So Tay Can Lam Sang

_ebook oc xy dng bi CLB195_
Ngun ti liu t YKhoanet.com

S TAY GIP TR NH CN LM SNG
MUC LUC
1. in tm bnh thng
1.1. in bnh l
1.2. Xc nh trc in tim
2. Nghim php gng sc
3. Cc tiu chun o c v siu
m kiu tim
3.1. Cc tiu chun o ac v
siu m kiu tim
3.2. Cc s o v siu m tim
ngi bnh thng
3.3. nh gi chc nng tht
tri - tm thu
3.4. nh gi chc nng tht
tri - tm trng
3.5. H van 2 l
3.6. Hp van 2 l
3.7. Hp van ng mch ch
3.8. H van ng mch ch
3.9. Tnh p lc ng mch
phi
4. Ch s huyt ng hc
5. Mch mu
5.1. ng mch vnh T
5.2. ng mch vnh P
5.3. Phn loi cc on mch
vnh theo hip hi tim
mch Hoa K
5.4. Phn loi cc tn thng
mch vnh theo hip hi
tim mch Hoa K
5.5. Phn loi dng mu mch
vnh
6. M s cc my to nhp tim
7. Tiu ha
8. Thn hc
9. H hp
10. iu tr bng dch truyn trong
tnh trng mt nc
10.1. iu tr bng dch truyn
trong tnh trng mt nc
10.2. Nguyn tc bi hon in
gii
10.3. Dch truyn v thuc
(ng tnh mch)
thng c dng
10.4. K thut truyn tnh
mch
10.5. Dch truyn tnh mch -
nng cht in gii
10.6. S milimol ca mi Ion
trong 1g mui
10.7. Thnh phn in gii
trong dch tit s dng
ng tiu ha
10.8. Lu lng - vn tc/ thi
gian truyn
10.9. S truyn mu: cc nhm
mu
10.10. S truyn mu: kho st
cc xt nghim
11. Huyt hc
11.1. Huyt hc
11.2. Gi tr bnh thng ca
mu
12. Test dung np Glucose
13. Dch no ty
14. Ty
15. Prothrombin
1. IN TM BNH THNG

PHC QRS BNH THNG
Sng P:
o Thi gian <0,12s
o Bin <2,5 mm
o Dng D1 D2 aVL aVF V3 V4 V5
V6
o m aVR
o Thay i D3 aVL V1 V2
Khong PR:
o T u sng P n QRS
o Thi gian 0,12 0,20s
o ng in
Sng Q:
o Thi gian <0,04s
o Bin <25% sng R k
o QRS:
o Thi gian <0,10 s
o Sokolow = (SV1 + RV5) < 35mm
o R/S < 1 V1, V2; R/S > 1 V5,V6
ST:
o ng in
Khong QT:
o T u sng Q n cui sng T
o Thi gian thay i tu theo tn s tim
o
Sng T:
o Khng i xng
o nh trn
o Dng D1 D2 aVL V23456
o m aVR
o Thay i D3 aVF V1

o tn s tim:

1.1 IN BNH L:

SNG P: Ph i nh P:
o Sng P cao, nhn > 2,5mm D23 aVF
o Dng 2 pha V1 vi phn dng chim
u th.
Ph i nh T:
o Sng P rng >0,12s D2
o Dng 2 pha V1 vi phn m
chim u th.
KHONG PR:
o ngn <0,12s hi chng kch thch sm.
o di >0,20 s: Block nh tht I
QRS:
0,12 S: Block nhnh hon ton
0,10-0,12s: Block nhnh khng hon ton
PH I THT T NU:
QRS rng
Sokolow 35mm
Dng rS V1, Rs V5
Trc lch T
o

ON ST:
Chnh ln:
un li: tn thng di thng mc
un lm: vim mng ngoi tim
Chnh xung:
thng, i xung: tn thng di ni
mc
dng hnh y chn: ngm Digitalique
SNG T:
Cao bt thng, nhn, i xng thiu mu
di ni mc, tng cali mu
o ngc, su, i xng thiu mu di
thng mc, vim mng ngoi tim, vim c tim.
o ngc khng i xng ph i tht
KHONG QT:
Di - h calci mu, h kali mu, dng
quinidine, Amiodarone.
ngn tng calci mu, ngm Digitalique.
SNG Q:
Nhi mu c tim (sau 6 gi)

Chuyn o Vng nhi mu
D1 aVL bn
D2 D3 aVF di
V1 V2 V3 trc vch
V3 V4 mm
V1-V6 D1 aVL trc rng
V7 V8 V9 y
V3R V4R tht P

1.2 XC NH TRC IN TIM

TNH TRC TRUNG BNH CA QRS TRN CC CHUYN O MT PHNG TRN

Xc nh chuyn o c tng i s ca cc thnh phn phc QRS bng 0. Trc QRS s l 90
o
so vi
chuyn o ny.
TRC BNH THNG
i vi AVF: trc 0
o

i vi D3: trc +30
o

i vi AVL: trc +60
o

i vi D1: trc + 90
o

TRC LCH P
i vi D1: trc +90
o

i vi AVR: trc +120
o

i vi D2: trc +150
o

i vi AVF: trc +180
o

TRC LCH T
i vi AVF: trc 0
o

i vi D2: trc -30
o

i vi D1: trc -90
o

i vi AVR: trc -60
o

TRC V NH
i vi D1: trc -90
o

i vi AVL: trc -120
o

i vi AVF: trc -180
o

i vi D3: trc -150
o

VECT QRS TRUNG BNH MT PHNG TRN CC BNH L
Bnh thng Trc lch T Trc lch P
Cc gii hn 0; +90
o
0; -90
o
+0
o
; +180
o

Cc bnh l thng
phi hp
Bloc phn nhnh T trc
Nhi mu vng di
Ph i tht T
Tn thng tht P Bloc
phn nhnh T sau. Tr em.
Tr nh nhi.

2 NGHIM PHP GNG SC

PHNG PHP
p xe p gng sc.
Thm ln.
CNG CA NGHIM PHP GNG
SC:
FMT = tn s ti a trn l thuyt = 220
tui
(cng thc ASTRAND)
Nghim php ti a u t c FMT.
STT = thi gian huyt p tm thu
PAS = Huyt p ng mch ti a khi gng
sc
FC = Tn s tim ti a khi gng sc
Nghim php c ngha nu STT > 30000
CC TIU CHUN IN TIM CHO THY
C THIU MU CC B C TIM
ST chnh xung i ngang hoc hng
xung >= 1mm trong thi gian 0,08 giy
ST chnh ln >= 1mm
i vi 1 s tc gi: sng T tng bin
hoc T su o ngc
Tng bin sng R, gim bin sng Q
Sng U m V5
Xut hin bloc nhnh T hon ton hoc bloc
phn nhnh T trc

TIU CHUN NGNG NGHIM PHP:
Nghim php t ti a
C cc du hiu in tim dng tnh
au ngc
Huyt p tm thu > 250 mmHg
Tt huyt p
Ri lon nhp: Rung nh, nhanh tht, ngoi
tm thu tht xut hin nhiu.
Ri lon dn truyn: bloc nh tht, bloc
phn nhnh T trc trn nn bloc nhnh P sn c
Cc du hiu khng dung np v tun hon
(xu, l ln, ngt)

PHC NGHIM PHP GNG SC

3 Cc tiu chun o c v siu m kiu tim
1. Cc tiu chun o ac v siu m kiu tim
2. Cc s o v siu m tim ngi bnh thng
3. nh gi chc nng tht tri - tm thu
4. nh gi chc nng tht tri - tm trng
5. H van 2 l
6. Hp van 2 l
7. Hp van ng mch ch
8. H van ng mch ch
9. Tnh p lc ng mch phi
3.1 CC TIU CHUN O C V SIU M KIU TM:

LVd: Kch thc tht tri cui tm trng, o u QRS
LVs: Kch thc tht tri cui tm thu, o im vch lin tht co bp nhiu nht v pha sau.
IVSd: Chiu dy vch lin tht cui tm trng, o u QRS
IVSs: Chiu dy vch lin tht cui tm thu, o ch dy nht
PWd: Chiu dy thnh sau t do tht tri cui tm thu, o ch dy nht.
Ao: Kch thc gc ng mch ch cui tm trng, o lc bt u QRS
LA: Kch thc nh tri cui tm thu, o ch ln nht t thnh sau ng mch ch n thnh
sau nh tri
3.2 CC S O V SIU M TIM NGI BNH THNG

MT CT CNH C TRC DC THT
TRI:

RV: tht phi
PW: thnh sau
IVS: vch lin tht
pillier post: ct sau
LV : tht tri
aml: l ln (l trc) van 2 l
LA: nh tri
pml: l nh (l sau) van 2 l
Ao: ng mch ch
KCH THC THT TRI ( LV )
MODE TM
LVd: 37 56 mm
IVSs: 12 3mm
LVs: 27 37 mm
IVSd: 6 11mm
PWs: 15 3mm
PWd: 6 11mm
T l: vch lin tht/ thnh sau 0,9 1,2
KCH THC THT PHI (RV) MODE
TM
(NG CT CNH C TRI TRC
DC)
RVd (tm trng) 9 26mm
RVs (tm thu) 24mm
KCH THC THT PHI ECHO 2D
(MT CT T MM, 4 BUNG)
Trc di tht phi tm trng (RVd): 80mm
Trc ngn tht phi tm trng: 33mm
Din tch tht phi tm thu (RVs): 10.9 cm2
Din tch tht phi tm trng (RVd): 20,1 cm2
T l tht phi / tht tri: 1/3
KCH THC NH TRI (LA) MODE TM
(MT CT CNH C TRC DC)
Nh tri: 25 45mm (20 tui)
Nh tri: 30 45mm (80 tui)
T l nh tri/ng mch ch: 1,1
KCH THC GC NG MCH CH
(AO) V M VAN SIGMA (OS)
Ao < 42 mm nam
Ao < 35 mm n
Os: 19mm
3.3 NH GI CHC NNG THT TRI CHC NNG TM THU

Phn sut rt ngn tm thu ca tht tri (FS)

Dtd: ng knh cui tm trng
Dts: ng knh cui tm thu
Bnh thng = 36 6%
Tc rt ngn trung bnh theo chu vi ca c
tim (VCF)

ET: Thi gian tng mu
(thi gian m van ng mch ch)
BT = 1,2 0,1 circonf/giy
nh gi th tch tm tht (cng thc Teicholz)
V= 7D
3
/2,4 + D
Vtd = 70 10 ml/m
2
(th tch cui tm trng)
Vts = 25 5 ml/m
2
(th tch cui tm thu)
VES = Vtd Vts (th tch tng mu tm thu)
Phn sut tng mu tht tri (EF)

BT 60%
Vtd: th tch cui tm trng
Vts: th tch cui tm thu
KHI LNG THT TRI: LVM
(DEVEREUX)
Bnh thng (Devereux):
LVM = 176 45g (nam)
LVM = 121 40g (n)
Ph i tht
LVMI > 134g/m
2
(nam)
LVMI > 110g/m
2
(n)
LVMI: ch s khi lng c tht tri

Dtd: ng knh cui tm trng
3.4 NH GI CHC NNG THT TRI: CHC NNG TM TRNG

PHN LOI THEO APPLETON

Cc dng khc nhau ca ph Doppler dng chy
qua van 2 l
AoC: ng van ng mch ch
IVR: th gin ng th tch
Tahoma'>OM: m van 2 l
E: vn tc ti a y nhanh
A: vn tc ti a nh thu
MC: ng van 2 l
Type 1:
E/A < 1 + trin xung sng E chm li
Thi gian th gin ng th tch ko di (lm gia
tng s ng gp ca nh trong giai on y
tm trng) = Ri lon th gin tht tri
Type 2:
E/A > 1 + trin xung sng E rt ngn
Thi gian th gin ng th tch rt ngn:
dng siu bnh thng
= bnh c tim hn ch

Ri lon s n hi tht tri
Type 3: (bnh thng)
E/A > 1 + trin xung sng E bnh thng
Thi gian th gin ng th tch bnh thng
(khong 95ms)
LVM (Penn) = 1,04 x lang=VI [ (td + IVS + PW)3 (Dtd)3] 13,6
LVM (ASE) = 0,8 x 1,04 x [(Dtd +IVS + PW)3 (Dtd)3] + 0,6

3.5 H VAN 2 L KHO ST DNG 2 L (DOPPLER XUNG)

Vn tc u tm trng (sng E) ln hn 1,5m/s
gi h van 2 l nng

T L VTI (Velocity Time Infegral)
VTI = din tch pha di ng biu din vn
tc dng mu qua van 2 l.
m: van 2 l
Ao: van ng mch ch

T l > 1,3: H lang=VI hai l nng
KHO ST LUNG MU TRO NGC
Doppler xung: Kho st chnh xc tan ca
dng h bng cch o in tch dng h trong
nh tri

1: H hai l nh
2: H hai l va
3: H hai l trung bnh
4: H hai l nhiu
SIU M QUA THC QUN
ng knh dng pht ngc ti gc (D)
1: D < 6mm
2 v 3: D = 6 8mm
4: D > 8 10mm
Din tch dng pht ngc
1: 1,5 4cm
2

2 v 3: 4 7cm
2

4: > 7 cm
2

3.6 HP VAN 2 L NH GI HP 2 L BNG CCH TNH CHNH P TRUNG BNH

S bin dng 4 cnh ca ng biu din vn
tc qua van 2 l (my t tnh sau khi v dc theo
cc cnh ca dng qua van 2 l)

NH GI HP 2 L BNG CNG THC
HATLE

PHT (Pressure Half Time): thi gian gim
chnh p
NH GI HP VAN 2 L BNG
PHNG TRNH LIN TC

SAo: din tch gc ng mch ch
MVA: din tch van 2 l
VTI: tng din tch di ng biu din vn tc
MVA < 1cm
2
: Hp rt kht
MVA: 1 1,5cm
2
: Hp kht
MVA> 1,5cm
2
: Hp va
3.7 HP VAN NG MCH CH CHNH P TRUNG BNH THT TRI NG MCH
CH (DOPPLER LIN TC)

nh gi chnh lch qua van ng mch ch
bng nh lut Bermouilli
P
2
-P
1
= 4 x V
2

G > 50 mmHg: Hp kht van ng mch ch

NH GI DIN TCH L VAN NG
MCH CH
Dng phng trnh lin tc p dng cho hnh tr,
lu lng chy vo bng vi lu lng chy ra
Q1 = S1 x V1 = S2 x V2 = Q2

S1: Din tch bung tng tht tri (din tch di
van ng mch ch)
V1: Vn tc trong bung tng tht tri (Vmax
hoc VTI)
S2: Din tch van ng mch ch cn tnh
V2: Vn tc dng mu ti ch hp ng mch
ch
Hp kht van ng mch ch:din tch < 0,75cm
2

3.8 H VAN NG MCH CH O NG KNH DNG H TI GC

o ng knh h ch bng TM mu (cnh
c trc dc)
1: ng knh < 8mm
2: ng knh 8 11mm
3: ng knh 12 15mm
4: ng knh > 15mm

O BNG PH DOPPLER LIN TC
o bng PHT (thi gian gim chnh
p) ca dng h ch
PHT > 400 ms => I hay II
PHT < 400 ms => III hay IV

Theo Scheubi
I: 470 90 ms
II: 370 70ms
III: 250 80ms
IV: 140 30ms
DNG TI EO NG MCH CH
t Doppler xung ti ng mch ch xung
on di eo
Vtd= vn tc cui tm trng
Vs= vn tc tm thu
Vs > 0,2 m/s: h ch 3 hay 4
Vtd/Vs VTId/VTIs
I 0 <20%
II 1-10% 20-39%
III 11-20% 40-59%
IV >20% >60%


3.9 TNH P LC NG MCH PHI

PAPs= p lc ng mch phi tm thu
PAPd= p lc ng mch phi tm trng

O P LC NG MCH PHI (PAP)
BNG DNG H 3 L
PAPs = (4 x V
2
) + P
RA

V= Vn tc ti a dng h 3 l
P
RA
= p lc nh phi: trung bnh 10 mmHg
(nhng thay i theo bnh cnh lm sng: c th
20 mmHg trong trng hp h 3 l nng)
O P LC NG MCH PHI BNG
DNG H PHI
PAPs = (3 xPAPm) (2 x PAPd)
PAPm = p lc ng mch phi trung bnh
= (4 x V proto
2
) + 10mmHg
PAPd = p lc ng mch phi tm trng
= (4 x V tl
2
) + 10 mmHg

4 CH S HUYT NG HC
P LC
Bnh thng
Nh phi (mmHg) 5/0
Tht phi (mmHg) 30/5
ng mch phi (mmHg) 10
Cung lng tim (l/pht) 5 6
CH S V KHNG LC
Bnh thng
C.I.: ch s tim (l/pht/m
2
) 3 5
S.I.: ch s tm thu (ml/m
2
) 50
Khng lc mch mu h thng
(dynes/sec/cm
-5
)
960 1300
Khng lc ng mch phi
(dynes/sec/cm
-5
)
200 300
BO HO O2
Tnh mch ch trn 74%
Tnh mch ch di 78%
Tht tri nh tri 97%
Tht phi ng mch phi 76%
5 Mch mu
1. ng mch vnh T
2. ng mch vnh P
3. Phn loi cc on mch vnh theo hip hi tim mch Hoa K
4. Phn loi cc tn thng mch vnh theo hip hi tim mch Hoa K
5. Phn loi dng mu mch vnh
5.1 NG MCH VNH T
Theo nhm cc thm d chc nng v chp mch mu ca SFC 1978
01. Thn chung ng mch vnh T 07. Nhnh cho th 1
02. Nhnh lin tht trc on gn 08. Nhnh cho th 2
03. Nhnh lin tht trc on gia 09. Nhnh vch th lang=VI 1
04. Nhnh lin tht trc on xa 010. Cc nhnh vch
05. Nhnh ng mch vnh m 011. Cc nhnh tm nh ca ng mch ch
06. Nhnh ng mch b T 012. Nhnh ng mch b th 2

T th chp chch sau

T th chp chch trc T 55
o

T th chp chch trc P 30
o

T th chp ngang

T th chp ch

5.2 NG MCH VNH P
1. on u (nm ngang) ca ng mch vnh P 7. ng mch nt xoang
2. on 2 (nm dc) ca ng mch vnh P 8. ng mch b P
3. on 3 (nm ngang) ca ng mch vnh P 9. ng mch tht P
4. ng mch lin tht sau 10. ng mch nt nh tht
5. ng mch qut ngc tht 11. ng mch c honh
6. ng mch chp 12. Cc nhnh vch di

T th chch trc P 45
o

T th chch trc T 45
o

5.3 PHN LOI CC ON MCH VNH THEO HIP HI TIM MCH HOA K

ng mch vnh P

T th chch trc T 45
o

ng mch vnh T

T th chch trc P 45
o

5.4 PHN LOI CC TN THNG MCH VNH THEO HIP HI TIM MCH HOA K

TYPE C:
Di > TN THNG TYPE A:
o Ngn < 10mm
o ng tm
o D i ti c tn thng
o Tn thng khng gp gc (< 45
o
)
o B trn lng
o t hoc khng vi ho.
o Khng tc hon ton
o Tn thng xa l xut pht
o Khng c nhnh bng h quan trng
ch ng mch b hp
o Khng c huyt khi
TN THNG TYPE B:
o Di 10 - 20 mm
o Lch tm
o on mch mu trc tn thng ch
ngon ngoo va phi
o Tn thng khng gp gc trung bnh
(>45
o
v <90
o
)
o B khng u
o Vi ho trung bnh
o Tc hon ton < 3 thng
o Nm ch l xut pht
o Nm ch chia nhnh, cn phi lm k
thut dy dn i
o Huyt khi lng mch vnh
o B1: ch 1 tiu chun nhm B
o B2: t nht 2 tiu chun nhm B
o TN THNG 20mm
o on mch mu trc tn thng rt
ngon ngoo
o Tn thng gp gc nhiu (> 90
o
)
o Tc hon ton > 3 thng
o Khng th bo v cc nhnh bng h
chnh
o Tn thng trn ming ghp tnh mch
vi tn thng d v.
5.5 PHN LOI DNG MU MCH VNH
(TIU SI HUYT TRONG TH NGHIM NMTC)
TIMI 0 khng h c dng mu ngang qua ch b tc
TIMI I c cht cn quang ngang ch hp nhng khng ngm thuc hon ton vng h lu
TIMI II cht cn quang i qua c ch hp, ngm thuc hon ton h lu, tc tho lu thuc
chm
TIMI III cht cn quang qua ch hp tt, ngm thuc hon ton h lu, tc tho lu thuc khng b
chm
6 M S CC MY TO NHP TIM M s chung NASPE/BPEG (NBG)

Ch th 1 bung tim c kch thch

0: khng c bung tim no
A: tm nh
V: tm tht
D: 2 bung (tm nh & tm tht)
Ch th 2 bung tim c nhn cm

0: khng c bung tim no
A: tm nh
V: tm tht
D: 2 bung (tm nh & tm tht)
Ch th 3 Cch p ng

0: khng c
T: khi pht
I: c ch
D: c 2 (va khi pht + c ch)
Ch th 4 chng trnh thch ng nhp
0: khng c
P: chng trnh n gin
M: nhiu chng trnh
C: o t xa
R: thch ng nhp
Ch th 5 chc nng chng nhp nhanh
B: hng lot (BURST)
N: tn s bnh thng
S: r sot
E: kim sot t bn ngoi

7. TIU HO
GI TR BNH THNG CA CC XT NGHIM CHC NNG GAN
Xt nghim Gii hn bnh
thng
Bt
thng
Nguyn nhn gy bt thng
Bilirubin ton phn/
huyt thanh (hth)
5 17 mol/l Tng Tng bilirubin khng lin hp (ester ton phn).
do tng to (vd: tn huyt) hoc do gim kh
nng lin hp.
Bilirubin ester/hth < 6 mol/l Tng bilirubin ester do bnh nhu m gan hoc
tc mt ngoi gan
Bilirubin niu (-) (-) hoc
tng
Kt qu (-): tng bilirubin khng lin hp trong
mu
Kt qu (+): hu ht cc nguyn nhn khc gy
vng da
Aspartatet
aminotransferase/hth
(AST)
5 40 IU/L
(37
o
C)
Tng Nhiu loi bnh gan, nhi mu c tim, bnh c
Alnine amino
transferase/hth (ALT)
5 40 IU/l Tng Bnh gan
Alkaline
phosphatase/hth
30 110 IU/l
tui tr con v
tui dy th th cc
tr s ny s cao
hn
Tng Bnh gan c bit l c tc nghn ng mt
Bnh xng bnh Pagets, nhuyn xng, mt
s tn thng xng th pht hoc cng tuyt
cn gip
Ph n c thai
5 nucleotidase/hth 1 15 IU/l
(37
o
C)
Tng Bnh gan c bit l c tc mt. Thng c
dng xc nhn tnh trng phosphatase kim
cao l c ngun gc t gan (khng cn nu c
alkaline phosphatase isoenzyme).
g - glutamyl
transferase/hth
Nam :065IU/L
N: 0-40 IU/L
Tng
(37
o
C)
Hu ht cc loi bnh gan
Nghin ru lu ngy, vim tu cp, nhi mu
c tim, tiu ng, cc thuc to ra enzyme
Albumin/hth 35 50 g/l Gim Tn thng gan lan rng, hi chng thn h,
bnh l ng tiu ho, tnh trng dch (c th
l bin chng ca bnh gan).
Caeruloplasmin/hth 270 370 mg/l Gim Bnh Wilson
Mt s ri lon khc v gan
ng ton phn/ hth 13 -21 mol/l Gim Bnh Wilson
ng/nc tiu 24h 0 0,4 mol/24h Tng Bnh Wilson
Thi gian
prothrombin (PT)
PT: 10 14 giy Tng Bnh gan
Thi gian
Thromboplastin tng
phn (PTT)
PTT: 32 42 giy Tng Thiu vitamin K c iu chnh sau 3 ngy
iu tr tr khi s tng hp b gim v tn
thng t bo gan
Ri lon di truyn v c ch ng mu
Cc gii hn ca tr s c th thay i cc phng xt nghim khc nhau.

8. THN HC
TNG PHN TCH NC TIU
Cht c phn tch Gii hn n v Kt qu Yu cu Cht bo
qun
Albumin (vi th) <15 Mg/l <24h Mu ngu nhin Khng c
T l
albumine/creatinine
<3.5 Mg/mmol <24h Cho chc nng
thn bnh thng

Albuminium <1.0 mol/l Khi yu cu Tip xc phng xt
nghim
Cht bo
qun c
bit
Albuminium (nc) <1.0 mol/l Khi yu cu Tip xc phng xt
nghim
Cht bo
qun c
bit
Amino acids Khi yu cu Tip xc phng xt
nghim
Hibitane
Aminolaevulinic acid
(ALA)
<40 mol/24h <14ngy Nc tiu 24h,
trnh nh sng
Khng c
Ampheatamines Khng pht
hin thy
<72h Mu th ti mi,
1 phn ca xt
nghim tm sot,
pht hin cht gy
nghin
Khng c
Amylase 80 575 U/24h <24h Hibitane
Barbiturates Khng pht
hin thy
<72h Mu th mi ti Khng c
Bence Jones protein Khng pht
hin thy
Khi yu cu Mu th lc sng
sm Gi ng
thi mu nc tiu
v huyt thanh
Khng c
Benzodiazepines Khng pht
hin thy
<72h Mu ti mi, 1
phn ca xt
nghim tm sot,
pht hin cht gy
nghin
Khng c
Bilirubin Khng pht
hin thy
Khi n ni Mu th ti mi Khng c
Cc th nghim v
xng
Khi yu cu Tip xc vi phng
xt nghim
Khng c
C-Amp
(c ngun gc thn)
26 66 (8
30)
Nmol/GF Khi yu cu Gi cng lc mu
mu v mu nc
tiu ly trong 2 gi
Hibitane
Cadmium <0.15 Mmol/24h Khi yu cu Khi yu cu tip
xc t 4240
Cht bo
qun c
bit
Calcium 2.5 7.5 Mmol/24h <24h Khi thu nhp
calcium bnh
thng
Hibitane
T l calcium/creatinine 0.0 0.7 Mmol/mmol <24h Vi chc nng thn
bnh thng
Hibitane
Phn tch si Khi yu
cu
Tip xc vi phng
xt nghim bit
thm thng tin
Khng c
Canabinoids Khng pht
hin thy
<72h Mu th ti mi,
1 phn ca xt
nghim tm sot,
pht hin cht gy
nghin
Khng c
Catecholamines 14 ngy Cht bo qun
sulphuric acid
Cht bo
qun c
bit
Noradrealine 120 590 Nmol/24h
Adrenaline 30 -190 Nmol/24h
Dopamine 650 3270 Nmol/24h
Citrate 1.0 5.0 Nmol/24h Khi yu cu Chuyn n phng
xt nghim ngay
lp tc
Hibitane
Cht chuyn ho cocaine Khng pht
hin thy
<72h Mu th ti mi,
1 phn ca xt
nghim tm sot,
pht hin cht gy
nghin
Khng c
ng 0.1 Mmol/l Khi yu cu Khng c
Corproporphyrin <246 Mmol/24h Khi yu cu Khng c
Cortisol <350 Nmol/24h <7 ngy Hibitane
T l cortisoll/creatinine <25 Nmol/nmol <7 ngy Vi chc nng thn
bnh thng
Hibitane
Creatinine 9 18 Mmol/24h <24h T l vi kch
thc c th
Hibitane
Cystine <250 mol/24h Khi yu cu Hibitane
T l Deoxypyridinoline/
creatinine
0.4 6.4 Nmol/mmol Khi yu cu Ly mu nc tiu
sng sau khi nhn
i 2 gi, b nc
tiu qua m
Khng c
Thuc pht hin cht gy
nghin
<72 Mu th ti mi Khng c
Glucose Khng thy <24h Mu th ngu
nhin
Khng c
Haemoglobin Khng thy <24h Mu th ngu
nhin
Khng c
Homocystine Khng thy Khi cn Tip xc vi phng
xt nghim
Hibitane
Homogentisic acid Khng thy Khi n ni Mu th ti mi,
chuyn ngay n
phng xt nghim
Hibitane
Hydroxy indole acetic <50 mol/24h <7 ngy Cht bo qun
sulphuric acid
Cht bo
qun c
bit
Acid (5-HIAA)
hydroxyproline
115 270 mol/24h <14 ngy Hn ch n ung Hibitane
T l
Hydroxyproline/creatinin
e
<40 Mmol/mmol <14 ngy Phi bo m chc
nng thn bnh
thng
Hibitane
Indican Khng thy Khi n ni Mu th mi,
chuyn ngay n
phng xt nghim
Khng c
St <0.5 mol/24h Khi yu cu Tip xc vi phng
xt nghim
Cht bo
qun chuyn
bit
Ketones Khng thy Khi n ni Mu th ngu
nhin
Khng c
Laxative abuse Khng thy Khi yu cu Mu th mi Khng c
Ch <0.54 mol/l Khi yu cu Tip xc vi phng
xt nghim
Cht bo
qun chuyn
bit
Magnesium 3.0 5.0 Mmol/24h Khi yu cu
Manganese <182 Nmol/l Khi yu cu Tip xc vi phng
xt nghim
Cht bo
qun chuyn
bit
Thu ngn <32 Nmol/24h Khi yu cu Tip xc vi phng
xt nghim
Cht bo
qun c
bit
Methadone Khng thy <72h Mu th mi, mt
phn ca xt
nghim tm sot
pht hin cht gy
nghin
Khng c
Myoglobin Khng thy Khi n ni Mu ngu nhin Khng c
Nitrogen 10 15 g/24h Khi yu cu Thay i theo
lng n vo
Khng c
nh gi v dinh dng Khi yu cu Tip xc vi phng
xt nghim
Hibitane
Thuc phin Khng thy <72h Mu th mi, mt
phn ca xt
nghim tm sot
pht hin cht gy
nghin
Khng c
p sut thm thu 250 750 Mosmol/kg
H
2
O
<24h Khng c
Oxalate <500 mol/24h <14 ngy Nu tng, i km
vi tng tn sut
to si
Hibitane
T l T/K Thiu tu <20
Pht hin paraquat Khng thy Khi n ni Mu ngu nhin Khng c
Pht hin
Phaeochromocytoma
<14 ngy Cht bo qun acid
sulphuric
Tip xc vi phng
xt nghim
Cht bo
qun chuyn
bit
Phenolphthalein Khng thy <24h Mu ngu nhin Khng c
Phosphate Mmol/24h <24h Thay i theo
lng n vo
Hibitane
Porphobilinogen <16 mol/24h <14 ngy Nc tiu 24h, Khng c
trnh nh sng
Pht hin porphyrin Khng thy <24h Mu th mi, trnh
nh sng
Khng c
Kali 25 -100 mol/24h <24h Hibitane
Th thai Dng
tnh/m tnh
Mu nc tiu lc
sng sm
Khng c
Protein <0.15 g/24h <24h Hibitane
T l
Pyridinoline/creatinine
5.0 21.8 Nmol/mmol Khi yu cu Mu nhn i 2h,
mu th hai sau
bui sng, b nc
tiu qua m
Khng c
Pyrophosphate <130 mol/24h Khi yu cu Hibitane
Hnh dng si thn Khi yu cu Tip xc phng xt
nghim
Hibitane
Selenium ,1.3 mol/l Khi yu cu Thay i theo
lng n vo, tip
xc vi phng xt
nghim
Khng c
Natri 130 - 220 Mmol/24h <24h Hibitane
Nguyn t gy c Khi yu cu Tip xc phng xt
nghim
Cht bo
qun chuyn
bit
Cc nguyn t c s
lng rt nh
Khi yu cu Tip xc phng xt
nghim
Cht bo
qun chuyn
bit
U v E <24h Tip xc phng
xt nghim
Hibitane
Urea 250 500 Mmol/24h <24h Thay i theo
lng n vo
Hibitane
Acid uric Mmol/24h <24h Thay i theo
lng n vo
Hibitane
Urobilinogen Khng thy <24h Mu th mi Khng c
Xylose >8 Mmol/5h Khi yu cu Ly nc tiu 5h
sau mt liu 5g
Khng c
CC GI TR BNH THNG TRONG THN HC
Gii hn n v
Huyt tng
Sodium* 135-145 mmol/l
Potassium* 3.5-5.0 mmol/l
Chloride* 96-106 mmol/l
Bicarbonate* 23-29 mmol/l
Ammonium** phi nam 34-58 mol/l
phi n 17-51 mol/l
Urea*** 2.5-7.0 mmol/l
2.9-8.9 mmol/l
2.0-4.2 mmol/l
creatinine** 60-130 mol/l
18-64 mol/l
Urate*** phi nam 0.15-0.42 mmol/l
phi n 0.12-0.39 mmol/l
Base*** 145-148 mmol/l
Nng thm thu 280-295 mosmol/kg
Huyt thanh
Calcium ton phn* 2.12-2.61 mmol/l
Calci ion ho * 1.14-1.30 mmol/l
Phosphate v c ** 0.8-1.4 mmol/l
Protein ton phn* 60-80 g/l
Albumin* 35-50 g/l
Globulin 20-40 g/l
IgG** 9.5-16.5 g/l
IgA** 0.9-4.5 g/l
IgM 0.6-2.0 g/l
Sulphate 50-150 mol/l
C3 0.94-2.14 g/l
C4* 0.16-0.5 g/l
Aluminium*** 0.07-0.55 mol/l
Bi tit ra nc tiu 24h
Protein* ti a l 200 mg
Albumin* ti a l 50 mg
Calcium*** 2.5-7.5 mmol
Oxalate*** 0.22-0.44 mmol
Cystine** 0.04-0.42 mmol
Tc lc cu thn v cc xt nghim chc nng thn khc
GFR** Nam tui 20 117-170 ml/pht/1.73m2
tui 50 96-138 ml/pht/1.73m2
tui 70 70-110 ml/pht/1.73m2
N tui 20 104-158 ml/pht/1.73m2
tui 50 90-130 ml/pht/1.73m2
tui 70 74-114 ml/pht/1.73m2
c thai cao thm khong 20 %
Nng nc tiu ti a >800 mosmol/kg
pH nc tiu ti thiu <5.3
*: Thay i cht t theo tui, pht tnh, ch n v kch thc c th; chng ta c th s dng nhng gi
tr bnh thng c cng b v nn nh thuc lng mt s gi tr trong .
**: Thay i theo phi tnh, tui hoc kch thc c th. Cc gii hn cn chia theo nhm hoc iu chnh
theo kch thc c th th tt hn.
***: Thay i theo ch n; i vi cc cht ny th cc tr s c tra cu ti cc bnh vin ca bn
thng l mt hng dn tt hn bt c d kin no c cng b.
9. H HP
CHC NNG PHI: TR CON
Tr trai v gi 2-15 tui
Chiu cao
Tr trai 7-15 tui Tr gi 7-15 tui
m ft/inchs
PEFR
l/pht
FEV
1
FVC FEV
1
FVC
0.90 211 92
0.95 31 107
1.00 33 124
1.05 35 146
1.10 3.7 169 1.06 1.30 1.02 1.21
1.15 39 192 1.20 1.47 1.15 1.36
1.20 311 215 1.35 1.65 1.30 1.52
1.25 41 238 1.51 1.84 1.45 1.69
1.30 43 260 1.68 2.05 1.61 1.88
1.35 45 283 1.86 2.27 1.79 2.07
1.40 47 306 2.06 2.51 1.97 2.28
1.45 49 329 2.27 2.76 2.17 2.49
1.50 411 352 2.50 3.02 2.38 2.73
1.55 51 374 2.73 3.31 2.61 2.97
1.60 53 397 2.99 3.61 2.84 3.23
1.65 55 419 3.25 3.92 3.09 3.50
1.70 57 442 3.53 4.25 3.35 3.78
1.75 59 465 3.83 4.60 3.63 4.08
1.80 511 488 4.14 4.97 3.92 4.39

PEFR: Tc nh ca dng ca dng khi th ra.
PEV: th tch th ra gng sc trong 1 giy.
FVC: dung tch sng gng sc.
CHC NNG PHI NGI LN
Nam N
Th tch th ra gng sc trong 1 giy (FEV
1
) 3.51.51 2.51.01
Dung tch sng gng sc (FVC) 4.51.51 3.51.01
Lu lng th ra gng sc (FEF) 4.30.51 l/giy 3.484.7 l/giy
Tc nh ca dng kh th ra (PEFR) 550150 l/pht 400100 l/pht
NHNG C TRNG TRONG CC RI LON V PHI IN HNH
Ri lon Dung tch
sng *
Th tch
th ra
gng sc
Gng
sc**
Th tch
d tr*
Dung tch
khuyt tn
CO***
PO
2
ng
mch
(mmHg)
PCO
2

ng mch
(mmHg)
Bnh
thng
>80 >75 >80 80-120 25-30 80-100 38-42
Cc ri lon hn ch
Nh 60-80 >75 >80 80-120 E 80-100 38-42
Trung
bnh
50-60 >75 >80 70-80 R
Nng 35-50 >75 60-80 60-70
Rt nng <35 >75 <60 <60
Cc ri lon tc nghn
Nh >80 60-75 65-80 120-150 25-30 E 38-42
Trung
bnh
>80 40-60 45-65 150-175 25-30
Nng <40 30-45 >200 E
Rt nng <40 <30 >200 R

E: gng sc
R: ngh
*: % tin on
**: % dung tch sng
***: ml/pht/mmHg gi tr chnh (gi hi th 10 giy)
10 iu tr bng dch truyn trong tnh trng mt nc
1. iu tr bng dch truyn trong tnh trng mt nc
2. Nguyn tc bi hon in gii
3. Dch truyn v thuc (ng tnh mch) thng c dng
4. K thut truyn tnh mch
5. Dch truyn tnh mch - nng cht in gii
6. S milimol ca mi Ion trong 1g mui
7. Thnh phn in gii trong dch tit s dng ng tiu ha
8. Lu lng - vn tc/ thi gian truyn
9. S truyn mu: cc nhm mu
10. S truyn mu: kho st cc xt nghim
10.1 IU TR BNG DCH TRUYN TRONG TNH TRNG MT NC

nh gi lm sng Xt nghim cn lm sng b sung
Mt th tch Du hiu mt nc PCV
Du hiu shock u khuyt
Cc thay i thm thu Tng natri mu
Tnh trng kch thch
Da th nhm Na
+
huyt tng
Tun hon tng i tt thm thu huyt tng
Gim natri mu Natri huyt tng
Shock
Huyt p thp
thm thu huyt tng (nu
thm thu nc tiu cao ngh
n s tit ADH bt hp)
Toan kim Th nhanh v su Kh mu, pH mu, bicarbonate
Th nhanh HCO3/mu
Mt Kali ni bo Mt mi K
+
huyt tng
Nhc c Thay i ECG phn nh nng
trong huyt tng
H Calci huyt Tnh kch thch thn kinh c Lng calcium ton phn trong
huyt tng khng phi l 1
hng dn tt, calcium ion ho
mi phn nh tht, thay i ECG
gip thm cho chun on
H ng huyt Ng g ng huyt
Hn m
Co git
10.2 NGUYN TC BI HON IN GII
NGUYN TC
Nhu cu dch ton phn = lng duy tr + 0.2 normal saline trong 4,3% glucose + KCl + lng thiu +
normal saline + KCl + lng ang tip tc mt normal saline
+ KCl


THC HNH
0 1/2h iu tr chong ngay lp tc Huyt tng hoc normal saline
20ml/kg cn nng c th
-4h Kh u bi hon (ch kt qu
ion huyt thanh)
0.5 normal saline hoc normal
saline 10ml/kg/gi
4-24h Tip tc bi hon:
Nu Natri huyt thanh <
150mmol/l
0.2 normal saline trong Dextrose
4.3% + KCl 30-40 mmol/l v
iu chnh ton b trong 24gi
Nu Natri huyt thanh >
150mmol/l
0.2 normal saline trong Dextrose
4.3% +KCl 30-40 mmol/l
Gii hn dch 150 ml/kg trong
24gi u v iu chnh phn cn
li trong 48h.
10.3 DCH TRUYN V THUC (NG TNH MCH) THNG C DNG
Nng (mmol/l) Nng lng Dung dch
Na Cl K Ca Bic Glucose (Cal/l)
Dch truyn tnh mch
Mui ng trng (NaCl 0.9%) 150 150 - - - - -
mui ng trng + Dextrose
(NaCl 0.45% + Dextrose 5%
77 77 - - - 28 180
1/5 mui ng trng + Dextrose
(NaCl 0.18% + Dextrose 4%)
30 30 - - - 22.4 150
dung dch Hartmann
(1/2 Hartmann
60 56 3 1 14 - -
dd Hartmann + Destrose
(1/2 Hartmann + Dextrose 5%)
66 56 3 1 14 28 180
Thuc ng tnh mch
Dung dch bicarbonate natri 8,4% = 1 ml c cha 1mmol bicarbonate natri
Dung dch clorure kali 20% = 5ml c cha 13 mmol K (=1g)
Dung dch gluconate calci 10% 10ml c cha 2,25 mmol Ca
2+

10.4 K THUT TRUYN TNH MCH
CN BNG DCH BNH THNG
Nhp Th tch (ml) Xut Th tch (ml)
Dch ung vo 1500 Phn 200
Nc mt khng nhn
bit c

Nc t thc n c 600 T phi 400
Nc t s oxy ho
(20ml/420 J)
300 T da 400
M hi 200
Nc tiu 1200
Tng cng 2400 Tng cng 2400
10.5 DCH TRUYN TNH MCH NNG CHT IN GII
Mmol/l Truyn tnh mch
Na
+
K
+
HCO
3-
Cl
-
Ca
2+

Gi tr bnh thng trong huyt tng 142 4.5 26 103 2.5
Clorure natri 0.9% 150 - - 150 -
Phc hp dactate natri (ca Hartmann) 131 5 29 111 2
Clorure natri 0.18% v glucose 4% 30 - - 30 -
Clorure kali 0,3% v glucose 5% - 40 - 40 -
Clorure kali 0,3% v clorure natri 0,9% 150 40 - 190 -
iu chnh toan chuyn ho
Bicarbonate natri 1,26% 150 - 150 - -
Bicarbonate natri 8,4% cho tnh trng ngng tim 1000 - 1000 - -
Dactate natri (M/6) 167 - 167 - -
10.6 S MILIMOL CA MI ION TRONG 1G MUI
Cht in gii mmol/g
Clorure ammonium 18,7
Clorure Calci (CaCl
2
.2H
2
O) Ca=6,8 Cl=13,6
Bicarbonate kali 10
Clorure kali 13,4
Bicarbonate natri 11,9
Clorure natri 17,1
Lactate natri 8,9

10.7 THNH PHN IN GII TRONG DCH TIT S DNG NG TIU HO
mmol/l Loi dch tit
H
+
Na
+
K
+
HCO
3-
Cl
-

Dch da dy 40-60 20-80 5-20 - 100-150
Dch mt - 120-140 5-15 30-50 80-120
Dch tu - 120-140 5-15 70-110 40-80
Dch rut - 120-140 5-15 20-40 90-130
Phn, cht i ra hoc cht ht vo phi c gi li v phn tch ni no c th c nu ngh n s mt
i bt thng. ni no iu ny khng thc hin c th nhng phng on ny c th gip ch cho k
hoch iu tr bi hon dch.
10.8 LU LNG VN TC/ THI GIAN TRUYN
Cng thc tnh ton

10.9 S TRUYN MU: CC NHM MU
Hng cu Huyt thanh Nhm Tn sut %
(ngi da
trng
c truyn
t ngi cho
l
B ngng
kt bi
huyt thanh
ca
nhm
Cha khng
nguyn gy
ngng kt
Ngng kt
cc t bo
ca ca
Cha khng
th gy
ngng kt
AB 5 A,B,AB,O O,A,B A,B Khng Khng
A 40 A hoc O O,B A AB,B B
B 110 B hoc O O,A B AB,A A
O 45 O Khng Khng AB,A,B A,B
Rh
+
86 Rh
+
hoc Rh
-

Rh
-
14 Rh
-

1. nh hng ca huyt thanh bnh nhn ln hng cu ngi cho l quan trng khng c s ngc li
2. Mu ca ngi cho c xt nghim phn ng trc tip vi huyt thanh ca bnh nhn v s tng hp
v vi huyt thanh ca cc nhm mu A v nhm mu B
3. Trong trng hp khn cp ch c mu nhm O, Rh(-) l c th dng c
10.10 S TRUYN MU: KHO ST CC XT NGHIM
Nhng mu mu c dn nhn khng hoc khng ng s khng c chp nhn Ghi y l iu
tuyt i cn thit
Kho st Kt qu Mu
Nhm v huyt thanh d tr / phn ng
cho
- C th lm trn 1 mu mu ng 10ml, ng
nghim truyn mu chuyn bit cho 1
mu th nh vo lithium heparin nu bnh
nhn c iu tr vi heparin
Nhn khng th gy ngng kt lnh Tham vn phng xt nghim
Xt nghim Coombs trc tip m tnh Mu EDTA
Gim st phn ng truyn Tham vn phng xt nghim. Ngi cho
mu phi c tr li phng xt nghim
cng vi mu EDTA v mt mu mu ng
10ml, ng nghim truyn mu chuyn bit
Khng th khng tiu cu m tnh Tham vn phng xt nghim
11 Huyt hc
1. Huyt hc
2. Gi tr bnh thng ca mu

11. HUYT HC
Th nghim Gii hn n v ng nghim*
Cng thc mu z
Hb: Haemoglobin Nam 12.5 18.0 g/dl z
N 11.5-16.0 g/dl z
HC: Hng cu Nam 4.50-6.00 10
12
/l z
N 3.60-5.60 10
12
/l z
MCV: Th tch t bo (TB) trung
bnh (trb)
80.0-100.0 Fl z
MCH: Heamoglobin t bo trung
bnh
28.0-33.0 Pg z
MCHC: Nng Hb t bo trung
bnh
33.0-36.0 g/dl z
RDW: Phn b hng cu 11.0-15.0% z
PLTS: Tiu cu 150-400 10
9
/l z
MPV: Th tch tiu cu trung bnh 7.0-11.0 fl z
WBC: Cng thc bch cu 3.5-11.0 10
9
/l z
NEUT: Bch cu trung bnh 2.0-7.5 10
9
/l z
LYMPH: Lympho bo 1.0-3.5 10
9
/l z
MONO: Bch cu n nhn 0.2-0.8 10
9
/l z
EOSIN: Bch cu i toan 0.0-0.4 10
9
/l z
BASO: Bch cu i kim 0.0-0.2 10
9
/l z
Retics: t bo li 10-220 10
9
/l z
Heamoglobin S m tnh z
Heamoglobin H m tnh z
Th Heinz m tnh z
K sinh trng st rt Khng z
Phosphate kim bch cu trung tnh 15-100 n v/100 TB
a nhn trung
tnh
z
Sng lc thiu st 15-55 mol/mol z
Tc mu lng (VS) Nam <10 {
N <20
mm trong 1 gi
{
Test bnh st huyt m tnh
Haptoglobins 100-300 mg/dl
nhy huyt tng 1.50-1.72 cp z
Test ly gii sucrose m tnh
Xt nghim mu ng
Test sng lc dng mu Xem phn lin quan S
INR (ch khi iu tr Wartarin) S
PT: Thi gian Prothrombin 10.6-14.9 Giy S
APTT: Thi gian Thromboplastin
bn phn hot ho
23.0-35.0 Mc iu tr heparin
1.8-3.3 ln so vi chng
Giy S
Cht nh trng D <0.25 g/ml S
Fibrinogen 1.5-3.8 g/l S
Thi gian Thrombin 10.5-15.5 Giy S
Thi gian chy mu 2.5-9.0 Pht U
Phn tch yu t tin ng mu S

Phn tch ly gii Fibrin U
Thi gian Reptilase 13.0-19.0 Giy S

Sng lc khng phospholipid S
Sng lc khng ng lupus S
Nghin cu ngng tp tiu cu U
Sng lc huyt khi S

Xt nghim t bo hc
Kt qu film v / hoc cng thc t
bo bch cu
Xem phn trn Xem phn trn z
Tu xng U
T bo nh du (marker) U
Xt nghim c bit
Vit B 12- huyt thanh 130-770 ng/l
Folate-huyt thanh 1.5-10.0 g/l
Folate-hng cu 95-570 g/l z
G.6.P.D 3.3-5.7 iu/gHb z
PK pyruvate kinase 5.7-10.9 iu/gHb z
in di hemoglobin z
Hemoglobin A2 2.2-3.3 %Hb ton phn z
Hemoglobin F Ngi ln <0.9 %Hb ton phn z
N 0.5-1.1
Methaemoglobin 0.01-0.5 g/dl z
Tnh d v khi thm lc Tin bnh 4.00-4.45 g/NaCl
Tnh d v TB trung bnh Hu bnh 4.65-5.90 g/NaCl
Th tch mu ton phn
Khi hng cu Nam 25-35
N 20-30
ml/kg-cn nng U
Th tch huyt tng 40-50 ml/kg-cn nng U

z, EDTA; { , ESR tube; , plain/serum; , Li hepatin; S , citrate; U , special tube
(contact lab).
GI TR BNH THNG CA MU
Phn tch Gii hn iu tr n v ng nghim*
1
-Acid glycoprotein 0.55-1.40 g/l
1
-antitrypsin (a1-AT) 1.1-2.3 g/l
1
-Antitrypsin phenotype
2
Macroglobulin 0.7-2.4 g/l
lang=VI CMC(c ch men
chuyn)
Nam 18-66
N 13-54
U/l
in di acetylcholinesterase (dch)
Axit phosphatse (ton b) Nam <5.0 IU/l
N <4.2
ACTH 09:00h 2.0-11.3 pmol/l z
AFP (alphafetoprotein) <2.5 MOM
AFP (dch) mg/l
AFP (cht nh du khi u) <7.0 g/l
Albumin 36-52 g/l
Cn Khng mmol/l
Aldolase <7.6 U/L
Aldosterone Nm 80-300
ng 140-850
pmol/l
ALP (Alkaline phosphatese) 35-125 U/l
ALP isonezymes
ALT (alanine aminotransferase) <35 U/l
Aluminium <1.0 umol/l
Amino acids
Amiodarone 0.5-2.0 mg/l
Ammonia 10-47 mol/l
Amylase <200 U/l
Androstenedione 3-10 nmol/l
Anion gap 10-18 mmol/l
Apo At >130 mg/dl
Apo 8 75-125 mg/dl
Apo E phenotype
Arginine vasopressin (ADH) 1.0-4.5 pmol/l
AST (Aspartate aminotransferase) <45 U/l
-Carotene 0.2-1.4 mol/l
2
-Microglobulin <2.4 mg/l
Barbiturates (sng lc) Khng pht hin
Benzodiazepine (sng lc) khng pht hin
Bicarbonate 20-30 mmol/l
Bilirubin (direct) 1-6 mol/l
Bilirubin (total) 2-17 mol/l
Bilirubin -
Blood sugar series
Bone studies
C-Amp 10-34.8 nmol/l z
C-peptide 165-993 pmol/l
C-Peptide/insulin ratio 5-10
Cadmium (whole bood) <27 nmol/l
Caeruloplasmin Nam 0.18-0.34 g/l
N 0.14-0.46
Caffeine <258 mol/l

Calcitonin <27 pmol/l
Calicum 2.20-2.60 mmol/l
Calicium (hiu chnh) 2.20-2.60 mmol/l
Calcium (dng ion) 2.20-2.60 mmol/l
Calicium profile
CAM 17.1 <39 U/l
Carbamazepine 15-50 mol/l
Carboxy-haemoglobin Khng ht thuc <2
Ht thuc <10
% U
Mem tim
Catecholamines
Noradrenaline Khi ngh 0.5-3.0 nmol/l
Adrenaline Khi ngh 0.1-0.3 nmol/l
Dopamine Khi ngh <0.1 nmol/l
CEA (carcinoembryonic antigen) <4 g/l
Chloride 99-109 mmol/l
Cholinesterase (pseudo) 620-1370 IU/l
Chromium <5 nmol/l U
Chromium (whole blood) <20 nmol/l
CK (creatine kinase) Nam 33-194
N 35-143
U/l
CK isoenzyme (CK-MB) <3%
<12 U/l
% v U/l
Clonidine
Test kch thch

Test chc nng tuyn yn kt hp
Siu phn t alpha (TSH, HCG,
LH, FSH)
<1.9 g/l
ng 12.0-25.0 mol/l
Cortisol 09:00h 140-500
24:00h 50-300
nmol/l
Creatinine 50-130 mol/l
thanh thi creatinine 85-140 ml/pht
CRP (C-reactive protein) <5 mg/l
Cyclosporin A ( mu ton b) HPLC equiv 180-350 g/l
CyA mono 200-400 g/l
Cy A poly 400-1000 g/l
Deoxycortisol <30 nmol/l

Test c ch dexamethasone (di
hoc m)

DHEAS <12 mol/l
Digoxin 1.0-2.5 nmol/l

Tnh nguy c sng lc hi chng
Down

Erythropoietin <50 U/l
Ferritin Nam 19-300
N 17-165
g/l
Fructosamine <285 mol/l
ESH Xem trn

-Glutamyl transferase (GGT) Nam < 50 U/l
N <35
Gastrin 10-90 ng/l
Globunlin 22-32 g/l
Glucagon 0-100 pmol/l
Glucose 3.5-5.5 (i) mmol/l
Glucose (CSF) mmol/l
Test dung np glucose (GTT)
Glutathione peroxidase

77-126 U/g Hb
Glycated haemoglobin
(heamoglobin A
1C
)
Khng tiu ng 4.0-6.0 %
Kim sot tt 6.0-8.0 %

Kim sot km > 8.0 %
Gonadotrophin releasing hormone
test (GnRH test)

Growth hormone (GH) mU/l
GTT U
Hormon rut
Haptoglobin 0.3-2.1 g/l
HCG- <10 U/l
Hydroxyprogesterone (17) Ngi ln <12
S sinh thng >48 gi
<20
nmol/l
Sng lc n
Sng lc nam
Insulin mU/I
T l Insulin/glucose >4.5 u tu (glu<2.2) <14 ngy
T khng th insulin
nulin tolerance test (ITT)
Yu t tng trng 1 ging insulin
(IGF-1)
10-50 nmol/l
Interleukin-6 <12.5 pg/ml
Nghin cu v st
St 13-32 mol/l
Kh nng gn st 45-70 mol/l

%Bo ho 20-55 %
ITT ca hormon tng trng d
tr

Ketones Khng pht hin
L-DOPA 0.3-1.6 mg/l
1.5-8.0 mol/l
Lactate 0.5-2.2 mmol/l

Lamotrigine 4-16 mol/l
LDH <450 U/l

LDH (isoenzymes) %
Ch (mu ton b) <0.5 mol/l
z
LH Xem trn U/l
Lipid
Cholesterol <5.2 mmol/l
Triglycerides <2.3 mmol/l
HDL-cholesterol >1.0 mmol/l
Lipid subfractions mmol/l
Lipoprotein (a) (Lp(a)) <25 mg/dl
Lithium 0.5-1.2 mmol/l
Gan
Magnesium 0.75-1.00 mmol/l
Magnesium (hng cu) 1.7-2.6 mmol/l
Manganese 4-23 nmol/l
Manganese (mu ton phn) 73-210 nmol/l z
Sng lc k kinh
Mercury (mu ton phn) <32 nmol/l
Test metoclopromide ca
prolactin d tr

nh gi dinh dng
Oestradiol-17B Xem trn pmol/l
Tnh thm 288-298 mosmol/kg H
2
O
Osteocalcin 3.2-9.7 g/l z
Paracetamol <40 mol/l
Test kch thch Pentagastrin
Phenobarbitone 65-170 mol/l
Phenytoin 40-80 mol/l
Phosphate 0.70-1.40 mmol/l
Potassium 3.5-5.0 mmol/l
Prealbumin 0.15-0.4 g/l
40-49 tui 0-2.5 ng/ml
50-59 tui 0-3.5 ng/ml
60-69 tui 0-4.5 ng/ml
PSA (Prostatic specific antigen)
70-79 0-6.5 ng/ml
Progesterone >35 nmol/l
Prolactin Nam <350 mU/l
N <500
Protein (CSF) 0.15-0.45 g/l
Protein (ton phn) 60-80 g/l
in di Protein
T l chn lc protein
(transferin/IgG)
<0.2
Nghin cu Protein
PTH (nguyn vn) 1.1-6.9 pmol/l
PTH Rp <0.7-2.6 pmol/l U
Renin (PRA) Nm 0.2-2.8 ng/ml/h z
ng 1.5-5.7 z
T3 d tr 0.14-0.54 nmol/l
Salicylate <70 mol/l
Selenium 0.7-1.6 mol/l
Selenium (mu ton phn) 0.6-1.5 mol/l
SHBG (sex hormone binding
globulin)
Nam 9-64 nmol/l
Khng thai 32-96
c thai 200-380
Silicon <10 mol/l
Sodium 135-145 mmol/l
Synacthen test
Testosterone Nam 9-40 nmol/l
N <3.5
Theophylline 55-110 mol/l
Thiamine (vit B1), (hng cu) 165-286 nmol/l tbHC
Test chc nng tuyn gip
TSH 0.17-3.2 mU/l
T4 ton phn 70-155 nmol/l
T4 t do 11-22 pmol/l
T3 ton phn <65 tui 1.1-2.6 nmol/l
>65 tui 0.8-2.3
TBG (thyroxine binding globulin) 16-28 mg/l
TRAb (thyroid receptor
antibodies)
<8 % c ch
Thyroglobulin <5 g/l
Thyrotrophin releasing hormone
test (TRH test)

Thnh phn c t (Hg, Pb, Cd)
Thnh phn vt (Cu, Zn, Se, Mn)
Transferin 2.2-4.0 g/l
TRH test d tr protactin
Tricyclics (sng lc) khng tht hin
U & E
Urea 2.5-70 mmol/l
Uric acid Nam 200-420 mol/l
N 140-340*
Valproate 350-700 mol/l
Vitamin A S sinh 1.2-2.6 mol/l
Tr em 1.1-2.8
Ngi ln 1.1-2.3
Vitamin C (bch cu) (1.25-
dihydroxy)
119-301 nmol/10
8
tbBC U
Vitamin D2 & D3 43-144 pmol/l
Vitamin D2 (25-hydroxy) <10 g/l
Vitamin D3 (25-hydroxy) H 10-60 g/l
ng 5-25 g/l
Vitamin E 11.6-46.5 mol/l
Water deprivation test Zinc 12.7-20.2 mol/l
Phn tch Immunoglobulin
IgG 5.0-14.0* g/l
IgA 1.0-4.0* g/l
IgM 0.5-2.0* g/l
Phn nhm IgG (IgG1-IgG4) xem bng bo co g/l
IgE ton phn 0-1 nm <10 kU/l
1-15 nm <30 kU/l
trn 15 nm <100 kU/l
D nguyn c
hiu
<0.35* kU/l
z , EDTA; { , ESR tube; , plain/serum; , Li hepatin; S , citrate; U , special tube (contact lab).
12. TEST DUNG NP GLUCOSE
Glucose mao mch
(mmol/l)
Glucose tnh mch
(mmol/l)
Tiu ng
Khi i >8.0 >8.0
2 gi sau glucose >12.2 >11.0
Ri lon dung np ng
Khi i <8.0 <8.0
2 gi sau glucose 8.9-12.2 8.0-11.0
13. DCH NO TU
n v non S sinh Tr
nh
Thanh
nin
Ngi
ln
Thnh phn t
bo:
Khng m v trong
a nhn S lng/l
(s
lng/mm
3
)
0-100x10
6

(0-100)
0-70x10
6

(0-70)
0
(0)
0
(0)
0
(0)
Lympho bo S lng/l
(s
lng/mm
3
)
0-25x10
6

(0-25)
0-20x10
6

(0-20)
0-5x10
6

(0-5)
0-5x10
6

(0-5)
0-5x10
6

(0-5)
Hng cu S lng/l
(s
lng/mm
3
)
0-
1000x10
6

(0-1000)
0-
800x10
6

(0-800)
0-5x10
6

(0-5)
0-5x10
6

(0-5)
0-5x10
6

(0-5)
m mg/l
(mg/dl)
400-3000
(40-300)
450-1000
(45-100)
100-200
(10-20)
150-300
(15-30)
100-450
(10-45)
ng mmol/l
(mg/dl)
1.7-4.4
(30-80)
3.5-4.4
(60-80)
2.3-3.9
(40-70)
2.8-4.0
(50-72)
IgG mg/l
(mg/dl)
8-64
(0.8-6.4)
8-64
(0.8-6.4)
5-54
(0.5-5.4)
<15%
Dch no tu bnh thng c 0-5 HC/mm3, nhng c th ln n 50 m vn khng c bt thng.Glucose
dch tu no bt thng khi <50% mc glucose mu.
14. TU
S lng t bo tu 20000-100000 mi mm
3

T l tu bo hng cu 3 : 1 5 : 1
Dng tu (70%)
Nguyn tu bo 0-2.5
Tin tu bo 0.5-5.0
Tu bo
Trung tnh 2-8
i toan 0-1
Hu tu bo
Trunh tnh 10-25
i toan 0-2.5
Bch cu a nhn
Trung tnh 10-40
i toan 0-4
Bch cu ht (57.4%)
i kim 0-1
Lympho bo 5-20
n nhn 0-5
Khc (12.6%)
Tng bo 0-1
Dng hng cu (19.1%)
Nguyn hng cu 0-1
Tin nguyn hng cu 0-4
TB non, trung gian, bnh thng 4-15
Hng cu c nhn
TB gi 7-19
Khng xc nh c (10.9%)
15. THI GIAN PROTHROMBIN
INR* Lm sng
2.5-2.5 Nga huyt khi tnh mch su bao gm phu thut nguy c cao (vd: gy xng
i)
2.0-3.0 iu tr huyt khi tnh mch su, thuyn tc phi, cn thiu mu cc b thong
qua.
3.0-4.5 Huyt khi tnh mch su v ph phi ti pht, bnh ng mch gm NMCT; ghp
ng mch, van tim nhn to
*INR: International Nomolized Ratio.

So Tay Can Lam Sang

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

So Tay Can Lam Sang

Uploaded by

Copyright:

Available Formats

_ebook oc xy dng bi CLB195_

Ngun ti liu t YKhoanet.com

Phn tch yu t tin ng mu S

Thi gian Reptilase 13.0-19.0 Giy S

Sng lc huyt khi S

Caffeine <258 mol/l

CyA mono 200-400 g/l

Cy A poly 400-1000 g/l

Deoxycortisol <30 nmol/l

Digoxin 1.0-2.5 nmol/l

Fructosamine <285 mol/l

ESH Xem trn

Kh nng gn st 45-70 mol/l

_ebook oc xy dng bi CLB195_

Lactate 0.5-2.2 mmol/l

LDH <450 U/l

You might also like