Bai01-Gioi thieu

8/4/2019 Bai01-Gioi thieu

1/4

1

GII THIU MN GII PHU BNH HC

Mc tiu hc tp1. Trnh by c ni dung v c im ca mn gii phu bnh hc

2. Nu c 5 phng php chnh ca gii phu bnh

3. Nu c gi tr ca phng php t bo hcv k thut chc ht t bo bng kim nh

I. NH NGHAGii phu bnh hc l khoa hc v cc tn thng, hay ni mt cch c th hn , m x phntch cc bnh tt v mt hnh thi cng nh c ch. Do nhiu nc ngi ta khng gi lgii phu bnh hc m gi ngn gn l bnh hc gm c m bnh ln t bo bnh.

Tn thng l nhng bin i gy nn do bnh tt, bin i khng ch v hnh thi mt c qua cc gic quan, m c v ha hc, men hc, hin vi in t hc, v.v...biu hin

bng nhng ri lon chc nng.Hnh thi l nhng c im pht hin v m t c qua s quan st ca cc gic

quan, cn bn l con mt, nhng cng c th l nhng gic quan khc. khi nhn bng mtthng th gi l i th. Nhn vi knh hin vi th gi l vi th . Vi knh hin vi in t thgi l siu vi th.

II. QU TRNH PHT TRIN CA MN GII PHU BNH HCGii phu bnh hc, nh mi chuyn khoa khng th tch ri khi y hc trong nc

cng nh th gii.

1. Giai on y hc kinh nghim ( trc nm 1850) l gii phu bnh ch m t m khng hiu ngha ca tn thng.

2.Giai on gii phu bnh hc bnh cn (t 1850 -1900) bt u tm ra nguyn nhn v cch ca cc tn thng.

3.Giai on gii phu bnh hc kinh in (1900 -1950) vi cc phng php ct nhumthng thung v knh hin vi quang hc.

4.Giai on gii phu bnh hc hin i (t 1950 cho n nay) thm d su sc bng nhngphng php hin i nh m ha hc min dch, knh hin vi in t kt hp vi s nh v,dn ng ca siu m, CT, MRI.

III.NI DUNG CA MN GII PHU BNHKinh in ngi ta chia gii phu bnh hc ra hai phn:

1. Gii phu bnh hc i cnghc nhng tn thng chung cho mi bnh tt mi c quan, bao gm nhng nhm bnh cn:

-Vim

-U hay bu

-Chuyn ha, dinh dng, ni tit, min dch.

-Bnh di truyn, bm sinh.

2.Gii phu bnh hc b phn hay c quan

Hc nhng tn thng ring ca tng c quan, b my nh b my h hp , tiu ha, b mythn kinh v.v...m nhng bnh cng ch nm trong bn nhm bnh cn bn ca gii phu bnhi cng.

IV.PHNG PHP CA GII PHU BNH HC


2/4

2

1. Phng php i th

2. Phng php vi th bao gm t bo hc v m bnh hc

3. Phng php h a m, ha t bo

4. Phng php men hc, min dch hc

V. C IM CA MN GII PHU BNH HC-Tnh c th: c s "vt cht" ca bnh tt l nhng tn thng c m t r rng,

y .

-Tnh chnh xc kh sai lm, t v tr pht hin do mt thng n nhng chi tit trngthy qua knh hin vi,

-Tnh khch quan: thng t b cc suy ngh ch quan lm sai lc.

-Tnh tng hp: y khi khm nghim t thi mt cch ton din, hoc khi phn tchnhng thng tin vi th v nhng thng tin khc ca lm sng v cn lm sng, i n mtkt lun dt khot.

V. GII THIU V PHNG PHP T BO HC V K THUT CHC

HT T BO BNG KIM NH1. nh ngha

Phng php t bo hc l mt khoa hc v hnh thi t bo ng dng vo vic pht hin vchn on bnh.

2.Cc phng php xt nghim t bo hc

Chn on t bo bnh hc gm c cc phng php sau:

2.1. T bo hc bong (Cytologie exfotiative)

Nhm xt nghim t bo cc dch, cht tit ca c th v d dch mng phi, mng tim,mng bng v.v...Cc cht dch ny thng c quay ly tm, sau ly cn pht ln lam

knh, sau c nh, nhum v c.2.2. Xt nghim t bo hc bng phng php p (apposition)

Thng p dng vi cc tn thng h da, nim mc m tay c th tip cn c.v d c t cung, nim mc ming, mi.

2.3. Xt nghim t bo hc bng phng php chc ht t bo bng kim nh

c p dng vi hu ht cc khi hoc t chc m kim c th vi ti.

Trong 3 phng php ni trn, phng php t bo hc chc thng c s dng nhiu nhtv hiu qu nht.

3. Gi tr phc v ca phng php

nh gi vn ny, hi ngh cc chuyn gia hng u th gii v pht hin ungth 1968 ti Genve ghi nhn:

- u im:

+ n gin: thc hin c nhanh chng, d dng vi phng tin ti thiu, t gy khchu. c th p dng rng ri bt k tuyn y t no vi an ton cao.

+ Nhy: c kh nng pht hin bnh sm vi t l m tnh gi thp, kt qu r rng.

+ ng tin cy: bi t l (+) gi thp.

+ C hiu sut: p dng cho nhiu bnh nhiu v tr khc nhau.

+ Tit kim: t tn cng , ca, thi gian, chi ph( Ch bng 1% ca m bnh hc ), ttn bnh phm.

- Nhc im: So vi sinh thit th chc ht t bo bng kim nh:


3/4

3

+ Rt kh ly bnh phm nhng tn thng x cng.

+ Khng cho bit c im cu trc m hc ca tn thng.

+ Nu k thut khng chun xc, nhng t bo d b tn thng khi ngoy kim hoc dnphin qu mnh lm t bo b v, bo tng tan r to ra nhng hnh nh thoi ha gito. Di y l bng so snh gia cc phng php:

(+) ( ) sai( -)

Lm sng 30-35% 40-45% 25-30%

T bo hc 85-87% 10-12% 3-7%

M bnh hc 86-88% 7-10% 6-8%

Trong nghin cu khoa hc, chn on ca gii phu bnh cn c coi nh tiuchun vng (gold standard).

4. K thut chc ht t bo bng kim nh

y l k thut c s dng ph bin nc ta trong khong 2 chc nm tr li y

4.1.Ch nh

Ch nh chc ht t bo bng kim nh rt rng ri cho mi tn thng dng u, vim cc cquan nh m mm, xng, khp, hch cng nh cc c quan ni tng nh phi ,gan, thnv.v...

4.2.Chng ch nh

Hu nh khng c chng ch nh tuyt i, ch khng nn lm khi:

-bnh nhn c c a d b chy mu, mu lu ng(i vi khi u ni tng)

-Bnh nhn ang trng thi nguy kch: cao huyt p nng, au tht ngc, st cao donhim trng, nhim c.

Cn thn trng trong cc trng hp sau:

-Bnh nhn c trng thi hoc c a thn kinh nhy cm, d b kch thch.-Do v tr c bit ca tn thng d gy chong nh: tinh hon, u nm v

4.3.Kh nng tai bin: trn thc t tai bin rt t gp

-Chong nh nht thi: 1%

-Chy mu nh 10%( tng ng tim bp) .

-Di cn ung th : tng ng vi thm khm thng thng.

4.4.Dng c v phng tin:

-Bm tim: tt nht l loi 20 ml

-Kim tim: chn di thch hp v tr ca tn thng

Ngoi ra dng c cn c lam knh, pice, bng cn70 , ng nghe, my o huyt p. thuctrn tnh, thuc t.

4.5.Th tc cn thit trc khi tin hnh ly bnh phm

-Nghin cu k h s bnh n, lu n tui, gii.

-Khm k vng tn thng

-Gii thch tnh cht an ton v nh nhng ca xt nghim

4.6.Chc ht ly bnh phm

- Kh trng nh thng l

- Gy t: hu ht khng cn thit tr trng hp c bit u tinh hon, hng. i vi

tr nh khng gii thch c, phn ng mnh, nn dng thuc trn tnh trc 30 pht.


4/4

4

Thng chn ng i ngn nht i n tn thng, chc vung gc. Kim i vo khiu on cng di cng tt nhng khng c xuyn qua.

Khi i vo trung tm tn thng , ht mnh bm tim 3-4 ln, duy tr p lc mtrong khi a kim ln xung hoc xoay v cc pha ht bnh phm, khi thy bnh phm ivo c kim th gim dn p lc bm tim, rt nhanh kim ra.Nu chc trng, thay i bm

kim tim, chc li v tr khc.Cht ht ra rt a dng: c,lng, hoc l dch ln mu v mt mnh t chc. :..Da

trn bnh phm ly c, bng mt thng, ta c th hng v nguyn nhn gy bnh mc nht nh.

-C nh tiu bn: Tt nht bng dung dch 50% ethanol v 50 % ether nhng thng dngnht l c nh bng cn 96.

- Nhum bnh phm : thng dng nht l nhm bng dung dch Giem sa vi t l: 2 ml dungdch Giemsa m ha vi 5 ml nc ct. Ph kn tiu bn bng dung dch ny ri trong 30

pht, ra sch di nc chy, sy kh ri em c kt qu di knh hin vi.

Documents

Bai01-Gioi thieu