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GII THIU MN GII PHU BNH HC

Mc tiu hc tp 1. 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 NGHA
Gii phu bnh hc l khoa hc v cc tn thng, hay ni mt cch c th hn , m x phn tch cc bnh tt v mt hnh thi cng nh c ch. Do nhiu nc ngi ta khng gi l gii 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 m t 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 mt thng th gi l i th. Nhn vi knh hin vi th gi l vi th . Vi knh hin vi in t th gi l siu vi th.

II. QU TRNH PHT TRIN CA MN GII PHU BNH HC

Gii 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 c ch ca cc tn thng. 3.Giai on gii phu bnh hc kinh in (1900 -1950) vi cc phng php ct nhum thng 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 nhng phng 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 BNH

Kinh in ngi ta chia gii phu bnh hc ra hai phn: 1. Gii phu bnh hc i cng hc 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 my thn kinh v.v...m nhng bnh cng ch nm trong bn nhm bnh cn bn ca gii phu bnh i cng.

IV.PHNG PHP CA GII PHU BNH HC

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 trng thy 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 tch nhng thng tin vi th v nhng thng tin khc ca lm sng v cn lm sng, i n mt kt lun dt khot.

V. GII THIU V PHNG PHP T BO HC V K THUT CHC HT T BO BNG KIM NH

1. nh ngha Phng php t bo hc l mt khoa hc v hnh thi t bo ng dng vo vic pht hin v chn 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 nht v 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 ung th 1968 ti Genve ghi nhn: - u im: + n gin: thc hin c nhanh chng, d dng vi phng tin ti thiu, t gy kh chu. 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 ), t tn bnh phm. - Nhc im: So vi sinh thit th chc ht t bo bng kim nh:

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 dn phin qu mnh lm t bo b v, bo tng tan r to ra nhng hnh nh thoi ha gi to. 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 tiu chun 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 c quan nh m mm, xng, khp, hch cng nh cc c quan ni tng nh phi ,gan, thn v.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 do nhim 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. thuc trn 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 Thng chn ng i ngn nht i n tn thng, chc vung gc. Kim i vo khi u 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 m trong khi a kim ln xung hoc xoay v cc pha ht bnh phm, khi thy bnh phm i vo 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 dng nht l c nh bng cn 96. - Nhum bnh phm : thng dng nht l nhm bng dung dch Giem sa vi t l: 2 ml dung dch 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.