kOl tOAN klFM - TOAN

l. MO A:
! nh thoong, on H
+
phu dooc doy tr trong mot go hun hop t35 -
45mmo/L) huy pH trong muo dong much phu to 7,35 - 7,45 do dum buo
cho choc nung cou cuc to buo trong co tho hout dong bnh thoong.
! ko oun thung bung toun kom xuy ru kh trung thu cun bung tron b phu
vo. Co nhoo ou ro oun toun kom do nhoo ngoyon nhun khuc nhuo guy
ru, doo tr ro oun toun kom qoun trong u doo tr ngoyon nhun, doo
chnh toun kom ch gop phun hun cho nhong ngoy hom do ro oun toun
kom guy ru.
! Cuc ro oun toun kom tron um sung:
- 1oun choyon hou
- 1oun ho hup
- Kom ho hup vu kom choyon hou
- Ngou ru, con co cuc dung ro oun pho hop
1rong do huy gup u toun choyon hou huy toun ho hup
! 1r so bnh thoong cou cuc thong so kh muo:

1hong so Kot qou bnh thoong Ch cho
pH 7,35 - 7,45
luCO2 35 - 45 mmHg Ap sout phun CO
2
trong muo dong
much
luO2 80 - l00 mmHg Ap sout phun O2 trong muo dong
much
SuO2 94 - l00% Do buo hou O2 cou Hb trong muo
HCO
3
-
22 - 26 mLq/ Nong do HCO3 trong hoyot toong
SC 22 - 26 mLq/ Nong do HCO3 trong doo kon
choun t1 = 37
0
C, lCO2 =
40mmHg
tCO2 24 - 28 mLq/ Nong do toun phun cou CO2
ctO2 l5,8 22,2 V%
tm/d)
1ong oong oxy choyon cho trong
muo
AL tL) -2 - +2 mLq/ Kom do trong muo
SL tLoc) -2 - +2 mLq/ Kom do trong dch ngou buo
AuDO2 t*) < l0 60 mmHg Khoynh up O2 pho nung vu muo
dong much
Loo y:
- pH, luCO2, luO2 do bung muy,
- Cuc thong so con u co dooc qou tnh toun dou pH, lCO2, lO2, lO2, 1
0
,
Hb. Do do, phu gh cuc thong so lO2, 1
0
, Hb cou bonh nhun vuo phoo
xot nghom tho kh muo do nhup vuo muy do kh muo th kot qou mo
chnh xuc. Noo khong gh, muy ngum hoo lO2 = 2l%, 1
0
= 37
0
C, Hb =
l5 g%
t*) AuDO2 = l
A
O2 luO2 = lO2 tlb 47) - l
A
CO2 luO2 = lO2 tlb 47) -
luCO2 /k luO2. k: thoong so ho hup

ANG kOl tOAN TOAN klFM FHOl HOF

FH FCO2
(mmHg)
kicm do
(mmoI/t)
HCO3
(mmoI/t)
nh thoong 7,35 7,45 36 - 44 -5 " +3 l8 - 25
1oun choyon hou ton phut
+ kom ho hup bo tro tvom
du duy root, hon mo too
doong)
# houc 1 # # #
Kom choyon hou ton phut
+ toun ho hup bo tro thop
mon v)
$ houc 1 $ $ $
lho hop toun ho hup vu
choyon hou ton phut tHC
soy ho hup cup)
# $ $ 1

! CAC OC OC NHANH kFT QA kHl MA:
anb gia tbang bang kicm toan:
Toan mao kicm mao
Ho bap CO2 $ CO2 #
Cboycn boa Kom do #
houc
curbonuto #
Kom do $
houc
curbonuto $
% OC 1: doc pH
- pH < 7,35 " 1oun,
- pH > 7,45 " kom,
- pH bnh thoong: tnh % thuy do lCO2 vu HCO
3
-
so vo tr so bnh thoong do
qoyot dnh ro oun ho hup huy choyon hou u chnh.
VDl: pH: 7,39, lCO2: 30, HCO
3
-
: l6, L: -4
pH: 7,39: bnh thoong, lCO2 gum 25%, HCO
3
-
gum 33% " toun choyon hou
u chnh
VD2: pH: 7,45, lCO
2
: 30, HCO
3
-
: 33, L: +6
pH: 7,45: bnh thoong, lCO
2
gum 25%, HCO
3
-
tung 37,5% " kom choyon
hou u chnh, kom kom ho hup
VD3: pH: 7,38, lCO
2
: 50, HCO
3
-
: 28 , L: +2
pH: 7,38: bnh thoong, lCO
2
tung 25%, HCO
3
-
tung l6,6% " toun ho hup u
chnh
% OC 2: doc FaCO2
- luCO2 thuy do ngooc choo vo pH " ro oun vo ho hup,
- lCO2 thuy do cong choo vo pH " ro oun vo choyon hou
VDl: pH: 7,3l, lCO
2
: l0, HCO
3
-
: 5, L: -l4, Nu
+
: l23, C
-
: 99
pH: 7,3l <7.36: toun, lCO
2
thuy do cong choo vo pH: ro oun choyon hou "
toun choyon hou,
VD2: pH: 7,24, luCO
2
: 60, HCO
3
-
: 32, L: +2
pH: 7,24 < 7,35: toun, luCO
2
thuy do ngooc choo vo pH: ro oun ho hup "
toun ho hup
% OC 3: doc kicm do (asc Fxccss:F)
- L > 2: kom choyon hou,
- L < -2: toun choyon hou too y HCO
3
-
toy thooc vuo thuy do lCO
2
, trong kh
L th khong) " tnh Anon Cup & tong hop cuc ro oun
Cong thoc tnh Anon gup: AC = Nu tHCO
3
-
+ C
-
)

. nh thoong AC = l2 ' 4
mLq/L
anb gia tnb trang oxy mao, tbong kb:
* oc FaO
2

- luO
2
: bnh thoong: 80 - l00 mmHg
- luO
2
< 60 mmHg
- luO
2
/lO
2

< 300 " 1hoo oxy muo
< 200 " AkDS
- A-uDO
2
> 60mmHg: shont trong pho, tm
* oc FaCO
2

- lCO
2
> 45 mmHg: gum thong kh
- lCO
2
< 35 mmHg: tung thong kh, oo y lCO
2
thuy do thoo thung bung kom
toun
ll. TOAN CHYFN HOA:
1. Cong vicc cban doan:
a) Hoi bcnb so:
! Duo hoo co nung khong duc hoo cou toun choyon hou: mot mo, boon non,
non.
! Duo hoo gop chun doun ngoyon nhun:
- 1oo chuy.
- Ho ton cun nhong bonh du dooc chun doun:
+ onh thun: soy thun, toun hou ong thun,
+ 1oo doong
- Ho bonh so cou ngo doc: thooc tusprno, lNH,), rooo, othyon gyco
- Ho doo tr trooc kh xuy ru toun choyon hou: troyon dong dch Acd
umno, dun oo cuc dch cou doong too hou ttro dch du duy).
b) kbam:
! Duo hoo tung thong kh bo tro: duy u duo hoo go y gop ngh don toun
choyon hou:
- 1ho suo, o gu doun duo.
- 1ho nhunh, tho koo Kossmuo vu ro oun tr guc o gu doun suo.
! Duo hoo gop chun doun ngoyon nhun:
- Duo mut nooc: too chuy, too doong
- Duo hoo soc: soc nhom trong, soc gum tho tch
c) Xct ngbicm dc ngb|:
Xot nghom co bun:
! Kh muo dong much
! lon do: Nu
+
, K
+
, Cu
++
, C
-
" Anon gup = Nu - tC + HCO3
-
)
! Doong hoyot
! Choc nung thun
! l0 ch so nooc too tpH, doong, kotono)
Xot nghom tm ngoyon nhun dou bonh so, um sung:
! CN gun,
! Kotono muo
! Luctuto muo
! un nhom trong
! lon do: Nu
+
, K
+
, C
-
" AC noo
! Osmouto muo " OC muo
! Xot nghom tm thooc tsucyuto,), doc chut trooo, cyundo), hormono
tcortsono muo udostorono muo, l7-OHl muo, l7-KS, l7-OHCS noo
24go)
! Soo um bong: dunh gu gun, thun, thoong thun,
! Xot nghom khuc: orc muo, trgycordo muo, snh thot gun, C1 / Mkl
d) Cban doan:
! 1oun choyon hou:
- pH < 7,35.
- HCO
3

-
< 2l mLq/L
- lCO
2
< 40 mHg tdo bo tro), thoong lCO
2
gum ll-l3 mmHg cho mo l0
mLq/L HCO
3
b gum, noo pCO
2
thup houc cuo hon so vo do tnh th go
y co so pho hop vo kom houc toun ho hup.
! Chun doun ngoyon nhun toun choyon hou, dou vuo:
- onh so vu duo hoo um sung
- Anon gup:
+ 1ung: too doong tdo kotoucds), gum too muo mo tsoc), soy gun, tdo
tung ucd uctc), soy thun tdo o dong phosphuto, soutos, oruto,), ngo
doc Mothuno, othyono gyco, suycuto ttch to unon hoo co ngou
snh).
+ nh thoong: too chuy, mut dch too hou qou dun oo mut, toy, dch
root tmut HCO
3
), toun hou ong thun gun houc xu, bonh thun mo ko
tgum bu tot H
+
)

ANG MOT SO NGYFN NHAN TOAN CHYFN HOA

Ngoycn nban toan
cboycn boa
Trico cbong Iam sang
goi y
Xct ngbicm
AG tang
* 1oo doong - An + oong + too nhoo
- Cuy
- Hon mo, tho nhunh suo
$ Doong hoyot, kotonos
hoyot
Nooc too: doong, kotono
t+)
* Do - An oong kom,
- Soy dnh doong
# Doong hoyot, kotono
noo t+)
* Ngo doc
- kooo - onh so co oong rooo,
- Mo rooo, hon mo
$ Nong do rooo trong
muo,
$ Osmour gup
- Sucyuto
tAsprno)
|ong qou oo sucyuto $ sucyuto trong muo
Soy choc nung gun
- Cyundo An khou m cuo sun
Kho tho
- Cyundo trong dch du
duy t+)
- $ Acd uctc
* Soc nhom trong onh cunh nhom trong
hoyot
uch cuo $, Ckl $
Cuy muo t+)
$ Acd uctc
* Vom du duy root do
soo v
Sot, too chuy, khong duo
hoo mut nooc, tho nhunh
suo
C1M, Ckl trong go hun
bnh thoong
* Soy thun cup, mun onh y dou don soy thun
cup, mun
$ |ro, croutnno muo
* Soy gun VCSV , CMV, Soy choc nung gun,
Hoyot thunh chun doun
t+)
$ Acd uctc
* 1royon nhoo dum onh nhun dooc troyon
Ngoycn nban toan
cboycn boa
Trico cbong Iam sang
goi y
Xct ngbicm
nhoo dum

* ut thoong choyon
hou bum snh

- Ho chong MLLAS
tMtochrondru
Fncophuomyoputhy,
tuctc Acdoss und
Stroko-ko opsodos:
bonh nuo co tung ucd
uctc do ro oun choc
nung t tho)
1oun choyon hou tu phut,
co gut, o mou, nhoc duo,
bun munh dong dunh
houc mo vo nuo, toun
thun bon dung on

$ Acd uctc
C1/Mkl
Snh thot co
- onh tch to
gycogon
Chum phut tron, gun to,
hu doong hoyot
$ 1rgycordo,
choostoro, ucd orc, ucd
uctc
- ko oun choyon
hou ucd umn: bonh
too oocno-
sooocno-vuno
tMupo syrop orno
dsouso: nooc too mo
ngot cuy thch), too
proponc, too
mothymuonc, too
sovuorc
Xout hon som suo snh:
chum on cun, o mou, ro
oun troong oc co,
Dnh tnh, dnh oong cuc
ucd umn trong nooc too
Anion Gap bnb
tboong

* Mat icarbonatc
qoa doong tico boa

- 1oo chuy 1oo chuy nhoo un,
Mut nooc


Ngoycn nban toan
cboycn boa
Trico cbong Iam sang
goi y
Xct ngbicm
- Do doong too hou,
mut qou huo mon tum,
dun oo dch toy, root
non,
onh cunh ngou khou,
Huo phuo co dun oo
doong too hou

* Mat icarbonatc
qoa tban

- So dong
Acotuzoumdo
1ro oong nhum Dumox
- 1oun hou ong thun
gun ttypo ll)
Chum phut tron, o mou,
khut nhoo, co xoong
pH noo <5,8
Cum Ku muo
- 1oun hou ong thun
xu ttypo l, lll)
Chum phut tron, too
nhoo, un nhoo
pH noo > 5.8
Cum Ku muo
So thun tnophrothuss),
Cuc hou thun
tNophrocucnoss)
- 1oun hou ong thun
thoo
mnoruocortcod
ttypo lV)
ut thoong ho noo,
nhom trong too tu phut
pH noo < 5,8
$ ku muo
- lh du toyon
thoong thun bum snh
lh du bo phun snh doc,
o mou, chum phut tron,
tung ku muo
# cortsono muo
$ l7-OHl muo, l7-KS,
l7-OHCS noo 24go
- onh Addson Du thum, tot hoyot up, hu
doong hoyot, o mou
# cortsono, udostorono
muo

ang tbanb pban dicn giai trong cac d|cb co tbc:
Na
+

mFq/I
k
+

mFq/I
CI
-
mFq/I
HCO
3
-
mFq/I
Du duy 50 l0 - l5 l50 0
1oy l40 5 50 l00 l00
Mut l30 5 l00 40
lostomy l30 l5 20 l20 25 30
1oo chuy 50 35 40 50
Mo ho 50 5 55 0
Muo l40 4 5 l00 25
Nooc too 0 - l00 20 l00 70 - l00 0

2. ico tr|:
2.1 ico cbnb toan mao bang bo Natri icarbonatc:
! Ch dnh bo curbonuto:
* 1oun choyon hou trong soc: HCO
3
-
< l5, luCO2 < 25 - 35 mmHg
* Kotoucdoss/ too doong: pH < 7.l houc HCO
3
-
< 5
* Khuc: pH < 7.2 houc HCO
3
-
< 8
! Chong ch dnh:
Co toun ho hup d kom, ch bo kh toun ho hup du dooc gu qoyot. Do
bot co toun ho hup d kom, dong cong thoc \ntor tnh lCO2 ooc oong =
l,5 ( HCO
3
-
+ t8 ' 2) noo < lCO2 do dooc, toc u co toun ho hup d kom.
! Cong thoc bo curbonuto:

HCO
3
-
cun bo = tl8 - HCO
3
-
) ( CN ( 0,4 houc = L ( CN ( 0,4

Ch bo l/2 oong HCO
3
-
dooc tnh thoo cong thoc tron, troyon chum trong 6
- 8 go, phu oung thunh dong dch dung troong tdong dch phu: Doxtroso
5% houc NuC 0,45%). Noo choyon hou nung, co tho tom tnh much 2
mLq/kg, suo do troyon doy tr phun con u trong 6-8 go. 1ho u kh muo
suo kh troyon, noo tCO
2
houc HCO
3
) l5mmo/ " khong cun bo top v
thun co khu nung bo phun con u noo ngoyon nhun toun dooc gu qoyot.
Nutrbcurbonuto 8,4% 2,5 m/kg/un tung HCO
3
-
4 mLq/L
! Loo y:
Kh troyon curbonuto thoo do on do: $ Nu
+
, # K
+
, # Cu
++
, phu oung
thunh dd dung troong, troyon chum t< 0,5mLq/, bom nhunh guy kLN1).
Khong chch Cucom, troyon thooc vun much Dopumno, Dobotumno
chong vo doong troyon Nutr curbonuto.
2.2 ico tr| ngoycn nban:
! Soc: bo dch chong soc.
! 1oo chuy cup mut nooc: bo dch.
! Huo mon tum tostomy), do root, mut, toy,): bo urbonuto thoo hoong dun.
! Soy thun cup: chuy thun nhun tuo houc thum phun phoc muc kh co ch dnh
! 1oo doong: lnson, bo dch.
! Nhom trong hoyot: khung snh thch hop.
! Do: dnh doong do nung oong.
! Do troyon dum: ngong.
! Ngo doc: toy ngoyon nhun: usprno: kom hou nooc too.
! 1ung snh toyon thoong thun bum snh: Hydrocortsono, Syncorty.


lll. TOAN HO HAF:
1. Cong vicc cban doan:
a) Hoi bcnb so:
! Mot, nhoc duo.
! Ho cuc duo hoo co nung cou cuc ngoyon nhun: yoo ot ch, noot kho,
! 1on cun: soyon, bonh ho hup mun tnh.
b) kbam:
! 1m cuc duo hoo cou toun ho hup: cho yoo u duo hoo cou bonh y nuo do
choyon hou tmotuboc oncophuoputhy) gom: nhoc duo, o do, hon mo, ron
gut co nhoo o, co tho kom dun cuc tnh much vong muc vu pho gu th do
tung up oc no so.
! 1m duo hoo soy ho hup: tho nhunh, rot om ngoc, tho ngoc-bong nghch
choo tot co ho hup).
! 1m cuc duo hoo go y ngoyon nhun:
- Yoo ot co do sot bu ot, nhooc co, H/c Coun-urro
- Soyon, vom pho nung, trun kh mung pho
- 1uc nghon vong thunh qoun, kh qoun
c) Xct ngbicm dc ngb|:
! Kh muo dong much
! Xot nghom chun doun ngoyon nhun
d) Cban doan:
! Toan bo bap:
- pH < 7,35, lCO
2
> 45 mmHg, HCO
3
bnh thoong houc tung nho trong gu
doun cup.
- 1oun ho hup mun tnh HCO
3
so tung 3-4 mLq/L cho mo l0 mmHg tung
lCO
2
, HCO
3
tung on hon houc t hon so vo do tnh cho bot co kom houc
toun choyon hou kom thoo.
! Cban doan ngoycn nban: dou vuo duo hoo um sung vu cuc xot nghom cun
thot khuc.
2. ico tr|:
! Cho yoo u doo tr ngoyon nhun guy soy ho hup vu co ch dnh gop tho kp
tho tlCO
2
> 60 mmHg trong soy ho hup cup)
! 1rong soy ho hup mun tnh cun oo y mot so dom suo:
- Huo hot bonh nhun dong nup vo lCO2 cuo, vu yoo kch thch ho hup chnh
u tnh trung gum Oxy muo, do do ch non cong cup Oxy vo nong do o moc
thup nhut do nung luO2 o moc chup nhun dooc t>50 mmHg) trunh nung
luO2 tung cuo dot ngot so guy oc cho ho hup.
- Noo bonh nhun soy ho hup mun tnh dung dooc gop tho, cong cun thun
trong um gum luCO2 to to, trunh guy gum dot ngot so guy kom muo
nung, um doong cong phun y oxyhomogobn choyon tru vu guy co thut
much muo nuo co tho dun don co gut vu to vong.
! 1oun ho hup co pho hop toun houc kom choyon hou, doo tr phu dou tron
ngoyon tuc doo chnh ngoyon nhun cou tong ou ro oun.
lV. klFM CHYFN HOA:
1. Cong vicc cban doan:
a) Hoi bcnb so:
! O nhoo
! Khu thuc doo tr trooc do:
- 1royon NuHCO
3
, dun oo dch du duy, so dong thooc nhoun troong koo du,
thooc o too koo du
- Kom choyon hou suo toun ho hup du doo chnh tpost-hyporcupnu).
b) kbam:
! 1m duo hoo khong duc hoo: tung kch thch do thoo Oxy, do doong cong
phun y Oxyhomogobn choyon tru.
! Duo hoo do huo qou cou kom choyon hou guy ru:
- 1otuny do gum Cunx muo.
- Yoo co, ot root do gum Ku muo
! Duo hoo cou cuc bonh y u ngoyon nhun guy kom choyon hou do co cho
coong mnoruocortcod: Coshng, hop dong much thun.
c) Xct ngbicm dc ngb|:
! Kh muo dong much.
! lon do muo, lon do nooc too tNu, C nooc too).
! Xot nghom chun doun ngoyon nhun.
d) Cban doan:
! Kom choyon hou: pH muo dong much > 7,45, HCO
3
thoong tung cuo > 40
mLq/L tmoc HCO
3
tung nho thoong do dup ong bo tro soy ho hup mun),
lCO
2
tung 6-7 mmHg cho mo l0 mLq/L tung HCO
3
do dup ong bo tro.
lCO
2
tung o moc cuo hon houc thup hon go y co kom toun houc kom ho
hup.
! Chun doun ngoyon nhun cho yoo dou vuo khu thuc bonh so vu cuc cun
thop doo tr trooc do.
! Chun doun phun bot 2 nhom ngoyon nhun:
- Kom choyon hou kom gum tho tch dch ngou buo: C nooc too thup t< l0
mLq/L), Nu nooc too tung t> 20 mLq/L)
- Kom choyon hou kom tung tot storod thoong thun: C nooc too cuo.
2. ico tr|:
! Kom choyon hou nho: khong cun doo tr duc hoo.
! Noo do thooc: ngong cuc thooc guy kom choyon hou.
! Kom choyon hou nung: bo C cho dch ngou buo bung dong dch NuC
doong oong houc troyon tnh much, chong ch dnh trong troong hop co
ngoy co qou tu. Loo y: bo C ch co tuc dong kh Ku muo du dooc bo trong
kom choyon hou do co cho coong mnoruocortcod: ho chong Coshng,
coong Adostorono ton phut, booo tot konn, hop dong much thun.
V. klFM HO HAF:
1. Cong vicc cban doan:
a) Hoi bcnb so:
! 1rung thu huy o ung
! So dong thooc: qou oo Sucyuto
! onh y du muc: xo gun, bonh y thun knh trong oong
b) kbam:
! 1ho nhunh, suo tdo ngoyon nhun tu nuo houc ro oun choyon hou)
! 1otuny do kom ho hup
! onh nhun dung tho muy: kom tru cuc thong so muy tho
c) Xct ngbicm dc ngb|:
! Kh muo dong much.
! lon do.
! Cuc xot nghom khuc gop chun doun ngoyon nhun.
d) Cban doan:
! Kom ho hup: pH muo tung, lCO
2
gum con 20 25 mmhg, HCO
3
gum
khong qou 3-4 mLq/L do bo tro, trong troong hop kom ho hup mun tnh
HCO
3
gum 4-5 mLq/L cho mo l0 mmHg gum lCO
2
. Noo HCO
3
gum o
moc nhoo hon houc t hon so vo do tnh, thoong go y co kom thoo toun
houc kom choyon hou.
2.ico tr|:
! 1run un so o ung cho bonh nhun.
! Co tho dong phoong phup cho tho u kh CO
2
bung cuch tho qou l to bung
guy, trunh dong to nhou v co tho guy ngut.
! Noo tung thong kh do muy tho, doo chnh cuc thong so muy tho do gum
thong kh phot.