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VIM NI CHUNG

Mc tiu hc tp

1- Trnh by c nh ngha, cc nguyn nhn v bn cht ca vim2- M t, gii thch c 4 giai on ca qu trnh vim v ngha ca tng giai on

3- K tn, phn tch c 7 loi vim theo m bnh hc v 3 loi vim theo lm sng

I. I CNG

Vim (t nguyn la tinh inflammare c ngha l la chy v t nguyn Hn c ngha l nng)l mt hin tng c ni n t thi c i (nin k 4 trc cng nguyn), sau mt thythuc La m ghi nhn 4 triu chng kinh in ca vim: sng, nng, , au. Virchow(1821-1902) li xc nhn thm mt du hiu th nm ca vim l: mt chc nng. Tuy nhinsut mt thi gian di nhiu th k, cc nh y hc vn coi vim nh l mt hin tng c hii vi c th. Mi n nhiu thp k sau, vi nhng nghin cu v knh hin vi hc, hasinh, min dch hc v.v.., khng nh rng: vim l mt phn ng khng mang tnh cht chiu v hon ton c li cho c th.

T , ngi ta a ra mt nh ngha ca vim nh sau: Vim l qu trnh phn ng tv ca c th, ca t chc v cc thnh phn dch th ca c th nhm chng li cc tc nhnxm nhp, biu hin ch yu l ti ch.

Cc hin tng kinh in ca vim nh: Sng l do ng dch ph vim. Nng v l do hin tng xung huyt, cc mch y mu. au l do dch ph v nhiu tc nhn gy

vim chn p m v kch thch cc u tn cng thn kinh.Cn lu phn bit nhim khun v vim: Nhim khun l hin tng hnh thnh docc tc nhn gy bnh (vi khun, virus, k sinh trng) c th khu tr hoc lan ta ton thn.

Ngc li vim l mt qu trnh iu chnh cn bng ni mi. Nh vy, nhim khun lunkm qu trnh vim, ngc li, vim khng phi bao gi cng l hin tng nhim khun.

II. NGUYN NHN

Phn ng vim gy nn do nhiu tc nhn khc nhau nhng u lm thay i tnh cht l haca cht gian bo hoc hoi t t bo... v c th xp vo cc loi tc nhn chnh nh sau:

1. Tc nhn nhim trng

y l tc nhn ph bin, do vi trng, k sinh trng, virus.2. Tc nhn vt l

- C hc: do ng, dp vt thng, k c vt thng v trng.

- Nhit hc: do bng nng, lnh.

- Bc x ion ha.

3. Tc nhn ha hc

Gm cc cht ha tan v khng ha tan.

4. Hoi t t bo

Do thiu mu, chn thng...

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5. Nhng thay i ni sinh ca cht gian bo gm

- Mt s cht dng bt, cc phc hp min dch, cc sn phm ca ung th.

III. DIN BIN CA VIM

Hnh 1: Vim ni chung

Sau tn thng m, ngi ta c th thy mt lot cc hin tng xy ra nhm p ng, sacha tn thng ny. Qua th nghim, ngi ta c th tm tt qu trnh phn ng vim gm 4giai on:

1. Giai on khi u: cn gi l giai on sinh ha, thn kinhy l giai on gia thi im ca cc tc nhn xm nhp v khi u ca nhng biu hinxung huyt v au.

1.1. Bin i sinh ha

1.1.1 Hin tng toan ha nguyn pht:hin tng ny xy ra rt sm v c lin quan nvic s dng glycogen ca t bo v m.Ti ni tn thng, cc mch ngoi vi co li v tnthng, dn n lng O2 ti vng vim b h thp, lng CO2 tng ln. S chuyn haglucose m se i theo con ng k kh v sn sinh ra nhiu sn phm acid (acid pyruvic,acid lactic)

C6H12O6 + 6O2 = 6CO2 + H2O + EC6H12O6 = 3C3H6O3 (acid lactic)

Cc sn phm acid ny va c tc dng lm tng tnh thm thnh mch v lm PH vngm b vim h thp 6,8 - 6

1.1.2 Hin tng toan ha th pht: do tc ng ca vim ko di, pH mi trng ca m tiptc gim thp xung 5,3. Mt khc cc t bo vng vim b tn thng khng chuyn ha htcc acid hu c dn n pH vng m cng h thp xung. ng thi, do cc t bo b tnthng, cc ti tiu th (ti lysosom) nm trong bo tng ca t bo cng v v ra, gii

phng cc men thy phn, c th tiu ha c cc thnh phn protein, lipid, v glucid, phnha cc cht khc nhau vng vim thnh cc phn t nh, c bit l phn gii cc proteinthnh cc chui peptid v cc acid hu c gy gin mch v tng tnh thm thnh mch, gichung l cht trung gian hot mch. Cc cht trung gian hot mch v cc acid hu c c tc

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dng gy gin mch v tng tnh thm thnh mch rt mnh, ng thi tc ng ti nhiu loivi khun, virus, k sinh trng vn nhy cm vi mi trng acid.

1.1.3 Cc cht trung gian hot mch : bao gm

* Cc amin hot mch (vaso active amin), trong ch yu l histamin v serotonin.

* Cc proteaza ca huyt tng gm:+ H kinin huyt tng (plasma kinin) gm bradykinin, kallikrein tc l cc polypeptid c 8-14 acid amin.

+ H b th (complement system) gm C3a, C5a, C5b, C9.

+ H ng mu v tiu si huyt.

* Cc thnh phn ca lysosome.

* Cc thnh phn t do ca dn cht oxygen.

* Cc yu t hot ha tiu cu (platelet activator factor).

* Cc cytokine

+ Cc amin hot mch gm histamin, serotonin l nhng sn phm trung gian xut hin smgiai on u; histamin l dn cht ca histidin, mt acid amin bnh thng c bn trongnguyn sinh cht ca t bo. Khi t bo thoi ha, histidin b kh carboxyl v gii phng rahistamin, ngoi ra histamin cn nm trong nguyn sinh cht ca cc dng bo (mastocyte).Khi c gii phng chng gy gin tiu ng mch do tc ng trc tip ln th th H 1 cacc t bo c trn ca tiu ng mch, lm xung huyt, lm tng tnh thm thnh mch vcng tc ng vo cc th th H1 ca t bo ni mc mch, lm co cc t bo ni m, to nncc k h gian bo, ng thi lm long cht ciment gn gia cc t bo ni m. Serotonincng nm trong cc dng bo, chng cng tc ng ging nh histamin, lm gin mch v

tng tnh thm.+ Cc proteaza ca huyt tng gm h kinin, h b th v h ng mu. C 3 h ny hotng lin quan vi nhau, trong h b th l quan trng v n lin quan n yu t hotmch v ha hng ng (chemotatic).

- H kinin: gm bradykinin, kallikrein. Chng c pht ng bi yu t hageman nm trongcc mu khi c tip xc vi cht hot mch, chng gy tng tnh thm ng thi gy hahng ng v s kt dnh ca cc bch cu.

- H b th: h ny gm 20 thnh phn protein v c m cao trong huyt tng, h nyrt quan trng trong p ng min dch.

+ C3a gy tng thm huyt qun v c th b tch bi proteaza ca vi khun.+ C5a cng gy tng tnh thm, c bit c hin tng ha hng ng cao, C5a gy dnh bchcu vi t bo ni m.

+ C3b c nhn dng rt nhanh bi cc i thc bo, bch cu toan, bch cu trung tnh.

+ C5b9 l cht cui cng, l phc hp tn cng vo mng.

-H ng mu: gm mt lot cc protein c trong huyt tng, c th c hot ha do yu tHageman, bc cui cng l bin i fibrinogen thnh fibrin to ra cc cht tng thm maoqun, gy ha hng ng. Chnh h ny lm tiu si huyt trong phn ng vim bng nhiucon ng (thng qua h kinin v hot ha plasminogen thnh plasmin v vai tr chnh l tiu

cc mu).1.2. Bin i thn kinh

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Cc cht hoi t, cc cht trung gian, cc acid hu c u c th kch thch cc dy thn kinhco mch, gy co tht cc c tht tiu ng mch, sau chng b t lit v lng dn ra, mch

b gin nn mu dn n nhiu. Hin tng trn sinh ra do phn x ca si trc.

Tm li: Trong giai on khi u, cc tn thng ban u cng ph to nn nhng binng su sc, c bit l s hot ha ca cc men tiu protein c trong ti lysosome, pHca m b h thp c tc dng dit khun, kch thch s sinh sn ca cc t bo, to mitrng thun li cho hot ng ca bch cu a nhn, cc cht trung gian gy gin mch, tngtnh thm chun b y cc tin cho cc phn ng tip theo.

2. Giai on huyt qun huyt

Giai on ny cng xy ra rt sm, di tc ng ca cc cht hot mch, cc h thng maomch ti vim b gin, mu s dn n nhiu lm khi lng mu tng ln, gy hin tngxung huyt. Hin tng xung huyt bao gm: xung huyt ng mch v xung huyt tnhmch.

2.1. Xung huyt ng mch

Khi h thng mao mch b gin, mu s dn n nhiu vng vim lm khi lng mu tngln. Vch mao qun gm 2 lp, lp t bo ni m v mng y, c 2 lp ny u b tnthng.

Lp t bo ni m tr nn th rp, sng to v c nhiu nh li, cht ciment gn gia cc tbo b lng lo khi c vim, to nhiu khe h cho dch thot ra ngoi.

Lp mng y, di tc ng ca cc cht phn gii ca vi khun lm cho cc l trn mngy rng ra. Tn thng vch mao qun lm tng tnh thm mao qun l hin tng ht scc bn trong vim.

2.2. Xung huyt tnh mch

Khi cc cht thot qun nhiu, qunh mu trong lng mch tng ln lm hng cu d ktdnh, to thnh mt chui gy bt tc, dng mu chy chm li, mt khc dch thot ra ngoili gy chn p tr li thnh mch, cn tr mu tr v v gy xung huyt tnh mch.

2.3. Dch ph vim

L hin tng tch t cht dch vo trong m k do hu qu ca tn thng thnh mch cngvi tc ng ca cc cht trung gian hot mch v gy ph vim. Do xung huyt, mu lmtng p lc thy tnh ni mch, tng p lc keo, tt c cc yu t ny ko nc v cc thnh

phn khc ca mu ra m k. Do vy dch ph trong vim m k cha nhiu huyt tnggiu protein (phn ng Rivalta dng tnh) c trng lng phn t >1020 nn c gi ldch xut tit. Cn phn bit vi dch thm, dch thm thng c lng protein thp di1g/100ml c trng lng phn t

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ngha: Nh vy trong nhng iu kin thch hp th dch ph vim c nhiu tc dng huch.

- Bin cht gian bo t trng thi gel sang sol, lm long tc nhn gy bnh v to mi trngthun li cho vn ng ca bch cu.

- Dch ph vim mang n t chc k mt lng ln cc protein tham gia mt cch hu hiuvo phn ng vim.

- Hng ro li si t huyt lm ngn cn khng cho vim lan rng.

Tuy nhin, nu dch ph vim qu nhiu c th gy nhng hu qu nh :

+ Gy chn p m xung quanh, gy au, thm ch hn ch hot ng ca mt s cquan (v d: trn dch mng tim, mng phi...) v gy vim dnh cc mng.

+ Dch tit trn b mt nim mc, thanh mc (to nn mng gi trong bng bch hu,dch xut tit trong vim long ng h hp trn)

+ Dch tit trn m k ca da gy hin tng n to t bo v cc bng nc trong mt

s bnh v da.2.4. Xm nhp bch cu v hin tng thc bo

Trong giai on huyt qun huyt, bch cu a nhn ng vai tr quan trng. Chng chuy ng u tin v rt cng hiu nhm tiu dit v loi tr vt l. Bch cu ch di chuyntrong mu khong thi gian 6 gi ri b hy lch v c thi ra ngoi trn b mt cc nimmc h hp, tiu ha ,tit niu.

2.4.1. Xm nhp bch cu

Trong qu trnh xut tit, cc bch cu a nhn s chui qua thnh mch b tn thng v tinn vim thc hin chc nng thc bo, gii phng cc men tiu hy. Hot ng ca

chng qua cc bc:- Giai on t tp bch cu

Bnh thng cc bch cu di chuyn trong dng mu theo ng trc gia, nhng khi n ti vim chng li r sang hai bn v bm vo thnh mch (c ch cha tht r nhng c l ti vim c nhng yu t huy ng bch cu), gi chung l hin tng ni mc bch cu.

+ Pha t bo ni m thnh mch: B mt cc t bo ni m dnh qunh v c nhiu nh li,ng thi c nhng yu t th cm I.C.A.M. (Intra cellular adhesion molecular, phn t dnhni t bo). Cc yu t ny trng hp vi cc yu t c b mt ca bch cu d kt dnh.

+ Pha bch cu: Bnh thng trong ti ni bo ca bch cu c mt h thng 3 glycoproteinl LFA1 (Leuco factor A1), M.0, P150. Khi c nhng tn hiu trung gian, nhng b th C5a, ccsn phm c t ca vi khun v cc yu t hng ng th cc yu t ny s c hot hav th ra b mt ca bch cu n ni cn thit v thng chng c huy ng nhanhtrong 6 gi u.

2.4.2. Giai on xuyn mch ca bch cu

Khi bch cu p st thnh mch, tc ng do cc t bo ni m b tn thng, cht xi mnggn cc t bo b lng, mng y thng tn. Cc bch cu th cc gi tc lun lch chui quathnh mch, ngay c bch cu cng cha nhiu men lm tiu hy m nn c th xuyn mchd dng.

2.4.3 Hin tng thc bo

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L hin tng cc t bo nut, thu tm v tiu hy tc nhn xm nhp. Trong cc t botham gia thc bo giai on huyt qun huyt th ch yu l bch cu a nhn. Chng csn xut ty xng ri bit ha thnh 3 dng bch cu.

+ Bch cu a nhn trung tnh

Loi ny c huy ng nhiu trong cc loi vim m do tc ng ca sn phm ca vikhun, ca cc yu t ha hng ng, cc cht hoi t ca c th. Trong bo tng cachng cha cc men phn gii nm bn trong ti lysosome (ancalin, phosphates acid,lactoferin, protease, glycosidaza...) Cc men ny lm tng hiu lc dit khun.

+ Bch cu a nhn i toan

Dng ny ch chim t l 2-5% cng c tc dng dit khun nhng trong ti lysosome cha tmen phn gii hn. Chng ch c huy ng v tp trung ti cc ni xy ra phn ng d ng.Chng tng cao trong cc phn ng bnh nhim k sinh trng.

+ Bch cu a nhn i kim

Dng ny ch chim t l 1% loi ny ging t bo bn, c vai tr trong cc phn ng d ngv phn v do IgE gy ra. Loi ny trong bo tng cha cc amin hot mch nh histamin,serotonin, thy r nht trong cc phn ng da. Chng c kch thch bi oestrogen v b cch bi corticoid.

Hnh 2: Hin tng xuyn mch v thc bo ca bch cu

Hnh 2. Hin tng thc bo ca bch cu

Thc bo l hin tng c nh ng vt hc ngi Nga Metchnikoff (1845-1946) phthin khi nghin cu cc t bo thu tm v tiu hy cc vt l cc ng vt bin v cgii thng Nobel Y hc (1908). Khi bch cu a nhn huy ng n vim th chng tit racc cht ph trn b mt vt l (gi l hin tng ph), tip theo l chng th cc gi tc bmdnh v ko vt l st vo mnh, co cun nguyn sinh cht li, hnh thnh hc thc bo, sau l tiu ha. Hin tng thc bo b gim thiu r rt trong cc iu kin: Nhit >40 o, c

phng x mnh, mi trng u trng.

Tm li: Giai on huyt qun huyt l bc to iu kin cho bch cu a nhn bm st vtl, bc u dch ph vim hn ch, phn gii c t, chng c mt trong hu ht cc loinhim khun. S hot ng ca bch cu a nhn c tnh quyt nh khng nhng giai onhuyt qun huyt m cn cho ton b cc qu trnh vim v sau.

2.5. Hu qu ca giai on huyt qun huyt

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-Phc hi hon ton: giai on cui ca giai on huyt qun huyt, vim c th ktthc, cc vi khun b tiu dit v loi b, cc cht gy tr ngi b loi thi, cc huyt qunthng sut, dch ph vim c rt ht nhanh chng, l s phc hi hon ton vim khng li du vt g.

- Qu trnh vim tip din:Nu bch cu a nhn khng lm trn nhim v, c th s phnng li bng cch huy ng cc t bo n nhn v vim chuyn qua giai on phn ng m.Hoc xu, ti ch xc cc bch cu, cc t bo b hy hoi nhng vim vn khu tr v xungquanh c mt hng ro bch cu, si t huyt v cc t bo n nhn xut hin, to nn pxe hoc vim lan trn mt vng thm ch gy nhim trng huyt. Lc ny, nu c iu trkhng sinh thch hp th c th qua khi.

3. Giai on phn ng m

y l giai on tip theo ca phn ng huyt qun huyt. Tuy nhin, khng ch c t chcti ch tham gia trong qu trnh vim m cn c c mt h thng c mt hu khp c th ntip sc. Ngoi ra, giai on ny cn ty thuc vo:

- S mt cht nhiu hay t ti vim- Tc nhn gy vim

- c im ca m b vim (m c, m xng...)

Trong giai on ny, c th s huy ng 3 h t bo tham gia: h lympho n bo, h linkt v h biu m.

3.1. H lympho n bo

H ny gm nhiu hnh thi khc nhau nhng u c chung ngun gc xut pht t ty xngv cng chung chc nng l thc bo, thng tin, sn xut khng th, loi tr vt l. Xut phtt ty xng, qua qu trnh bit ha, chng gm 3 dng: dng bch cu n nhn, dnglympho B, dng lympho T.3.1.1. Dng bch cu n nhn

Xut pht t t bo ngun (sterm cell) chng bin thnh nguyn bo n nhn (monoblast) rithnh t bo tin n nhn (promonocyte) vo mu thnh bch cu n nhn (monocyte) thai nhi, chng theo mu i khp cc ni, vo cc c quan, v d gan (t bo Kuffer), xng (hy ct bo), lch (m bo -histocyte), t bo li (reticulocyte), da (m bo)...Cc t bo ny tham gia vo c ch khng nhm loi tr vi sinh vt ra khi mu.

Hnh 3: H thng lympho-n bo

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Metchnikoff gi chung l i thc bo (macrophage) trong bo tng ca chng c nhiulysosome ni bo. Chng khng nhng l nhng t bo tiu dit vt l m cn phn ct, trnhdin cc siu cu trc khng nguyn ca vt l cho cc t bo c thm quyn min dchnhn din v tiu dit.

3.1.2. Dng lympho B

ty xng, di dng tin lympho B sau i qua ti Fabricius (Bursa Fabricius) ca loig con v nhiu loi c cnh, tng ng ngi l cc hch lympho, cc nang lympho c mtkhp ni trong c th sau bit ha thnh lympho B trng thnh, khi gp cc khngnguyn ca c th th tr thnh lympho B c tr nh. Cui cng chng bin thnh tng bo(plasmocyte) sn xut ra khng th dch th lu hnh trong mu.bao gm IgA, IgM, IgD,IgE. Ngc li cc lympho B cng c hot ha di tc ng ca i thc bo n khngnguyn v ca lympho bo T.

3.1.3. Dng lympho T

ty xng cng di dng tin lympho T, sau i qua tuyn c (thymus) tr thnh

lympho T trng thnh (v vy cn c gi l lympho bo ph thuc tuyn c). .Lympho Tchim t l 70-80% tng s lympho lu thng trong mu ngoi vi, c i sng di ti nhiunm v thng di chuyn theo mch bch huyt n cc hch k cn hoc khp ni, c vai trnhn din cc t bo l i vi c th tham gia p ng min dch qua trung gian t bo.

C ba dng t bo ni trn khng hot ng c lp m tri li chng hot ng h tr hpng nhau, ty theo tnh cht ca s xm nhp m chng c th bin hnh t loi ny sangloi khc i ph.

3.2. H lin kt

H ny bao gm cc t bo thuc m lin kt ti ni vim xy ra. Khi m b vim, cc t bolin kt trc y trng thi tnh nay s c hot ha. Phn ng ca h ny nhm to nnnhng t bo mi. Nhiu t bo tr nn di ng v sinh sn mnh. S sinh sn ph thuc vos mt cht nhiu hay t. c bit, p ng vi s tng cng chuyn ha ca vng quanh vim, cc n huyt qun mc ra thc s cung cp mu v cc t bo vim n tham gia: l cc huyt qun tn to. Cc thnh phn to nn mt m ht vim (m ht vimthng gp trong nhng tn thng mt cht nh vim lot d dy) hoc tng sinh cc t box, to so nhm b p vng tn thng.

3.3. H biu m

- H ny bao gm cc lp t bo biu m ph b mt da v biu m tuyn lt mt tronglng cc ng tuyn .Trong iu kin bnh thng cc lp biu m ny c vai tr nh hngro bo v to nn ranh gii gia mi trng bn ngoi v c th.

+ Da: nh lp biu m lt tng c sng ha nn c th ngn cn vi khun, virus .Ch khi lpda b xy xt cc tc nhn mi c c hi xm nhp c.

+ Nim mc: Trong c th c nhiu loi cu trc nim mc nh vng ming hng, thc qun,c t cung c cu trc gn ging vi da cng c c ch tng t. Cn nim mc tr ch titnhy ca hc mi, kh ph qun, d dy, rut, cc cht nhy c cha cc men tiu hy c tcdng nh mt mng che ch b mt nim mc. Khi c vim cc cht nhy tng ln r rt(vim mi xut tit, vim ng rut xut tit) hoc vim mt cht, cc t bo biu m cngqu sn ti to tn thng .Tuy nhin, h biu m tuy c tham gia qu trnh vim nhng rtt v cn ty thuc vo s hy hoi nhiu hay t v ty thuc vo ph tng. c bit, trong

vim ko di thng thy hin tng d sn biu m. V d d sn biu m tr thnh biu mlt tng trong vim ph qun mn, vim c t cung mn...

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4. Giai on sa cha, phc hi hoc hy hoi

4.1. Qu trnh sa cha

L qu trnh loi b nhng mnh m vn, nhng cht hoi t, d vt v c dch ph cavim. Qu trnh c th xy ra:

- Trong c th: i thc bo ( n v tiu hy nhng sn phm vim) cng nh dch ph uc vn chuyn theo ng tnh mch, mch bch huyt.

- Ngoi c th: nhng sn phm vim khi c qu nhiu, s c thi b ra ngoi c th (quada, theo ng ng t nhin, hoc theo l d mi hnh thnh)

- Theo kiu nhn to: Phu thut rch rng vim c th thc y nhanh qu trnh dn sch.

Nu tc nhn gy vim c loi khi th vim c th chm dt v tn thng s c dnsch mau chng, dch ph vim s c rt i dn, vim s i vo qu trnh hn gn, cc t

bo x s ti to dn v c s sp xp theo nh cu trc c. Ngc li, nu hoi t v mtcht nhiu, s x ha rng s nh hng ln n chc nng ca cc ph tng.

4.2. Qu trnh hy hoiNu tc nhn gy vim khng b gim i, t bo v m s b hy hoi, qu trnh vim c tipdin, chuyn t cp tnh sang bn cp v vim mn tnh, c lc th rm r, c lc th m .Vim cng ko di th s sa cha cng kh, d c khi, vng m b tn thng cng linhiu di chng v nh hng n chc nng ca m b vim.

4.3. Qu trnh hn gn

L qu trnh thay th cc m v cc t bo b hy hoi bng m hoc t bo mi, baogm 2 hin tng: Ti to (thng dn n s phc hi hon ton ca m nguyn thy ). Sacha (thng dn n kt qu x ha, so ha).

4.4. Nhng yu t nh hng n qu trnh hn gn- Tui ngi bnh:vic hn gn vt thng s rt nhanh i vi ngi tr, v chm hn ivi ngi trng thnh v rt chm i vi ngi gi yu.

- V tr: mt vt thng vng da u thng hn gn nhanh hn vt thng vng lng, mtvt thng mt trc bn tay thng hn gn nhanh hn mt vt thng mt sau (cng

bn tay ).

Hnh 4: Hu qu ca vim

A. Xu. 1) Vim cp: BCN 2) Vim bn cp: BCN - Lympho

3) Vim mn: t bo x - tng bo 4) p xe: cc vng hoi t

B. Tt. 1) Ph n hon ton 2) Ln so 3) X ha

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- Ch dinh dng: vic hn gn vt thng s chm hn ngi thiu n.

- Trnh trng bnh:bnh tiu ng (hn gn vt thng s chm i v vch mch mu chu nhiu tc ng xu), bng ung th, bnh bch huyt (gy cn tr cho vic huy ng bchcu), bnh lao, AIDS v.v...

- S dng qu nhiu thuc: Cc thuc chng vim, chng ung th s nh hng n vic bov c th

IV. LI V HI DO VIM

1. Li ca vim

Qu trnh vim thng to iu kin thun li cho c th nhm khu tr vng tn thng, bov cc m lnh k cn, hnh thnh nhiu yu t trung ha hy dit cc tc nhn xm nhpv hn gn vt thng.

2. Tc hi ca vim

Qu trnh vim cng c th gy nhiu nguy hi cho c th: to ra cc triu chng, sng,nng, , au, gy hy hoi m, lm v cc tng, gy l d li nhiu di chng dn n huqu xu trong qu trnh ti to v sa cha.

V. PHN LOI VIM

1. Phn loi theo m bnh hc

1.1. Vim xut tit: Do hin tng ph vim xut tit dch vo m k hoc vo cc khoangc th, v d nh trn dch mng phi, mng tim v.v...

1.2. Vim xung huyt: Do gin mch tm thi biu hin di dng ban .

1.3. Vim chy mu: Do hng cu thot mch vo m k nh chy mu da, nim mc,

vim cu thn chy mu.1.4. Vim t huyt: Gm dch xut tit, huyt tng v t huyt. Vim hng gi mc trong

bnh bch hu, giai on u ca vim phi cp, cc hc phi cha y hng cu v t huyt.

1.5. Vim huyt khi: Do vim thnh mch, vim ni tm mc, nh vim tc tnh mch huytkhi

1.6. Vim m: Do ng bch cu a nhn gii phng cc men phn hy t bo v m linkt ca vng vim, nh vim m mng phi, vim m rut tha.

1.7. Vim lot: Gp trong cc tn thng mt cht do m hoi t bong ra nh vim lot nimmc ming, d dy.

2. Phn loi theo lm sng2.1. Vim cp: Qu trnh vim ko di vi ngy gm ch yu l phn ng huyt qun

huyt v xm nhp nhiu bch cu a nhn .Vim cp c th phc hi hon ton hoc hnhthnh cc p xe hoc tr thnh vim mn.

2.2. Vim bn cp: Thng ko di nhiu tun hoc vi thng, ch yu l giai on phnng m v hin din t chc ht nh vim lot da.

2.3. Vim mn: Qu trnh vim ko di nhiu thng, nhiu nm. Bao gm phn ng sacha, tng sinh t chc x.

Kt lun: Khng th coi vim nh l mt bnh m y l phn ng hu hiu ca c th

chng li s xm nhp ca vt l. Do vy ngi thy thuc cn nhn thc r v can thipng lc.