi\u1ec5m \u0111\u1ed9c r\u01b0\u1ee3u, mocphin, nicotin\u2026 \u0110\u00f3 l\u00e0 do gan suy \u0111\u00e3 m\u1ea5t kh\u1ea3 n\u0103ng trung h\u00f2a c\u00e1c ch\u1ea5t \u0111\u1ed9c b\u1eb1ng c\u00e1ch oxi h\u00f3a, h\u00f3a h\u1ee3p.<\/p>\n
\u00e0 B\u1ec7nh nh\u00e2n suy gan th\u01b0\u1eddng ch\u1ebft trong t\u00ecnh tr\u1ea1ng nhi\u1ec5m \u0111\u1ed9c.<\/p>\n
C\u00e2u 7: Tr\u00ecnh b\u00e0y r\u1ed1i lo\u1ea1n ch\u1ee9c ph\u1eadn c\u1ea5u t\u1ea1o v\u00e0 b\u00e0i ti\u1ebft m\u1eadt c\u1ee7a gan?<\/p>\n
M\u1ed9t ch\u1ee9c n\u0103ng quan tr\u1ecdng n\u1eefa c\u1ee7a gan l\u00e0 t\u1ea1o m\u1eadt v\u00e0 b\u00e0i ti\u1ebft m\u1eadt. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u00e1y g\u00e2y ra ch\u1ee9ng v\u00e0ng da, r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a v\u00e0 b\u1ec7nh s\u1ecfi m\u1eadt.<\/p>\n
1. Chuy\u1ec3n h\u00f3a s\u1eafc t\u1ed1 m\u1eadt:<\/p>\n
– Ngu\u1ed3n g\u1ed1c ch\u00ednh c\u1ee7a s\u1eafc t\u1ed1 m\u1eadt l\u00e0 do tho\u00e1i bi\u1ebfn Hb \u1edf h\u1ec7 v\u00f5ng n\u1ed9i m\u00f4 (t\u1ea1i gan v\u00e0 ngo\u00e0i gan).<\/p>\n
– Bilirubin t\u1ef1 do h\u00ecnh th\u00e0nh \u0111\u1ed5 v\u00e0o m\u00e1u, \u0111\u1eadm \u0111\u1ed9 th\u1ea5p (0- 0,1 mg\/100 ml) do s\u1ea3n sinh \u0111\u01b0\u1ee3c bao nhi\u00eau th\u00ec k\u1ecbp th\u1eddi \u0111\u01b0\u1ee3c gan chuy\u1ec3n th\u00e0nh bilirubin h\u00f3a h\u1ee3p v\u1edbi nhau. Bilirubin t\u1ef1 do v\u00e0o gan \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p axit uridin diphotpho – glucuronic (nh\u1edd men glucuronyl-transferaza) \u0111\u1ec3 t\u00e1i t\u1ea1o bilirubin h\u00f3a h\u1ee3p v\u00e0 axit uridin diphotphat.<\/p>\n
– Bilirubin h\u00f3a h\u1ee3p \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft theo m\u1eadt v\u00e0o ru\u1ed9t non, \u1edf \u0111\u1ea5y s\u1eafc t\u1ed1 m\u1eadt \u0111\u01b0\u1ee3c kh\u1eed oxy th\u00e0nh urobilinogen hay m\u1ea1nh h\u01a1n n\u1eefa th\u00e0nh stercobilinogen (b\u1edfi vi khu\u1ea9n \u0111\u01b0\u1eddng ru\u1ed9t). T\u1ea1i ru\u1ed9t 1 ph\u1ea7n urobilinogen t\u00e1i h\u1ea5p thu v\u00e0o m\u00e1u \u0111\u01b0\u1ee3c gan gi\u1eef l\u1ea1i \u0111\u1ec3 bi\u1ebfn th\u00e0nh bilirubin h\u00f3a h\u1ee3p r\u1ed3i b\u00e0i ti\u1ebft theo m\u1eadt (tuy nhi\u00ean m\u1ed9t ph\u1ea7n r\u1ea5t nh\u1ecf urobilinogen kh\u00f4ng \u0111\u01b0\u1ee3c gan gi\u1eef l\u1ea1i v\u00e0 \u0111\u01b0\u1ee3c m\u00e1u v\u1eadn chuy\u1ec3n t\u1edbi th\u1eadn \u0111\u1ec3 b\u00e0i ti\u1ebft theo n\u01b0\u1edbc ti\u1ec3u ra ngo\u00e0i). \u0110\u00f3 l\u00e0 chu tr\u00ecnh ru\u1ed9t – gan.<\/p>\n
– Khi nhu m\u00f4 gan b\u1ecb t\u1ed5n th\u01b0\u01a1ng urobilinogen t\u1eeb ru\u1ed9t t\u1edbi kh\u00f4ng \u0111\u01b0\u1ee3c gan gi\u1eef l\u1ea1i \u0111\u1ec3 t\u00e1i t\u1ed5ng h\u1ee3p bilirubin h\u00f3a h\u1ee3p, do \u0111\u00f3 urobilinogen s\u1ebd xu\u1ea5t hi\u1ec7n trong n\u01b0\u1edbc ti\u1ec3u. T\u1ea1i ru\u1ed9t, urobilinogen v\u00e0 stecobilinogen b\u1ecb ti\u1ebfp t\u1ee5c oxy h\u00f3a \u0111\u1ec3 t\u1ea1o ra mu\u1ed1i m\u1eadt.<\/p>\n
Bilirubin t\u1ef1 do kh\u00f4ng tan trong n\u01b0\u1edbc (do \u0111\u00f3 kh\u00f4ng b\u00e1i ti\u1ebft ra ngo\u00e0i theo n\u01b0\u1edbc ti\u1ec3u), ch\u1ec9 tan trong dunh m\u00f4i h\u1eefu c\u01a1 (do d\u00f3 bilirubin t\u1ef1 do c\u00f3 \u00e1i t\u00ednh v\u1edbi nh\u1eefng t\u1ed5 ch\u1ee9c m\u1ee1, c\u1ee5 th\u1ec3 l\u00e0 v\u1edbi t\u1ed5 ch\u1ee9c n\u00e3o). \u0110i\u1ec3m n\u00e0y gi\u1ea3i th\u00edch t\u1ea1i sao v\u00e0ng da do bilirubin t\u1ef1 do hay g\u00e2y nhi\u1ec5m \u0111\u1ed9c n\u00e3o. Bilirubin h\u00f3a h\u1ee3p, tr\u00e1i l\u1ea1i, kh\u00f4ng \u0111\u1ed9c. Do \u0111\u00f3 qu\u00e1 tr\u00ecnh chuy\u1ec3n bilirubin t\u1ef1 do th\u00e0nh bilirubin h\u00f3a h\u1ee3p c\u00f3 th\u1ec3 coi nh\u01b0 m\u1ed9t qu\u00e1 tr\u00ecnh gi\u1ea3i \u0111\u1ed9c<\/p>\n
2. V\u00e0ng da:<\/p>\n
V\u00e0ng da ph\u00e1t sinh khi c\u00e1c s\u1eafc t\u1ed1 m\u1eadt trong m\u00e1u cao h\u01a1n b\u00ecnh th\u01b0\u1eddng v\u00e0 ng\u1ea5m v\u00e0o t\u1ed5 ch\u1ee9c b\u00ec (da, ni\u00eam m\u1ea1c) Khi bilirubin huy\u1ebft thanh t\u0103ng t\u1edbi 2-3 mg%, th\u01b0\u1eddng \u0111\u00e3 xu\u1ea5t hi\u1ec7n v\u00e0ngm\u1eaft.C\u00f3 nhi\u1ec1u c\u00e1ch x\u1ebfp lo\u1ea1i v\u00e0ng da kh\u00e1c nhau, th\u00edch h\u1ee3p h\u01a1n c\u1ea3 l\u00e0 x\u1ebfp lo\u1ea1i theo b\u1ec7nh sinh:<\/p>\n
– V\u00e0ng da do nguy\u00ean nh\u00e2n tr\u01b0\u1edbc gan (hay v\u00e0ng da tan m\u00e1u).<\/p>\n
– V\u00e0ng da do t\u1ed5n th\u01b0\u01a1ng t\u1ea1i gan (hay v\u00e0ng da nh\u1edd m\u00f4).<\/p>\n
– V\u00e0ng da do t\u1eafc m\u1eadt (hay v\u00e0ng da c\u01a1 h\u1ecdc).<\/p>\n
1) V\u00e0ng da tan m\u00e1u:<\/p>\n
Trong lo\u1ea1i n\u00e0y gan kh\u00f4ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng. V\u00e0ng do \u1edf \u0111\u00e2y do t\u0103ng c\u01b0\u1eddng tan m\u00e1u n\u00ean hemoglobin \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng nhi\u1ec1u d\u1eabn t\u1edbi t\u0103ng bilirubin .<\/p>\n
Nguy\u00ean nh\u00e2n g\u00e2y tan m\u00e1u c\u00f3 th\u1ec3 l\u00e0: k\u00fd sinh tr\u00f9ng s\u1ed1t r\u00e9t, nhi\u1ec5m li\u00ean c\u1ea7u khu\u1ea9n tan m\u00e1u, xo\u1eafn khu\u1ea9n, nhi\u1ec5m \u0111\u1ed9c (sulfamit phenylhydrazin\u2026), truy\u1ec1n m\u00e1u nh\u1ea7m lo\u1ea1i\u2026<\/p>\n
\u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a lo\u1ea1i v\u00e0ng da n\u00e0y l\u00e0 bilirubin t\u1ef1 do t\u0103ng cao trong m\u00e1u, nh\u01b0ng kh\u00f4ng tan trong n\u01b0\u1edbc n\u00ean kh\u00f4ng \u0111\u00e0o th\u1ea3i theo n\u01b0\u1edbc ti\u1ec3u. Do c\u00f3 nhi\u1ec1u bilirubin t\u1ef1 do n\u00ean gan t\u0103ng t\u1ed5ng h\u1ee3p bilirubin h\u00f3a h\u1ee3p, stercobilin v\u00e0 urobilin l\u00e0m cho ph\u00e2n th\u1eabm m\u00e0u.<\/p>\n
V\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng, lo\u1ea1i v\u00e0ng da n\u00e0y kh\u00f4ng c\u00f3 ng\u1ee9a, kh\u00f4ng c\u00f3 tim \u0111\u1eadp ch\u1eadm v\u00e0 nh\u1ea5t l\u00e0 kh\u00f4ng c\u00f3 n\u01b0\u1edbc ti\u1ec3u m\u00e0u v\u00e0ng s\u1eabm. S\u1edf d\u0129 c\u00f3 bi\u1ec3u hi\u1ec7n nh\u01b0 v\u1eady l\u00e0 do kh\u00f4ng t\u00edch l\u0169y mu\u1ed1i m\u1eadt trong c\u01a1 th\u1ec3. Tuy nhi\u00ean khi \u0111\u1eadm \u0111\u1ed9 bilirubin t\u1ef1 do qu\u00e1 cao trong m\u00e1u th\u01b0\u1eddng g\u00e2y ph\u00e1t sinh nhi\u1ec5m \u0111\u1ed9c h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng (c\u01a1 ch\u1ebf \u0111\u00e3 tr\u00ecnh b\u00e0y \u1edf tr\u00ean).<\/p>\n
2) V\u00e0ng da do t\u1ed5n th\u01b0\u01a1ng gan:<\/p>\n
C\u00f3 th\u1ec3 chia l\u00e0m 2 lo\u1ea1i:<\/p>\n
a)V\u00e0ng da b\u1ea9m sinh do thi\u1ebfu men: R\u1ea5t \u00edt g\u1eb7p, ch\u1ee7 y\u1ebfu do c\u1ea5u t\u1ea1o gan kh\u00f4ng ho\u00e0n ch\u1ec9nh, cho n\u00ean thi\u1ebfu men glucuronyl transferaza kh\u00f4ng bi\u1ebfn bilirubin t\u1ef1 do th\u00e0nh bilirubin h\u00f3a h\u1ee3p.<\/p>\n
\u00e0 Do \u0111\u00f3 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a lo\u1ea1i v\u00e0ng da n\u00e0y l\u00e0 bilirubin t\u1ef1 do trong m\u00e1u t\u0103ng cao, n\u01b0\u1edbc ti\u1ec3u b\u00ecnh th\u01b0\u1eddng (kh\u00f4ng c\u00f3 bilirubin d\u00f9 c\u00f3 v\u00e0ng da), ph\u00e2n c\u00f3 \u00edt stercobilin. Khi bilirubin t\u1ef1 do qu\u00e1 cao trong m\u00e1u, th\u01b0\u1eddng ph\u00e1t sinh nhi\u1ec5m \u0111\u1ed9c c\u00e1c nh\u00e2n th\u1ea7n kinh. Lo\u1ea1i v\u00e0ng da n\u00e0y g\u1eb7p trong b\u1ec7nh v\u00e0ng da di truy\u1ec1n Gin- be (Gilbert) v\u00e0 b\u1ec7nh v\u00e0ng da sinh l\u00fd \u1edf tr\u1ebb s\u01a1 sinh (tr\u1ebb em m\u1edbi \u0111\u1ebb \u0111\u1ed9 1-2 ng\u00e0y \u0111\u00e3 th\u1ea5y xu\u1ea5t hi\u1ec7n v\u00e0ng da, c\u00f3 th\u1ec3 k\u00e9o d\u00e0i 5-6 ng\u00e0y).<\/p>\n
b)V\u00e0ng da do t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 gan:B\u1ec7nh sinh c\u1ee7a lo\u1ea1i n\u00e0y kh\u00e1 ph\u1ee9c t\u1ea1p. Ch\u1ee7 y\u1ebfu l\u00e0 do t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 gan g\u00e2y thi\u1ebfu th\u1ee9 ph\u00e1t nh\u1eefng men c\u1ea7n thi\u1ebft \u0111\u1ed1i v\u1edbi qu\u00e1 tr\u00ecnh chuy\u1ec3n bilirubin t\u1ef1 do th\u00e0nh bilirubin h\u00f3a h\u1ee3p.<\/p>\n
\u00e0 Do \u0111\u00f3 bilirubin t\u1ef1 do t\u0103ng cao trong m\u00e1u, stecobilin trong ph\u00e2n gi\u1ea3m (ph\u00e2n nh\u1eadt m\u00e0u) v\u00e0 urobili n\u01b0\u1edbc ti\u1ec3u t\u0103ng. Trong lo\u1ea1i v\u00e0ng da n\u00e0y, th\u01b0\u1eddng ph\u00e1t sinh nhi\u1ec1u r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a v\u00e0 ch\u1ee9c n\u0103ng, n\u1ebfu n\u1eb7ng c\u00f3 th\u1ec3 d\u1eabn t\u1edbi suy gan.<\/p>\n
Ngo\u00e0i ra c\u00f3 th\u1ec3 k\u00e8m theo vi\u00eam nh\u1eefng \u1ed1ng d\u1eabn m\u1eadt nh\u1ecf g\u00e2y t\u1eafc m\u1eadt l\u00e0m cho bilirubin h\u00f3a h\u1ee3p t\u0103ng trong m\u00e1u \u0111\u1ed3ng th\u1eddi stecobilin trong ph\u00e2n c\u00e0ng gi\u1ea3m. Trong vi\u00eam gan, m\u00e0ng t\u1ebf b\u00e0o nhu m\u00f4 gan t\u0103ng t\u00ednh th\u1ea5m c\u0169ng l\u00e0m cho bilirubin h\u00f3a h\u1ee3p d\u1ec5 th\u1ea5m v\u00e0o m\u00e1u.<\/p>\n
Nguy\u00ean nh\u00e2n g\u00e2y v\u00e0ng da nhu m\u00f4 c\u00f3 th\u1ec3 l\u00e0:<\/p>\n
– Nhi\u1ec5m khu\u1ea9n: \u0111\u1eb7c bi\u1ec7t l\u00e0 virut vi\u00eam gan, sau \u0111\u00f3 t\u1edbi nhi\u1ec5m khu\u1ea9n m\u00e1u, giang mai\u2026<\/p>\n
– Nhi\u1ec5m \u0111\u1ed9c: photpho, benzol\u2026<\/p>\n
3)V\u00e0ng da do t\u1eafc m\u1eadt:Lo\u1ea1i n\u00e0y c\u00f3 nh\u1eefng tri\u1ec7u ch\u1ee9ng \u0111\u1eb7c hi\u1ec7u nh\u1ea5t. Do t\u1eafc \u1ed1ng d\u1eabn m\u1eadt, m\u1eadt kh\u00f4ng v\u00e0o ru\u1ed9t \u0111\u01b0\u1ee3c n\u00ean th\u1ea5m v\u00e0o m\u00e1u v\u00e0 trong m\u00e1u th\u1ea5y \u0111\u1ee7 c\u00e1c th\u00e0nh ph\u1ea7n c\u1ee7a m\u1eadt: bilirubin h\u00f3a h\u1ee3p, cholesterol axit m\u1eadt.<\/p>\n
V\u1ec1 l\u00e2m s\u00e0ng, lo\u1ea1i n\u00e0y r\u1ea5t v\u00e0ng, ng\u00e0y c\u00e0ng v\u00e0ng k\u00e8m theo c\u00e1c tri\u1ec7u ch\u1ee9ng nhi\u1ec5m \u0111\u1ed9c mu\u1ed1i m\u1eadt (ng\u1ee9a, tim \u0111\u1eadp ch\u1eadm), n\u01b0\u1edbc ti\u1ec3u v\u00e0ng th\u1eabm v\u00ec t\u0103ng bilirubin h\u00f3a h\u1ee3p, ph\u00e2n tr\u1eafng b\u1ec7ch (ph\u00e2n c\u00f2). Trong d\u1ecbch t\u00e1 tr\u00e0ng th\u1ea5y \u00edt ho\u1eb7c kh\u00f4ng c\u00f3 m\u1eadt.<\/p>\n
N\u1ebfu m\u1eadt \u1ee9 \u0111\u1ecdng l\u00e2u ng\u00e0y, nhu m\u00f4 gan c\u00f3 th\u1ec3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng d\u1ea7n d\u1ea7n t\u1edbi suy gan, b\u1ea5y gi\u1edd trong m\u00e1u bilirubin h\u00f3a h\u1ee3p s\u1ebd gi\u1ea3m, t\u0103ng bilirubin t\u1ef1 do l\u00e0 ch\u1ee7 y\u1ebfu.<\/p>\n
Nguy\u00ean nh\u00e2n g\u00e2y v\u00e0ng da do t\u1eafc m\u1eadt c\u00f3 th\u1ec3 l\u00e0:<\/p>\n
– C\u01a1 h\u1ecdc: s\u1edfi. giun chui \u1ed1ng m\u1eadt, u \u0111\u1ea7u t\u1ee5y\u2026<\/p>\n
– Vi\u00eam, s\u1eb9o, d\u00e2y ch\u1eb1ng\u2026<\/p>\n
– Co c\u01a1 th\u1eaft Oddi.<\/p>\n
C\u00e2u 8: Tr\u00ecnh b\u00e0y \u0111\u1ecbnh ngh\u0129a thi\u1ebfu m\u00e1u, c\u00e1ch t\u00ednh v\u00e0 \u00fd ngh\u0129a c\u1ee7a c\u00e1c ch\u1ec9 s\u1ed1?<\/p>\n
– \u0110\u1ecbnh ngh\u0129a: Thi\u1ebfu m\u00e1u l\u00e0 m\u1ed9t hi\u1ec7n t\u01b0\u1ee3ng b\u1ec7nh l\u00fd ph\u1ed5 bi\u1ebfn ph\u00e1t sinh khi c\u00f3 r\u1ed1i lo\u1ea1n s\u1ef1 c\u00e2n b\u1eb1ng gi\u1eefa hai qu\u00e1 tr\u00ecnh s\u1ea3n xu\u1ea5t v\u00e0 ti\u00eau h\u1ee7y h\u1ed3ng c\u1ea7u, ho\u1eb7c do h\u1ed3ng c\u1ea7u b\u1ecb ti\u00eau h\u1ee7y qu\u00e1 m\u1ee9c ( m\u1ea5t m\u00e1u, h\u1ee7y h\u1ed3ng c\u1ea7u do c\u00e1c nguy\u00ean nh\u00e2n b\u1ec7nh l\u00fd ), ho\u1eb7c do qu\u00e1 tr\u00ecnh s\u1ea3n xu\u1ea5t h\u1ed3ng c\u1ea7u b\u1ecb gi\u1ea3m s\u00fat, \u1ee9c ch\u1ebf ( thi\u1ebfu nguy\u00ean li\u1ec7u, nhi\u1ec5m khu\u1ea9n, nhi\u1ec5m \u0111\u1ed9c n\u1eb7ng ).<\/p>\n
Bi\u1ec3u hi\u1ec7n c\u1ee7a thi\u1ebfu m\u00e1u l\u00e0 gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u, huy\u1ebft c\u1ea7u t\u1ed1 ngo\u1ea1i vi, \u0111\u1ed3ng th\u1eddi c\u00f3 nh\u1eefng r\u1ed1i lo\u1ea1n v\u1ec1 ch\u1ea5t l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u.<\/p>\n
– Thay \u0111\u1ed5i c\u1ee7a h\u1ed3ng c\u1ea7u v\u00e0 ch\u1ee9c n\u0103ng t\u1ea1o h\u1ed3ng c\u1ea7u trong thi\u1ebfu m\u00e1u.<\/p>\n
+ Thay \u0111\u1ed5i ch\u1ec9 s\u1ed1 nhi\u1ec5m s\u1eafc c\u1ee7a h\u1ed3ng c\u1ea7u :<\/p>\n
Ch\u1ec9 s\u1ed1 nhi\u1ec5m s\u1eafc l\u00e0 \u0111\u1eadm \u0111\u1ed9 huy\u1ebft s\u1eafc t\u1ed1 trong h\u1ed3ng c\u1ea7u, th\u1ec3 hi\u1ec7n gi\u00e1 tr\u1ecb ch\u1ee9c n\u0103ng c\u1ee7a h\u1ed3ng c\u1ea7u<\/p>\n
hemoglobin%CSNS = \u2014\u2014\u2014\u2014\u2014 =0.9-1.1 2 s\u1ed1 \u0111\u1ea7u HC<\/p>\n
\u00b7 \u00dd ngh\u0129a :<\/p>\n
Thi\u1ebfu m\u00e1u \u0111\u1eb3ng s\u1eafc: khi h\u1ed3ng c\u1ea7u v\u00e0 huy\u1ebft s\u1eafc t\u1ed1 gi\u1ea3m t\u01b0\u01a1ng \u1ee9ng, c\u00e1c tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu m\u00e1u c\u00f3 h\u1ee7y h\u1ed3ng c\u1ea7u v\u1eeba ph\u1ea3i, \u00edt ho\u1eb7c kh\u00f4ng b\u1ecb thi\u1ebfu s\u1eaft do Fe \u0111\u01b0\u1ee3c gi\u1eef l\u1ea1i s\u1eed d\u1ee5ng cho t\u00e1i t\u1ea1o h\u1ed3ng c\u1ea7u<\/p>\n
Thi\u1ebfu m\u00e1u nh\u01b0\u1ee3c s\u1eafc: khi CSNS gi\u1ea3m d\u01b0\u1edbi 0,9 do huy\u1ebft s\u1eafc t\u1ed1 gi\u1ea3m nhi\u1ec1u h\u01a1n so v\u1edbi HC<\/p>\n
Thi\u1ebfu m\u00e1u \u01b0u s\u1eafc: khi CSNS tr\u00ean 1,1. Thi\u1ebfu m\u00e1u \u01b0u s\u1eafc g\u1eb7p trong b\u1ec7nh thi\u1ebfu m\u00e1u \u00e1c t\u00ednh Addison- Biermer<\/p>\n
+ C\u1ee1 kh\u1ed5 kh\u00f4ng \u0111\u1ec1u hay hi\u1ec7n t\u01b0\u1ee3ng \u0111a c\u1ee1 :<\/p>\n
Trong m\u00e1u th\u1ea5y xu\u1ea5t hi\u1ec7n m\u1ed9t s\u1ed1 h\u1ed3ng c\u1ea7u to h\u01a1n b\u00ecnh th\u01b0\u1eddng, \u0111\u01b0\u1eddng k\u00ednh 8- 10 microm\u00e9t.<\/p>\n
H\u1ed3ng c\u1ea7u nh\u1ecf, \u0111\u01b0\u1eddng k\u00ednh 5- 6 ho\u1eb7c 3- 5 microm\u00e9t, l\u00e0 bi\u1ec3u hi\u1ec7n kh\u00f4ng t\u1ed1t v\u00ec \u0111\u00f3 l\u00e0 nh\u1eefng HC gi\u00e0 c\u1ed7i, nh\u1eefng m\u1ea3nh v\u1ee1 c\u1ee7a HC, ho\u1eb7c nh\u1eefng HC b\u1ecb teo \u0111i d\u01b0\u1edbi t\u00e1c d\u1ee5ng c\u1ee7a y\u1ebfu t\u1ed1 b\u1ec7nh l\u00fd, nh\u1eefng HC s\u1ea3n xu\u1ea5t trong \u0111i\u1ec1u ki\u1ec7n x\u1ea5u, thi\u1ebfu nguy\u00ean li\u1ec7u.<\/p>\n
– Thay \u0111\u1ed5i ch\u1ee9c n\u0103ng t\u1ea1o h\u1ed3ng c\u1ea7u c\u1ee7a t\u1ee7y x\u01b0\u01a1ng:<\/p>\n
+ T\u0103ng sinh b\u00ecnh th\u01b0\u1eddng :<\/p>\n
T\u0103ng h\u1ed3ng c\u1ea7u l\u01b0\u1edbi 10- 20% c\u00f3 khi t\u1edbi 50% v\u00e0 h\u01a1n n\u1eefa<\/p>\n
Bi\u1ebfn \u0111\u1ed5i v\u1ec1 ch\u1ea5t l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u \u00edt ho\u0103c kh\u00f4ng r\u00f5 r\u1ec7t.<\/p>\n
B\u1ea1ch c\u1ea7u h\u1ea1t v\u00e0 ti\u1ec3u c\u1ea7u c\u0169ng c\u00f3 d\u1ea5u hi\u1ec7u t\u0103ng sinh nh\u1eb9<\/p>\n
+ Ch\u1ee9c n\u0103ng b\u1ecb r\u1ed1i lo\u1ea1n ho\u1eb7c b\u1ecb \u1ee9c ch\u1ebf<\/p>\n
H\u1ed3ng c\u1ea7u l\u01b0\u1edbi gi\u1ea3m th\u1ea5p ho\u1eb7c kh\u00f4ng xu\u1ea5t hi\u1ec7n.<\/p>\n
Nhi\u1ec1u bi\u1ebfn \u0111\u1ed5i v\u1ec1 ch\u1ea5t l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u.<\/p>\n
B\u1ea1ch c\u1ea7u v\u00e0 ti\u1ec3u c\u1ea7u gi\u1ea3m song song v\u1edbi thi\u1ebfu m\u00e1u.<\/p>\n
C\u00e2u 9: Tr\u00ecnh b\u00e0y v\u00e0 gi\u1ea3i th\u00edch c\u01a1 ch\u1ebf v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m bi\u1ec3u hi\u1ec7n c\u1ee7a ba d\u1ea1ng thi\u1ebfu m\u00e1u?<\/p>\n
A- Thi\u1ebfu m\u00e1u do m\u1ea5t m\u00e1u: c\u00f3 2 h\u00ecnh th\u1ee9c: C\u1ea5p t\u00ednh v\u00e0 m\u00e3n t\u00ednh.<\/p>\n
1. Thi\u1ebfu m\u00e1u do m\u1ea5t m\u00e1u c\u1ea5p t\u00ednh<\/p>\n
a. Nguy\u00ean nh\u00e2n: th\u01b0\u1eddng do nguy\u00ean nh\u00e2n ngo\u1ea1i khoa ( v\u1ebft th\u01b0\u01a1ng, \u0111\u1ee9t m\u1ea1ch m\u00e1u, g\u1eaby x\u01b0\u01a1ng,ph\u1eabu thu\u1eadt\u2026) h\u1ecd\u0103c bi\u1ebfn ch\u1ee9ng n\u1ed9i khoa ( n\u00f4n ra m\u00e1u, kh\u1ea1c ra m\u00e1u, ch\u1ea3y m\u00e1u d\u1ea1 d\u1ea7y, \u0111\u00e1i ra m\u00e1u, ch\u1ea3y m\u00e1u cam, ch\u1ea9y m\u00e1u d\u01b0\u1edbi da, n\u1ed9i t\u1ea1ng quan tr\u1ecdng\u2026).<\/p>\n
b. \u0110\u1eb7c \u0111i\u1ec3m: Ngo\u00e0i nguy c\u01a1 tr\u01b0\u1edbc m\u1eaft ( s\u1ed1c, tr\u1ee5y tim m\u1ea1ch ), thi\u1ebfu m\u00e1u ph\u00e1t sinh sau \u0111\u00f3 v\u1edbi c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m sau \u0111\u00e2y:<\/p>\n
+ Gi\u1ea3m h\u1ed3ng c\u1ea7u v\u00e0 hu\u1ef5\u1ebft c\u1ea7u t\u1ed1 nghi\u00eam tr\u1ecdng, m\u00e1u lo\u00e3ng do d\u1ecbch gian b\u00e0o v\u00e0o d\u00f2ng m\u00e1u \u0111\u1ec3 b\u00f9 \u0111\u1eafp kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n.<\/p>\n
+ Thi\u1ebfu m\u00e1u nh\u01b0\u1ee3c s\u1eafc, ch\u1ec9 s\u1ed1 nhi\u1ec5m s\u1eafc gi\u1ea3m r\u00f5 r\u1ec7t, v\u00ec m\u1ea5t h\u1ed3ng c\u1ea7u, hu\u1ef5\u1ebft c\u1ea7u t\u1ed1 th\u01b0\u1eddng d\u1eabn t\u1edbi thi\u1ebfu s\u1eaft do s\u1eaft trong c\u01a1 th\u1ec3 ch\u1ee7 y\u1ebfu \u1edf d\u1ea1ng k\u1ebft h\u1ee3p v\u1edbi huy\u1ebft c\u1ea7u t\u1ed1 ( chi\u1ebfm t\u1edbi 2\/3 t\u1ed5ng s\u1ed1 l\u01b0\u1ee3ng s\u1eaft trong c\u01a1 th\u1ec3, c\u1ee9 1l\u00edt m\u00e1u ch\u1ee9a kho\u1ea3ng 500mg s\u1eaft<\/p>\n
+ T\u0103ng h\u1ed3ng c\u1ea7u l\u01b0\u1edbi, t\u1ee7y gi\u1ea7u t\u1ebf b\u00e0o v\u00e0 c\u00f3 d\u1ea5u hi\u1ec7u t\u0103ng s\u1ea3n d\u00f2ng h\u1ed3ng c\u1ea7u. H\u1ed3i ph\u1ee5c c\u00e0ng nhanh n\u1ebfu m\u1ee9c \u0111\u1ed9 thi\u1ebfu m\u00e1u kh\u00f4ng n\u1eb7ng ( d\u01b0\u1edbi 20% t\u1ed5ng l\u01b0\u1ee3ng) v\u00e0 tr\u1ea1ng th\u00e1i to\u00e0n th\u00e2n t\u1ed1t. C\u00e1c bi\u1ebfn \u0111\u1ed5i v\u1ec1 ch\u1ea5t l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u c\u0169ng \u00edt ho\u1eb7c kh\u00f4ng xu\u1ea5t hi\u1ec7n.<\/p>\n
T\u1ed5n th\u01b0\u01a1ng huy\u1ebft qu\u1ea3n<\/p>\n
M\u1ea5t m\u00e1u<\/p>\n
\u2193Gi\u1ea3m kh\u1ed1i l\u01b0\u01a1ng m\u00e1u tu\u1ea7n ho\u00e0n<\/p>\n
\u2193\u2193Gi\u1ea3m huy\u1ebft \u00e1p Gi\u1ea3m Oxy- m\u00e1u<\/p>\n
Tim co b\u00f3p y\u1ebfu Thi\u1ebfu Oxy<\/p>\n
\u2193\u2193K\u00edch th\u00edch th\u1ee5 H\u01b0ng ph\u1ea5n h\u1ec7<\/p>\n
c\u1ea3m huy\u1ebft qu\u1ea3n TKT\u01af<\/p>\n
\u2193\u2193T\u0103ng c\u00e1c ph\u1ea3n\u2190\u1ee8c ch\u1ebf h\u1ec7 TKT\u01af<\/p>\n
\u1ee9ng b\u00f9 \u0111\u1eafp<\/p>\n
\u2193\u2193H\u1ed3i ph\u1ee5c<\/p>\n
R\u1ed1i lo\u1ea1n c\u00e1c ch\u1ee9c<\/p>\n
ph\u1eadn v\u00e0 c\u01a1 ch\u1ebf b\u00f9\u2192T\u1eed vong do S\u1ed1c m\u1ea5t m\u00e1u hay tr\u1ee5y tu\u1ea7n ho\u00e0n ( tr\u1ee5y tim m\u1ea1ch )<\/p>\n
S\u01a1 \u0111\u1ed3 v\u1ec1 b\u1ec7nh sinh c\u1ee7a m\u1ea5t m\u00e1u<\/p>\n
2. Thi\u1ebfu m\u00e1u do m\u1ea5t m\u00e1u tr\u01b0\u1eddng di\u1ec5n:<\/p>\n
\u25cf Nguy\u00ean nh\u00e2n; Ph\u00e1t sinh trong c\u00e1c b\u1ec7nh l\u00fd m\u00e3n t\u00ednh c\u00f3 ch\u1ea3y m\u00e1u. \u00cdt m\u1ed9t, k\u00e9o d\u00e0i ( lo\u00e9t d\u1ea1 d\u00e0y, tr\u0129, giun m\u00f3c, dong kinh ph\u1ee5 n\u1eef\u2026).<\/p>\n
\u25cf \u0110\u1eb7c \u0111i\u1ec3m<\/p>\n
Thi\u1ebfu m\u00e1u di\u1ec5n bi\u1ebfn th\u01b0\u1eddng k\u00e9o d\u00e0i, m\u1ee9c \u0111\u1ed9 gi\u1ea3m h\u1ed3ng c\u1ea7u, huy\u1ebft c\u1ea7u t\u1ed1 kh\u00f4ng nhi\u1ec1u l\u1eafm, th\u01b0\u1eddng l\u00e0 thi\u1ebfu m\u00e1u nh\u01b0\u1ee3c s\u1eafc, c\u0169ng c\u00f3 khi \u0111\u1eb3ng s\u1eafc.<\/p>\n
Trong m\u00e1u th\u1ea5y t\u0103ng h\u1ed3ng c\u1ea7u l\u01b0\u1edbi, nh\u01b0ng t\u1ef7 l\u1ec7 kh\u00f4ng cao v\u00e0 t\u1ed1c \u0111\u1ed9 h\u1ed3i ph\u1ee5c c\u0169ng ch\u1eadm h\u01a1n, bi\u1ebfn \u0111\u1ed5i v\u1ec1 ch\u1ea5t l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u c\u0169ng nhi\u1ec1u v\u00e0 r\u00f5 h\u01a1n ph\u1ee5 thu\u1ed9c v\u00e0o c\u00e1c b\u1ec7nh ch\u00ednh c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n
\u25cf Di\u1ec5n bi\u1ebfn<\/p>\n
B\u1ec7nh c\u00e0ng di\u1ec5n bi\u1ebfn l\u00e2u d\u00e0i c\u00e0ng \u1ea3nh h\u01b0\u1edfng t\u1edbi th\u1ec3 tr\u1ea1ng to\u00e0n th\u00e2n nh\u1ea5t l\u00e0 tim v\u00e0 h\u1ec7 th\u1ea7n kinh ( gi\u1ea3m tr\u00ed nh\u1edb, d\u1ec5 b\u1ecb cho\u00e1ng v\u00e1ng, ng\u1ea5t l\u1ecbm, tim c\u00f3 ti\u1ebfng th\u1ed5i ch\u1ee9c ph\u1eadn\u2026 ) Gi\u1ea3i quy\u1ebft thi\u1ebfu m\u00e1u trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y ph\u1ea3i song song v\u1edbi \u0111i\u1ec1u tr\u1ecb b\u1ec7nh ch\u00ednh.<\/p>\n
B- Thi\u1ebfu m\u00e1u do tan m\u00e1u ( do h\u1ee7y h\u1ed3ng c\u1ea7u ):<\/p>\n
L\u00e0 lo\u1ea1i thi\u1ebfu m\u00e1u do h\u1ed3ng c\u1ea7u b\u1ecb ph\u00e1 h\u1ee7y qu\u00e1 m\u1ee9c, nguy\u00ean nh\u00e2n v\u00e0 b\u1ec7nh sinh r\u1ea5t ph\u1ee9c t\u1ea1p c\u00f3 th\u1ec3 ph\u00e2n th\u00e0nh ba y\u1ebfu t\u1ed1 ch\u00ednh.<\/p>\n
1. Tan m\u00e1u nguy\u00ean nh\u00e2n do y\u1ebfu t\u1ed1 h\u1ed3ng c\u1ea7u: hay do b\u1ea3n th\u00e2n h\u1ed3ng c\u1ea7u k\u00e9m b\u1ec1n v\u1eefng, d\u1ec5 v\u1ee1 v\u00e0 b\u1ecb th\u1ef1c b\u00e0o b\u1edfi c\u00e1c t\u1ebf b\u00e0o h\u1ec7 v\u00f5ng n\u1ed9i m\u00f4, do \u0111\u00f3 ng\u01b0\u1eddi ta x\u1ebfp v\u00e0o lo\u1ea1i \u201c tan m\u00e1u trong t\u1ebf b\u00e0o \u201c lo\u1ea1i thi\u1ebfu m\u00e1u n\u00e0y c\u00f3 th\u1ec3 g\u1eb7p trong c\u00e1c b\u1ec7nh:<\/p>\n
B\u1ec7nh huy\u1ebft c\u1ea7u t\u1ed1 ph\u00e1t sinh do r\u1ed1i lo\u1ea1n t\u1ed5ng h\u1ee3p huy\u1ebft c\u1ea7u t\u1ed1, c\u00e1c b\u1ecb bi\u1ebfn d\u1ecb t\u1ea1o th\u00e0nh c\u00e1c huy\u1ebft c\u1ea7u t\u1ed1 b\u1ec7nh l\u00fd F,S\u2026 l\u00e0m thay \u0111\u1ed5i c\u1ea5u tr\u00fac v\u00e0 h\u00ecnh th\u1ec3 h\u1ed3ng c\u1ea7u, h\u1ed3ng c\u1ea7u chuy\u1ec3n th\u00e0nh c\u00e1c d\u1ea1ng h\u00ecnh bia, h\u00ecnh li\u1ec1m n\u00ean d\u1ec5 v\u1ee1, \u0111\u1ec3 k\u1ebft d\u00ednh v\u1edbi nhau g\u00e2y thi\u1ebfu m\u00e1u tan m\u00e1u c\u00f3 t\u00ednh ch\u1ea5t di truy\u1ec1n, gia \u0111\u00ecnh.<\/p>\n
B\u1ec7nh v\u00e0ng da tan m\u00e1u do h\u1ed3ng c\u1ea7u hinh tr\u00f2n ( spherocyte ) do thi\u1ebfu men enolaza l\u00e0 men chuy\u1ec3n lysophotphattidyl- ethalonamin do \u0111\u00f3 kh\u1ea3 n\u0103ng dung gi\u1ea3i \u0111\u01b0\u1eddng c\u1ee7a h\u1ed3ng c\u1ea7u l\u00e0m h\u1ed3ng c\u1ea7u d\u1ec5 b\u1ecb h\u1ee7y.<\/p>\n
B\u1ec7nh v\u00e0ng da tan m\u00e1u b\u1ea9m sinh do h\u1ed3ng c\u1ea7u b\u1ecb thi\u1ebfu men pyruvatkinaza ho\u1eb7c men diaphoraza.<\/p>\n
B\u1ec7nh thi\u1ebfu m\u00e1u tan m\u00e1u do d\u00f9ng m\u1ed9t s\u1ed1 thu\u1ed1c ( premaquine, sulfamid, acetalinit, l\u00e1 \u0111\u1eadu f\u00e8ve\u2026 ) do h\u1ed3ng c\u1ea7u thi\u1ebfu men G.6.P.D. ( gluco- 6 photphat dehydrogenaza).Trong c\u00e1c b\u1ec7nh n\u00e0y s\u1ee9c b\u1ec1n c\u1ee7a h\u1ed3ng c\u1ea7u v\u1edbi c\u00e1c n\u1ed3ng \u0111\u1ed9 dung d\u1ecbch NaCl nh\u01b0\u1ee3c tr\u01b0\u01a1ng gi\u1ea3m, \u0111\u1eddi s\u1ed1ng h\u1ed3ng c\u1ea7u ng\u1eafn l\u1ea1i ch\u1ec9 c\u00f2n 40- 80 ng\u00e0y hay \u00edt h\u01a1n n\u1eefa.<\/p>\n
2. Tan m\u00e1u do nguy\u00ean nh\u00e2n ngo\u00e0i h\u1ed3ng c\u1ea7u:<\/p>\n
a. Tan m\u00e1u do y\u1ebfu t\u1ed1 t\u1ed5 ch\u1ee9c:<\/p>\n
Do c\u01b0\u1eddng ho\u1ea1t h\u1ec7 th\u1ed1ng l\u01b0\u1edbi n\u1ed9i m\u00f4 ch\u1ee7 y\u1ebfu l\u00e0 c\u01b0\u1eddng l\u00e1ch th\u01b0\u1eddng g\u1eb7p trong b\u1ec7nh thi\u1ebfu m\u00e1u tan m\u00e1u c\u00f3 k\u00e8m gi\u1ea3m ti\u1ec3u c\u1ea7u, ho\u1eb7c trong c\u00e1c h\u1ed9i ch\u1ee9ng gan- l\u00e1ch to. Nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 do t\u0103ng ch\u1ee9c ph\u1eadn th\u1ef1c b\u00e0o c\u1ee7a l\u00e1ch \u0111\u1ed1i v\u1edbi h\u1ed3ng c\u1ea7u, v\u00e0 t\u0103ng t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf c\u1ee7a l\u00e1ch \u0111\u1ed1i v\u1edbi t\u1ee7y x\u01b0\u01a1ng. C\u00f3 t\u00e1c gi\u1ea3 cho r\u1eb1ng khi c\u01b0\u1eddng l\u00e1ch c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng xung huy\u1ebft \u1ee9 \u0111\u1ecdng h\u1ed3ng c\u1ea7u do \u0111\u00f3 h\u1ed3ng c\u1ea7u k\u00e9m b\u1ec1n v\u1eefng v\u00e0 d\u1ec5 v\u1ee1. C\u00f3 th\u1ec3 do t\u1ed5 ch\u1ee9c l\u00e1ch ti\u1ebft ra c\u00e1c men ti\u00eau h\u1ee7y ( lysin lysolecithin… ) ho\u1eb7c s\u1ea3n sinh c\u00e1c ng\u01b0ng k\u1ebft t\u1ed1 kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 c\u1ed1 \u0111\u1ecbnh v\u00e0o b\u1ec1 m\u1eb7t h\u1ed3ng c\u1ea7u l\u00e0m \u0111\u1ea3o l\u1ed9n c\u00e2n b\u1eb1ng l\u00fd h\u00f3a c\u1ee7a h\u1ed3ng c\u1ea7u l\u00e0m h\u1ed3ng c\u1ea7u d\u1ec5 v\u1ee1 do \u1ea3nh h\u01b0\u1edfng c\u1ee7a t\u1ed5n th\u01b0\u01a1ng c\u01a1 gi\u1edbi c\u0169ng nh\u01b0 c\u1ee7a c\u00e1c t\u1ea5n c\u00f4ng b\u1ec7nh l\u00fd kh\u00e1c.<\/p>\n
Lo\u1ea1i thi\u1ebfu m\u00e1u do hai nguy\u00ean nh\u00e2n tr\u00ean \u0111\u01b0\u1ee3c x\u1ebfp chung v\u00e0o lo\u1ea1i thi\u1ebfu m\u00e1u tan m\u00e1u trong t\u1ebf b\u00e0o v\u00ec h\u1ed3ng c\u1ea7u b\u1ecb h\u1ee7y v\u00e0 th\u1ef1c b\u00e0o trong c\u00e1c t\u1ed5 ch\u1ee9c v\u00f5ng n\u1ed9i m\u00f4.<\/p>\n
b. Tan m\u00e1u nguy\u00ean nh\u00e2n do y\u1ebfu t\u1ed1 d\u1ecbch th\u1ec3:<\/p>\n
C\u00f2n g\u1ecdi l\u00e0 thi\u1ebfu m\u00e1u do tan m\u00e1u m\u1eafc ph\u1ea3i, chi\u1ebfm m\u1ed9t v\u1ecb tr\u00ed ch\u1ee7 y\u1ebfu trong b\u1ec7nh l\u00fd thi\u1ebfu m\u00e1u \u1edf Vi\u1ec7t Nam. Nguy\u00ean nh\u00e2n v\u00e0 b\u1ec7nh sinh lo\u1ea1i thi\u1ebfu m\u00e1u n\u00e0y r\u1ea5t ph\u1ee9c t\u1ea1p, th\u01b0\u1eddng do c\u00e1c y\u1ebfu t\u1ed1 b\u00ean ngo\u00e0i ho\u1eb7c y\u1ebfu t\u1ed1 mi\u1ec5n d\u1ecbch t\u00e1c \u0111\u1ed9ng tr\u1ef1c ti\u1ebfp tr\u00ean h\u1ed3ng c\u1ea7u l\u00e0m choh\u1ed3ng c\u1ea7u b\u1ecb ti\u00eau h\u1ee7y ngay trong huy\u1ebft qu\u1ea3n, th\u01b0\u1eddng l\u00e0 c\u00e1c huy\u1ebft qu\u1ea3n th\u1eadn n\u00ean d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng ph\u1ed5 bi\u1ebfn c\u1ee7a lo\u1ea1i thi\u1ebfu m\u00e1u n\u00e0y l\u00e0 c\u00f3 huy\u1ebft c\u1ea7u t\u1ed1 ni\u1ec7u.<\/p>\n
\u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a thi\u1ebfu m\u00e1u tan m\u00e1u:<\/p>\n
1. Thi\u1ebfu m\u00e1u c\u00f3 t\u00ednh ch\u1ea5t \u0111\u1eb3ng s\u1eafc n\u1ebfu tan m\u00e1u v\u1eeba ph\u1ea3i, chuy\u1ec3n th\u00e0nh nh\u01b0\u1ee3c s\u1ea5c khi tan m\u00e1u nghi\u00eam tr\u1ecdng. S\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u gi\u1ea3m nhanh, d\u1eef d\u1ed9i ngay trong giai \u0111o\u1ea1n \u0111\u1ea7u.<\/p>\n
2. Ch\u1ea5t l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u thay \u0111\u1ed5i r\u00f5 r\u1ec7i: h\u1ed3ng c\u1ea7u \u0111a d\u1ea1ng, m\u00e9o m\u00f3 kh\u00f4ng \u0111\u1ec1u, c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng \u0111a c\u1ee1, nhi\u1ec1u ti\u1ec3u h\u1ed3ng c\u1ea7u v\u00e0 vi h\u1ed3ng c\u1ea7u, do m\u00e0ng h\u1ed3ng c\u1ea7u b\u1ecb t\u1ed5n th\u01b0\u01a1ng, h\u1ed3ng c\u1ea7u b\u1ecb bi\u1ebfn ch\u1ea5t tho\u00e1i h\u00f3a. C\u00f3 nhi\u1ec1u d\u1ea1ng h\u1ed3ng c\u1ea7u b\u1ea5t th\u01b0\u1eddng do chuy\u1ec3n h\u00f3a v\u1ed9i v\u00e0ng khi h\u1ed3ng c\u1ea7u b\u1ecb h\u1ee7y qu\u00e1 m\u1ee9c( nguy\u00ean h\u1ed3ng c\u1ea7u, th\u1ec3 Joli, v\u00f2ng Cabo, h\u1ea1t \u00e1i ki\u1ec1m\u2026). \u0110\u1eb7c bi\u1ec7t trong tan m\u00e1u trong t\u1ebf b\u00e0o th\u00ec s\u1ee9c b\u1ec1n h\u1ed3ng c\u1ea7u v\u00e0 \u0111\u1eddi s\u1ed1ng h\u1ed3ng c\u1ea7u \u0111\u1ec1u gi\u1ea3m.<\/p>\n
3. Thi\u1ebfu m\u00e1u c\u00f3 h\u1ed3i ph\u1ee5c, h\u1ed3ng c\u1ea7u l\u01b0\u1edbi t\u0103ng r\u1ea5t m\u1ea1nh 10- 20- 30 % v\u00e0 h\u01a1n n\u1eefa. T\u1ed1c \u0111\u1ed9 v\u00e0 t\u00ecnh tr\u1ea1ng h\u1ed3i ph\u1ee5c ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 tan m\u00e1u v\u00e0 t\u00ednh ch\u1ea5t c\u1ee7a nguy\u00ean nh\u00e2n g\u00e2y tan m\u00e1u. N\u1ebfu c\u00f3 t\u00ecnh tr\u1ea1ng nhi\u1ec5m \u0111\u1ed9c t\u1ee7y x\u01b0\u01a1ng th\u00ec ph\u1ea3n \u1ee9ng t\u0103ng sinh y\u1ebfu \u1edbt v\u00e0 h\u1ed3i ph\u1ee5c ch\u1eadm, kh\u00f3 kh\u0103n h\u01a1n.<\/p>\n
4. C\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a tan m\u00e1u : t\u0103ng hemoglobin t\u1ef1 do, t\u0103ng bilirurbin t\u1ef1 do trong m\u00e1u, t\u0103ng s\u1eafc huy\u1ebft th\u00e1nh t\u0103ng s\u1eafc t\u1ed1 m\u1eadt trong ph\u00e2n v\u00e0 n\u01b0\u1edbc ti\u1ec3u.<\/p>\n
5. Di\u1ec5n b\u00ed\u00ean c\u1ee7a thi\u1ebfu m\u00e1u ph\u1ee5 thu\u1ed9c v\u00e0o nguy\u00ean nh\u00e2n: tan m\u00e1u trong huy\u1ebft qu\u1ea3n th\u00ec di\u1ec5n bi\u1ebfn th\u01b0\u1eddng r\u1ea7m r\u1ed9, c\u1ea5p t\u00ednh, c\u00e1c d\u1ea5u hi\u1ec7u tan m\u00e1u bi\u1ec3u hi\u1ec7n r\u00f5 r\u1ec7t, c\u00f3 huy\u1ebft c\u1ea7u t\u1ed1 ni\u1ec7u v\u00e0 gan l\u00e1ch to, m\u1ec1m, \u0111au. Tan m\u00e1u trong t\u1ebf b\u00e0o th\u00ec ph\u1ea3n \u1ee9ng l\u1eb7ng l\u1ebd h\u01a1n, di\u1ec5n bi\u1ebfn m\u00e3n t\u00ednh, k\u00e9o d\u00e0i v\u00e0 ch\u1ec9 c\u00f3 hu\u1ef5\u1ebft s\u1eafc t\u1ed1 ni\u1ec7u khi k\u1ecbch ph\u00e1t, c\u00e1c bi\u1ec3u hi\u1ec7n tan m\u00e1u k\u00edn \u0111\u00e1o, gan l\u00e1ch to, r\u1eafn ch\u1eafc v\u00e0 kh\u00f4ng \u0111au<\/p>\n
C- Thi\u1ebfu m\u00e1u do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u1ea1o h\u1ed3ng c\u1ea7u:<\/p>\n
Ch\u1ee9c n\u0103ng t\u1ea1o h\u1ed3ng c\u1ea7u c\u1ee7a t\u1ee7y x\u01b0\u01a1ng c\u00f3 th\u1ec3 b\u1ecb r\u1ed1i lo\u1ea1n do thi\u1ebfu nguy\u00ean li\u1ec7u t\u1ea1o h\u1ed3ng c\u1ea7u ( protit, s\u1eaft, sinh t\u1ed1 B12, axitfolic\u2026 ) ho\u1eb7c do t\u1ee7y x\u01b0\u01a1ng b\u1ecb \u1ee9c ch\u1ebf do c\u00e1c nguy\u00ean nh\u00e2n b\u1ec7nh l\u00fd kh\u00e1c nhau.<\/p>\n
1. Thi\u1ebfu m\u00e1u do thi\u1ebfu nguy\u00ean li\u1ec7u t\u1ea1o h\u1ed3ng c\u1ea7u :<\/p>\n
a.Thi\u1ebfu m\u00e1u do thi\u1ebfu protit hay thi\u1ebfu dinh d\u01b0\u1ee1ng:<\/p>\n
\u25cf Nguy\u00ean nh\u00e2n c\u1ee7a thi\u1ebfu protit th\u01b0\u1eddng do cung c\u1ea5p kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 : \u0111\u00f3i, thi\u1ebfu \u0103n, nh\u1ea5t l\u00e0 \u1edf nh\u1eefng c\u01a1 th\u1ec3 \u0111ang ph\u00e1t tri\u1ec3n nh\u01b0 tr\u1ebb \u0111ang l\u1edbn, ph\u1ee5 n\u1eef c\u00f3 thai\u2026 ho\u1eb7c do ho\u00e0n c\u1ea3nh chi\u1ebfn tr\u01b0\u1eddng ti\u1ebfp t\u1ebf v\u1eadn chuy\u1ec3n l\u01b0\u01a1ng th\u1ef1c kho kh\u0103n, l\u1ea1c r\u1eebng, l\u1ea1c bi\u1ec3n, t\u00f9 \u0111\u1ea7y l\u00e2u ng\u00e0y.<\/p>\n
Trong b\u1ec7nh l\u00fd thi\u1ebfu protit g\u1eb7o trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p : b\u1ec7nh nh\u00e2n \u0103n kh\u00f4ng \u0111\u01b0\u1ee3c h\u1ea5p th\u1ee5 k\u00e9m ( b\u1ec7nh d\u1ea1 d\u1ea7y, ru\u1ed9t) t\u1ed5ng h\u1ee3p ch\u1ea5t protit gi\u1ea3m, r\u1ed1i lo\u1ea1n ( b\u1ec7nh gan, r\u1ed1i lo\u1ea1n chuy\u1ec3n ho\u00e1 ), t\u0103nng c\u01b0\u1eddng tho\u00e1i bi\u1ebfn protit, m\u1ea5t protit ( s\u1ed1t, nhi\u1ec5m khu\u1ea9n, b\u1ecfng, b\u1ec7nh th\u1eadn v\u00e0 c\u00e1c b\u1ec7nh kh\u00e1c.<\/p>\n
\u25cf \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a lo\u1ea1i thi\u1ebfu m\u00e1u n\u00e0y l\u00e0:<\/p>\n
Thi\u1ebfu m\u00e1u nh\u01b0\u1ee3c s\u1eafc, s\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u v\u00e0 huy\u1ebft s\u1eafc t\u1ed1 gi\u1ea3m ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 c\u1ee7a thi\u1ebfu m\u00e1u, thi\u1ebfu protit. Da v\u00e0 ni\u00eam m\u1ea1c nh\u1ee3t nh\u1ea1t, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 teo c\u01a1, m\u1ec7t m\u1ecfi v\u00e0 ph\u00f9 n\u1ec1 nh\u1eb9. T\u1ee7y t\u00e1i sinh nhanh v\u00e0 m\u1ea1nh khi thi\u1ebfu m\u00e1u v\u1eeba ph\u1ea3i.<\/p>\n
Prot\u00edt m\u00e1u to\u00e0n ph\u1ea7n gi\u1ea3m, albumin gi\u1ea3m ganma, globulin t\u0103ng, c\u00e1c t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u v\u00e0 ti\u1ec3u c\u1ea7u ngo\u1ea1i vi \u0111\u1ec1u gi\u1ea3m khi thi\u1ebfu protit nghi\u00eam tr\u1ecdng, k\u00e9o d\u00e0i, c\u00f3 th\u1ec3 d\u1eabn t\u1edbi suy t\u1ee7y.<\/p>\n
Cung c\u1ea5p \u0111\u1ea7y \u0111\u1ee7 nguy\u00ean li\u1ec7u, b\u1ed3i d\u01b0\u1ee1ng \u0103n u\u1ed1ng h\u1ee3p l\u00fd, dung c\u00e1c rhu\u1ed1c k\u00edch th\u00edch t\u1ea1o m\u00e1u k\u1ecbp th\u1eddi, c\u00f3 th\u1ec3 gi\u1ea3i quy\u1ebft t\u1ed1t.<\/p>\n
b.Thi\u1ebfu m\u00e1u do thi\u1ebfu S\u1eaft :<\/p>\n
S\u1eaft l\u00e0 nguy\u00ean li\u1ec7u \u0111\u1ec3 t\u1ed5ng h\u1ee3p huy\u1ebft c\u1ea7u t\u1ed1 c\u1ea7n thi\u1ebft cho s\u1ef1 tr\u01b0\u1edfng th\u00e0nh h\u1ed3ng c\u1ea7u. Qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a s\u0103t c\u00f3 th\u1ec3 t\u00f3m t\u1eaft theo s\u01a1 \u0111\u1ed3 sau :<\/p>\n
S\u1eaft h\u1eefu c\u01a1, v\u00f4 c\u01a1 t\u1eeb th\u1ee9c \u0103n t\u1edbi d\u1ea1 d\u00e0y, nh\u1edd HCl \u0111i\u1ec7n t\u1eed h\u00f3a th\u00e0nh s\u1eaft c\u00f3 h\u00f3a tr\u1ecb: Fe3+, Fe2+sau \u0111\u00f3 \u0111\u01b0\u1ee3c h\u1ea5p th\u1ee5 qua m\u00e0ng ru\u1ed9t v\u00e0o m\u00e1u. \u1ede m\u00e1u, mu\u1ed1n v\u1eadn chuy\u1ec3n \u0111\u01b0\u1ee3c s\u1eaft ph\u1ea3i \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi 1 glubulin b\u00eata, v\u1eadn chuy\u1ec3n s\u1eaft l\u00e0 transferrin( hay siderophill ) \u0111\u1ec3 \u0111\u01b0a t\u1edbi d\u1ef1 tr\u1eef t\u1ea1i gan d\u01b0\u1edbi d\u1ea1ng Ferritin v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng theo y\u00eau c\u1ea7u c\u01a1 th\u1ec3.<\/p>\n
\u25cf Thi\u1ebfu s\u1eaft c\u00f3 th\u1ec3 do nhi\u1ec1u nguy\u00ean nh\u00e2n:<\/p>\n
– M\u1ea5t m\u00e1u, ch\u1ea3y m\u00e1u ra ngo\u00e0i c\u01a1 th\u1ec3.<\/p>\n
– Cung c\u1ea5p thi\u1ebfu m\u00e0 nhu c\u1ea7u cao: tr\u1ebb \u0103n s\u1eefa b\u00f2, c\u01a1 th\u1ec3 \u0111\u00e3 ph\u00e1t tri\u1ec3n, ph\u1ee5 n\u1eef c\u00f3 kinh nguy\u1ec7t, c\u00f3 thai, cho con b\u00fa\u2026<\/p>\n
– R\u1ed1i lo\u1ea1n h\u1ea5p th\u1ee5 s\u1eaft: b\u1ec7nh l\u00fd d\u1ea1 d\u00e0y ru\u1ed9t, c\u1eaft \u0111o\u1ea1n d\u1ea1 d\u00e0y.<\/p>\n
– R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a s\u1eaft: thi\u1ec3u n\u0103ng bu\u1ed3ng tr\u1ee9ng, thi\u1ec3u n\u0103ng tu\u00fd\u00ean gi\u00e1p, b\u1ec7nh l\u00fd gan\u2026<\/p>\n
\u25cf \u0110\u1eb7c \u0111i\u1ec3m thi\u1ebfu m\u00e1u thi\u1ebfu s\u1eaft:<\/p>\n
– Thi\u1ebfu m\u00e1u c\u00f3 t\u00ednh ch\u1ea5t nh\u01b0\u1ee3c s\u1eafc, s\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u, huy\u1ebft c\u1ea7u t\u1ed1 gi\u1ea3m r\u00f5 r\u1ec7t, ch\u1ec9 s\u1ed1 nhi\u1ec5m s\u1eafc gi\u1ea3m, c\u00f3 nhi\u1ec1u h\u1ed3ng c\u1ea7u nh\u1ecf v\u00e0 h\u1ed3ng c\u1ea7u h\u00ecnh nh\u00e3n. Trong t\u1ee7y x\u01b0\u01a1ng t\u1ef7 l\u1ec7 Nguy\u00ean h\u1ed3ng c\u1ea7u ki\u1ec1m t\u0103ng, t\u1ef7 l\u1ec7 Nguy\u00ean h\u1ed3ng c\u1ea7u \u0111a s\u1eafc v\u00e0 Nguy\u00ean h\u1ed3ng c\u1ea7u gi\u1ea3m h\u1eb3n.<\/p>\n
– Su\u1ea5t huy\u1ebft thanh gi\u1ea3m h\u1eb3n.<\/p>\n
– Thi\u1ebfu m\u00e1u c\u00f3 t\u00e1i sinh nh\u01b0ng t\u1ed1c \u0111\u1ed9 v\u00e0 t\u00ecnh tr\u1ea1ng t\u00e1i sinh ph\u1ee5 thu\u1ed9c v\u00e0o s\u1ef1 cung c\u1ea5p nguy\u00ean li\u1ec7u v\u00e0 tr\u1ea1ng th\u00e1i to\u00e0n th\u00e2n c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n
c.Thi\u1ebfu m\u00e1u do thi\u1ebfu sinh t\u1ed1 B12 v\u00e0 axit folic:Thi\u1ebfu m\u00e1u do thi\u1ebfu sinh t\u1ed1 B12c\u00f3 th\u1ec3 nguy\u00ean phat ho\u1eb7c th\u1ee9 ph\u00e1t, th\u01b0\u1eddng g\u1eb7p l\u00e0 thi\u1ebfu m\u00e1u do thi\u1ebfu B12th\u1ee9 ph\u00e1t.<\/p>\n
1) B\u1ec7nh thi\u1ebfu m\u00e1u do B12 nguy\u00ean ph\u00e1t: c\u00f2n g\u1ecdi l\u00e0 thi\u1ebfu m\u00e1u ac t\u00ednh Bi\u1ebfc- men ( b\u1ec7nh Addison- Biermer ).<\/p>\n
\u25cf Nguy\u00ean nh\u00e2n : do thi\u1ebfu ch\u1ea5t GMP d\u1ea1 d\u1ea7y n\u00ean kh\u00f4ng h\u1ea5p thu \u0111\u01b0\u1ee3c sinh t\u1ed1 B12.<\/p>\n
\u25cf \u0110\u1eb7c \u0111i\u1ec3m lo\u1ea1i thi\u1ebfu m\u00e1u n\u00e0y:<\/p>\n
Thi\u1ebfu m\u00e1u c\u00f3 t\u00ednh ch\u1ea5t \u01b0u s\u1eafc, ch\u1ec9 s\u1ed1 nhi\u1ec5m s\u1eafc t\u0103ng tr\u00ean 1,2. S\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u gi\u1ea3m r\u1ea5t th\u1ea5p th\u01b0\u1eddng d\u01b0\u1edbi 2 tri\u1ec7u \/1mm3, c\u00f3 th\u1ec3 d\u01b0\u1edbi 1 tri\u1ec7u \/1mm3, huy\u1ebft c\u1ea7u t\u1ed1 gi\u1ea3m d\u01b0\u1edbi 50% so v\u1edbi m\u1ee9c b\u00ecnh th\u01b0\u1eddng.<\/p>\n
Trong m\u00e1u ngo\u1ea1i vi, nh\u1eefng bi\u1ebfn \u0111\u1ed5i v\u1ec1 ch\u1ea5t c\u1ee7a h\u1ed3ng c\u1ea7u bi\u1ec3u hi\u1ec7n r\u00f5 r\u1ec7t, k\u00e8m theo c\u1ea3 nh\u1eefng bi\u1ebfn \u0111\u1ed5i v\u1ec1 ch\u1ea5t v\u00e0 gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u v\u00e0 ti\u1ec3u c\u1ea7u. \u0110\u1eb7c bi\u1ec7t, x\u00fa\u00e2t hi\u1ec7n trong m\u00e1u nh\u1eefng h\u1ed3ng c\u1ea7u kh\u1ed5ng l\u1ed3 megalo (m\u00e9galoblas, megalocyt).<\/p>\n
Thi\u1ebfu m\u00e1u c\u00f3 t\u00ednh ch\u1ea5t \u00e1c t\u00ednh, kh\u00f4ng h\u1ed3i ph\u1ee5c do s\u1ef1 s\u1ea3n xu\u1ea5t h\u1ed3ng c\u1ea7u b\u00ecnh th\u01b0\u1eddng b\u1ecb \u1ee9c ch\u1ebf, \u0111\u1ed3ng th\u1eddi ph\u00e1t tri\u1ec3n d\u00f2ng h\u1ed3ng c\u1ea7u b\u1ec7nh l\u00fd m\u00eagalo. S\u1ed1 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u l\u01b0\u1edbi gi\u1ea3m r\u1ea5t th\u1ea5p ho\u1eb7c kh\u00f4ng xu\u1ea5t hi\u1ec7n.<\/p>\n
C\u00f3 c\u00e1c r\u1ed1i lo\u1ea1n th\u1ea7n kinh nh\u01b0 gi\u1ea3m tr\u00ed nh\u1edb, cu\u1ed3ng s\u1ea3ng, r\u1ed3i lo\u1ea1n ph\u1ea3n x\u1ea1, li\u1ec7t hai chi d\u01b0\u1edbi do t\u1ed5n th\u01b0\u01a1ng t\u1ee7y ho\u1eb7c vi\u00eam nhi\u1ec1u d\u00e2y th\u1ea7n kinh, nh\u1ea5t l\u00e0 c\u00e1c d\u00e2y s\u1ecd n\u00e3o.<\/p>\n
\u0110i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u b\u1eb1ng sinh t\u1ed1 B12 li\u1ec1u cao, b\u1ec7nh c\u00f3 th\u1ec3 chuy\u1ec3n bi\u1ebfn t\u1ed1t, ng\u01b0\u1ee3c l\u1ea1i \u0111\u1ec3 k\u00e9o d\u00e0i ho\u1eb7c \u0111i\u1ec1u tr\u1ecb kh\u00f4ng h\u1ee3p l\u00fd c\u00f3 th\u1ec3 chuy\u1ec3n nghi\u00eam tr\u1ecdng d\u1eabn t\u1edbi t\u1eed vong.<\/p>\n
2) B\u1ec7nh thi\u1ebfu m\u00e1u do thi\u1ebfu B12 th\u1ee9 ph\u00e1t,<\/p>\n
\u25cf Nguy\u00ean nh\u00e2n th\u01b0\u1eddng do cung c\u1ea5p kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 (tr\u1ebb nu\u00f4i b\u1eb1ng s\u1eefa b\u1ed9t, thi\u1ebfu d\u01b0\u1ee1ng ) r\u1ed1i lo\u1ea1n h\u1ea5p thu ( thi\u1ebfu GMP, trong c\u00e1c b\u1ec7nh vi\u00eam toe ni\u00eam m\u1ea1c d\u1ea1 d\u1ea7y ), giang mai, \u01b0ng th\u01b0 d\u1ea1 d\u1ea7y, c\u1eaft \u0111o\u1ea1n d\u1ea1 d\u1ea7y, r\u1ed1i lo\u1ea1n h\u1ea5p thu \u1edf ru\u1ed9t do s\u00e1n, vi\u00eam ru\u1ed9t m\u00e3n, c\u1eaft m\u1ed9t \u0111o\u1ea1n ru\u1ed9t l\u1edbn \u2026) nhu c\u1ea7u B12 cao ( ch\u1eeda \u0111\u1ebb nhi\u1ec1u l\u1ea7n, nhi\u1ec5m \u0111\u1ed9c, nhi\u1ec5m khu\u1ea9n m\u00e3n\u2026 ) ho\u1eb7c trong b\u1ec7nh ph\u00f3ng x\u1ea1\u2026<\/p>\n
\u25cf \u0110\u1eb7c \u0111i\u1ec3m: Thi\u1ebfu B12 th\u1ee9 ph\u00e1t th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi thi\u1ebfu protit v\u00e0 thi\u1ebfu s\u1eaft n\u00ean t\u00ednh ch\u1ea5t th\u01b0\u1eddng l\u00e0 thi\u1ebfu m\u00e1u nh\u01b0\u1ee3c s\u1eafc v\u1edbi nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m tu\u01a1ng t\u1ef1 nh\u01b0 thi\u1ebfu m\u00e1u do thi\u1ebfu protit v\u00e0 thi\u1ebfu s\u1eaft. Thi\u1ebfu m\u00e1u c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c t\u1ed1t n\u1ebfu k\u1ecbp th\u1eddi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng sinh t\u1ed1 B12 k\u1ebft h\u1ee3p v\u1edbi cung c\u1ea5p s\u1eaft v\u00e0 protit, b\u1ed3i d\u01b0\u1ee1ng h\u1ee3p l\u00fd cho b\u1ec7nh nh\u00e2n.<\/p>\n
2. Thi\u1ebfu m\u00e1u do t\u1ee7y x\u01b0\u01a1ng b\u1ecb \u1ee9c ch\u1ebf:<\/p>\n
\u25cf Nguy\u00ean nh\u00e2n: T\u1ee7y x\u01b0\u01a1ng c\u00f3 th\u1ec3 b\u1ecb \u1ee9c ch\u1ebf t\u1ea1m th\u1eddi ho\u1eb7c l\u00e2u d\u00e0i g\u00e2y tr\u01b0\u1eddng h\u1ee3p nh\u01b0\u1ee3c t\u1ee7y ho\u0103c suy t\u1ee7y, do nhi\u1ec1u nguy\u00ean nh\u00e2n ph\u1ee9c t\u1ea1p:<\/p>\n
Do nhi\u1ec5m khu\u1ea9n n\u1eb7ng, c\u00e1c \u0111\u1ed9c t\u1ed1 vi sinh v\u1eadt c\u00f3 \u0111\u1ed9c l\u1ef1c m\u1ea1nh t\u00e1c \u0111\u1ed9ng l\u00ean t\u1ee7y x\u01b0\u01a1ng, th\u01b0\u1eddng ch\u1ec9 \u1ee9c ch\u1ebf t\u1ea1m th\u1eddi. C\u00f3 th\u1ec3 do t\u00e1c d\u1ee5ng c\u1ee7a k\u00fd sinh khu\u1ea9n ( nh\u1ef1oc, suy t\u1ee7y sau s\u1ed1t r\u00e9t ).<\/p>\n
Do nhi\u1ec5m \u0111\u1ed9c c\u00e1c h\u00f3a ch\u1ea5t nh\u01b0 ch\u00ec, phenyl hydrazin, ho\u1eb7c c\u00e1c ch\u1ea5t \u0111\u1ed9c trong q\u00fda tr\u00ecnh b\u1ec7nh l\u00fd ( x\u01a1 gan, vi\u00eam th\u1eadn m\u00e3n\u2026 ) do nhi\u1ec5m x\u1ea1 n\u1eb7ng : d\u00f9ng quang tuy\u1ebfn X li\u1ec1u cao, b\u1ec7nh ph\u00f3ng x\u1ea1 c\u1ea5p v\u00e0 m\u00e3n t\u00ednh.<\/p>\n
Do lo\u1ea1n s\u1ea3n t\u1ee7y ho\u1eb7c t\u1ee7y x\u01b0\u01a1ng b\u1ecb \u1ee9c ch\u1ebf, ch\u00e8n \u00e9p trong m\u1ed9t s\u1ed1 b\u1ec7nh \u00e1c t\u00ednh: b\u1ec7nh b\u1ea1ch c\u1ea7u, ung th\u01b0 c\u00e1c lo\u1ea1i, x\u01a1 h\u00f3a t\u1ee7y x\u01b0\u01a1ng.<\/p>\n
Do n\u1ed9i ti\u1ebft: c\u01b0\u1eddng l\u00e1ch do thi\u1ebfu m\u00e1u k\u00e8m gi\u1ea3m ti\u1ec3u c\u1ea7u; thi\u1ebfu Erythropoietin trong vi\u00eam th\u1eadn m\u00e3n; thi\u1ec3u b\u0103ng tuy\u1ebfn gi\u00e1p, tuy\u1ebfn sinh d\u1ee5c, tuy\u1ebfn y\u00ean\u2026<\/p>\n
\u25cf \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a lo\u1ea1i thi\u1ebfu m\u00e1u n\u00e0y l\u00e0: thi\u1ebfu m\u00e1u nh\u01b0\u1ee3c s\u1eafc n\u1eb7ng, c\u00f3 th\u1ec3 \u01b0u s\u1eafc ( c\u1eadn \u00e1c t\u00ednh ), nhi\u1ec1u bi\u1ebfn \u0111\u1ed5i v\u1ec1 ch\u1ea5t l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u v\u00e0 t\u00e1i sinh ch\u1eadm c\u00f3 th\u1ec3 kh\u00f4ng h\u1ed3i ph\u1ee5c. Do ch\u1ee9c n\u0103ng c\u1ee7a t\u1ee7y x\u01b0\u01a1ng b\u1ecb \u1ee9c ch\u1ebf n\u00ean c\u00f3 gi\u1ea3m s\u1ea3n xu\u1ea5t c\u1ea3 ba d\u00f2ng t\u1ebf b\u00e0o m\u00e1u h\u1ed3ng c\u1ea7u, b\u1ea1ch c\u1ea7u v\u00e0 ti\u1ec3u c\u1ea7u d\u1eabn t\u1edbi tr\u1ea1ng th\u00e1i nh\u01b0\u1ee3c ho\u1eb7c suy t\u1ee7y.<\/p>\n
C\u00e2u 10: Tr\u00ecnh b\u00e0y \u0111\u1eb7c \u0111i\u1ec3m, \u0111\u1ecbnh t\u00ean v\u00e0 x\u1ebfp lo\u1ea1i c\u1ee7a b\u1ec7nh b\u1ea1ch c\u1ea7u?<\/p>\n
B\u1ec7nh b\u1ea1ch c\u1ea7u l\u00e0 m\u1ed9t b\u1ec7nh \u00e1c t\u00ednh c\u1ee7a c\u01a1 quan t\u1ea1o m\u00e1u, l\u00e0 m\u1ed9t b\u1ec7nh r\u1ea5t hi\u1ec3m ngh\u00e8o, t\u1ef7 l\u1ec7 t\u1eed vong r\u1ea5t cao v\u00e0 t\u1ef7 l\u1ec7 m\u1eafc b\u1ec7nh ng\u00e0y c\u00e0ng nhi\u1ec1u.<\/p>\n
A- Quy lu\u1eadt di\u1ec5n bi\u1ebfn v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a b\u1ec7nh b\u1ea1ch c\u1ea7u:<\/p>\n
Trong b\u1ec7nh b\u1ea1ch c\u1ea7u c\u00e1c t\u1ebf b\u00e0o m\u00e1u kh\u00f4ng ph\u00e1t tri\u1ec3n theo quy lu\u1eadt b\u00ecnh th\u01b0\u1eddng m\u00e0 c\u00f3 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m ri\u00eang sau:<\/p>\n
1. T\u0103ng s\u1ea3n qu\u00e1 m\u1ee9c hay qu\u00e1 s\u1ea3n :<\/p>\n
T\u0103ng s\u1ea3n qu\u00e1 m\u1ee9c m\u1ed9t d\u00f2ng t\u1ebf b\u00e0o, t\u1ed5 ch\u1ee9c t\u1ea1o b\u1ea1ch c\u1ea7u \u0111\u00f3 c\u00f3 bi\u1ec3u hi\u1ec7n ph\u00ec \u0111\u1ea1i, t\u0103ng sinh lan tr\u00e0n ( t\u0103ng sinh qu\u00e1 m\u1ee9c d\u00f2ng b\u1ea1ch c\u1ea7u h\u1ea1t th\u00ec t\u1ee7y \u0111\u1ecf v\u00e0 t\u1ee7y v\u00e0ng \u0111\u1ec1u tr\u00e0n ng\u1eadp c\u00e1c t\u1ebf b\u00e0o \u0111\u00f3 ) \u0111\u1ed3ng th\u1eddi c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng \u1ee9c ch\u1ebf bi\u1ec7t h\u00f3a n\u00ean \u1edf m\u00e1u ngo\u1ea1i vi xu\u1ea5t hi\u1ec7n r\u1ea5t nhi\u1ec1u b\u1ea1ch c\u1ea7u non ( b\u00ecnh th\u01b0\u1eddng ch\u1ec9 \u1edf trong t\u1ee7y x\u01b0\u01a1ng ).<\/p>\n
B\u00f3p ngh\u1eb9t, \u1ee9c ch\u1ebf c\u00e1c d\u00f2ng t\u1ebf b\u00e0o kh\u00e1c: khi c\u00e1c t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u h\u1ea1t t\u0103ng sinh th\u00ec t\u1ea1o h\u1ed3ng c\u1ea7u b\u1ecb \u1ee9c ch\u1ebf, t\u0103ng \u0111\u1ed9 huy\u1ebft t\u00e1n n\u00ean g\u00e2y thi\u1ebfu m\u00e1u n\u1eb7ng, d\u00f2ng ti\u1ec3u c\u1ea7u c\u0169ng b\u1ecb \u1ee9c ch\u1ebf g\u00e2y gi\u1ea3m ti\u1ec3u c\u1ea7u v\u00e0 h\u1ed9i ch\u1ee9ng ch\u1ea3y m\u00e1u ( ch\u1ea3y m\u00e1u r\u0103ng, l\u1ee3i, d\u01b0\u1edbi da, ni\u00eam m\u1ea1c m\u0169i, m\u1eaft, v\u00f5ng m\u1ea1c, n\u1ed9i t\u1ea1ng… ) B\u1ec7nh c\u00e0ng \u00e1c t\u00ednh c\u00e1c bi\u1ec3u hi\u1ec7n tr\u00ean c\u00e0ng r\u00f5 r\u1ec7t.<\/p>\n
2. D\u1ecb s\u1ea3n: s\u1ea3n xu\u1ea5t kh\u00f4ng theo quy lu\u1eadt b\u00ecnh th\u01b0\u1eddng m\u00e0 lan tr\u00e0n sang c\u00e1c t\u1ed5 ch\u1ee9c l\u00e2n c\u1eadn, ho\u1eb7c sang c\u00e1c t\u1ed5 ch\u1ee9c t\u1ea1o m\u00e1u kh\u00e1c m\u00e0 b\u00ecnh th\u01b0\u1eddng kh\u00f4ng s\u1ea3n xu\u1ea5t ra d\u00f2ng t\u1ebf b\u00e0o \u0111\u00f3. Nh\u01b0 trong b\u1ec7nh b\u1ea1ch c\u1ea7u t\u1ee7y hay t\u1ed5 ch\u1ee9c h\u1ea1ch, l\u00e1ch c\u0169ng s\u1ea3n xu\u1ea5t c\u00e1c b\u1ea1ch c\u1ea7u h\u1ea1t, x\u00e2m nh\u1eadp ch\u00e8n \u00e9p c\u1ed1t m\u1ea1c g\u00e2y \u0111au x\u01b0\u01a1ng, \u0111au kh\u1edbp; x\u00e2m nh\u1eadp ch\u00e8n \u00e9p t\u1ed5 ch\u1ee9c th\u1ea7n kinh g\u00e2y li\u1ec7t, h\u1ed9i ch\u1ee9ng ch\u00e8n \u00e9p t\u1ee7y s\u1ed1ng\u2026 Trong b\u1ec7nh b\u1ea1ch c\u1ea7u Lympho t\u1ee7y x\u01b0\u01a1ng tr\u00e0n ng\u1eadp t\u1ebf b\u00e0o lympho , t\u1ed5 ch\u1ee9c lympho c\u00f2n x\u00e2m nh\u1eadp t\u1ed5 ch\u1ee9c da, n\u1eb1m trong trung b\u00ec v\u00f9ng m\u1eb7t, m\u0169i, m\u00e1, g\u00e2y bi\u1ebfn d\u1ea1ng di\u1ec7n m\u1ea1o, x\u00e2m nh\u1eadp nhu m\u00f4 ph\u1ed5i, th\u00e0nh d\u1ea1 d\u1ea7y, ru\u1ed9t g\u00e2y c\u00e1c u c\u1ee5c r\u1ea3i r\u00e1c, g\u00e2y xu\u1ea5t huy\u1ebft lo\u00e9t v\u00e0 ho\u1ea1i t\u1eed\u2026<\/p>\n
3. Lo\u1ea1n s\u1ea3n: t\u1ee9c l\u00e0 s\u1ea3n xu\u1ea5t nh\u1eefng t\u1ebf b\u00e0o b\u1ec7nh l\u00fd kh\u00f4ng \u0111i\u1ec3n h\u00ecnh c\u1ea3 v\u1ec1 h\u00ecnh th\u00e1i v\u00e0 ch\u1ee9c n\u0103ng. Ch\u1ee9c n\u0103ng th\u1ef1c b\u00e0o, mi\u1ec5n d\u1ecbch c\u1ee7a c\u00e1c t\u1ebf b\u00e0o \u0111\u00f3 gi\u1ea3m l\u00e0m gi\u1ea3m s\u1ee9c \u0111\u1ec1 kh\u00e1ng ch\u1ed1ng \u0111\u1ee1 c\u1ee7a c\u01a1 th\u1ec3. C\u00e1c t\u1ebf b\u00e0o th\u01b0\u1eddng c\u00f3 d\u1ea5u hi\u1ec7u tho\u00e1i h\u00f3a, h\u00ecnh d\u1ea1ng b\u1ea5t th\u01b0\u1eddng, c\u00f3 kh\u00f4ng b\u00e0o, ph\u00e1t tri\u1ec3n kh\u00f4ng \u0111\u1ed3ng \u0111\u1ec1u gi\u1eefa nh\u00e2n v\u00e0 nguy\u00ean sinh ch\u1ea5t. C\u00e1c nguy\u00ean t\u1ee7y b\u00e0o kh\u00f4ng \u0111i\u1ec3n h\u00ecnh \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 c\u1eadn nguy\u00ean t\u1ee7y b\u00e0o ( paramy\u00ealoblast ) ho\u1eb7c nguy\u00ean t\u1ee7y b\u00e0o nh\u1ecf ( micromy\u00ealoblast ), c\u00f3 tr\u01b0\u1eddng h\u1ee3p kh\u00f3 x\u00e1c \u0111\u1ecbnh l\u00e0 nguy\u00ean b\u00e0o c\u1ee7a d\u00f2ng n\u00e0o n\u00ean g\u1ecdi chung l\u00e0 c\u00e1c nguy\u00ean b\u1ea1ch c\u1ea7u ( Leucoblast ).<\/p>\n
B- Nguy\u00ean t\u1eafc ph\u00e2n lo\u1ea1i b\u1ec7nh b\u1ea1ch c\u1ea7u :<\/p>\n
a. Theo t\u1ed5 ch\u1ee9c, t\u1ebf b\u00e0o b\u1ecb b\u1ec7nh: b\u1ec7nh c\u1ee7a t\u1ebf b\u00e0o d\u00f2ng t\u1ee7y g\u1ecdi l\u00e0 b\u1ec7nh b\u1ea1ch c\u1ea7u t\u1ee7y (myelogenous leukemia); b\u1ec7nh c\u1ee7a t\u1ed5 ch\u1ee9c t\u1ebf b\u00e0o lympho b\u1ec7nh b\u1ea1ch c\u1ea7u lympho (lymphogenous- leukemia)\u2026<\/p>\n
b. Theo s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u ngo\u1ea1i vi: chia c\u00e1c th\u1ec3 t\u0103ng b\u1ea1ch c\u1ea7u tr\u00ean 50000\/ mm3( b\u1ec7nh b\u1ea1ch c\u1ea7u \u0111a sinh ), kh\u00f4ng t\u0103ng b\u1ea1ch c\u1ea7u \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 th\u1ec3 \u1ea9n, ch\u1ec9 ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c khi c\u00f3 nh\u1eefng k\u00edch th\u00edch b\u1ea5t th\u01b0\u1eddng g\u00e2y t\u0103ng s\u1ed1 l\u01b0\u1ee3ng v\u00e0 xu\u1ea5t hi\u1ec7n c\u00e1c b\u1ea1ch c\u1ea7u non \u1edf m\u00e1u ngo\u1ea1i vi; th\u1ec3 gi\u1ea3m b\u1ea1ch c\u1ea7u d\u01b0\u1edbi 4000\/ mm3th\u01b0\u1eddng l\u00e0 th\u1ec3 c\u1ea5p t\u00ednh, nghi\u00eam tr\u1ecdng.<\/p>\n
c. Theo h\u00ecnh th\u00e1i di\u1ec5n bi\u1ebfn c\u1ee7a b\u1ec7nh:<\/p>\n
\u25cf Th\u1ec3 c\u1ea5p t\u00ednh th\u01b0\u1eddng di\u1ec5n bi\u1ebfn tr\u1ea7m tr\u1ecdng:<\/p>\n
Ch\u1ebft nhanh trong v\u00f2ng v\u00e0i th\u00e1ng, c\u00f3 khi v\u00e0i tu\u1ea7n<\/p>\n
Trong m\u00e1u xu\u1ea5t hi\u1ec7n nhi\u1ec1u nguy\u00ean b\u00e0o do kh\u1ea3 n\u0103ng bi\u1ec7t h\u00f3a b\u1ecb \u1ee9c ch\u1ebf kh\u00f4ng chuy\u1ec3n th\u00e0nh c\u00e1c t\u1ebf b\u00e0o trung gian n\u00ean b\u1ea3ng m\u00e1u c\u00f3 \u201c kho\u1ea3ng tr\u1ed1ng b\u1ea1ch c\u1ea7u\u201d<\/p>\n
K\u00e8m theo:+ H\u1ed3ng c\u1ea7u gi\u1ea3m, xu\u1ea5t hi\u1ec7n thi\u1ebfu m\u00e1u<\/p>\n
+ Ti\u1ec3u c\u1ea7u gi\u1ea3m, xu\u1ea5t hi\u1ec7n xu\u1ea5t huy\u1ebft<\/p>\n
+ B\u1ea1ch c\u1ea7u t\u0103ng nh\u01b0ng kh\u00f4ng c\u00f3 ch\u1ee9c n\u0103ng n\u00ean nhi\u1ec5m tr\u00f9ng, s\u1ed1t\u2026<\/p>\n
\u25cf Th\u1ec3 m\u00e3n t\u00ednh th\u00ec di\u1ec5n bi\u1ebfn c\u00f3 th\u1ec3 k\u00e9o d\u00e0i h\u01a1n h\u00e0ng n\u0103m:<\/p>\n
– Trong m\u00e1u xu\u1ea5t hi\u1ec7n nh\u1ec1u lo\u1ea1i t\u1ebf b\u00e0o t\u1eeb nguy\u00ean b\u00e0o, c\u00e1c t\u1ebf b\u00e0o trung gian t\u1edbi c\u00e1c t\u1ebf b\u00e0o tr\u01b0\u1edfng th\u00e0nh, kh\u00f4ng c\u00f3 kho\u1ea3ng tr\u1ed1ng b\u1ea1ch c\u1ea7u<\/p>\n
– S\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u th\u01b0\u1eddng t\u0103ng r\u1ea5t cao song song v\u1edbi di\u1ec5n bi\u1ebfn nghi\u00eam tr\u1ecdng c\u1ee7a b\u1ec7nh.<\/p>\n
C- Nguy\u00ean nh\u00e2n:<\/p>\n
+Virus<\/p>\n
+Tia x\u1ea1<\/p>\n
+H\u00f3a ch\u1ea5t, nh\u1ea5t l\u00e0 nh\u00f3m alkyl h\u00f3a<\/p>\n
+C\u00e1c y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng v\u00e0 th\u1ee5 th\u1ec3 c\u1ee7a n\u00f3<\/p>\n
C\u00e2u 11: N\u00eau 4 ph\u1ea3n \u1ee9ng r\u1ed1i lo\u1ea1n v\u1eadn m\u1ea1ch trong vi\u00eam?<\/p>\n
R\u1ed1i lo\u1ea1n v\u1eadn m\u1ea1ch:<\/p>\n
Ph\u00e1t sinh v\u1edbi h\u00ecnh th\u00e1i 4 giai \u0111o\u1ea1n li\u00ean ti\u1ebfp : co ch\u1edbp nho\u00e1ng c\u00e1c ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch, sung huy\u1ebft \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u1ed9ng, sung huy\u1ebft c\u00e1c ti\u1ec3u t\u0129nh m\u1ea1ch v\u00e0 \u1ee9 m\u00e1u, t\u1eafc m\u1ea1ch.<\/p>\n
a) Co m\u1ea1ch<\/p>\n
Co ch\u1edbp nho\u00e1ng c\u00e1c ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch ph\u00e1t sinh do c\u00e1c y\u1ebfu t\u1ed1 g\u00e2yvi\u00eam k\u00edch th\u00edch th\u1ea7n kinh co m\u1ea1ch v\u00e0 c\u00e1c t\u1ebf b\u00e0o c\u01a1 tr\u01a1n ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch t\u1ea1i \u1ed5 vi\u00eam. Hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y r\u1ea5t ng\u1eafn, kh\u00f3 quan s\u00e1t v\u00ec t\u00e1c d\u1ee5ng k\u00edch th\u00edch nguy\u00ean ph\u00e1t qua r\u1ea5t nhanh, v\u00e0 c\u00e1c trung gian ho\u00e1 h\u1ecdc c\u1ee7a ph\u00e2n b\u1ed1 th\u1ea7n kinh giao c\u1ea3m, noradrenalin b\u1ecb hu\u1ef7 b\u1edfi monoaminooxydaza l\u00fac \u0111\u00f3 t\u0103ng cao trong t\u1ed5 ch\u1ee9c vi\u00eam.<\/p>\n
b) Sung huy\u1ebft \u0111\u1ed9ng m\u1ea1ch<\/p>\n
Gi\u00e3n c\u00e1c ti\u1ec3u \u0111\u1ed9ng m\u1ea1ch v\u00e0 mao m\u1ea1ch, hay xung huy\u1ebft \u0111\u1ed9ng m\u1ea1ch, ch\u1ee7 \u0111\u1ed9ng ph\u00e1t sinh theo c\u01a1 ch\u1ebf th\u1ea7n kinh th\u1ec3 d\u1ecbch. Th\u1ea7n kinh d\u00e3n m\u1ea1ch b\u1ecb k\u00edch th\u00edch theo ph\u1ea3n x\u1ea1 s\u1ee3i tr\u1ee5c, \u0111\u1ed3ng th\u1eddi ch\u1ecbu \u1ea3nh h\u01b0\u1edfnh c\u1ee7a c\u00e1c s\u1ea3n ph\u1ea9m c\u00f3 ho\u1ea1t t\u00ednh sinh v\u1eadt trong \u1ed5 vi\u00eam nh\u01b0 histamin, serotorin, bradikinin\u2026T\u0103ng n\u1ed3ng \u0111\u1ed9 ion H+v\u00e0 nhi\u1ec5m toan c\u0169ng c\u00f3 t\u00e1c d\u1ee5ng g\u00e2y d\u00e3n m\u1ea1ch. \u0110\u1eb7c bi\u1ec7t t\u0103ng n\u1ed3ng \u0111\u1ed9 ion K+trong \u1ed5 vi\u00eam t\u1edbi 0,5 \u2013 2% c\u0169ng c\u00f3 gi\u00e1 tr\u1ecb t\u01b0\u01a1ng t\u1ef1. T\u00ednh ch\u1ea5t ch\u1ee7 \u0111\u1ed9ng \u0111\u01b0\u1ee3c th\u1ec3 h\u1ec7n b\u1eb1ng t\u0103ng \u00e1p l\u1ef1c m\u00e1u v\u00e0 t\u0103ng t\u1ed1c \u0111\u1ed9 m\u00e1u ch\u1ea3y, \u0111\u01b0a nhi\u1ec1u oxy, b\u1ea1ch c\u1ea7u v\u00e0 c\u00e1c ch\u1ea5t dinh d\u01b0\u1ee1ng t\u1edbi \u1ed5 vi\u00eam, c\u00f3 t\u00e1c d\u1ee5ng th\u00edch \u1ee9ng ph\u00f2ng ng\u1ef1.<\/p>\n
\u2022 Bi\u1ec3u hi\u1ec7n c\u1ee7a sung huy\u1ebft \u0111\u1ed9ng m\u1ea1ch<\/p>\n
\u0110M m\u00e0u \u0111\u1ecf t\u01b0\u01a1i, c\u0103ng ph\u1ed3ng, \u0111au v\u00e0 n\u00f3ng<\/p>\n
Sung huy\u1ebft \u0110M t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i cho b\u1ea1ch c\u1ea7u th\u1ef1c b\u00e0o<\/p>\n
c) Sung huy\u1ebft t\u0129nh m\u1ea1ch<\/p>\n
D\u00e3n c\u00e1c ti\u1ec3u t\u0129nh m\u1ea1ch v\u00e0 mao m\u1ea1ch t\u0129nh m\u1ea1ch, hay xung huy\u1ebft t\u0129nh m\u1ea1ch th\u1ee5 \u0111\u1ed9ng ti\u1ebfp theo \u0111\u00f3 t\u1ea5c d\u1ee5ng m\u1ea1nh h\u01a1n c\u1ee7a c\u00e1c nh\u00e2n t\u1ed1 g\u00e2y vi\u00eam. C\u01a1 ch\u1ebf ch\u1ee7 y\u1ebfu do t\u00e1c d\u1ee5ng m\u1ea1nh h\u01a1n c\u1ee7a c\u00e1c nh\u00e2n t\u1ed1 g\u00e2y vi\u00eam. C\u01a1 th\u1ec3 ch\u1ee7 y\u1ebfu do t\u1ea5c d\u1ee5ng c\u1ee7a c\u00e1c s\u1ea3n ph\u1ea9m c\u00f3 ho\u1ea1t t\u00ednh sinh v\u1eadt \u0111\u01b0\u1ee3c t\u1ea1o th\u00e0nh m\u1ed9t s\u1ed1 l\u01b0\u1ee3ng l\u1edbn, b\u1ecb \u1ee9 l\u1ea1i trong t\u1ed5 ch\u1ee9c vi\u00eam g\u00e2y hu\u1ef7 ho\u1ea1i c\u00e1c s\u1ee3i t\u1ed5 ch\u1ee9c li\u00ean k\u1ebft (s\u1ee3i chun d\u00e3n, s\u1ee3i k\u00e9o c\u1ee7a th\u00e0nh t\u0129nh m\u1ea1ch) l\u00e0m cho ch\u00fang d\u00e3n ra, v\u00e0 d\u00f2ng m\u00e1u ch\u1ea3y ch\u00e2m l\u1ea1i. S\u1ef1 ph\u00e1t sinh v\u00e0 ph\u00e1t tri\u1ec3n c\u1ee7a hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y c\u00f2n ph\u1ee5 thu\u1ed9c v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1 chi ph\u1ed1i:<\/p>\n
Th\u1ea7n kinh \u2013 c\u01a1 c\u1ee7a huy\u1ebft qu\u1ea3n b\u1ecb t\u00ea li\u1ec7t l\u00e0m cho th\u00e0nh huy\u1ebft qu\u1ea3n m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c.<\/p>\n
– Bi\u1ec3u hi\u1ec7n:<\/p>\n
\u1ed5 vi\u00eam b\u1edbt n\u00f3ng, chuy\u1ec3n t\u1eeb m\u00e0u \u0111\u1ecf t\u01b0\u01a1i sang m\u00e0u t\u00edm s\u1eabm<\/p>\n
Ph\u00f9, c\u1ea3m gi\u00e1c c\u0103ng v\u00e0 \u0111au gi\u1ea3m, ch\u1ec9 c\u00f2n \u0111au \u00e2m \u1ec9<\/p>\n
– Vai tr\u00f2:<\/p>\n
D\u1ecdn s\u1ea1ch \u1ed5 vi\u00eam, chu\u1ea9n b\u1ecb cho qu\u00e1 tr\u00ecnh s\u1eeda ch\u1eeda v\u00e0 c\u00f4 l\u1eadp \u1ed5 vi\u00eam, ng\u0103n c\u1ea3n s\u1ef1 lan r\u1ed9ng c\u1ee7a t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh<\/p>\n
d) \u1ee8 m\u00e1u:Sung huy\u1ebft TM l\u00e0 giai \u0111o\u1ea1n \u1ee9 m\u00e1u m\u00e0 c\u01a1 ch\u1ebf ch\u00ednh l\u00e0 do:<\/p>\n
1, Th\u1ea7n kinh v\u1eadn m\u1ea1ch b\u1ecb t\u00ea li\u1ec7t, t\u00e1c d\u1ee5ng c\u1ee7a ch\u1ea5t d\u00e3n m\u1ea1ch -> t\u0103ng t\u00ednh th\u1ea5m th\u00e0nh m\u1ea1ch<\/p>\n
2, BC b\u00e1m v\u00e0o th\u00e0nh m\u1ea1ch c\u1ea3n tr\u1edf l\u01b0u th\u00f4ng m\u00e1u<\/p>\n
3, T\u1ebf b\u00e0o n\u1ed9i m\u00f4 ph\u00ec \u0111\u1ea1i, l\u00e0m m\u00e1u v\u1eadn chuy\u1ec3n kh\u00f3 kh\u0103n<\/p>\n
4, N\u01b0\u1edbc tr\u00e0n v\u00e0o m\u00f4 k\u1ebd g\u00e2y ph\u00f9 v\u00e0 ch\u00e8n \u00e9p th\u00e0nh m\u1ea1ch<\/p>\n
5, Huy\u1ebft kh\u1ed1i g\u00e2y t\u1eafc m\u1ea1ch<\/p>\n
VAI TR\u00d2: C\u00f4 l\u1eadp \u1ed5 vi\u00eam<\/p>\n
C\u00e2u 12: Tr\u00ecnh b\u00e0y c\u00e1c ph\u1ea3n \u1ee9ng t\u1ebf b\u00e0o trong vi\u00eam?<\/p>\n
– Hi\u1ec7n t\u01b0\u1ee3ng t\u1ebf b\u00e0o t\u0103ng sinh di\u1ec5n bi\u1ebfn \u0111\u1ed3ng th\u1eddi v\u1edbi t\u1ed5n th\u01b0\u01a1ng t\u1ed5 ch\u1ee9c v\u00e0 r\u1ed1i lo\u1ea1n tu\u1ea7n ho\u00e0n, do t\u00e1c d\u1ee5ng k\u00edch th\u00edch c\u1ee7a m\u1ed9t s\u1ed1 s\u1ea3n ph\u1ea9m ph\u00e2n gi\u1ea3I t\u1ed5 ch\u1ee9c v\u00e0 ph\u00e2n gi\u1ea3I chuy\u1ec3n ho\u00e1 b\u1ecb r\u1ed1i lo\u1ea1n, ngo\u00e0i ra b\u1ea1ch c\u1ea7u ch\u1ebft \u1edf \u1ed5 vi\u00eam c\u0169ng gi\u1ea3I ph\u00f3ng c\u00e1c ch\u1ea5t c\u00f3 t\u00e1c d\u1ee5ng k\u00edch th\u00edch t\u1ebf b\u00e0o t\u0103ng sinh.<\/p>\n
– Giai \u0111o\u1ea1n \u0111\u1ea7u, hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng sinh ch\u1ee7 y\u1ebfu th\u1ea5y \u1edf c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4 v\u00e0 l\u1edbp ngo\u00e0I c\u1ee7a huy\u1ebft qu\u1ea3n, c\u00e1c b\u1ea1ch c\u1ea7u ph\u00e1t tri\u1ec3n \u0111\u1ec3 ch\u1ed1ng \u0111\u1ee1 k\u1ecbp th\u1eddi v\u1edbi nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam. M\u1eb7t kh\u00e1c \u1edf trung t\u00e2m \u1ed5 vi\u00eam ph\u1ea3n \u1ee9ng toan m\u1ea1ch, t\u00ecnh tr\u1ea1ng thi\u1ebfu oxy nghi\u00eam tr\u1ecdng n\u00ean hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng sinh kh\u1ed5ng th\u1ec3 ti\u1ebfn h\u00e0nh \u0111\u01b0\u1ee3c.<\/p>\n
– Hi\u1ec7n t\u01b0\u1ee3ng t\u1ebf b\u00e0o t\u0103ng sinh c\u00f2n ph\u1ee5 thu\u1ed9c v\u00e0o lo\u1ea1i vi\u00eam v\u00e0 t\u1ed5 ch\u1ee9c t\u1ebf b\u00e0o b\u1ecb hu\u1ef7 ho\u1ea1i nhi\u1ec1u hay \u00edt. \u0110i\u1ec3n h\u00ecnh nh\u1ea5t l\u00e0 vi\u00eam m\u1ee7, khi \u1ed5 m\u1ee7 v\u1ee1, m\u1ee7 tho\u00e1t ra \u0111\u1ec3 l\u1ea1i m\u1ed9t h\u1ed1c \u201cthi\u1ebfu t\u1ed5 ch\u1ee9c\u201d, h\u1ed1c n\u00e0y s\u1ebd d\u1ea7n d\u00e0y l\u00ean do t\u0103ng sinh c\u00e1c t\u1ebf b\u00e0o li\u00ean k\u1ebft t\u1ea1i ch\u1ed7, c\u00e1c histiocyte r\u1ed3i t\u1ebf b\u00e0o x\u01a1 non fibroblaste.<\/p>\n
C\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o th\u00e2u t\u00ednh, ti\u00eau ho\u00e1, l\u00e0m s\u1ea1ch c\u00e1c s\u1ea3n ph\u1ea9m tho\u00e1i bi\u1ebfn trong t\u1ed5 ch\u1ee9c vi\u00eam c\u00f2n s\u00f3t l\u1ea1i b\u1eb1ng con \u0111\u01b0\u1eddng ti\u00eau ho\u00e1 b\u00ean trong t\u1ebf b\u00e0o. \u0110\u1ed3ng th\u1eddi c\u00e1c t\u1ebf b\u00e0o x\u01a1 non ph\u00e1t tri\u1ec3n m\u1ea1nh t\u1eeb ngo\u1ea1i vi ti\u1ebfn \u0111\u00e0n v\u00e0o trung t\u00e2m \u1ed5 vi\u00eam thay th\u1ebf c\u00e1c t\u1ed5 ch\u1ee9c ho\u1ea1i t\u1eed \u0111\u1ed3ng th\u1eddi t\u1ea1o m\u1ed9t h\u00e0ng r\u00e0o c\u00f3 t\u00e1c d\u1ee5ng b\u1ea3o v\u1ec7 ng\u0103n c\u1ea3n kh\u00f4ng cho \u0111\u1ed9c t\u1ed1 v\u00e0 ch\u1ea5t \u0111\u1ed9c lan r\u1ed9ng.<\/p>\n
– Nhi\u1ec1u c\u00e1c t\u1ebf b\u00e0o t\u1ed5 ch\u1ee9c \u1edf \u1ed5 vi\u00eam b\u1ecb hu\u1ef7 ho\u1ea1i kh\u00f4ng nhi\u1ec1u l\u1eafm v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng t\u00e1i sinh t\u1ed1t th\u00ec t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 l\u00e0nh, t\u1ed5 ch\u1ee9c ho\u00e0n to\u00e0n h\u1ed3i ph\u1ee5c v\u1ec1 m\u1eb7t c\u1ea5u t\u1ea1o v\u00e0 ch\u1ee9c ph\u1eadn. Th\u00e0nh s\u1eb9o th\u01b0\u1eddng kh\u00f4ng g\u00e2y \u1ea3nh h\u01b0\u1edfng g\u00ec, nh\u01b0ng v\u1edbi nh\u1eefng t\u1ed5n th\u01b0\u01a1ng r\u1ed9ng v\u00e0 s\u00e2u c\u00f3 th\u1ec3 d\u1eabn t\u1edbi nh\u1eefng bi\u1ebfn ch\u1ee9ng s\u1eb9o co th\u1eaft, l\u1ed3i, d\u00ednh l\u00e0m bi\u1ebfn d\u1ea1ng c\u1ea5u tr\u00fac b\u00ecnh th\u01b0\u1eddng v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c ph\u1eadn c\u01a1 quan, nh\u01b0 s\u1eb9o d\u00ednh sau khi b\u1ecb vi\u00eam \u1ed5 b\u1ee5ng, s\u1eb9o co \u1edf th\u1ea7n kinh, g\u00e2n kh\u1edbp. \u0110\u1ed1i v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng qu\u00e1 r\u1ed9ng v\u00e0 s\u00e2u, ho\u1eb7c v\u1edbi c\u00e1c t\u1ebf b\u00e0o nhu m\u00f4 c\u00e1c c\u01a1 quan t\u1ed5 ch\u1ee9c bi\u1ec7t ho\u00e1 cao (tim, n\u00e3o\u2026), c\u00e1c t\u1ed5 ch\u1ee9c b\u1ecb hu\u1ef7 ho\u1ea1i c\u00f3 th\u1ec3 kh\u00f4ng h\u1ed3i ph\u1ee5c \u0111\u01b0\u1ee3c g\u00e2y nhi\u1ec1u h\u1eadu qu\u1ea3 nghi\u00eam tr\u1ecdng cho \u0111\u1eddi s\u1ed1ng.<\/p>\n
C\u00e2u 13: N\u00eau m\u1ed1i quan h\u1ec7 gi\u1eefa ph\u1ea3n \u1ee9ng vi\u00eam v\u1edbi c\u01a1 th\u1ec3 ?<\/p>\n
1.Vi\u00eam l\u00e0 m\u1ed9t ph\u1ea3n \u1ee9ng to\u00e0n th\u00e2n<\/p>\n
Trong qu\u00e1 tr\u00ecnh vi\u00eam tu\u1ef3 bi\u1ec3u hi\u1ec7n c\u1ee5c b\u1ed9 l\u00e0 ch\u1ee7 y\u1ebfu song t\u00ednh ch\u1ea5t, t\u00ecnh tr\u1ea1ng di\u1ec5n bi\u1ebfn v\u00e0 k\u1ebft th\u00fac c\u1ee7a vi\u00eam ch\u1ecbu \u1ea3nh h\u01b0\u1edfng s\u00e2u s\u1eafc c\u1ee7a to\u00e0n th\u00e2n, \u0111\u1ed3ng th\u1eddi ph\u1ea3n \u1ee9ng vi\u00eam c\u0169ng g\u00e2y nhi\u1ec1u r\u1ed1i lo\u1ea1n trong to\u00e0n b\u1ed9 c\u01a1 th\u1ec3<\/p>\n
*\u1ea2nh h\u01b0\u1edfng c\u1ee7a to\u00e0n th\u00e2n \u0111\u1ed1i v\u1edbi vi\u00eam: T\u00ednh ph\u1ea3n \u1ee9ng c\u01a1 th\u1ec3 \u1ea3nh h\u01b0\u1edfng s\u00e2u s\u1eafc \u0111\u1ebfn ph\u1ea3n \u1ee9ng vi\u00eam. Tr\u00ean c\u01a1 th\u1ec3 kho\u1ebb m\u1ea1nh di\u1ec5n bi\u1ebfn c\u1ee7a vi\u00eam th\u01b0\u1eddng kh\u1ea3 quan h\u01a1n, di\u1ec5n bi\u1ebfn m\u1ea1nh v\u00e0 nghi\u00eam tr\u1ecdng th\u01b0\u1eddng th\u1ea5y \u1edf c\u01a1 th\u1ec3 \u0111\u00e3 b\u1ecb m\u1eabn c\u1ea3m g\u00e2y c\u00e1c th\u1ec3 b\u1ec7nh n\u1eb7ng, v\u00e0 ph\u1ea3n \u1ee9ng y\u1ebfu \u1edbt v\u00e0 di\u1ec5n bi\u1ebfn nguy hi\u1ec3m g\u1eb7p tr\u00ean c\u01a1 th\u1ec3 suy nh\u01b0\u1ee3c, \u0111\u00f3i \u0103n, ng\u01b0\u1eddi gi\u00e0 s\u1ee9c \u0111\u1ec1 kh\u00e1ng b\u1ecb suy s\u1ee5p.<\/p>\n
– H\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u1ecf n\u00e3o \u1ea3nh h\u01b0\u1edfng r\u00f5 r\u1ec7t t\u1edbi b\u1ec7nh sinh c\u1ee7a vi\u00eam. \u1ede \u0111\u1ed9ng v\u1eadt m\u1ea5t n\u00e3o, ph\u1ea3n \u1ee9ng vi\u00eam y\u1ebfu v\u00e0 k\u00e9o d\u00e0i. Vi\u00eam v\u1edbi d\u1ea1ng n\u1ed3i ban v\u00e0 xung huy\u1ebft c\u00f3 th\u1ec3 g\u00e2y \u1edf ng\u01b0\u1eddi b\u1eb1ng c\u00e1ch \u00e1m th\u1ecb l\u00e0 \u0111\u1eb7t tr\u00ean da m\u1ed9t \u0111\u1ed3ng xu n\u00f3ng, m\u1eb7c d\u1ea7u \u0111\u1ed3ng xu \u0111\u00f3 ch\u1ec9 b\u00ecnh th\u01b0\u1eddng. G\u00e2y b\u1ecfng cho \u0111\u1ed9ng v\u1eadt \u1edf tr\u1ea1ng th\u00e1i g\u00e2y m\u00ea th\u1ea5y vi\u00eam di\u1ec5n bi\u1ebfn n\u1eb7ng h\u01a1n, ho\u1ea1n t\u1eed nghi\u00eam tr\u1ecdng v\u00e0 v\u1ebft b\u1ecfng l\u00e2u l\u00e0nh h\u01a1n\u2026<\/p>\n
– C\u00e1c tuy\u1ebfn n\u1ed9i ti\u1ebft c\u0169ng \u1ea3nh h\u01b0\u1edfng r\u00f5 r\u1ec7t t\u1edbi ph\u1ea3n \u1ee9ng vi\u00eam. C\u1eaft b\u1ecf tuy\u1ebfn gi\u00e1p l\u00e0m suy y\u1ebfu ph\u1ea3n \u1ee9ng vi\u00eam. N\u1ed9i ti\u1ebft t\u1ed1 sinh d\u1ee5c nh\u01b0 oestrogen \u1ee9c ch\u1ebf r\u00f5 ho\u1ea1t t\u00ednh men hyaluronidaza. C\u1eaft b\u1ecf tuy\u1ebfn tu\u1ef5 ho\u1ea1t t\u00ednh th\u1ef1c b\u00e0o c\u1ee7a b\u1ea1ch c\u1ea7u gi\u1ea3m.<\/p>\n
M\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 cho r\u1eb1ng c\u00e1c corticoit \u0111\u01b0\u1eddng (cortison, hydrocortison..) \u1ee9c ch\u1ebf ph\u1ea3n \u1ee9ng vi\u00eam g\u00e2y gi\u1ea3m t\u00ednh th\u1ea5m mao m\u1ea1ch, \u1ee9c ch\u1ebf th\u1ef1c b\u00e0o v\u00e0 t\u1ea1o kh\u00e1ng th\u1ec3, \u1ee9c ch\u1ebf hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng sinh c\u00e1c t\u1ebf b\u00e0o t\u1ed5 ch\u1ee9c li\u00ean k\u1ebft.<\/p>\n
G\u1ea7n \u0111\u00e2y ng\u01b0\u1eddi ta d\u00f9ng cortison v\u1edbi t\u00e1c d\u1ee5ng \u1ed5n \u0111\u1ecbnh m\u00e0ng lizocom, \u1ee9c ch\u1ebf s\u1ef1 t\u1ea1o th\u00e0nh polypeptit h\u1ec7 kinin n\u00ean cortison v\u00e0 nh\u1eefng ch\u1ea5t t\u1ed5ng h\u1ee3p t\u01b0\u01a1ng t\u1ef1 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i \u1edf l\u00e2m s\u00e0ng trong \u0111i\u1ec1u tr\u1ecb vi\u00eam nh\u1ea5t l\u00e0 vi\u00eam d\u1ecb \u1ee9ng.<\/p>\n
– H\u1ec7 v\u00f5ng m\u1ea1c n\u1ed9i m\u00f4 l\u00e0 n\u01a1i sinh s\u1ea3n ra kh\u00e1ng th\u1ec3 v\u00e0 c\u00e1c lo\u1ea1i th\u1ef1c b\u00e0o, c\u00f3 ch\u1ee9c n\u0103ng gi\u1ea3i \u0111\u1ed9c n\u00ean khi ch\u1ee9c n\u0103ng n\u00e0y b\u1ecb suy y\u1ebfu c\u0169ng \u1ea3nh h\u01b0\u1edfng nghi\u00eam tr\u1ecdng t\u1edbi ph\u1ea3n \u1ee9ng vi\u00eam.<\/p>\n
* \u1ea2nh h\u01b0\u1edfng c\u1ee7a vi\u00eam t\u1edbi to\u00e0n b\u1ed9 c\u01a1 th\u1ec3:<\/p>\n
– T\u1eeb \u1ed5 vi\u00eam c\u00f3 th\u1ec3 gay nhi\u1ec1u thay \u0111\u1ed5i ch\u1ee9c ph\u1eadn \u1ea3nh h\u01b0\u1edfng s\u00e2u s\u1eafc t\u1edbi to\u00e0n b\u1ed9 c\u01a1 th\u1ec3: r\u1ed1i lo\u1ea1n th\u1ea7n kinh xu\u1ea5t hi\u1ec7n s\u1edbm nh\u1ea5t, r\u1ed3i t\u1edbi r\u1ed1i lo\u1ea1n ti\u00eau ho\u00e1, ti\u1ebft ni\u1ec7u, \u0111i\u1ec1u ho\u00e0 th\u00e2n nhi\u1ec7t v\u00e0 quan tr\u1ecdng nh\u1ea5t l\u00e0 nh\u1eefng thay \u0111\u1ed5i c\u1ee7a m\u00e1u.<\/p>\n
C\u00e1c r\u1ed1i lo\u1ea1n n\u00e0y ph\u00e1t sinh do t\u00e1c d\u1ee5ng c\u1ee7a c\u00e1c vi khu\u1ea9n, \u0111\u1ed9c t\u1ed1, c\u00e1c s\u1ea3n ph\u1ea9m c\u1ee7a r\u1ed1i lo\u1ea1n chuy\u1ec3n ho\u00e1 v\u00e0 t\u1ed5n th\u01b0\u01a1ng t\u1ed5 ch\u1ee9c t\u1eeb \u1ed5 vi\u00eam v\u00e0o m\u00e1u g\u00e2y ra.<\/p>\n
– Vi\u00eam c\u00f2n th\u00f4ng qua c\u01a1 ch\u1ebf ph\u1ea3n x\u1ea1 \u1ea3nh h\u01b0\u1edfng t\u1edbi c\u00e1c b\u1ed9 ph\u1eadn kh\u00e1c v\u00e0 khi vi\u00eam n\u1eb7ng v\u00e0 k\u00e9o d\u00e0i c\u01a1 th\u1ec3 suy y\u1ebfu d\u1ea7n do thi\u1ebfu dinh d\u01b0\u1ee1ng, s\u1ee9c \u0111\u1ec1 kh\u00e1ng gi\u1ea3m s\u00fat c\u00f3 th\u1ec3 ph\u00e1t sinh nh\u1eefng t\u1ed5n th\u01b0\u01a1ng th\u1ef1c th\u1ec3 \u1edf nh\u1eefng \u01a1 quan xa (tim, gan, th\u1eadn\u2026)<\/p>\n
=>T\u1eeb m\u1ed1i quan h\u1ec7 m\u1eadt thi\u1ebft gi\u1eefa \u1ed5 vi\u00eam v\u00e0 to\u00e0n th\u00e2n \u0111\u00e3 x\u00e2y d\u1ef1ng \u0111\u01b0\u1ee3c m\u1ed9t quan \u0111i\u1ec3m khoa h\u1ecdc \u0111\u00fang \u0111\u1eafn l\u00e0 \u201cvi\u00eam l\u00e0 m\u1ed9t ph\u1ea3n \u1ee9ng to\u00e0n th\u00e2n v\u1edbi nh\u1eefng bi\u1ec3u hi\u1ec7n c\u1ee5c b\u1ed9 l\u00e0 ch\u1ee7 y\u1ebfu\u201d \u0111i\u1ec1u tr\u1ecb c\u1ee5c b\u1ed9 ph\u1ea3i k\u1ebft h\u1ee3p v\u1edbi \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n tr\u00ean c\u01a1 s\u1edf \u0111i\u1ec1u tr\u1ecb to\u00e0n di\u1ec7n.<\/p>\n
2. Vi\u00eam l\u00e0 m\u1ed9t ph\u1ea3n \u1ee9ng th\u00edch \u1ee9ng b\u1ea3o v\u1ec7 c\u01a1 th\u1ec3:<\/p>\n
Ph\u00e2n t\u00edch nh\u1eefng bi\u1ec3u hi\u1ec7n ch\u1ee7 y\u1ebfu trong vi\u00eam ta th\u1ea5y c\u00f3 2 lo\u1ea1i hi\u1ec7n t\u01b0\u1ee3ng:<\/p>\n
– Hi\u1ec7n t\u01b0\u1ee3ng ph\u00e1 ho\u1ea1i do c\u00e1c y\u1ebfu t\u1ed1 g\u00e2y vi\u00eam x\u00e2m nh\u1eadp c\u01a1 th\u1ec3 g\u00e2y nh\u1eefng t\u1ed5n th\u01b0\u01a1ng t\u1ebf b\u00e0o t\u1ed5 ch\u1ee9c d\u1eabn \u0111\u1ebfn nh\u1eefng bi\u1ebfn \u0111\u1ed5i ch\u1ee9c ph\u1eadn nhi\u1ec1u hay \u00edt \u1edf c\u00e1c c\u01a1 quan trong to\u00e0n b\u1ed9 c\u01a1 th\u1ec3.<\/p>\n
– Hi\u1ec7n t\u01b0\u1ee3ng th\u00edch \u1ee9ng ph\u00f2ng ng\u1ef1 \u0111\u1ed3ng th\u1eddi xu\u1ea5t hi\u1ec7n d\u01b0\u1edbi nhi\u1ec1u bi\u1ec3u hi\u1ec7n: t\u0103ng ti\u1ebft d\u1ecbch r\u1ec9, ph\u00f9 vi\u00eam c\u00f3 kh\u1ea3 n\u0103ng li\u00ean k\u1ebft, c\u1ed1 \u0111\u1ecbnh c\u00e1c \u0111\u1ed9c t\u1ed1 vi khu\u1ea9n trong \u1ed5 vi\u00eam kh\u00f4ng cho h\u1ea5p thu v\u00e0 lan r\u1ed9ng trong c\u01a1 th\u1ec3. Ch\u1ee9c ph\u1eadn th\u1ef1c b\u00e0o v\u00e0 t\u0103ng sinh c\u00e1c t\u1ed5 ch\u1ee9c li\u00ean k\u1ebft nh\u1eb1m ti\u00eau di\u1ec7t nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam, kh\u00f4i ph\u1ee5c l\u1ea1i c\u00e1c ch\u1ee9c n\u0103ng sinh l\u00fd, h\u00e0n g\u1eafn t\u1ed5n th\u01b0\u01a1ng t\u1ed5 ch\u1ee9c. T\u1ed5 ch\u1ee9c h\u1ea1t \u0111\u00e0o t\u1ea1o th\u00e0nh h\u00e0ng r\u00e0o b\u1ea3o v\u1ec7 r\u1ea5t m\u1ea1nh ch\u1ed1ng vi khu\u1ea9n.<\/p>\n
C\u00e2u 14: Nguy\u00ean nh\u00e2n g\u00e2y s\u1ed1t v\u00e0 c\u00e1c giai \u0111o\u1ea1n c\u1ee7a s\u1ed1t?<\/p>\n
A- Nguy\u00ean nh\u00e2n g\u00e2y s\u1ed1t<\/p>\n
S\u1ed1t ph\u00e1t sinh do c\u00e1c nguy\u00ean nh\u00e2n nhi\u1ec5m khu\u1ea9n, do c\u00e1c t\u00e1c d\u1ee5ng c\u00e1c ch\u1ea5t g\u00e2y s\u1ed1t, ngo\u1ea1i sinh v\u00e0 n\u1ed9i sinh.<\/p>\n
1. Ch\u1ea5t g\u00e2y s\u1ed1t ngo\u1ea1i sinh: L\u00e0 c\u00e1c ch\u1ea5t g\u00e2y s\u1ed1t \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft t\u1eeb c\u00e1c vi khu\u1ea9n trong qu\u00e1 tr\u00ecnh ho\u1ea1t \u0111\u1ed9ng s\u1ed1ng ho\u1eb7c ch\u1ebft. Ho\u1ea1t t\u00ednh g\u00e2y s\u1ed1t g\u1ea7n nh\u01b0 c\u00f3 s\u1eb5n \u1edf t\u1ea5t c\u1ea3 c\u00e1c vi khu\u1ea9n g\u00e2y b\u1ec7nh v\u00e0 kh\u00f4ng g\u00e2y b\u1ec7nh, c\u00f3 th\u1ec3 \u1edf c\u1ea3 vi r\u00fat. Kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ednh g\u00e2y b\u1ec7nh v\u00e0 \u0111\u1ed9c t\u00ednh c\u1ee7a ch\u00fang.<\/p>\n
– B\u1eb1ng c\u00e1ch chi\u1ebft xu\u1ea5t ho\u00e1 h\u1ecdc \u0111\u1eb7c hi\u1ec7u t\u1eeb c\u00e1c vi khu\u1ea9n kh\u00e1c nhau, c\u00f3 th\u1ec3 t\u00e1ch \u0111\u01b0\u1ee3c c\u00e1c ch\u1ea5t g\u00e2y s\u1ed1t ngo\u1ea1i sinh tinh khi\u1ebft v\u00e0 \u00edt \u0111\u1ed9c.<\/p>\n
– C\u1ea5u tr\u00fac ho\u00e1 h\u1ecdc c\u1ee7a c\u00e1c ch\u1ea5t g\u00e2y s\u1ed1t ngo\u1ea1i sinh l\u00e0 m\u1ee1 \u2013 da d\u01b0\u1eddng v\u00e0 l\u00e0 th\u00e0nh ph\u1ea7n c\u00e1c n\u1ed9i \u0111\u1ed9c t\u1ed1 c\u1ee7a c\u00e1c t\u1ebf b\u00e0o vi khu\u1ea9n. Ch\u1ea5t g\u00e2y s\u1ed1t ngo\u1ea1i sinh tinh khi\u1ebft c\u00f3 ho\u1ea1t t\u00ednh v\u1edbi \u0111i\u1ec1u r\u1ea5t nh\u1ecf \u1edf ng\u01b0\u1eddi (1micro\/c\u00e2n) v\u00e0 \u1edf th\u1ecf (0,01 \u2013 0,001micro\/c\u00e2n).<\/p>\n
– S\u1ed1t \u1edf th\u1ecf do ch\u1ea5t g\u00e2y s\u1ed1t ngo\u1ea1i sinh xu\u1ea5t hi\u1ec7n sau m\u1ed9t giai \u0111o\u1ea1n ti\u1ec1n ng\u1eafn v\u00e0 t\u0103ng nhi\u1ec7t \u0111\u1ed9 gi\u1eef \u0111\u01b0\u1ee3c v\u00e0i gi\u1edd cho n\u00ean hi\u1ec7u qu\u1ea3 c\u00e1c ch\u1ea5t g\u00e2y s\u1ed1t th\u01b0\u1eddng \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh tr\u00ean th\u1ecf. Ho\u1ea1t t\u00ednh g\u00e2y s\u1ed1t th\u1ea5y \u1edf ngo\u1ea1i \u0111\u1ed9c t\u1ed1 (b\u1ea1ch c\u1ea7u, li\u00ean c\u1ea7u tan m\u00e1u) th\u01b0\u1eddng g\u00e2y s\u1ed1t sau m\u1ed9t th\u1eddi gian ti\u00eam k\u00e9o d\u00e0i 3 \u2013 6 gi\u1edd.<\/p>\n
– Ch\u1ea5t g\u00e2y s\u1ed1t ngo\u1ea1i sinh c\u00f2n c\u00f3 t\u00e1c d\u1ee5ng g\u00e2y s\u1ed1t qua c\u00e1c c\u1ea5u tr\u00fac t\u1ebf b\u00e0o t\u1ed5 ch\u1ee9c t\u1ed5n th\u01b0\u01a1ng, t\u1ee9c l\u00e0 qua s\u1ef1 t\u1ea1o th\u00e0nh c\u00e1c ch\u1ea5t g\u00e2y s\u1ed1t n\u1ed9i sinh.<\/p>\n
2. Ch\u1ea5t g\u00e2y s\u1ed1t n\u1ed9i sinh: C\u00e1c t\u1ebf b\u00e0o v\u00e0 t\u1ed5 ch\u1ee9c c\u1ee7a c\u01a1 th\u1ec3 kh\u00e1c v\u1edbi c\u00e1c t\u1ebf b\u00e0o vi khu\u1ea9n l\u00e0 kh\u00f4ng c\u00f3 s\u1eb5n c\u00e1c y\u1ebfu t\u1ed1 g\u00e2y s\u1ed1t.<\/p>\n
– Ch\u1ea5t g\u00e2y s\u1ed1t n\u1ed9i sinh ch\u1ec9 \u0111\u01b0\u1ee3c t\u1ea1o ra trong c\u00e1c \u0111i\u1ec1u ki\u1ec7n b\u1ec7nh l\u00fd ph\u00f9 h\u1ee3p, trong c\u00e1c b\u1ec7nh nhi\u1ec5m khu\u1ea9n v\u00e0 c\u1ea3 trong c\u00e1c t\u1ed5n th\u01b0\u01a1ng v\u00f4 khu\u1ea9n v\u00e0 vi\u00eam nhi\u1ec5m t\u1ed5 ch\u1ee9c, t\u1eeb c\u00e1c t\u1ebf b\u00e0o b\u1ecb t\u1ed5n th\u01b0\u01a1ng d\u1ecbch d\u1ecb, c\u00e1c \u0111\u1ea1m m\u00e1u bi\u1ebfn ch\u1ea5t, c\u00e1c b\u1ea1ch c\u1ea7u trung t\u00ednh, c\u00e1c t\u1ebf b\u00e0o Lympho v\u00e0 t\u1ebf b\u00e0o n\u00e1ch trong c\u00e1c ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng ch\u1eadm \u0111\u1ec1u c\u00f3 th\u1ec3 l\u00e0 ngu\u1ed3n g\u1ed1c t\u1ea1o c\u00e1c ch\u1ea5t g\u00e2y s\u1ed1t n\u1ed9i sinh.<\/p>\n
– \u0110\u01b0\u1ee3c nghi\u00ean c\u1ee9u nhi\u1ec1u ch\u1ea5t l\u00e0 c\u00e1c ch\u1ea5t g\u00e2y s\u1ed1t n\u1ed9i sinh chi\u1ebft t\u1eeb c\u00e1c b\u1ea1ch c\u1ea7u trung t\u00ednh trong d\u1ecbch di tho\u00e1t t\u1eeb c\u00e1c huy\u1ebft qu\u1ea3n b\u1ecb vi\u00eam. Th\u00e0nh ph\u1ea7n h\u00f3a h\u1ecdc g\u1ed3m ch\u1ea5t \u0111\u1ea1m v\u00e0 1% ch\u1ea5t da d\u01b0\u1eddng, \u0111\u1eb7c bi\u1ec7t l\u00e0 g\u00e2y s\u1ed1t nhanh, nhi\u1ec7t \u0111\u1ed9 t\u0103ng ngay sau 10 \u2013 15 ph\u00fat v\u00e0 kh\u00f4ng b\u1ecb quen \u0111\u01b0\u1eddng thu\u1ed1c.<\/p>\n
B- C\u00e1c giai \u0111o\u1ea1n c\u1ee7a s\u1ed1t:<\/p>\n
S\u1ed1t th\u01b0\u1eddng di\u1ec5n ra qua 3 giai \u0111o\u1ea1n d\u00e0i ng\u1eafn tu\u1ef3 theo m\u1ee9c \u0111\u1ed9 v\u00e0 t\u00ednh ch\u1ea5t c\u1ee7a b\u1ec7nh: vi\u00eam ph\u1ed5i, s\u1ed1t di\u1ec5n bi\u1ebfn trong 6,8 ng\u00e0y, th\u01b0\u01a1ng h\u00e0n 18-21 ng\u00e0y lao v\u1edbi s\u1ed1t v\u1ec1 chi\u1ec1u dai d\u1eb3ng ch\u1ec9 h\u1ebft s\u1ed1t khi b\u1ec7nh t\u1ea1m \u1ed5n \u0111\u1ecbnh.<\/p>\n
– Giai \u0111o\u1ea1n t\u0103ng th\u00e2n nhi\u1ec7t haygiai \u0111o\u1ea1n s\u1ed1t t\u0103ng: C\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u \u0111\u1ed9t ng\u1ed9t, s\u1ed1t cao sau v\u00e0i g\u00ec\u1edd (Vi\u00eam ph\u1ed5i, c\u00fam) ho\u1eb7c t\u0103ng d\u1ea7n trong v\u00e0i ng\u00e0y, (th\u01b0\u01a1ng h\u00e0n, s\u1edfi).<\/p>\n
+ Trong giai \u0111o\u1ea1n n\u00e0y, th\u00e2n nhi\u1ec7t th\u01b0\u1eddng t\u0103ng cao h\u01a1n so v\u1edbi th\u1ea3i nhi\u1ec7t (s\u1ea3n nhi\u1ec7t l\u1edbn h\u01a1n th\u1ea3i nhi\u1ec7t) do c\u00e1c ch\u1ea5t g\u00e2y s\u1ed1t ngo\u1ea1i sinh v\u00e0 n\u1ed9i sinh k\u00edch th\u00edch ph\u1ea3n x\u1ea1 v\u00e0 tr\u1ef1c ti\u1ebfp trung t\u00e2m \u0111i\u1ec1u ho\u00e0 nhi\u1ec7t g\u00e2y t\u0103ng s\u1ea3n nhi\u1ec7t.<\/p>\n
+ S\u1ea3n nhi\u1ec7t t\u0103ng nh\u1edd c\u00e1c qu\u00e1 tr\u00ecnh oxy ho\u00e1 chuy\u1ec3n ho\u00e1 v\u00e0 t\u0103ng m\u1ea1nh ch\u1ee7 y\u1ebfu \u1edf c\u01a1 gan v\u00e0 t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1 v\u00e0 xu\u1ea5t hi\u1ec7n r\u00f9ng m\u00ecnh.<\/p>\n
+ R\u00f9ng m\u00ecnh ph\u00e1t sinh theo c\u01a1 ch\u1ebf ph\u1ea3n x\u1ea1, c\u00e1c xung \u0111\u1ed9ng \u0111i t\u1eeb da (c\u00f3 c\u00e1c mao m\u1ea1ch b\u1ecb co t\u1edbi hypothalamus qua ph\u1ea7n b\u00ean th\u1ec3 l\u01b0\u1edbi r\u1ed3i theo d\u00e2y TK v\u1eadn \u0111\u1ed9ng t\u1edbi c\u01a1 cho n\u00ean r\u00f9ng m\u00ecnh kh\u00f4ng xu\u1ea5t hi\u1ec7n \u1edf \u0111\u1ed9ng v\u1eadt khi b\u1ecb t\u1ed5n th\u01b0\u01a1ng ph\u1ea7n sau hypothalamus gi\u1eefa th\u1ec3 v\u00fa v\u00e0 ti\u1ec3u n\u00e3o).<\/p>\n
+ R\u00f9ng m\u00ecnh th\u01b0\u1eddng k\u00e8m theo c\u1ea3m gi\u00e1c l\u1ea1nh, r\u00e9t run, n\u1ed5i gai \u1ed1c l\u00e0 do c\u00e1c c\u01a1 tr\u01a1n c\u1ee7a ch\u00e2n l\u00f4ng co l\u1ea1i l\u00e0m l\u1edbp kh\u00f4ng kh\u00ed c\u00e1ch nhi\u1ec7t t\u0103ng l\u00ean \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh th\u1ea3i nhi\u1ec7t. C\u00f2n th\u1ea3i nhi\u1ec7t gi\u1ea3m l\u00e0 do c\u1ecd c\u00e1c m\u1ea1ch ngo\u1ea1i vi n\u00ean tr\u1edf th\u00e0nh nh\u1ee3t nh\u1ea1t v\u00e0 \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh ti\u1ebft m\u1ed3 h\u00f4i.<\/p>\n
– Giai \u0111o\u1ea1n s\u1ed1t \u0111\u1ee9ng:Th\u00e2n nhi\u1ec7t duy tr\u00ec \u1edf m\u1ee9c cao do s\u1ea3n nhi\u1ec7t v\u1eabn t\u0103ng song th\u1ea3i nhi\u1ec7t c\u0169ng t\u0103ng (s\u1ea3n nhi\u1ec7t b\u1eb1ng th\u1ea3i nhi\u1ec7t) \u0111\u00e3 c\u00f3 c\u00e2n b\u1eb1ng nhi\u1ec7t \u1edf m\u1ee9c \u0111\u1ed9 nh\u1ea5t \u0111\u1ecbnh nh\u01b0ng v\u1eabn ch\u01b0a th\u1ea3i \u0111\u01b0\u1ee3c nhi\u1ec7t l\u01b0\u1ee3ng t\u00edch lu\u1ef9 trong giai \u0111o\u1ea1n \u0111\u1ea7u n\u00ean th\u00e2n nhi\u1ec7t duy tr\u00ec \u1edf m\u1ee9c cao.<\/p>\n
S\u1ef1 xu\u1ea5t hi\u1ec7n th\u1ea3i nhi\u1ec7t bi\u1ec3u hi\u1ec7n b\u1eb1ng c\u00e1ch d\u1eabn c\u00e1c m\u1ea1ch ngo\u1ea1i vi do k\u00edch th\u00edch c\u00e1c ph\u00e2n b\u1ed1 th\u1ea7n kinh ph\u00f3 giao c\u1ea3m n\u00ean da t\u00e1i nh\u1ee3t chuy\u1ec3n th\u00e0nh xung huy\u1ebft, nhi\u1ec7t \u0111\u1ecd da t\u0103ng v\u00e0 h\u1ebft r\u00e9t run. L\u00fac n\u00e0y c\u00f3 th\u1ec3 l\u00e0m t\u0103ng th\u1ea3i nhi\u1ec7t (ch\u01b0\u1eddm l\u1ea1nh) ho\u1eb7c d\u00f9ng c\u00e1c lo\u1ea1i thu\u1ed1c h\u1ea1 nhi\u1ec7t d\u1ec3 h\u1ea1n ch\u1ebf n\u1ebfu th\u00e2n nhi\u1ec7t \u0111e d\u1ecda qu\u00e1 cao<\/p>\n
– Giai \u0111o\u1ea1n s\u1ed1t lui:Th\u00e2n nhi\u1ec7t gi\u1ea3m xu\u1ed1ng t\u1edbi m\u1ee9c trung b\u00ecnh th\u01b0\u1eddng s\u1ea3n nhi\u1ec7t l\u00fac n\u00e0y nh\u1ecf h\u01a1n th\u1ea3i nhi\u1ec7t. Th\u1ea3i nhi\u1ec7t t\u0103ng m\u1ea1nh b\u1eb1ng c\u00e1ch ra nhi\u1ec1u m\u1ed3 h\u00f4i, ti\u1ec3u nhi\u1ec1u. S\u1ea3n nhi\u1ec7t c\u00f3 th\u1ec3 gi\u1ea3m h\u1eb3n ho\u1eb7c h\u01a1i t\u0103ng \u1edf b\u1ec7nh nh\u00e2n s\u1ed1t n\u1eb7ng, th\u01b0\u1eddng gi\u1ea3m th\u00e2n nhi\u1ec7t t\u1eeb t\u1eeb, nh\u01b0ng c\u0169ng c\u00f3 tr\u01b0\u1eddng h\u1ee3p gi\u1ea3m nhanh, \u0111\u1ed9t ng\u1ed9t sau v\u00e0i gi\u1edd .<\/p>\n
\u00e0 Gi\u1ea3m th\u00e2n nhi\u1ec7t \u0111\u1ed9t ng\u1ed9t c\u00f3 th\u1ec3 d\u1eabn t\u1edbi thi\u1ec3u n\u0103ng m\u1ea1ch c\u1ea5p, tru\u1ef5 m\u1ea1ch do gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u00e1c m\u1ea1ch thi\u1ebfu m\u00e1u nghi\u00eam tr\u1ecdng.<\/p>\n
Theo m\u1ee9c \u0111\u1ed9 t\u0103ng th\u00e2n nhi\u1ec7t c\u00f3 th\u1ec3 ph\u00e2n th\u00e0nh:<\/p>\n
+ S\u1ed1t nh\u1eb9 khi th\u00e2n nhi\u1ec7t t\u0103ng trong gi\u1edbi h\u1ea1n 380C<\/p>\n
+ S\u1ed1t v\u1eeba khi th\u00e2n nhi\u1ec7t t\u0103ng t\u1eeb 38-390C<\/p>\n
+ S\u1ed1t cao khi th\u00e2n nhi\u1ec7t tr\u00ean t\u1eeb 390C<\/p>\n
+ S\u1ed1t n\u1eb7ng khi th\u00e2n nhi\u1ec7t tr\u00ean 410C<\/p>\n
Trong s\u1ed1t \u00edt khi th\u00e2n nhi\u1ec7t l\u00ean t\u1edbi 420C v\u00ec t\u1edbi gi\u1edbi h\u1ea1n \u0111\u00f3 th\u01b0\u1eddng ph\u00e1t sinh r\u1ed1i lo\u1ea1n nghi\u00eam tr\u1ecdng h\u1ec7 TKTW v\u00e0 ph\u00e1t sinh nhi\u1ec5m n\u00f3ng, m\u1ee9c \u0111\u1ed9 t\u0103ng th\u00e2n nhi\u1ec7t trong c\u00e1c b\u1ec7nh nhi\u1ec5m khu\u1ea9n ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ednh ch\u1ea5t ph\u1ea3n \u1ee9ng c\u01a1 th\u1ec3 t\u00ednh ch\u1ea5t g\u00e2y s\u1ed1t c\u1ee7a vi khu\u1ea9n, t\u00ecnh tr\u1ea1ng nhi\u1ec5m \u0111\u1ed9c ho\u1eb7c do t\u00e1c d\u1ee5ng ph\u00e1 h\u1ee7y c\u1ee7a \u0111\u1ed9c t\u1ed1 vi khu\u1ea9n \u0111\u1ed1i v\u1edbi c\u00e1c trung t\u00e2m \u0111i\u1ec1u nhi\u1ec7t \u0111\u01b0\u1ee3c coi nh\u01b0 l\u00e0 bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh nhi\u1ec5m khu\u1ea9n \u1edf ng\u01b0\u1eddi gi\u00e0, suy nh\u01b0\u1ee3c th\u01b0\u1eddng kh\u00f4ng th\u1ea5y s\u1ed1t c\u0169ng l\u00e0 d\u1ea5u hi\u1ec7u kh\u00f4ng t\u1ed1t nh\u01b0 t\u0103ng th\u00e2n nhi\u1ec7t qu\u00e1 m\u1ee9c.<\/p>\n
C\u00e2u 15: C\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng c\u1ee7a ch\u1ea5t g\u00e2y s\u1ed1t n\u1ed9i sinh l\u00ean trung t\u00e2m \u0111i\u1ec1u h\u00f2a nhi\u1ec7t?<\/p>\n
– V\u1ecf n\u00e3o v\u00e0 c\u00e1c trung khu d\u01b0\u1edbi v\u1ecf c\u00f3 m\u1ed9t \u00fd ngh\u0129a quan tr\u1ecdng trong c\u01a1 ch\u1ebf c\u1ee7a s\u1ed1t. Trong th\u1ef1c nghi\u1ec7m c\u00f3 th\u1ec3 g\u00e2y \u0111\u01b0\u1ee3c s\u1ed1 theo c\u01a1 ch\u1ebf ph\u1ea3n x\u1ea1 c\u00f3 \u0111i\u1ec1u ki\u1ec7n \u1edf ch\u00f3 sau 10 l\u1ea7n t\u00e1c d\u1ee5ng m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 v\u00f4 quan k\u1ebft h\u1ee3p v\u1edbi ti\u00eam ch\u1ea5t g\u00e2y s\u1ed1t ngo\u1ea1i sinh vi khu\u1ea9n.<\/p>\n
+ Th\u00e2n nhi\u1ec7t \u1edf ng\u01b0\u1eddi c\u00f3 th\u1ec3 t\u0103ng \u1ea3nh h\u01b0\u1edfng c\u1ee7 th\u00f4i mi\u00ean trong c\u00e1c b\u1ec7nh t\u00e2m th\u1ea7n (s\u1ed1t t\u00e2m l\u00fd), trong c\u01a1n histeria nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 c\u00f3 th\u1ec3 t\u0103ng t\u1edbi 420C.<\/p>\n
+ S\u1ed1t do x\u00fac c\u1ea3m c\u00f3 th\u1ec3 th\u1ea5y \u1edf c\u00e1c di\u1ec5n gi\u1ea3, c\u00e1c di\u1ec5n vi\u00ean, c\u00e1c h\u1ecdc sinh trong k\u1ef3 thi… \u1edf \u0111\u1ed9ng v\u1eadt m\u1ea5t v\u1ecf n\u00e3o c\u1ea3 2 b\u00ean, s\u1ed1t ph\u00e1t sinh v\u1edbi nhi\u1ec7t \u0111\u1ed9 t\u0103ng cao h\u01a1n so v\u1edbi \u0111\u1ed9ng v\u1eadt l\u00e0nh v\u00ec \u0111\u00e3 lo\u1ea1i tr\u1eeb \u1ea3nh h\u01b0\u1edfng \u1ee9c ch\u1ebf c\u1ee7a v\u1ecf n\u00e3o \u0111\u1ed1i v\u1edbi c\u00e1c trung khu \u0111i\u1ec1u nhi\u1ec7t d\u01b0\u1edbi v\u1ecf. Trong g\u00e2y m\u00ea s\u00e2u, ph\u1ea3n \u1ee9ng s\u1ed1t gi\u1ea3m r\u00f5 r\u1ec7t.<\/p>\n
– V\u00f9ng d\u01b0\u1edbi th\u1ecb \u0111\u01b0\u1ee3c coi nh\u01b0 m\u1ed9t trung t\u00e2m \u0111i\u1ec1u ho\u00e0 nhi\u1ec7t t\u1ef1 \u0111\u1ed9ng quan tr\u1ecdng. T\u1ea5t c\u1ea3 3 nh\u00f3m nh\u00e2n \u0111\u1ec1u tham gia vo\u00e0 s\u1ef1 ph\u00e1t sinh ph\u1ea3n \u1ee9ng s\u1ed1ng.<\/p>\n
+ C\u00e1c nh\u00e2n gi\u1eefa v\u00e0 sau c\u1ee7a hypothalamus ch\u1ee7 y\u1ebfu \u0111i\u1ec1u ho\u00e0 s\u1ea3n nhi\u1ec7t v\u00e0 gi\u1eef nhi\u1ec7t l\u01b0\u1ecdng trong c\u01a1 th\u1ec3 qua h\u1ec7 th\u1ea7n kinh giao c\u1ea3m (t\u0103ng qu\u00e1 tr\u00ecnh \u00f4xy ho\u00e1 chuy\u1ec3n ho\u00e1, m\u1ea1ch ngo\u1ea1i vi) v\u00e0 qua c\u00e1c ph\u00e2n b\u1ed1 th\u1ea7n kinh x\u00f4ma c\u01a1 – x\u01b0\u01a1ng (t\u0103ng ch\u01b0\u01a1ng l\u1ef1c c\u01a1, co c\u01a1, r\u00f9ng m\u00ecnh).<\/p>\n
+ C\u00e1c nh\u00e2n ph\u1ea7n tr\u01b0\u1edbc khi hypothalamus ch\u1ee7 y\u1ebfu \u0111i\u1ec1u ho\u00e0 th\u1ea3i nhi\u1ec7t qua c\u00e1c ph\u00e2n b\u1ed5 th\u1ea7n kinh ph\u00f3 giao c\u1ea3m (d\u00e3n m\u1ea1ch), c\u00e1c s\u1ee3i giao c\u1ea3m thi\u1ebft cholin (b\u00e0i ti\u1ebft m\u1ed3 h\u00f4i) v\u00e0 c\u00e1c ph\u00e2n b\u1ed5 th\u1ea7n kinh x\u00f4ma c\u00e1c c\u01a1 th\u1edf (t\u0103ng h\u00f4 h\u1ea5p). T\u1ed5n th\u01b0\u01a1ng ho\u00e0n to\u00e0n hypothalamus ho\u1eb7c c\u1eaft th\u00e2n n\u00e3o d\u01b0\u1edbi hypothalamus \u0111\u1ed9ng v\u1eadt b\u00ecnh nhi\u1ec7t b\u1ecb bi\u1ebfn \u0111\u1ed5i th\u00e0nh bi\u1ebfn nhi\u1ec7t v\u00e0 m\u1ea5t kh\u1ea3 n\u0103ng g\u00e2y s\u1ed1t.<\/p>\n
– T\u1eeb c\u00e1c trung t\u00e2m \u0111i\u1ec1u nhi\u1ec7t, c\u00e1c xung \u0111\u1ed9ng \u0111i v\u1ec1 tu\u1ef7 s\u1ed1ng r\u1ed3i t\u1edbi c\u00e1c c\u1ea3m th\u1ee5 th\u1ea7n kinh.<\/p>\n
C\u00e1c nghi\u00ean c\u1ee9u th\u1ef1c nghi\u1ec7m c\u1ee7a V\u00eaceklin \u0111\u00e3 ch\u1ee9ng minh c\u01a1 ch\u1ebf ph\u1ea3n x\u1ea1 th\u1ea7n kinh l\u00e0 c\u01a1 ch\u1ebf kh\u1edfi \u0111\u1ea7u c\u1ee7a ph\u1ea3n \u1ee9ng s\u1ed1t. Khi ti\u00eam ch\u1ea5t g\u00e2y s\u1ed1t cho \u0111\u1ed9ng v\u1eadt, ch\u1ea5t g\u00e2y s\u1ed1t tr\u01b0\u1edbc h\u1ebft k\u00edch th\u00edch c\u00e1c c\u01a1 quan c\u1ea3m th\u1ee5 c\u1ee5c b\u1ed9, m\u1ed9t m\u1eb7t v\u00e0o m\u00e1u \u0111\u01b0a \u0111i kh\u1eafp c\u01a1 th\u1ec3 t\u00e1c d\u1ee5ng l\u00ean to\u00e0n b\u1ed9 h\u1ec7 th\u1ed1ng c\u00e1c n\u1ed9i th\u1ee5 c\u1ea3m, \u0111\u1ed3ng th\u1eddi t\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp l\u00ean trung t\u00e2m \u0111i\u1ec1u ho\u00e0 nhi\u1ec7t \u0111\u1ec3 g\u00e2y s\u1ed1t.<\/p>\n
C\u1eaft b\u1ecf d\u00e2y th\u1ea7n kinh h\u01b0\u1edbng t\u00e2m \u1edf h\u01a1i ti\u00eam ch\u1ea5t g\u00e2y s\u1ed1t ho\u1eb7c phong b\u1ebf Novocain tr\u01b0\u1edbc khi ti\u00eam ch\u1ea5t g\u00e2y s\u1ed1t ph\u1ea3n \u1ee9ng r\u00f5 r\u1ec7t 8-18 gi\u1edd sau s\u1ed1t m\u1edbi xu\u1ea5t hi\u1ec7n v\u00e0 10-20gi\u1edd (sau s\u1ed1t m\u1edbi \u0111\u1ea1t m\u1ee9c t\u1ed1i \u0111a). B\u00ecnh th\u01b0\u1eddng s\u1ed1t sau m\u1ed9t gi\u1edd v\u00e0 ch\u1ec9 10 gi\u1edd sau \u0111\u00e3 \u0111\u1ea1t m\u1ee9c t\u1ed1i \u0111a. Duy tr\u00ec ph\u1ea3n \u1ee9ng t\u1ed1t trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y ch\u1ee9ng t\u1ecf \u1ea3nh h\u01b0\u1edfng tr\u1ef1c ti\u1ebfp c\u1ee7a ch\u1ea5t g\u00e2y s\u1ed1t \u0111\u1ed1i v\u1edbi trung t\u00e2m \u0111i\u1ec1u nhi\u1ec7t qua \u0111\u01b0\u1eddng m\u00e1u<\/p>\n
C\u00e1c tuy\u1ebfn n\u1ed9i ti\u1ebft, h\u1ec7 tuy\u1ebfn y\u00ean-tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn b\u1ecb k\u00edch ho\u1ea1t b\u1edfi \u1ea3nh h\u01b0\u1edfng c\u1ee7a c\u00e1c tuy\u1ebfn g\u00e2y s\u1ed1t nh\u01b0ng ph\u1ea3n \u1ee9ng Stress n\u00e0y kh\u00f4ng tham gia v\u00e0o c\u01a1 th\u1ec3 ph\u00e1t sinh s\u1ed1t. Trong \u01b0u n\u0103ng tuy\u1ebfn gi\u00e1p th\u1ea5y th\u00e2n nhi\u1ec7t th\u01b0\u1eddng xuy\u00ean h\u01a1i t\u0103ng, hocmon thyroxin g\u00e2y t\u0103ng qu\u00e1 tr\u00ecnh oxy ho\u00e1 trong t\u1ed5 ch\u1ee9c. Do v\u1eady b\u1ec7nh nh\u00e2n th\u1ec3u n\u0103ng tuy\u1ebfn gi\u00e1p tr\u1ea1ng ng\u01b0\u1ee3c l\u1ea1i ph\u1ea3n \u1ee9ng s\u1ed1t bi\u1ec3u hi\u1ec7n kh\u00f4ng r\u00f5 r\u1ec7t.<\/p>\n
C\u00e2u 16: V\u1ebd s\u01a1 \u0111\u1ed3 ROSENDOFF \u0111\u1ec3 minh h\u1ecda c\u01a1 ch\u1ebf c\u1ee7a s\u1ed1t?<\/p>\n
– C\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng c\u1ee7a ch\u1ea5t g\u00e2y s\u1ed1t n\u1ed9i sinh: Ch\u1ea5t g\u00e2y s\u1ed1t \u2192 TT\u0110N \u2192 thay \u0111\u1ed5i (thermoregulatory setpoint) \u0111i\u1ec3m \u0111i\u1ec1u nhi\u1ec7t \u2192 t\u0103ng s\u1ea3n nhi\u1ec7t, gi\u1ea3m th\u1ea3i nhi\u1ec7t \u2192 s\u1ed1t.<\/p>\n
– Khi \u0111i\u1ec3m \u0111i\u1ec1u nhi\u1ec7t b\u1ecb thay \u0111\u1ed5i, nhi\u1ec7t \u0111\u1ed9 c\u1ee7a c\u01a1 th\u1ec3 tr\u1edf th\u00e0nh l\u1ea1nh, ng\u01b0\u1eddi b\u1ec7nh c\u00f3 c\u1ea3m gi\u00e1c l\u1ea1nh, r\u00f9ng m\u00ecnh, \u1edbn l\u1ea1nh, run, co m\u1ea1ch ngo\u1ea1i vi, th\u00e2n nhi\u1ec7t b\u1eaft \u0111\u1ea7u t\u0103ng, kh\u00f4ng v\u00e3 m\u1ed3 h\u00f4i cho \u0111\u1ebfn khi s\u1ed1t b\u1eaft \u0111\u1ea7u lui.<\/p>\n
– C\u01a1 ch\u1ebf l\u00e0m thay \u0111\u1ed5i \u0111i\u1ec3m \u0111i\u1ec1u nhi\u1ec7t:C\u00e1c t\u00e1c gi\u1ea3 \u0111\u1ec1u \u0111\u1ec1 c\u1eadp \u0111\u1ebfn vai tr\u00f2 c\u1ee7a c\u00e1c s\u1ea3n ph\u1ea9m t\u1eeb arachidonic acid, \u0111\u01b0\u1ee3c t\u1ed5ng h\u1ee3p t\u1eeb c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u1ea1c c\u1ee7a m\u1ea1ch m\u00e1u khi c\u00e1c cytokine g\u00e2y s\u1ed1t g\u1eafn l\u00ean th\u1ee5 th\u1ec3 tr\u00ean b\u1ec1 m\u1eb7t t\u1ebf b\u00e0o \u1edf v\u00f9ng d\u01b0\u1edbi \u0111\u1ed3i.<\/p>\n[\u200bIMG]\u200b
\n– Ng\u00e0y nay ng\u01b0\u1eddi ta cho r\u1eb1ng c\u00f3 m\u1ed9t l\u01b0\u1ee3ng l\u1edbn ch\u1ea5t g\u00e2y s\u1ed1t n\u1ed9i sinh t\u1eeb c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u1ea1c (quan tr\u1ecdng nh\u1ea5t l\u00e0 PGE2 v\u00e0 c\u00e1c s\u1ea3n ph\u1ea9m t\u1eeb arachidonic kh\u00e1c) g\u00e2y s\u1ef1 thay \u0111\u1ed5i h\u1ec7 th\u1ed1ng t\u00edn hi\u1ec7u th\u1ee9 hai l\u00e0 AMP v\u00f2ng (cAMP), cAMP g\u00e2y t\u0103ng \u0111i\u1ec3m \u0111i\u1ec1u nhi\u1ec7t.<\/p>\n
H\u00ecnh: S\u01a1 \u0111\u1ed3 c\u01a1 ch\u1ebf ph\u00e1t sinh c\u01a1n s\u1ed1t c\u1ee7a Rosendoff.<\/p>\n
C\u00e2u 17: C\u00e1c thay \u0111\u1ed5i chuy\u1ec3n h\u00f3a v\u00e0 ch\u1ee9c n\u0103ng c\u01a1 quan trong s\u1ed1t?<\/p>\n
D\u1ea5u hi\u1ec7u \u0111\u1eb7c tr\u01b0ng nh\u1ea5t c\u1ee7a s\u1ed1t l\u00e0 t\u0103ng th\u00e2n nhi\u1ec7t. Ngo\u00e0i ra, c\u00e1c b\u1ec7nh l\u00fd c\u00f3 s\u1ed1t th\u01b0\u1eddng k\u00e8m theo nh\u1eefng bi\u1ebfn \u0111\u1ed5i v\u1ec1 chuy\u1ec3n h\u00f3a v\u1eadt ch\u1ea5t v\u00e0 nh\u1eefng bi\u1ebfn \u0111\u1ed5i ch\u1ee9c ph\u1eadn h\u00e0ng lo\u1ea1t c\u00e1c c\u01a1 quan, h\u1ec7 th\u1ed1ng, ph\u1ee5 thu\u1ed9c v\u00e0o \u0111\u1eb7c tr\u01b0ng c\u1ee7a nguy\u00ean nh\u00e2n, t\u00ednh ch\u1ea5t c\u1ee7a b\u1ec7nh,v\u00e0 t\u00ecnh tr\u1ea1ng nhi\u1ec5m \u0111\u1ed9c c\u1ee7a c\u01a1 th\u1ec3.<\/p>\n
1. R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a trong s\u1ed1t:<\/p>\n
Trong s\u1ed1t th\u01b0\u1eddng ph\u00e1t sinh r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a v\u1eadt ch\u1ea5t do:<\/p>\n
– Th\u00e2n nhi\u1ec7t t\u0103ng, th\u01b0\u1eddng c\u1ee9 t\u0103ng l\u00ean 10Cso v\u1edbi b\u00ednh th\u01b0\u1eddng th\u00ec nhu c\u1ea7u oxy t\u0103ng 5 -10% v\u00e0 chuy\u1ec3n h\u00f3a v\u1eadt ch\u1ea5t t\u0103ng 3,3%.<\/p>\n
– T\u00e1c d\u1ee5ng c\u1ee7a nh\u00e2n t\u1ed1 g\u00e2y b\u1ec7nh: Vi khu\u1ea9n, \u0111\u1ed9c t\u1ed1\u2026<\/p>\n
– T\u00ecnh tr\u1ea1ng \u0111\u00f3i \u0103n c\u1ee7a c\u01a1 th\u1ec3.<\/p>\n
a. Chuy\u1ec3n h\u00f3a gluxit: Glucid l\u00e0 n\u0103ng l\u01b0\u1ee3ng ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a s\u1ed1t. c\u00f3 th\u1ec3 th\u1ea5y glucose huy\u1ebft t\u0103ng l\u00ean, d\u1ef1 tr\u1eef glycogen \u1edf gan gi\u1ea3m \u0111i v\u00e0 c\u00f3 th\u1ec3 c\u1ea1n ki\u1ec7t n\u1ebfu s\u1ed1t cao tr\u00ean 400C v\u00e0 c\u01a1n s\u1ed1t k\u00e9o d\u00e0i tr\u00ean 4h. Tr\u01b0\u1eddng h\u1ee3p s\u1ed1t cao v\u00e0 k\u00e9o d\u00e0i c\u00f3 th\u1ec3 l\u00e0m t\u0103ng acid lactic trong m\u00e1u (do glucid chuy\u1ec3n h\u00f3a theo con \u0111\u01b0\u1eddng y\u1ebfm kh\u00ed).<\/p>\n
b. Chuy\u1ec3n h\u00f3a lipit : b\u1ecb r\u1ed1i lo\u1ea1n khi gi\u1ea3m ho\u1eb7c suy ki\u1ec7t d\u1ef1 tr\u1eef glycogen gan, trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y s\u1ea3n nhi\u1ec7t \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ch\u1ee7 y\u1ebfu nh\u1edd qu\u00e1 tr\u00ecnh oxy h\u00f3a lipid. Qu\u00e1 tr\u00ecnh oxy h\u00f3a lipid kh\u00f4ng \u0111i t\u1edbi c\u00e1c s\u1ea3n ph\u1ea9n cu\u1ed1i c\u00f9ng s\u1ebd g\u00e2y \u1ee9 c\u00e1c th\u1ec3 x\u00eaton v\u00e0 t\u0103ng b\u00e0i ti\u1ebft x\u00eaton qua n\u01b0\u1edbc ti\u1ec3u. Khi cung c\u1ea5p \u0111\u1ea7y \u0111\u1ee7 ch\u1ea5t \u0111\u01b0\u1eddng trong th\u1ef1c nghi\u1ec7m, hi\u1ec7n t\u01b0\u1ee3ng X\u00eaton -ni\u1ec7u kh\u00f4ng th\u1ea5y xu\u1ea5t hi\u1ec7n.<\/p>\n
c. Chuy\u1ec3n h\u00f3a protitb\u1ecb r\u1ed1i lo\u1ea1n trong s\u1ed1t l\u00e0 quan tr\u1ecdng nh\u1ea5t, do:<\/p>\n
– T\u00e1c d\u1ee5ng c\u1ee7a vi khu\u1ea9n, \u0111\u1ed9c t\u1ed1. Tuy nhi\u00ean kh\u00f4ng ph\u1ea3i b\u1ea5t k\u1ef3 tr\u1ea1ng th\u00e1i s\u1ed1t n\u00e0o c\u0169ng c\u00f3 t\u0103ng tho\u00e1i bi\u1ebfn protit. Trong m\u1ed9t s\u1ed1 b\u1ec7nh nhi\u1ec5m khu\u1ea9n c\u1ea5p nh\u01b0 c\u00fam, vi\u00eam h\u1ecdng v\u00e0 m\u1ed9t v\u00e0i b\u1ec7nh nhi\u1ec5m khu\u1ea9n m\u00e3n, chuy\u1ec3n h\u00f3a protit h\u1ea7u nh\u01b0 kh\u00f4ng thay \u0111\u1ed5i, ng\u01b0\u1ee3c l\u1ea1i c\u00f3 tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m khu\u1ea9n th\u00e2n nhi\u1ec7t ch\u1ec9 t\u0103ng nh\u1eb9 nh\u01b0ng l\u1ea1i c\u00f3 tho\u00e1i bi\u1ebfn protit m\u1ea1nh.<\/p>\n
– Th\u00e2n nhi\u1ec7t t\u0103ng qu\u00e1 cao v\u00e0 pH toan c\u1ee7a t\u1ed5 ch\u1ee9c l\u00e0m t\u0103ng c\u01b0\u1eddng ho\u1ea1t t\u00ednh c\u00e1c men ti\u00eau protit n\u00ean qu\u00e1 tr\u00ecnh ph\u00e2n gi\u1ea3i t\u1ed5 ch\u1ee9c t\u0103ng l\u1ea1i l\u00e0m s\u1ed1t n\u1eb7ng th\u00eam.<\/p>\n
– Nhu c\u1ea7u n\u0103ng l\u01b0\u1ee3ng c\u1ee7a c\u01a1 th\u1ec3 \u0111\u00f2i h\u1ecfi, do d\u1ef1 tr\u1eef glycogen gi\u1ea3m v\u00e0 qu\u00e1 tr\u00ecnh oxy h\u00f3a lipit r\u1ed1i lo\u1ea1n n\u00ean khi s\u1ed1t v\u1eeba ph\u1ea3i chuy\u1ec3n h\u00f3a protit ph\u1ea3i cung c\u1ea5p 15 – 20% n\u0103ng l\u01b0\u1ee3ng cho c\u01a1 th\u1ec3, khi s\u1ed1t n\u1eb7ng t\u1edbi 30% v\u00e0 h\u01a1n n\u1eefa, m\u1eb7t trong s\u1ed1t th\u01b0\u1eddng c\u00f3 r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a v\u00e0 h\u1ea5p th\u1ee5 protit n\u00ean c\u00e2n b\u1eb1ng nit\u01a1 \u00e2m t\u00ednh, c\u00e1c s\u1ea3n ph\u1ea9m c\u1ee7a chuy\u1ec3n h\u00f3a protit t\u0103ng b\u00e0i ti\u1ebft qua n\u01b0\u1edbc ti\u1ec3u nh\u01b0 NH3, creatinin, ur\u00ea\/<\/p>\n
Do \u0111\u00f3 c\u1ea7n ch\u00fa \u00fd \u0111\u1ebfn v\u1ea5n \u0111\u1ec1 dinh d\u01b0\u1ee1ng \u1edf b\u1ec7nh nh\u00e2n s\u1ed1t. V\u1edbi s\u1ed1t nh\u1eb9, cho \u0103n nhi\u1ec1u \u0111\u01b0\u1eddng, v\u1edbi s\u1ed1t cao v\u00e0 k\u00e9o d\u00e0i cho gluxit d\u1ea1ng d\u1ec5 h\u1ea5p th\u1ee5 nh\u1ea5t (truy\u1ec1n dung d\u1ecbch glucoza \u0111\u1eb3ng, \u01b0u tr\u01b0\u01a1ng) ho\u1eb7c cho c\u00e1c axit amin th\u1ee7y ph\u00e2n \u0111\u1ec3 b\u00f9 hao qu\u00e1 \u0111\u1ed9 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ee9c \u0111\u1ec1 kh\u00e1ng c\u1ee7a c\u01a1 th\u1ec3. C\u1ea7n cho th\u00eam sinh t\u1ed1 v\u00ec trong s\u1ed1t c\u00f3 ti\u00eau hao nhi\u1ec1u sinh t\u1ed1 B v\u00e0 C.<\/p>\n
d. Chuy\u1ec3n h\u00f3a n\u01b0\u1edbc v\u00e0 mu\u1ed1ib\u1ecb r\u1ed1i lo\u1ea1n ch\u1ee7 y\u1ebfu trong giai \u0111o\u1ea1n th\u00e2n nhi\u1ec7t gi\u1eef \u1edf m\u1ee9c cao. N\u01b0\u1edbc \u1ee9 l\u1ea1i trong c\u00e1c c\u01a1 quan t\u1ed5 ch\u1ee9c, trong c\u00e1c c\u01a1 v\u00e0 trong \u1ed5 vi\u00eam (d\u1ecbch di). \u1ee8 n\u01b0\u1edbc s\u1ebd d\u1eabn \u0111\u1ebfn \u1ee9 \u0111\u1ecdng c\u00e1c t\u1ed5 ch\u1ee9c c\u00e1c s\u1ea3n ph\u1ea9m c\u1ee7a c\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a v\u00e0 \u1ee9 \u0111\u1ecdng c\u00e1c ch\u1ea5t mu\u1ed1i. B\u00e0i ti\u1ebft n\u01b0\u1edbc NaCl c\u0169ng b\u1ecb h\u1ea1n ch\u1ebf do ch\u1ee9c n\u0103ng th\u1eadn b\u1ecb \u1ea3nh h\u01b0\u1edfng va t\u0103ng ti\u1ebft m\u1ed3 h\u00f4i v\u00e0 c\u00f3 c\u01a1n \u0111i gi\u1ea3i nhi\u1ec1u \u0111\u1ec3 t\u0103ng th\u1ea3i c\u00e1c s\u1ea3n ph\u1ea9m chuy\u1ec3n h\u00f3a v\u00e0 c\u00e1c mu\u1ed1i b\u1ecb \u1ee9 \u0111\u1ecdng n\u00ean n\u01b0\u1edbc ti\u1ec3u th\u01b0\u1eddng v\u00e0ng s\u1eabm.<\/p>\n
2. R\u1ed1i lo\u1ea1n ch\u1ee9c ph\u1eadn c\u00e1c c\u01a1 quan, h\u1ec7 th\u1ed1ng khi s\u1ed1t:<\/p>\n
a. R\u1ed1i lo\u1ea1n th\u1ea7n kinh:ngay t\u1eeb tr\u01b0\u1edbc khi th\u00e2n nhi\u1ec7t t\u0103ng v\u00e0 giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a th\u00e2n nhi\u1ec7t t\u0103ng \u0111\u00e3 th\u1ea5y c\u00f3 nh\u1eefng r\u1ed1i lo\u1ea1n th\u1ea7n kinh nh\u01b0 nh\u1ee9c \u0111\u1ea7u, m\u1ec7t m\u1ecfi, bu\u1ed3n ng\u1ee7, k\u00e9m t\u1eadp trung t\u01b0 t\u01b0\u1edfng\u2026 bi\u1ec3u hi\u1ec7n tr\u1ea1ng th\u00e1i \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng th\u1ea7n kinh cao c\u1ea5p. Nh\u1eefng r\u1ed1i lo\u1ea1n s\u00e2u s\u1eafc h\u1ec7 TKT\u01af nh\u01b0 \u1ea3o gi\u00e1c, m\u00ea s\u1ea3ng, li b\u00ec, h\u00f4n m\u00ea, m\u1ea5t \u00fd th\u1ee9c\u2026, ph\u00e1t sinh do t\u00ecnh tr\u1ea1ng nhi\u1ec5m \u0111\u1ed9c h\u1eadu qu\u1ea3 c\u1ee7a qu\u00e1 tr\u00ecnh nhi\u1ec5m khu\u1ea9n ch\u1ee9 kh\u00f4ng ph\u1ea3i do nhi\u1ec7t \u0111\u1ed9 t\u0103ng. \u1ede tr\u1ebb em khi v\u1ecf n\u00e3o v\u00e0 c\u00e1c trung t\u00e2m \u0111i\u1ec1u nhi\u1ec7t ch\u01b0a ho\u00e0n thi\u1ec7n th\u01b0\u1eddng ph\u00e1t sinh co gi\u1eadt khi s\u1ed1t cao tr\u00ean 390C.<\/p>\n
b. R\u1ed1i lo\u1ea1n tu\u1ea7n ho\u00e0n, m\u00e1u:<\/p>\n
– Khi s\u1ed1t, nh\u1ecbp tim t\u0103ng do th\u1ea7n kinh giao c\u1ea3m t\u0103ng c\u01b0\u1eddng h\u01b0ng ph\u1ea5n v\u00e0 t\u00e1c d\u1ee5ng c\u1ee7a nhi\u1ec7t cao tr\u00ean h\u1ec7 th\u1ea7n kinh t\u1ef1 \u0111\u1ed9ng tim. Th\u01b0\u1eddng c\u1ee9 nhi\u1ec7t \u0111\u1ed9 t\u0103ng l\u00ean 10C th\u00ec m\u1ea1ch t\u0103ng t\u1eeb 8-10 \u0111\u1eadp. Thay \u0111\u1ed5i ho\u1ea1t \u0111\u1ed9ng tim c\u00f2n ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ednh ch\u1ea5t c\u1ee7a nhi\u1ec5m khu\u1ea9n: tim \u0111\u1eadp ch\u1eadm trong th\u01b0\u01a1ng h\u00e0n, vi\u00eam m\u00e0ng n\u00e3o l\u00e0 do t\u00e1c d\u1ee5ng \u0111\u1eb7c hi\u1ec7u c\u1ee7a n\u1ed9i \u0111\u1ed9c t\u1ed1 tr\u00ean h\u1ec7 tim m\u1ea1ch.<\/p>\n
– Huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch th\u01b0\u1eddng kh\u00f4ng thay \u0111\u1ed5i, c\u00f3 th\u1ec3 h\u01a1i t\u0103ng trong giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a s\u1ed1t do t\u00ecnh tr\u1ea1ng co m\u1ea1ch vi. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m khu\u1ea9n n\u1eb7ng, \u0111\u1ed9c t\u1ed1 vi khu\u1ea9n c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp c\u01a1 tim v\u00e0 trung t\u00e2m v\u1eadn m\u1ea1ch d\u1eabn t\u1edbi thi\u1ebfu n\u0103ng m\u1ea1ch c\u1ea5p v\u00e0 tr\u1ee5y m\u1ea1ch.<\/p>\n
– T\u1ed1c \u0111\u1ed9 m\u00e1u ch\u1ea3y t\u0103ng c\u01b0\u1eddng trong c\u00e1c n\u1ed9i t\u1ea1ng (th\u1eadn, gan, n\u00e3o) do co th\u1eaft tu\u1ea7n ho\u00e0n ngo\u1ea1i vi, l\u00e0 c\u01a1 s\u1edf c\u1ee7a nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb b\u1ec7nh huy\u1ebft \u00e1p cao do thi\u1ebfu m\u00e1u th\u1eadn b\u1eb1ng g\u00e2y s\u1ed1t nh\u00e2n t\u1ea1o.<\/p>\n
– Trong m\u00e1u ngo\u1ea1i vi, b\u1ea1ch c\u1ea7u v\u00e0 ho\u1ea1t t\u00ednh th\u1ef1c b\u00e0o c\u1ee7a b\u1ea1ch c\u1ea7u t\u0103ng. Ch\u1ee9c ph\u1eadn h\u1ec7 th\u1ed1ng v\u00f5ng n\u1ed9i m\u00f4 c\u0169ng t\u0103ng n\u00ean \u0111\u1ea1i th\u1ef1c b\u00e0o, c\u00e1c kh\u00e1ng th\u1ec3 v\u00e0 b\u1ed5 th\u1ec3 \u0111\u1ec1u t\u0103ng. N\u00f3i chung, khi s\u1ed1t ch\u1ee9c ph\u1eadn \u0111\u1ec1 kh\u00e1ng mi\u1ec5n d\u1ecbch c\u1ee7a c\u01a1 th\u1ec3 t\u0103ng c\u00f3 t\u00ednh ch\u1ea5t th\u00edch \u1ee9ng ph\u00f2ng ng\u1ef1, ch\u1ec9 khi s\u1ed1t n\u1eb7ng c\u00e1c ch\u1ee9c ph\u1eadn n\u00e0y m\u1edbi b\u1ecb r\u1ed1i lo\u1ea1n.<\/p>\n
c. R\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p:<\/p>\n
– H\u00f4 h\u1ea5p t\u0103ng trong s\u1ed1t do nhi\u1ec7t \u0111\u1ed9 m\u00e1u cao v\u00e0 t\u00ecnh tr\u1ea1ng nhi\u1ec5m toan k\u00edch th\u00edch trung t\u00e2m h\u00f4 h\u1ea5p. Th\u1edf nhanh trong s\u1ed1t c\u00f2n l\u00e0 m\u1ed9t bi\u1ec7n ph\u00e1p th\u1ea3i nhi\u1ec7t v\u1eady l\u00fd. Tuy nhi\u00ean t\u0103ng th\u00f4ng kh\u00ed c\u00f2n g\u00f3p ph\u1ea7n l\u00e0m m\u1ea5t m\u1ed9t l\u01b0\u1ee3ng n\u01b0\u1edbc \u0111\u00e1ng k\u1ec3.<\/p>\n
d. R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a:<\/p>\n
M\u1ed9t trong nh\u1eefng tri\u1ec7u ch\u1ee9ng th\u00f4ng th\u01b0\u1eddng c\u1ee7a s\u1ed1t l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng ch\u00e1n \u0103n, m\u1ea5t ngon, mi\u1ec7ng kh\u00f4, l\u01b0\u1ee1i b\u1ef1a v\u00e0 \u0111\u1eafng.<\/p>\n
C\u01a1 ch\u1ebf c\u1ee7a ch\u00e1n \u0103n trong c\u00e1c b\u1ec7nh nhi\u1ec5m khu\u1ea9n c\u00f3 th\u1ec3 l\u00e0 trung t\u00e2m \u0103n b\u1ecb \u1ee9c ch\u1ebf v\u00e0 ph\u1ea3n \u1ee9ng ph\u1ea3n x\u1ea1 do nhi\u1ec5m \u0111\u1ed9c, \u0111\u1ed3ng th\u1eddi b\u00e0i ti\u1ebft d\u1ecbch v\u1ecb, d\u1ecbch t\u1ee5y v\u00e0 d\u1ecbch m\u1eadt \u0111\u1ec1u gi\u1ea3m, toan t\u00ednh d\u1ecbch v\u1ecb c\u0169ng gi\u1ea3m.<\/p>\n
Ngo\u00e0i nh\u1eefng r\u1ed1i lo\u1ea1n ph\u1ea7n ti\u00eat d\u1ecbch ti\u00eau h\u00f3a c\u00f2n th\u1ea5y c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c ph\u1eadn co b\u00f3p c\u1ee7a d\u1ea1 d\u00e0y, ru\u1ed9t n\u00ean qu\u00e1 tr\u00ecnh chuy\u1ec3n ch\u1ee9c n\u0103ng t\u1eeb d\u1ea1 d\u00e0y c\u00f3 th\u1ec3 b\u1ecb \u1ee9 tr\u1ec7, tr\u01b0\u01a1ng l\u1ef1c ru\u1ed9t c\u0169ng b\u1ecb r\u1ed1i lo\u1ea1n c\u00f3 th\u1ec3 ph\u00e1t sinh \u0111\u1ea7y b\u1ee5ng ch\u01b0\u1edbng h\u01a1i v\u00e0 t\u00e1o b\u00f3n. R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a v\u00e0 ch\u00e1n \u0103n trong s\u1ed1t l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y h\u1ed1c h\u00e1c, g\u1ea7y v\u00e0 suy nh\u01b0\u1ee3c c\u01a1 th\u1ec3. Tr\u00ean th\u1ef1c nghi\u1ec7m, s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c h\u1ea1 nhi\u1ec7t l\u00e0m suy y\u1ebfu ph\u1ea3n \u1ee9ng s\u1ed1t, c\u0169ng kh\u00f4ng lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c nh\u1eefng r\u1ed1i lo\u1ea1n tr\u00ean.<\/p>\n
e. R\u1ed1i lo\u1ea1n ch\u1ee9c ph\u1eadn gan:<\/p>\n
Khi s\u1ed1t, qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a n\u0103ng l\u01b0\u1ee3ng c\u1ee7a gan t\u0103ng, \u0111\u1eb7c bi\u1ec7t qu\u00e1 tr\u00ecnh photphoryl h\u00f3a t\u0103ng m\u1ea1nh t\u1edbi 30 – 40% so v\u1edbi m\u1ee9c b\u00ecnh th\u01b0\u1eddng.<\/p>\n
Ch\u1ee9c ph\u1eadn h\u00e0ng r\u00e0o ch\u1ed1ng \u0111\u1ed9c c\u1ee7a gan, ch\u1ee9c ph\u1eadn t\u1ed5ng h\u1ee3p protit, phopholipit, ch\u1ee9c ph\u1eadn ur\u00ea, s\u1ea3n xu\u1ea5t fibringen c\u1ee7a gan \u0111\u1ec1u t\u0103ng c\u01b0\u1eddng c\u00f3 t\u00ednh ch\u1ea5t th\u00edch \u1ee9ng ph\u00f2ng ng\u1ef1. Nh\u01b0ng trong m\u1ed9t s\u1ed1 b\u1ec7nh nhi\u1ec5m khu\u1ea9n, nhi\u1ec5m \u0111\u1ed9c n\u1eb7ng ch\u1ea5t \u0111\u1ed9c v\u00e0 m\u1ed9t s\u1ed1 \u0111\u1ed9c t\u1ed1 vi khu\u1ea9n c\u00f3 th\u1ec3 l\u00e0m r\u1ed1i lo\u1ea1n qu\u00e1 tr\u00ecnh phophoryl h\u00f3a n\u00ean chuy\u1ec3n h\u00f3a n\u0103ng l\u01b0\u1ee3ng c\u1ee7a gian gi\u1ea3m d\u1ea7n t\u1edbi r\u1ed1i lo\u1ea1n ch\u1ee9c ph\u1eadn gan.<\/p>\n
f. Thay \u0111\u1ed5i ti\u1ebft ni\u1ec7u:<\/p>\n
Do nh\u1eefng thay \u0111\u1ed5i c\u1ee7a n\u1ed9i ti\u1ebft, tu\u1ea7n ho\u00e0n v\u00e0 s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a c\u00e1c s\u1ea3n ph\u1ea9m chuy\u1ec3n h\u00f3a trong s\u1ed1t n\u00ean giai \u0111o\u1ea1n \u0111\u1ea7u c\u1ee7a s\u1ed1t c\u00f3 t\u1ea1m t\u0103ng b\u00e0i ti\u1ebft n\u01b0\u1edbc ti\u1ec3u (do t\u0103ng tu\u1ea7n ho\u00e0n qua th\u1eadn v\u00e0 co m\u1ea1ch ngo\u1ea1i vi) nh\u01b0ng \u00edt \u00fd ngh\u0129a. \u1ede giai \u0111o\u1ea1n 2 c\u00f3 gi\u1ea3m r\u00f5 r\u1ec7t b\u00e0i ti\u1ebft n\u01b0\u1edbc ti\u1ec3u do t\u00e1c d\u1ee5ng c\u1ee7a ADH tr\u00ean \u1ed1ng th\u1eadn. Giai \u0111o\u1ea1n 3 ch\u1ee9c n\u0103ng \u1ed1ng th\u1eadn v\u00e0 tuy\u1ebfn m\u1ed3 h\u00f4i ph\u1ee5c h\u1ed3i, c\u00f3 t\u0103ng b\u00e0i ti\u1ebft n\u01b0\u1edbc ti\u1ec3u v\u00e0 v\u00e3 nhi\u1ec1u m\u1ed3 h\u00f4i.<\/p>\n
g. thay \u0111\u1ed5i n\u1ed9i ti\u1ebft:<\/p>\n
nhi\u1ec1u tuy\u1ebfn n\u1ed9i ti\u1ebft c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a s\u1ed1t gi\u00fap th\u1ef1c hi\u1ec7n \u00fd ngh\u0129a \u0111\u1ec1 kh\u00e1ng v\u00e0 b\u1ea3o v\u1ec7 c\u1ee7a s\u1ed1t tr\u01b0\u1edbc nh\u1eefng t\u00e1c nh\u00e2n c\u00f3 h\u1ea1i cho c\u01a1 th\u1ec3 nh\u01b0 Thyroxin, Adrenalin, Noradrenalin l\u00e0m t\u0103ng chuy\u1ec3n h\u00f3a, t\u0103ng th\u00e2n nhi\u1ec7t \u0111\u1ea1c bi\u1ec7t l\u00e0 t\u0103ng chuy\u1ec3n h\u00f3 glucid.. Aldosterol, ADH c\u00f3 ch\u1ee9c n\u0103ng gi\u1eef mu\u1ed1i v\u00e0 n\u01b0\u1edbc. Cortison v\u00e0 ACTH c\u00f3 vai tr\u00f2 ch\u1ed1ng vi\u00eam v\u00e0 d\u1ecb \u1ee9ng.<\/p>\n
h. T\u0103ng ch\u1ee9c ph\u1eadn mi\u1ec5n d\u1ecbch:<\/p>\n
S\u1ed1t l\u00e0m xu\u1ea5t hi\u1ec7n c\u00e1c y\u1ebfu t\u1ed1 s\u1ea3n sinh t\u1ebf b\u00e0o th\u1ef1c b\u00e0o k\u1ec3 c\u1ea3 c\u00e1c c\u01a1n s\u1ed1t kh\u00f4ng do nhi\u1ec5m khu\u1ea9n.<\/p>\n
C\u00e2u 18: \u00dd ngh\u0129a sinh v\u1eadt h\u1ecdc c\u1ee7a s\u1ed1t ?<\/p>\n
1. \u00dd ngh\u0129a t\u1ed1t:<\/p>\n
– T\u1eebtr\u01b0\u1edbc t\u1edbi nay, \u0111\u00e3 c\u00f3 nhi\u1ec1u quan \u0111i\u1ec3m kh\u00f4ng th\u1ed1ng nh\u1ea5t v\u1ec1 \u00fd ngh\u0129a c\u1ee7a ph\u1ea3n \u1ee9ng s\u1ed1t \u0111\u1ed1i v\u1edbi c\u01a1 th\u1ec3. Ngu\u1ed3n g\u1ed1c t\u1eeb “S\u1ed1t” l\u00e0 “februa” t\u1ee9c l\u00e0 ph\u01b0\u01a1ng ti\u1ec7n l\u00e0m cho tho\u00e1t kh\u1ecfi, ch\u1ee9ng t\u1ecf r\u1eb1ng t\u1eeb y h\u1ecdc c\u1ed5 \u0111\u1ea1i, s\u1ed1t \u0111\u00e3 \u0111\u01b0\u1ee3c coi nh\u01b0 tr\u1ea1ng th\u00e1i gi\u00fap c\u00f3 th\u1ec3 ch\u1ed1ng \u0111\u1ee1 nh\u1eefng ch\u1ea5t c\u00f3 h\u1ea1i. \u0110\u1ebfn th\u1ebf k\u1ef7 XVIII, m\u1ed9t s\u1ed1 nh\u00e0 l\u00e2m s\u00e0ng l\u1ea1i cho r\u1eb1ng s\u1ed1t l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng nguy hi\u1ec3m cho \u0111\u1eddi s\u1ed1ng v\u00ec c\u00f3 nhi\u1ec1u r\u1ed1i lo\u1ea1n ch\u1ee9c ph\u1eadn v\u00e0 nhi\u1ec1u bi\u1ebfn \u0111\u1ed5i tho\u00e1i h\u00f3a trong c\u00e1c t\u1ebf b\u00e0o t\u1ed5 ch\u1ee9c do t\u00e1c d\u1ee5ng c\u1ee7a nhi\u1ec7t \u0111\u1ed9 cao.<\/p>\n
– Do \u0111\u00f3 d\u1eabn t\u1edbi s\u1ef1 ham th\u00edch d\u00f9ng thu\u1ed1c h\u1ea1 nhi\u1ec7t, t\u1eafm l\u1ea1nh, b\u1ecdc \u01b0\u1edbt trong \u0111i\u1ec1u tr\u1ecb s\u1ed1t. Sau \u0111\u00f3 th\u1ea5y r\u1eb1ng khuynh h\u01b0\u1edbng h\u1ea1 nhi\u1ec7t th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u1ebft th\u00fac b\u1eb1ng s\u1ef1 s\u00fat k\u00e9m tr\u1ea1ng th\u00e1i c\u1ee7a b\u1ec7nh nh\u00e2n t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho b\u1ec7nh nh\u00e2n t\u00e1i ph\u00e1t th\u01b0\u01a1ng h\u00e0n.<\/p>\n
– Gi\u1ea3m th\u00e2n nhi\u1ec7t nh\u00e2n t\u1ea1o trong \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh nhi\u1ec5m khu\u1ea9n kh\u00f4ng lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c nh\u1eefng bi\u1ebfn \u0111\u1ed5i b\u1ec7nh l\u00fd m\u00e0 c\u00f2n l\u00e0m m\u1ed9t s\u1ed1 r\u1ed1i lo\u1ea1n ti\u1ebfn tri\u1ec3n n\u1eb7ng th\u00eam. R\u1ea5t nhi\u1ebfu th\u00ed nghi\u1ec7m tr\u00ean \u0111\u1ed9ng v\u1eadt ch\u1ee9ng t\u1ecf r\u1eb1ng khi tr\u1ea5n \u00e1p ph\u1ea3n \u1ee9ng s\u1ed1t th\u00ec m\u1ed9t s\u1ed1 b\u1ec7nh nhi\u1ec5m khu\u1ea9n di\u1ec5n bi\u1ebfn n\u1eb7ng h\u01a1n \u0111\u1ed9ng v\u1eadt th\u01b0\u1eddng ch\u1ebft. Nh\u1eefng qu\u00e1n s\u00e1t n\u00e0y \u0111\u00e3 th\u00fac \u0111\u1ea9y nh\u1eefng nghi\u00ean c\u1ee9u \u0111\u1eb7c hi\u1ec7u v\u1ec1 vai tr\u00f2 c\u1ee7a s\u1ed1t trong b\u1ec7nh l\u00fd.<\/p>\n
– Met-nhi-c\u1ed1p \u0111\u00e1nh gi\u00e1 s\u1ed1t nh\u01b0 m\u1ed9t ph\u1ea3n \u1ee9ng th\u00edch \u1ee9ng ph\u00f2ng ng\u1ef1 c\u1ee7a c\u01a1 th\u1ec3: “Vi\u00eam, t\u0103ng b\u1ea1ch c\u1ea7u v\u00e0 s\u1ed1t h\u00ecnh th\u00e0nh m\u1ed9t th\u1ebf ch\u00e2n ki\u1ec1ng c\u00f3 t\u00e1c d\u1ee5ng ng\u0103n c\u1ea3n c\u00e1c nguy\u00ean nh\u00e2n b\u1ec7nh l\u00fd khi ch\u00fang x\u00e2m nh\u1eadp c\u01a1 th\u1ec3”. Ph\u1ea3n \u1ee9ng s\u1ed1t c\u0169ng nh\u01b0 vi\u00eam \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh trong qu\u00e1 tr\u00ecnh ti\u1ebfn h\u00f3a v\u00e0 c\u01a1 b\u1ea3n l\u00e0 nh\u1eefng ph\u1ea3n \u1ee9ng th\u00edch \u1ee9ng b\u1ea3o v\u1ec7 c\u01a1 th\u1ec3.<\/p>\n
– Vai tr\u00f2 b\u1ea3o v\u1ec7 th\u00edch \u1ee9ng c\u1ee7a s\u1ed1t l\u00e0 \u1edf ch\u1ed7: nhi\u1ec7t \u0111\u1ed9 t\u0103ng cao nh\u1ea5t th\u1eddi k\u00edch ho\u1ea1t c\u00e1c qu\u00e1 tr\u00ecnh chuy\u1ec3n h\u00f3a trong t\u1ebf b\u00e0o v\u00e0 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n t\u00edch l\u0169y n\u0103ng l\u01b0\u1ee3ng d\u1ef1 tr\u1eef nh\u1edd t\u0103ng c\u01b0\u1eddng c\u00e1c qu\u00e1 tr\u00ecnh photphoryl oxy h\u00f3a \u0111\u1ed3ng th\u1eddi t\u0103ng c\u01b0\u1eddng ho\u1ea1t t\u00ednh ch\u1ee9c ph\u1eadn c\u00e1c c\u01a1 quan v\u00e0 t\u1ebf b\u00e0o.<\/p>\n
– Khi s\u1ed1t, c\u00e1c vi khu\u1ea9n v\u00e0 \u0111\u1ed9c t\u1ed1 k\u00edch ho\u1ea1t c\u00e1c men c\u1ee7a m\u00e1u v\u00e0 s\u1ef1 t\u0103ng c\u01b0\u1eddng c\u00e1c ph\u1ea3n \u1ee9ng sinh h\u00f3a l\u00e0 c\u01a1 s\u1edf t\u1ea1o th\u00e0nh c\u00e1c li\u00ean k\u1ebft gi\u00e0u n\u0103ng l\u01b0\u1ee3ng c\u1ea7n thi\u1ebft cho s\u1ef1 ph\u1ee5c h\u1ed3i ch\u1ee9c ph\u1eadn c\u00e1c t\u1ebf b\u00e0o t\u1ed5 ch\u1ee9c t\u1ed5n th\u01b0\u01a1ng do \u0111\u00f3 m\u1ed9t s\u1ed1 b\u1ec7nh nhi\u1ec5m khu\u1ea9n di\u1ec5n bi\u1ebfn x\u1ea5u n\u1ebfu d\u00f9ng thu\u1ed1c h\u1ea1 s\u1ed1t (vi\u00eam ph\u1ed5i, c\u0169m, th\u01b0\u01a1ng h\u00e0n, b\u1ea1ch h\u1ea7u\u2026).<\/p>\n
– Khi ti\u00eam ch\u1ee7ng ph\u00f2ng b\u1ec7nh, n\u1ebfu d\u00f9ng thu\u1ed1c h\u1ea1 s\u1ed1t th\u00ec kh\u1ea3 n\u0103ng mi\u1ec5n d\u1ecbch gi\u1ea3m. Nhi\u1ec7t \u0111\u1ed9 cao c\u00f2n ng\u0103n c\u1ea3n s\u1ef1 sinh s\u1ea3n m\u1ed9t s\u1ed1 vir\u00fat (c\u00fam, b\u1ea1i li\u1ec7t\u2026) v\u00e0 ri khu\u1ea9n (xo\u1eafn khu\u1ea9n, ph\u1ebf c\u1ea7u khu\u1ea9n\u2026). C\u00f9ng v\u1edbi t\u0103ng nhi\u1ec7t \u0111\u1ed9, \u0111\u1ed3ng th\u1eddi k\u00edch th\u00edch s\u1ea3n sinh kh\u00e1ng th\u1ec3. C\u00e1c ch\u1ea5t g\u00e2y s\u1ed1t c\u00f2n k\u00edch ho\u1ea1t h\u1ec7 tuy\u1ebfn y\u1ebfn – th\u01b0\u1ee3ng th\u1eadn l\u00e0m t\u0103ng s\u1ee9c \u0111\u1ec1 kh\u00e1ng c\u01a1 th\u1ec3 \u0111\u1ed1i v\u1edbi nhi\u1ec5m khu\u1ea9n. C\u00f3 th\u1ec3 n\u00f3i s\u1ed1t t\u1ea1o ra m\u1ed9t ti\u1ec1n \u0111\u1ec1 n\u0103ng l\u01b0\u1ee3ng cho s\u1ef1 t\u0103ng c\u01b0\u1eddng c\u00e1c ch\u1ee9c ph\u1eadn sinh l\u00fd, s\u1ee9c \u0111\u1ec1 kh\u00e1ng mi\u1ec5n d\u1ecbch v\u00e0 s\u1ef1 ph\u1ee5c h\u1ed3i c\u01a1 th\u1ec3.<\/p>\n
– Trong y h\u1ecdc, ng\u01b0\u1eddi ta c\u00f2n s\u1eed d\u1ee5ng s\u1ed1t nh\u00e2n t\u1ea1o v\u1edbi m\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb, th\u01b0\u1eddng d\u00f9ng ch\u1ea5t g\u00e2y s\u1ed1t ngo\u1ea1i sinh l\u1ea5y t\u1eeb c\u00e1c vi khu\u1ea9n \u00edt \u0111\u1ed9c. S\u1ed1t \u0111i\u1ec1u tr\u1ecb li\u1ec7u k\u1ebft h\u1ee3p v\u1edbi \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u c\u00f3 t\u00e1c d\u1ee5ng nh\u1ea5t trong m\u1ed9t s\u1ed1 b\u1ec7nh: th\u1ec3 s\u1edbm c\u1ee7a b\u1ec7nh giang mai c\u00f3 t\u1ed5n th\u01b0\u01a1ng h\u1ec7 TKT\u01af, v\u1edbi li\u1ec7t c\u00f3 ti\u1ebfn tri\u1ec3n t\u0103ng d\u1ea7n, m\u1ed9t s\u1ed1 b\u1ec7nh ngo\u00e0i da (eczema, nh\u1ecdt\u2026), vi\u00eam da kh\u1edbp d\u1ea1ng th\u1ea5p kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, b\u1ec7nh huy\u1ebft \u00e1p cao th\u1ec3 \u00e1c t\u00ednh. C\u00e1c ch\u1ea5t g\u00e2y s\u1ed1t (pyrog\u00e9nal, pyromen\u2026) c\u00f2n c\u00f3 hi\u1ec7u l\u1ef1c kh\u1ea3 qu\u1ea3n trong \u0111i\u1ec1u tr\u1ecb s\u1eb9o l\u1ed7i, s\u1eb9o co sau khi b\u1ecfng, c\u0169ng nh\u01b0 trong \u0111i\u1ec1u tr\u1ecb c\u00e1c t\u1ed5n th\u01b0\u01a1ng do ch\u1ea5n th\u01b0\u01a1ng t\u1ee7y s\u1ed1ng, v\u00e0 t\u1ed5n th\u01b0\u01a1ng d\u00e2y th\u1ea7n kinh ngo\u1ea1i vi do \u1ee9c ch\u1ebf s\u1ef1 ph\u00e1t tri\u1ec3n c\u00e1c s\u1ee3i keo, \u01b0c ch\u1ebf t\u1ea1o th\u00e0nh s\u1eb9o v\u00e0 l\u00e0m m\u1ec1m s\u1eb9o.<\/p>\n
2. \u00dd ngh\u0129a x\u1ea5u:<\/p>\n
C\u1ea7n ch\u00fa \u00fd l\u00e0 s\u1ed1t cao qu\u00e1 m\u1ee9c v\u00e0 k\u00e9o d\u00e0i kh\u00f4ng c\u00f3 \u00fd ngh\u0129a th\u00edch \u1ee9ng ph\u00f2ng ng\u1ef1, ng\u01b0\u1ee3c l\u1ea1i c\u00f2n nguy hi\u1ec3m cho \u0111\u1eddi s\u1ed1ng v\u00ec g\u00e2y nhi\u1ec1u r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a v\u00e0 ch\u1ee9c ph\u1eadn nghi\u00eam tr\u1ecdng. Trong qu\u00e1 tr\u00ecnh b\u1ec7nh l\u00fd nhi\u1ec5m khu\u1ea9n – nhi\u1ec5m \u0111\u1ed9c n\u1eb7ng c\u00f3 th\u1ec3 ph\u00e1t sinh bi\u1ebfn ch\u1ee9ng t\u0103ng th\u00e2n nhi\u1ec7t qu\u00e1 m\u1ee9c k\u00e8m theo m\u1ea5t \u00fd th\u1ee9c v\u00e0 co gi\u1eadt to\u00e0n th\u00e2n th\u01b0\u1eddng d\u1eabn t\u1edbi t\u1eed vong.<\/p>\n
C\u00e2u 19: Tr\u00ecnh b\u00e0y c\u00e1c nguy\u00ean nh\u00e2n, \u0111i\u1ec1u ki\u1ec7n, c\u01a1 ch\u1ebf g\u00e2y lo\u00e9t d\u1ea1 d\u00e0y?<\/p>\n
H\u00ecnh th\u00e1i<\/p>\n
– Lo\u00e9t d\u1ea1 d\u00e0y ri\u00eang bi\u1ec7t ch\u1ec9 g\u1eb7p t\u1eeb 16-28% tr\u01b0\u1eddng h\u1ee3p trong t\u1ed5ng s\u1ed1c\u00e1c b\u1ec7nh l\u00f3et, th\u01b0\u1eddng l\u00e0 lo\u00e9t \u1edf b\u1edd cong nh\u1ecf.<\/p>\n
– Lo\u00e9t t\u00e1 tr\u00e0ng l\u00e0 h\u00ecnh th\u00e1i ph\u1ed5 bi\u1ebfn nh\u1ea5t (40,67%).<\/p>\n
– Lo\u00e9t ph\u1ed1i h\u1ee3p c\u1ea3 d\u1ea1 d\u00e0y v\u00e0 t\u00e1 tr\u00e0ng.<\/p>\n
Nh\u00ecn chung, b\u1ec7nh k\u00e9o d\u00e0i \u1ea3nh h\u01b0\u1edfng \u0111\u1ebf c\u00f4ng t\u00e1c v\u00e0 n\u0103ng su\u1ea5t lao d\u1ed9ng, ngo\u00e0i ra c\u00f2n c\u00f3 th\u1ec3 g\u00e2y nhi\u1ec1u bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m \u0111\u00e9n t\u00ednh m\u1ea1ng. Bi\u1ebfn ch\u1ee9ng hay g\u1eb7p nh\u1ea5t l\u00e0 ch\u1ea3y m\u00e1u d\u1ea1 d\u00e0y chi\u1ebfm t\u1edbi 32% \u1edf lo\u00e9t d\u1ea1 d\u00e0y v\u00e0 18% \u1edf lo\u00e9t t\u00e1 tr\u00e0ng. Th\u1ee7ng d\u1ea1 d\u00e0y c\u00f3 th\u1ec3 g\u1eb7p \u1edf 6,2% c\u00e1c b\u1ec7nh nh\u00e2n lo\u00e9t, th\u1ee7ng t\u00e1 tr\u00e0ng v\u00e0 m\u00f4n v\u1ecb \u00edt g\u1eb7p h\u01a1n.<\/p>\n
Ch\u1ea5n th\u01b0\u01a1ng c\u00f3 \u1ea3nh h\u01b0\u1edfng r\u1ea5t l\u1edbn t\u1edbi lo\u00e9t d\u1ea1 d\u00e0y t\u00e1 tr\u00e0ng: ng\u01b0\u1eddi ta th\u01b0\u1eddng th\u1ea5y tri\u1ec7u ch\u1ee9ng lo\u00e9t xu\u1ea5t hi\u1ec7n kho\u1ea3ng 15-20 ng\u00e0y \u0111\u1ea7u sau khi b\u1ecb th\u01b0\u01a1ng, nh\u01b0ng 90% l\u00e0 c\u00e1c v\u1ebft lo\u00e9t c\u0169 ph\u00e1t tri\u1ec3n n\u00ean ng\u01b0\u1eddi ta k\u1ebft lu\u1eadn r\u1eb1ng th\u00f4ng th\u01b0\u1eddng ch\u1ea5n th\u01b0\u01a1ng kh\u00f4ng g\u00e2y b\u1ec7nh lo\u00e9t m\u1edbi m\u00e0 ch\u1ec9 g\u00e2y m\u1ed9t \u0111\u1ee3t ti\u1ebfn tri\u1ec3n tr\u00ean b\u1ec7nh lo\u00e9t c\u0169 ho\u1eb7c g\u00e2y nh\u1eefng bi\u1ebfn ch\u1ee9ng nh\u01b0 ch\u1ea3y m\u00e1u, th\u1ee7ng d\u1ea1 d\u00e0y, tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t v\u00e0 hi\u1ebfm m\u1edbi g\u00e2y b\u1ec7nh lo\u00e9t m\u1edbi.<\/p>\n
C\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a lo\u00e9t d\u1ea1 d\u00e0y-t\u00e1 tr\u00e0ng:<\/p>\n
Lo\u00e9t d\u1ea1 d\u00e0y \u2013 t\u00e1 tr\u00e0ng l\u00e0 do h\u1eadu qu\u1ea3 c\u1ee7a s\u1ef1 m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa y\u1ebfu t\u1ed1 t\u1ea5n c\u00f4ng v\u00e0 y\u1ebfu t\u1ed1 b\u1ea3o v\u1ec7.<\/p>\n
– Y\u1ebfu t\u1ed1 t\u1ea5n c\u00f4ng g\u1ed3m: Acid v\u00e0 pepsinogen<\/p>\n
– Y\u1ebfu t\u1ed1 b\u1ea3o v\u1ec7: ch\u1ea5t nh\u1ea7y, HCO3+, s\u1ef1 t\u00e1i t\u1ea1o ni\u00eam m\u1ea1c\u2026<\/p>\n
\u00b7 Y\u1ebfu t\u1ed1 b\u1ea3o v\u1ec7<\/p>\n
+ Th\u00e0nh ph\u1ea7n:<\/p>\n
-L\u1edbp nh\u1ea7y: Ph\u1ee7 tr\u00ean b\u1ec1 m\u1eb7t ni\u00eam m\u1ea1c. Do t\u1ed3n t\u1ea1i \u1edf d\u1ea1ng gel v\u00e0 mang t\u00ednh ki\u1ec1m n\u00ean kh\u00f4ng th\u00edch h\u1ee3p cho s\u1ef1 ti\u00eau h\u1ee7y c\u1ee7a pepsin v\u00e0 kh\u00f4ng cho acid t\u1eeb d\u1ecbch v\u1ecb t\u1ef1 do khuyeesch t\u00e1n v\u00e0o trong.<\/p>\n
– T\u1ebf b\u00e0o bi\u1ec3u m\u00f4 ni\u00eam m\u1ea1c: T\u00e1i sinh r\u1ea5t nhanh sau m\u1ed7i t\u1ed5n th\u01b0\u01a1ng, \u0111\u1ed3ng th\u1eddi s\u1ea3n sinh \u0111\u01b0\u1ee3c m\u1ed9t s\u1ed1 ion bicarbonat<\/p>\n
– S\u1ef1 t\u01b0\u1edbi m\u00e1u phong ph\u00fa: mang \u0111i c\u00e1c ion H+ v\u00e0 cung c\u1ea5p v\u1eadt li\u1ec7u h\u00e0n gawsn t\u1ed5n th\u01b0\u01a1ng.<\/p>\n
– Prostaglandin: \u0110\u01b0\u1ee3c s\u1ea3n xu\u1ea5t t\u1ea1i ch\u1ed7, c\u00f3 t\u00e1c d\u1ee5ng khuyeesch \u0111\u00e2\u1ecb v\u00e0 \u0111i\u1ec1u ph\u1ed1i c\u00e1c y\u1ebfu t\u1ed1 b\u1ea3o v\u1ec7, gi\u00fap qu\u00e1 tr\u00ecnh t\u00e1i t\u1ea1o di\u1ec5n ra l\u1eadp t\u1ee9c.<\/p>\n
+ S\u1ef1 t\u00e1i t\u1ea1o v\u00e0 h\u00e0n g\u1eafn<\/p>\n
Nh\u1eefng t\u1ed5n th\u01b0\u01a1ng do y\u1ebfu t\u1ed1 t\u1ea5n c\u00f4ng g\u00e2y ra cho ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y<\/p>\n
Khi c\u00e1c y\u1ebfu t\u00f4 b\u1ea3o v\u1ec7 n\u00f3i tr\u00ean t\u1ecf ra b\u1ea5t c\u1eadp, khi\u1ebfn th\u01b0\u01a1ng t\u1ed5n v\u01b0\u1ee3t qua l\u1edbp m\u00e0ng \u0111\u00e1y c\u1ee7a bi\u1ec3u m\u00f4 t\u1edbi l\u1edbp ni\u00eam m\u1ea1c th\u00ec s\u1ef1 t\u00e1i tao t\u1ee9c th\u1eddi c\u1ee7a bi\u1ec3u m\u00f4 kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n. qu\u00e1 tr\u00ecnh s\u1eed ch\u1eefa di\u1ec5n bi\u1ebfn ch\u1eadm l\u1ea1i v\u00ec ph\u1ea3i c\u00f3 c\u00e1c t\u1ebf b\u00e0o t\u1eeb ngo\u00e0i x\u00e2m nh\u1eadp v\u00e0 t\u0103ng sinh \u1edf v\u00f9ng t\u1ed5n th\u01b0\u01a1ng.<\/p>\n
\u00b7 Y\u1ebfu t\u1ed1 t\u1ea5n c\u00f4ng:<\/p>\n
+ Pepsinogen: trong lo\u00e9t pepsin t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho H+ c\u1ee7a acid khu\u1ebfch t\u00e1n s\u00e2u v\u00e0o l\u1edbp gel \u0111\u1ec3 ti\u1ebfp c\u1eadn l\u1edbp bi\u1ec3u m\u00f4 ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y.<\/p>\n
+ Acid HCl: H+ c\u00f3 kh\u1ea3 n\u0103ng th\u1ea5m t\u1eeb l\u00f2ng d\u1ea1 d\u00e0y qua l\u1edbp gel v\u00e0o t\u1eadn c\u1ea5u tr\u00fac d\u01b0\u1edbi ni\u00eam m\u1ea1c. Ion H+ c\u00f3 g\u00e2y \u0111\u01b0\u1ee3c t\u1ed5n th\u01b0\u01a1ng hay kh\u00f4ng th\u00ec c\u00f2n ph\u1ee5 thu\u1ed9c v\u00e0o n\u1ed3ng \u0111\u1ed9 H+ th\u1ea5m v\u00e0o v\u00e0 kh\u1ea3 n\u0103ng b\u1ea3o v\u1ec7.<\/p>\n
Nh\u1eefng t\u00e1c nh\u00e2n g\u00e2y t\u0103ng ti\u1ebft acid v\u00e0 l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng b\u1ea3o v\u1ec7 (\u0110i\u1ec1u Ki\u1ec7n v\u00e0 Nguy\u00ean Nh\u00e2n g\u00e2y b\u1ec7nh):<\/p>\n
\u25cf Di truy\u1ec1n<\/p>\n
Ch\u1ec9 \u0111\u01b0\u1ee3c coi l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1<\/p>\n
+ Nh\u00f3m m\u00e1u O v\u00e0 m\u1ee9c \u0111\u1ed9 th\u1ea5p h\u01a1n l\u00e0 nh\u00f3m m\u00e1u A<\/p>\n
+ Nh\u00f3m HLA, c\u00f3 B5 v\u00e0 DQ-A1<\/p>\n
+ T\u00ecnh tr\u1ea1ng t\u0103ng ti\u1ebfp b\u1ea9m sinh HCl v\u00e0 pepsinogen<\/p>\n
+ Ch\u1ee7ng t\u1ed9c<\/p>\n
+ S\u1ef1 nh\u1ea1y c\u1ea3m b\u1ea9m sinh \u0111\u1ed1i v\u1edbi c\u00e1c nguy c\u01a1 b\u1ea9m sinh c\u1ee7a ngo\u1ea1i c\u1ea3nh<\/p>\n
\u25cf Thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng steroid (v\u00e0 cortisol):<\/p>\n
H\u1ea7u h\u1ebft tr\u01b0\u1eddng h\u1ee3p, thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng steroid (NSAID) ch\u1ec9 l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 nh\u01b0ng l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 h\u00e0ng \u0111\u1ea7u<\/p>\n
C\u01a1 ch\u1ebf g\u00e2y t\u1ed5n th\u01b0\u01a1ng c\u1ee7a NSAID<\/p>\n
+ tr\u1ef1c ti\u1ebfp g\u00e2y t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y: do t\u00ednh ch\u1ea5t acid y\u1ebfu c\u1ee7a NSAID n\u00ean ch\u00fang kh\u00f4ng b\u1ecb ion h\u00f3a m\u00e0 ph\u00e1t huy \u00e1i t\u00ednh v\u1edbi lipid, nh\u1edd v\u1eady ch\u00fang d\u1ec5 d\u00e0ng th\u1ea5m qua l\u1edbp nh\u1ea7y \u0111\u1ec3 ti\u1ebfp c\u1eadn v\u1edbi bi\u1ec3u m\u00f4, nh\u01b0ng \u1edf \u0111\u00e2y do pH t\u01b0\u01a1ng \u0111\u1ed1i cao n\u00ean ch\u00fang l\u1ea1i c\u00f3 \u0111i\u1ec1u ki\u1ec7n ion h\u00f3a n\u00ean c\u00f3 t\u00e1c d\u1ee5ng ph\u00e1 ho\u1ea1i. NSAID c\u00f2n c\u00f3 kh\u1ea3n n\u0103ng n\u1eefa: l\u00e0m gi\u1ea3m t\u00ednh k\u1ef5 n\u01b0\u1edbc c\u1ee7a l\u1edbp nh\u1ea7y, gi\u00fap cho acid khu\u1ebfch t\u00e1n ti\u1ebfp c\u1eadn v\u1edbi bi\u1ec3u m\u00f4 ni\u00eam m\u1ea1c.<\/p>\n
+ T\u00e1c d\u1ee5ng gi\u00e1n ti\u1ebfp: L\u00e0m suy gi\u1ea3m h\u00e0ng r\u00e0o ph\u00f2ng ng\u1ef1, \u1ee9c ch\u1ebf s\u1ef1 t\u1ed5ng h\u1ee3p progtaglandin v\u00e0 NO, g\u00e2y gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng vi tu\u1ea7n ho\u00e0n \u1edf ni\u00eam m\u1ea1c, ng\u0103n c\u1ea3n qu\u00e1 tr\u00ecnh t\u00e1i t\u1ea1o v\u00e0 s\u1eeda ch\u1eefa.<\/p>\n
– C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a NSAID.<\/p>\n
+ Tu\u1ed5i b\u1ec7nh nh\u00e2n: c\u00e0ng cao c\u00e0ng d\u1ec5 bi\u1ebfn ch\u1ee9ng v\u00e0 c\u00e0ng n\u1eb7ng.<\/p>\n
+ L\u1ecbch s\u1eed v\u1ebft lo\u00e9t c\u0169: lo\u00e9t c\u00e0ng l\u00e2u c\u00e0ng d\u1ec5 bi\u1ebfn ch\u1ee9ng.<\/p>\n
+ D\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi c\u00e1c corticoides; d\u00f9ng li\u1ec1u cao; d\u00f9ng ph\u1ed1i h\u1ee3p nhi\u1ec1u lo\u1ea1i thu\u1ed1c c\u1ee5 th\u1ec3 trong NASAID; d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c kh\u00e1ng \u0111\u00f4ng<\/p>\n
+ Khi b\u1ec7nh nh\u00e2n c\u00f3 nh\u1eefng r\u1ed1i lo\u1ea1n h\u1ec7 th\u1ed1ng n\u1eb7ng, VD nh\u01b0 c\u00f3 HP k\u00fd sinh trong d\u1ea1 d\u00e0y, h\u00fat thu\u1ed1c l\u00e1 trong \u0111\u1ee3t \u0111i\u1ec1u tr\u1ecb\u2026<\/p>\n
\u25cf Thu\u1ed1c l\u00e1: L\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1<\/p>\n
\u25cf R\u01b0\u1ee3u<\/p>\n
\u25cf C\u00e0 ph\u00ea<\/p>\n
\u25cf Acid m\u1eadt: nguy c\u01a1 r\u1ea5t l\u1edbn \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 h\u1ed9i ch\u1ee9ng tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y.<\/p>\n
\u25cf Vi khu\u1ea9n Helicobacteria: L\u00e0 vi kh\u1ea9n gram \u00e2m, di chuy\u1ec3n \u0111\u01b0\u1ee3c v\u00e0 k\u00fd sinh \u1edf ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y<\/p>\n
+ C\u01a1 ch\u1ebf g\u00e2y lo\u00e9t c\u1ee7a HP:<\/p>\n
– Enzym urease c\u1ee7a HP t\u1ea1o ra amoniac kh\u00f4ng nh\u1eefng gi\u00fap ch HP t\u1ea1o m\u1ed9t m\u00f4i tr\u01b0\u1eddng trung t\u00ednh quanh n\u00f3 m\u00e0 c\u00f2n l\u00e0m t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c, t\u1ea1o \u0111i\u1ec1u ki\u1ec7n cho lo\u00e9t.<\/p>\n
– C\u00e1c enzym ti\u00eau h\u1ee7y protein g\u00e2y ra c\u00e1c kh\u00f4ng b\u00e0o trong t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 ni\u00eam m\u1ea1c.<\/p>\n
\u25cf Stress: \u0111\u01b0\u1ee3c coi l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 nguy c\u01a1, c\u00f3 vai tr\u00f2 nh\u1ea5t \u0111\u1ecbnh l\u00e0m lo\u00e9t d\u1ec5 xu\u1ea5t hi\u1ec7n.<\/p>\n
C\u00e2u 20: Tr\u00ecnh b\u00e0y c\u00e1c nguy\u00ean nh\u00e2n, c\u01a1 ch\u1ebf, h\u1eadu qu\u1ea3 c\u1ee7a r\u1ed1i lo\u1ea1n h\u1ea5p thu?<\/p>\n
*D\u1ea1 D\u00e0y:<\/p>\n
– B\u00ecnh th\u01b0\u1eddng ch\u1ee9c ph\u1eadn h\u1ea5p thu c\u1ee7a d\u1ea1 d\u00e0y kh\u00f4ng \u0111\u00e1ng k\u1ec3, nh\u01b0ng trong b\u1ec7nh l\u00fd ch\u1ee9c ph\u1eadn n\u00e0y l\u00e0m t\u0103ng c\u01b0\u1eddng r\u00f5 r\u1ec7t n\u00ean nh\u1eefng ch\u1ea5t \u0111\u1ed9c do \u1ee9 \u0111\u1ecdng kh\u1ed1i th\u1ee9c \u0103n trong d\u1ea1 d\u00e0y c\u00f3 th\u1ec3 th\u1ea5m qua th\u00e0nh c\u1ee7a d\u1ea1 d\u00e0y g\u00e2y nhi\u1ec5m \u0111\u1ed9c c\u01a1 th\u1ec3. Trong vi\u00eam d\u1ea1 d\u00e0y, ni\u00eam m\u1ea1c d\u1ea1 d\u00e0y c\u00f3 th\u1ec3 t\u0103ng th\u1ea5m m\u1ed9t s\u1ed1 ch\u1ea5t \u0111\u1ed9c, \u0111\u1ed9c t\u1ed1 vi khu\u1ea9n v\u00e0 c\u00e1c s\u1ea3n ph\u1ea9m \u0111\u1ed9c kh\u00e1c.<\/p>\n
*Ru\u1ed9t:<\/p>\n
H\u1ea5p thu l\u00e0 qu\u00e1 tr\u00ecnh v\u1eadn chuy\u1ec3n c\u00e1c ch\u1ea5t dinh d\u01b0\u1ee1ng trong \u1ed1ng ti\u00eau h\u00f3a qua ni\u00eam m\u1ea1c ru\u1ed9t v\u00e0o m\u00e1u. T\u1ea1i mi\u1ec7ng ch\u1ec9 c\u00f3 m\u1ed9t s\u1ed1 h\u00f3a ch\u1ea5t mocphin, adrrenalin, n\u1ed9i ti\u1ebft t\u1ed1 steroit h\u1ea5 thu \u0111\u01b0\u1ee3c. \u0110\u1ebfn d\u1ea1 d\u00e0y th\u00ec c\u00f3 th\u1ec3 h\u1ea5pt hu \u0111\u01b0\u1ee3c mu\u1ed1i, \u0111\u01b0\u1eddng, r\u01b0\u1ee3u nh\u01b0ng qu\u00e1 tr\u00ecnh h\u1ea5p thu ti\u1ebfn h\u00e0nh ch\u1ee7 y\u1ebfu \u1edf ru\u1ed9t khi th\u1ee9c \u0103n \u0111\u01b0\u1ee3c ti\u00eau h\u00f3a th\u00e0nh nh\u1eefng ch\u1ea5t c\u00f3 tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed nh\u1ecf, Nh\u1eefng ch\u1ea5t \u0111\u01b0\u1ee3c h\u1ea5p thu bao g\u1ed3m gluxit, lipit, protit, sinh t\u1ed1, n\u01b0\u1edbc, mu\u1ed1i\u2026 nh\u1eb1m duy tr\u00ec c\u00e2n b\u1eb1ng ki\u1ec1m toan, n\u01b0\u1edbc mu\u1ed1i cho c\u01a1 th\u1ec3. Qu\u00e1 tr\u00ecnh h\u1ea5p thu \u0111\u00f2i h\u1ecfi ni\u00eam m\u1ea1c ru\u1ed9t ph\u1ea3i l\u00e0nh l\u1eb7n v\u1edbi \u0111\u1ea7y \u0111\u1ee7 c\u00e1c men chuy\u1ec3n h\u00f3a. R\u1ed1i lo\u1ea1n h\u1ea5p thu bi\u1ec3u hi\u1ec7n d\u01b0\u1edbi 2 h\u00ecnh th\u00e1i:<\/p>\n
1.Gi\u1ea3m h\u1ea5p thuph\u00e1t sinh do:<\/p>\n
Nguy\u00ean nh\u00e2n:<\/p>\n
– Nguy\u00ean nh\u00e2n t\u1ea1i \u1ed1ng ti\u00eau h\u00f3a:<\/p>\n
+ Nguy\u00ean nh\u00e2n t\u1ea1i ru\u1ed9t<\/p>\n
\u25cf Nhi\u1ec5m khu\u1ea9n<\/p>\n
\u25cf Nhi\u1ec5m \u0111\u1ed9c ti\u00eau h\u00f3a<\/p>\n
\u25cf Gi\u1ea3m ti\u1ebft c\u00e1c enzym ti\u00eau h\u00f3a<\/p>\n
\u25cf Gi\u1ea3m di\u1ec7n h\u1ea5p thu<\/p>\n
+ Nguy\u00ean nh\u00e2n ngo\u00e0i ru\u1ed9t<\/p>\n
\u25cf B\u1ec7nh d\u1ea1 d\u00e0y<\/p>\n
\u25cf Suy gan, suy t\u1ee5y<\/p>\n
– Nguy\u00ean nh\u00e2n ngo\u00e0i \u1ed1ng ti\u00eau h\u00f3a: M\u1ed9t s\u1ed1 b\u1ec7nh n\u1ed9i ti\u1ebft Suy c\u1eadn gi\u00e1p, suy th\u01b0\u1ee3ng th\u1eadn l\u00e0m gi\u1ea3m canxi huy\u1ebft g\u00e2y t\u0103ng co b\u00f3p ru\u1ed9t.<\/p>\n
H\u1eadu qu\u1ea3:<\/p>\n
+ Suy dinh d\u01b0\u1ee1ng<\/p>\n
+ Thi\u1ebfu vitamin v\u00e0 m\u1ed9t s\u1ed1 y\u1ebfu t\u00f3 vi l\u01b0\u1ee3ng<\/p>\n
2.T\u0103ng h\u1ea5p thu b\u1ec7nh l\u00fd:<\/p>\n
Th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi t\u0103ng th\u1ea5m th\u00e0nh ru\u1ed9t (xung huy\u1ebft ch\u1ee7 \u0111\u1ed9ng ho\u1eb7c k\u00edch th\u00edch bi\u1ec3u m\u00f4 ru\u1ed9t), \u0111\u1eb7c bi\u1ec7t hay g\u1eb7p \u1edf tr\u1ebb nh\u1ecf ch\u1eadm l\u1edbn.<\/p>\n
T\u0103ng h\u1ea5p thu b\u1ec7nh l\u00fd c\u00f3 th\u1ec3 g\u00e2y nhi\u1ec5m \u0111\u1ed9c c\u00e1c s\u1ea3n ph\u1ea9m kh\u00f4ng ti\u00eau h\u00f3a \u0111\u1ea7y \u0111\u1ee7 c\u1ee7a th\u1ee9c \u0103n, \u0111\u00f4i khi th\u1ea5m c\u1ea3 ch\u1ea5t \u0111\u1ea1m tr\u1ee9ng g\u00e0, s\u1eefa b\u00f2 g\u00e2y m\u1eabn c\u1ea3m c\u01a1 th\u1ec3 v\u00e0 ph\u00e1t sinh d\u1ecb \u1ee9ng.<\/p>\n
C\u00e2u 21: Tr\u00ecnh b\u00e0y c\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a t\u1eafc ru\u1ed9t, h\u1eadu qu\u1ea3 c\u1ee7a t\u1eafc ru\u1ed9t?<\/p>\n
*T\u1eafc ru\u1ed9t l\u00e0 t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd: x\u1ea3y ra khi m\u1ed9t \u0111o\u1ea1n ru\u1ed9t b\u1ecb t\u1eafc ho\u1eb7c kh\u00f4ng co b\u00f3p l\u00e0m th\u1ee9c \u0103n kh\u00f4ng l\u01b0u th\u00f4ng \u0111\u01b0\u1ee3c. V\u1ec1 nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 chia l\u00e0m 2 lo\u1ea1i:<\/p>\n
– T\u1eafc c\u01a1 h\u1ecdc ph\u00e1t sinh khi ru\u1ed9t b\u1ecb b\u1ecbt k\u00edn do kh\u1ed1i u, giun, s\u1eb9o ho\u1eb7c ru\u1ed9t b\u1ecb xo\u1eafn, th\u1eaft, l\u1ed3ng\u2026<\/p>\n
– T\u1eafc th\u1ea7n kinh khi c\u01b0\u1eddng d\u00e2y X g\u00e2y co th\u1eaft m\u1ed9t \u0111o\u1ea1n ru\u1ed9t ho\u1eb7c li\u1ec7t d\u00e2y X g\u00e2y d\u00e3n h\u1eb3n m\u1ed9t \u0111o\u1ea1n ru\u1ed9t (bi\u00ean ch\u1ee9ng h\u1eadu ph\u1eabu).<\/p>\n
*Di\u1ec5n bi\u1ebfn c\u1ee7a t\u1eafc ru\u1ed9t th\u01b0\u1eddng nghi\u00eam tr\u1ecdng:<\/p>\n
– L\u00fac \u0111\u1ea7u ph\u1ea7n tr\u00ean ch\u1ed7 t\u1eafc t\u0103ng c\u01b0\u1eddng co b\u00f3p g\u00e2y c\u00e1c c\u01a1n \u0111au d\u1eef d\u1ed9i v\u00e0 hi\u1ec7n t\u01b0\u1ee3ng r\u1eafn b\u00f2 \u1edf th\u00e0nh b\u1ee5ng. Ru\u1ed9t b\u1ecb t\u1eafc, th\u1ee9c \u0103n kh\u00f4ng l\u01b0u th\u00f4ng \u0111\u01b0\u1ee3c g\u00e2y xu\u1ea5t hi\u1ec7n c\u00e1c s\u00f3ng ph\u1ea3n nhu \u0111\u1ed9ng l\u00e0m b\u1ec7nh nh\u00e2n n\u00f4n m\u1eeda, n\u1ebfu t\u1eafc \u1edf ph\u1ea7n d\u01b0\u1edbi c\u00f3 th\u1ec3 n\u00f4n ra ph\u00e2n.<\/p>\n
– Nhi\u1ec5m \u0111\u1ed9c c\u00e1c ch\u1ea5t \u0111\u1ed9c \u1edf ru\u1ed9t v\u00e0 m\u1ea5t n\u01b0\u1edbc, m\u1ea5t Cl l\u00e0m cho di\u1ec5n bi\u1ebfn r\u1ea5t tr\u1ea7m tr\u1ecdng, c\u00f2n c\u00f3 th\u1ec3 do ph\u1ea3n x\u1ea1 th\u1ea7n kinh khi ru\u1ed9t b\u1ecb c\u0103ng g\u00e2y s\u1ed1c. T\u1eafc ru\u1ed9t \u1edf \u0111o\u1ea1n cao, h\u1eadu qu\u1ea3 s\u1ebd n\u1eb7ng h\u01a1n, m\u1ea5t n\u01b0\u1edbc nhi\u1ec1u c\u00f3 th\u1ec3 g\u00e2y gi\u1ea3m l\u01b0\u1ee3ng m\u00e1u tu\u1ea7n ho\u00e0n, h\u1ea1 huy\u1ebft \u00e1p, tr\u1ee5y m\u1ea1ch, t\u0103ng ure m\u00e1u.<\/p>\n
H\u1eadu qu\u1ea3: t\u00f9y v\u1ecb tr\u00ed t\u1eafc \u1edf cao hay th\u1ea5p<\/p>\n
+ T\u1eafc cao: bi\u1ec3u hi\u1ec7n n\u1ed5i b\u1eadt l\u00e0 m\u1ea5t n\u01b0\u1edbc do n\u00f4n nhi\u1ec1u<\/p>\n
+ T\u1eafc \u1edf t\u00e1 tr\u00e0ng: n\u00f4n ra d\u1ecbch ru\u1ed9t k\u00e8m v\u1edbi m\u1ea5t n\u01b0\u1edbc v\u00e0 nhi\u1ec5m acid<\/p>\n
+ T\u1eafc \u1edf th\u1ea5p: Bi\u1ec3u hi\u1ec7n nhi\u1ec5m \u0111\u1ed9c s\u1edbm h\u01a1n v\u00e0 n\u1eb7ng h\u01a1n so v\u1edbi bi\u1ec3u hi\u1ec7n m\u1ea5t n\u01b0\u1edbc<\/p>\n
Bi\u1ec7n ph\u00e1p x\u1eed tr\u00ed ch\u1ee7 y\u1ebfu l\u00e0 ph\u1ea3i truy\u1ec1n d\u1ecbch, \u1ed5n \u0111i\u1ecbnh c\u00e2n b\u1eb1ng axit baz\u01a1, ch\u1ed1ng c\u0103ng ru\u1ed9t b\u1eb1ng h\u00fat h\u01a1i v\u00e0 n\u01b0\u1edbc \u1edf ph\u1ea7n tr\u00ean \u0111o\u1ea1n t\u1eafc. N\u1ebfu do nguy\u00ean nh\u00e2n c\u01a1 h\u1ecdc, ph\u1ea3i gi\u1ea3i quy\u1ebft b\u1eb1ng ph\u1eabu thu\u1eadt.<\/p>\n","protected":false},"excerpt":{"rendered":"
C\u00e2u 1: Tr\u00ecnh b\u00e0y t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n b\u1eb1ng Glucose m\u00e1u ? A – Gi\u1ea3m glucose m\u00e1u: N\u1ed3ng \u0111\u1ed9 glucose m\u00e1u \u1edf ng\u01b0\u1eddi b\u00ecnh th\u01b0\u1eddng 0,8 \u2013 1,2 g\/l. Gi\u1ea3m glucose m\u00e1u khi n\u1ed3ng \u0111\u1ed9 d\u01b0\u1edbi 0,8g\/l. 1. Nguy\u00ean nh\u00e2n: – Cung c\u1ea5p thi\u1ebfu : kh\u1ea9u ph\u1ea7n h\u1eb1ng ng\u00e0y thi\u1ebfu v\u1ec1 l\u01b0\u1ee3ng. – R\u1ed1i lo\u1ea1n …<\/p>\n","protected":false},"author":10,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30,39],"tags":[],"class_list":["post-2024","post","type-post","status-publish","format-standard","","category-mon-co-so","category-sinh-ly-benh-mien-dich"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2024","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/users\/10"}],"replies":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/comments?post=2024"}],"version-history":[{"count":1,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2024\/revisions"}],"predecessor-version":[{"id":2026,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/2024\/revisions\/2026"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=2024"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=2024"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=2024"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}