HC VIN QUN Y

B MN GII PHU
MT

S:.

TN BI GING
Mn hc: Gii phu
Bi: Tng hp khoang ngc
i tng: Bc s di hn chnh quy
Nm hc: 2009 2010

Ging vin:

H ni - 2010

K HOCH BI GING
1. Phn th tc
B mn: Gii phu
Mn hc: Gii phu
i tng hc vin: Bc s di hn chnh quy
Tn bi ging: Tng hp khoang ngc
Tn ging vin:
Nm hc: 2009-2010
Thi gian ging: 90 pht
2. Cc mc tiu hc tp:
- Nm c i cng v lng ngc v trung tht
- Nm c gii phu tim
- Nm c gii phu phi v mng phi
3. K thut tin hnh:
3.1 Loi bi ging: L thuyt c bn.
3.2 Phng php dy hc: Din ging, trnh by trc quan v kim tra.
3.3 Hnh thc t chc dy hc: Ln lp ti ging ng.
3.4 Phng tin dy hc: Bng, tranh v, PowerPoint.
4. Phn thi gian v cu trc bi ging:
4.1 T chc lp: 1
4.2 Kim tra bi c: 4
4.3 Gii thiu ti liu tham kho, nghin cu: 2
4.4 Tin hnh ni dung bi ging

Ni dung bi ging
1. i cng lng ngc
v trung tht

Thi
gian
15

2. Tim

35

3. Phi v mng phi

35

Nhng PPDH
vn dng
Din ging,
trnh chiu
powerpoint,
quan st trc
quan.

Phng tin
DH
Bng,
powerpoint

Hot ng
ca HV
Nghe, nhn,
ghi chp,
pht biu.

5. Kim tra nh gi (thng tin phn hi): 3

6. Tng kt bi ging:
7. Nhn xt v rt kinh nghim:

Thng qua
Ch nhim b mn

Ngy thng nm 2010

Ngi lm k hoch

TNG HP KHOANG NGC

1. i cng
Khoang ngc cha ng v bo v tim, phi v cc mch mu ln quan
trng, c chia thnh hai vng bn cha phi, mng phi v mt vng gia
cha trung tht. Trung tht c gii hn bi pha trc l mt sau xng c v
cc sn sn; pha sau l mt trc ct sng ngc; 2 bn l mt trung tht ca
phi, mng phi; di l c honh v trn l l trn ca lng ngc, thng ln c.
Ngi ta chia trung tht lm 2 khu trc v sau, ngn cch nhau bi kh
qun, ch phn chia ca kh qun v dy chng tam gic. Theo lm sng v X
quang th theo chiu trc, sau (trung tht trc, gia, sau ngn cch nhau bi 2
mt phng quy c mt trc v mt sau kh qun); theo chiu trn, di (trung
tht tng trn gia l trn ca lng ngc vi 1 mt phng tip tuyn vi nh ca
cung /m ch; tng gia di mt phng i ngang qua ch phn chia kh qun;
tng gia gia 2 mt phng quy c trn).
Trung tht sau l phn trung tht i t mt sau ca kh, ph qun n mt
trc ct sng. N chim 1/3 trung tht., l mt ng hp, ko di t nn c n c
honh. Trung tht sau thng trc vi trung tht trc, trn vi nn c, di
vi m di phc mc ca thnh bng qua l /m ch ca c honh nn 1 m
trung tht sau c th lan sang c cc ln cn trn.
2. Cc tng trong lng ngc
2.1. Tim
2.1.1. V tr
Tim nm trong lng ngc, trung tht trc, gia 2 l phi, trn c honh,
ngay sau xng c v xng sn, hi lch tri. nh tim ra trc sang tri. y
tim ra sau, ln trn, sang phi. Trc tim l mt ng chch t trn xung di, t
sau ra trc, t phi sang tri. V tr tim thay i ph thuc vo lng ngc (lng
ngc ngang th trc chch xa ng thng ng) v t th ca c th (nm, ngi,
th vo su).
2.1.2. Hnh th ngoi v lin quan
Tim c 3 mt, 1 nh v 1 y
2.1.2.1. Mt trc (mt c sn)
Gm tm nh trn, tm tht di, ngn cch nhau bi mt rnh nm
ngang. Tm nh b che lp bi cc mch mu (/m phi tri, /m ch bn phi)
v 2 tiu nh. Tm tht pha sau c l /m phi v l /m ch; pha trc lin

quan vi cc tm tht. Rnh lin tht trc chia mt trc tm nh thnh 2 phn
khng u (tm tht tri chim v tm tht phi chim 3/4). Cho nn vt thng
ngc th tm tht phi d b tn thng.
Mt trc tim st mt sau xng c, st cc sn sn III, IV, V, VI v cc
khoang gian sn. N lin quan vi /m v trong, c ngang ngc v cc ti cng
ph mc nn ng dng phu thut v chc tim phi thn trng.
2.1.2.2. Mt di (mt honh)
Gm rnh vnh chia nh (trn) v tht (di). Nh sau, rt hp. T/m ch trn,
di vo nh phi ; 4 t/m phi vo nh tri. Tht c rnh lin tht di (c
/m vnh phi v 1 nhnh ca t/m vnh) ; chia tm tht tri (chim 3/4) v tm tht
phi (chim 1/4). Mt di lin quan c honh, thu tri gan v phnh v ln d
dy.
2.1.2.3. Mt tri (mt phi)
Lin quan phi v mng phi tri. Gia phi v mt tri c dy TK honh
tri v /m honh trn. C tiu nh tri un cong ch S, m quanh /m phi. Nn
ng dng ct tiu nh tri chc ngn tay vo l nh tht trong phu thut m van
2 l.
2.1.2.4. y tim
Phng, hng ra sau, ln trn, sang phi. Gm nh phi v nh tri ngn cch
nhau bi rnh lin nh. Nh phi quay sang phi, tip gip phi, mng phi phi,
TK honh phi, /m honh trn ; t/m ch trn vo pha trn nh phi. Nh tri
quay ra sau (t sng ngc V, VI, VII, VIII), c 4 t/m phi vo 2 bn, lin quan
vi thc qun nn nh tri phnh to ln thc qun gy kh nut.
2.1.2.5. nh tim
Nm khoang gian sn V tri, trn ng gia n tri; di ng do s
mm tim thy p.
2.1.3. Hnh th trong
Tim c 2 na (phi v tri); hai na c ngn cch nhau bi mt vch. Mi
na c 1 tm nh v 1 tm tht. Tm nh v tm tht cng bn nhau thng nhau bi
l nh tht. Vch lin nh nm gia 2 nh, dnh vo thnh nh, dc theo rnh lin nh
v mt ngoi tim. Bn phi vch c h bu dc (l di tch ca l Botal thng 2 tm
nh phi). Pha trn, trc bn tri vch c van bn nguyt. vch nh thts mng
mng, nm gia nh phi v tht tri (do nh phi di, rng hn nh tri); dy 2mm,

dy 7-8mm. Vch lin tht nm gia 2 tm tht, trn mng (2mm), di dy

(10mm); cong lm sang tri nn tht tri rng hn tht phi.
ng dng:
+ Ba vch khng gp nhau: l thng gia hai tm tht gi l bnh Roger.
+ Thng tm tht + hp /m phi + tht phi phnh to gi l tam chng
Fallot.
+ Thng tm tht + hp /m phi + tht phi phnh to + d dng l /m ch
gi l t chng Fallot.
gia tm nh v tm tht c l van 2 l bn tri v 3 l bn phi. M
tm tht thng vi mt /m (tm tht phi thng vi /m phi, tm tht tri thng
vi /m ch). Tm tht dy hn tm nh do vt thng nh th kp (buc) cn
vt thng tht th khu tng mi.
2.1.4. Mng tim
Tim c bao bc bi 3 mng
- Mng ngoi cng l 1 bao si dy, chc
- Mng ngoi tim l mt mng thanh mc mng, gm 2 l: L bc mt
trong bao si l l thnh. L qut li bc trc tip ln c tim l l tng. Gia l
thnh v l tng l tm mc. Khi l thnh v l mc qut li lin tip vi nhau to
nn ti cng:
+ Ti cng sau MP MC: ti cng ngang
+ Ti cng sau tm nh tri: ti cng chch
Mng trong tim (ni tm mc): l mng mng, bao ph mt trong cc bung
v van tim. Mng ny rt nhy cm vi c t
2.1.5. Mch mu v thn kinh
* Mch mu
- ng mch: /m vnh tri v phi nui tim. C 2 ngnh cng (ngang
rnh vnh v dc rnh lin tht). /m vnh ch ni vi nhau ch khng ni vi
/m no khc nn tn thng /m vnh rt nguy him.
- Tnh mch: i theo cc nhnh ca /m v v t/m vnh ln.
* Thn kinh tim: c chi phi bi 2 h thng thn kinh tim.
- Thn kinh thc vt
+ TK giao cm lm tim p nhanh -> D: ngng tim t ngt -> tim
adrenalin

+ TK ph giao cm lm tim p chm

- TK t ng: l cc si c tim cha bit ho to thnh h thng nt Ketflac,
nt Tawara v b his. H thng ny iu ho nhp nh tht.
2.2. Tuyn c
Tuyn c nm trn lng ngc, sau xng c, trc bao tim, ln cc mch
mu ln nn tim v cc dy thn kinh, kh qun.
Tuyn c c hai thy: phi v tri, phn trn nhn v hp, di phnh to,
thay i theo gii.
- tr s sinh tuyn c nng 12 gam, n tui dt th nng 30 40 gam,
tui 14 15 nng ti a, sau tuyn bt u thoi ha v teo dn. ngi trng
thnh ch cn li di tch l t chc x - m.
- Tuyn hot ng nh mt c quan bch huyt, sn sinh ra cc t bo
lympho v l tuyn ni tit c lin quan n s ln ln v pht trin ca xng v
sinh dc. ngi trng thnh, tuyn c vai tr quan trng trong p ng min
dch v tng khng bng cch kch thch hot ng ca t bo lympho.
2.3. Phi v mng phi
2.3.1. V tr, hnh th ngoi, lin quan
Phi l c quan ch yu ca ng h hp, c nhim v trao i kh.
a.V tr: C hai l phi (phi v tri) nm trong lng ngc, ngn cch nhau
bi mt khoang gia (trung tht).
b. Hnh th ngoi v lin quan: mi l phi ging nh na hnh nn. Gm c
1 y (l mt trong ba mt), 1 nh, 3 mt v 3 b.
- Ba mt:
+ Mt ngoi (sn): li, p vo mt trong lng ngc, c cc n sn v cc
rnh lin thu. Hai phi u c rnh lin thu ln (rnh i chch xung di , ra
trc v n su vo rn phi). Phi phi c thm rnh ngang.Cho nn phi phi c
3 thy, phi tri c 2 thy.
+ Mt trong (mt trung tht): lm v c rn phi gn b sau. Trc di
rn phi phi c n tim, phi tri c h tim. Trc trn rn phi phi c n tnh
mch ch trn, phi tri c n quai ng mch ch. Sau rn phi tri c n ng
mch ch ngc, phi phi c n tnh mch n ln.
+ Mt di (mt honh): lm, p st vo c honh. Qua c honh lin quan
vi d dy, mt trn gan nn p xe mt trn gan v d gy p xe phi v ngc li,.

- nh phi: nh ln l trn ca lng ngc, ng dng nghe phi r nht

h trn n v hm nch; trc nh phi c ng mch di n, sau c hch sao
do phong b hch sao phi thn trng.
- y di, p ln vm honh.
- Ba b:
+ B trc sc, bn tri c khuyt tim v li phi tri.
+ B sau t, gn mt trong ct sng.
+ B di bao quanh ly y phi, c hai on: 1 on thng v 1 on cong
2.3.2. Ph qun v cy ph qun
- C hai ph qun gc tch ra t kh qun. Mi 1 ph qun gc i vo phi
phn chia to thnh cc ph qun thy. Ph qun gc phi to hn, ngn hn ph
qun gc tri v chy chch hn ph qun gc tri.
- Phi phi c 3 ph qun thy, phi tri c 2 ph qun thy. T cc ph
qun thy li phn chia ra thnh ph qun phn thy, mi phi c 10 ph qun
phn thy. Cc ph qun phn thy chia i nhiu ln cho n tn ph qun tiu
thy dn kh vo 1 tiu thy phi.
- Tiu thy phi l n v c s ca phi gm cc tiu ph qun h hp dn
kh vo cc ng ph nang, ri vo cung ph nang v cui cng l vo ph nang,
y l ni trao i kh gia mu v khng kh.
2.3.3. Cung phi
- Cung phi l tp hp nhng thnh phn i t ngoi vo phi v t phi i
ra (i vo gm: ph qun gc, ng mch phi, ng mch ph qun, thn kinh
phi; i ra gm tnh mch ph qun, tnh mch phi, bch huyt). Cc thnh phn
c chia ra 2 loi cung phi: Cung phi dinh dng gm: ng, tnh mch
ph qun, bch huyt v thn kinh chi phi phi; Cung phi chc phn gm ph
qun gc, ng mch v tnh mch phi.
- Lin quan:
+ Cc thnh phn vi nhau: ph qun gc nm sau cng, tnh mch phi
nm pha trc v di nht, ng mch phi bn tri nm trn ph qun gc
tri, bn phi nm trc ph qun gc phi.
+ Lin quan vi cc thnh phn xung quanh: pha trc c b mch thn
kinh honh; pha sau c dy X, bn tri c thm ng mch ch ngc, bn phi c
thm tnh mch n ln; pha di c tim; pha trn bn tri c quai ng mch
ch v trn bn phi c quai tnh mch n ln vt qua.

2.3.4. Mch thn kinh chi phi

2.3.4.1. Mch mu: gm c mch mu chc phn v mch mu dinh dng.
+ Mch mu chc phn:
- Thn ng mch phi i t tm tht phi ri chia ra ng mch phi phi
v ng mch phi tri, chng i cho qua mt trc ca hai bn ph qun gc v
chia thnh cc nhnh nh tng ng vi s phn chia ca cy ph qun, cui cng
i vo trung tm tiu thu phi cng cc tiu ph qun tn. Cc ng mch qun
xung quanh ph nang. Kt thc ca h mch to nn mng li mao mch ph
nang.
- Cc tnh mch phi: cc tnh mch chy quanh cc ph nang, v cc nhnh
tnh mch phi i cc vch lin tiu thu ri i trong cc vch lin thu v kt
thc bi 4 tnh mch v tm nh tri.
+ Mch mu dinh dng:
- ng mch ph qun: nui dng cho ph qun v cc nhu m phi. ng
mch tch t ng mch ch ngc hay ng mch v trong, ng mch gian sn.
N mang mu ti, khng i vo trong ph nang m ch to nn cc mng li
mao mch xung quang ph nang.
- Tnh mch ph qun: c 2 loi. Tnh mch ln v va v tnh mch n
ln bn phi v tnh mch n b bn tri. Tnh mch ph qun nh v cc
tnh mch quanh tiu thu ri v tnh mch phi v cui cng v tm nh tri.
2.3.4.2. Thn kinh: do cc nhnh ph giao cm ca dy X v cc nhnh giao cm
t rn phi ti to nn cc m ri thn kinh.
2.4. Mng phi
L 1 lp thanh mc gm 2 l:
- L thnh: ph tt c mt trong lng ngc, st cn ni ngc. L thnh quy
xung quanh phi cho nn cng c mt sn mt honh v mt trung tht. C ph
mc sn, ph mc honh, ph mc trung tht v ph mc nh phi.
- L tng: ph trc tip nhu m phi, dnh cht vo t chc phi, lch su
vo trong cc rnh lin thu. Mt ngoi ca l tng nhn bng v p st vo l
thnh ca mng phi.
Hai l lin kt vi nhau rn phi v gii hn cho ta 1 khoang o c
gi l khoang mng phi.
L thnh ph mc ph lin tip t mt ny n mt khc ca phi nn ranh
gii ca hai mt to nn ti cng ph mc. Mi phi c 5 ti cng:

+ Ti cng sn honh: nm gc sn honh. L ti bt su v quan trng

nht. N i vng t trc ra sau theo on cong ca b di phi do ngi ta
thng chc d dch mng phi ti bt ny.
+ Ti cng nh phi: cao nht, thng ng dng chc d kh mng phi.
+ Ti cng honh trung tht: nm hng trc sau dc theo phn trong ca
b di phi.
+ Ti cng sn trung tht trc: ng thng dc b trc phi.
+ Ti cng sn trung tht sau: ng thng dc b sau phi.
- Mch mu thn kinh mng phi:
+ ng mch: nui dng cho mng phi l cc nhnh ca ng mch gian
sn sau v ng mch honh ngoi tm mc.
+ Thn kinh : ph mc thnh nhn nhng si cm gic t 6 dy thn kinh
lin sn cui v t dy thn kinh honh. Ph mc tng nhn cc si thn kinh t
dy X v thn giao cm.
Kch thch ph mc thnh gy au. Kch thch ph mc tng khng gy au
nhng gy phn x lan to nn nguy him tnh mng (c bit khi kch thch cung
phi).