HC VIN QUN Y

B MN SINH L BNH

SINH L BNH TUN HON

NI DUNG
1.
2.

Ri lon hot ng ca tim

Ri lot ng ca h thng mch

MC TIU HC TP
1.
2.
3.

Cc bin php thch nghi ca tim

Bnh sinh ca suy tim
Bnh sinh ca tng HA v sinh l bnh sc

I CNG
H thng tun hon gm tim v mch mu
Chc nng
Ti mu cho t bo v m
Tham gia vo gi thng bng ni mi.
Trong sc, bng, mt mu huy ng mi
c ch b tr m bo cung cp mu cho
no v tim.

I CNG
Lin quan chc phn v bnh l
Gia tim v mch hot ng nhp nhng
Tun hon tim h hp lin quan v sinh l, gii
phu, chc nng...
Hot ng di s iu ho ca h TK chung
v TK ring bit ca tim.

1- Ri lon hot ng ca tim

1.1.KH NNG THCH NGHI CA TIM
1.1.1. Tng nhp tim
BT 60 - 80 l/pht, lao ng nng tng 140 - 180 l/p.
C 3 c ch tng nhp tim:
Phn x Marey: Gim p lc xoang ng
mch cnh, cung ng mch ch => tc ng ln
cc th th p lc => tim p nhanh, tng tn s
tim => phc hi HA.

1- Ri lon hot ng ca tim

1.1.KH NNG THCH NGHI CA TIM
Phn x Bainbridge: tng HA nh phi (suy
tim phi, ton b) => tc ng ln cc th th p
lc =>trung khu tim p nhanh= tng f tim
Phn x Alam-Smirk: Thiu oxy c tim kch
thch ln on cng ca m ri tim lm cho tim
p nhanh.

1- Ri lon hot ng ca tim

1.1.KH NNG THCH NGHI CA TIM
Cc phn x tng tn s tim c tc dng
tng lu lng tun hon.
Tim p nhanh ko di => tn thng c tim do
tim khng c ngh ngi y , do tun
hon vnh b hn ch.
Tn s tim qu nhanh c th => suy tim cp.

1- Ri lon hot ng ca tim

1.1.KH NNG THCH NGHI CA TIM
1.1.2. Dn tim
L tnh trng t bo c tim dn di ra, lm tng
dung tch bung tim, cha c nhiu mu hn.
Theo nh lut Frank-Starling: si c tim cng di
th sc bp c tim cng mnh, khi lng mu
tng ra cng ln, p lc tht bp cng cao (khi
dn mu v nhiu s pht i nhiu).

1- Ri lon hot ng ca tim

1.1.2. Dn tim
Dn tim sinh l: vn ng vin rn luyn tt tim
dn rng hn v bp cht hn so vi tim bnh
thng hoc ngi lao ng nng ko di. Sc
cha khi tim dn c th gp 2 - 4 ln.
Dn tim bnh l: xy ra th ng sau suy tim, do
c tim mm nho => sc bp gim, hn ch
tng mu ra khi bung tim => mu => dn
tim.
Th nghim: truyn nhiu dch -> dn tim cp

1- Ri lon hot ng ca tim

1.1.3.Ph i tim
L hu qu ca dn tim ko di si c tim to ra.
C ch:
Do si c ko di, tng trng lc -> sc
bp tng -> ph i
Pavlov: do kch thch TK dinh dng c tim
-> u sinh> hu hoi -> Ph i.

1- Ri lon hot ng ca tim

1.1.3. Ph i tim

C 2 loi:
Ph i ng tm: khi ton b tim to (vn
ng vin, hoc do thiu oxy trng din (ni
cao, kk long)
Ph i khng ng tm: ch c mt phn
tim to thng gp trong bnh l tim mch (Hp
ng mch ch, hp 2 l...)
3 c ch tng hot ng tim dn n tng
lu lng tun hon, ko di s gy suy tim.

1- Ri lon hot ng ca tim

1.2.THAY I LU LNG TRONG BNH L
1.2.1.Tng lu lng
Nguyn nhn ngoi tim:
Do c th tng chuyn ho: st, Basedow...
tng lu lng vn chuyn oxy.
Do thiu oxy, thiu mu -> tng tc tun
hon (tng nhp, tng bp)

1- Ri lon hot ng ca tim

1.2.THAY I LU LNG TRONG BNH L
1.2.1.Tng lu lng
Nguyn nhn do tim

Khi c s thng thng gia ng-tnh

mch (cn ng ng mch, thng lin tht,
thng lin nh) -> tng lu lng

V: mu nhanh chng tr v tim, thiu oxy

khu vc di ch thng.

1- Ri lon hot ng ca tim

1.2.THAY I LU LNG TRONG BNH L
1.2.2.Gim lu lng
Nguyn nhn ngoi tim:
Do gim chuyn ho: thiu nng gip trng,
i,... nhu cu oxy gim.
Do mt mu, sc, tru tim mch, bng ... =>
gim khi lng mu lu thng.

1- Ri lon hot ng ca tim

1.2.THAY I LU LNG TRONG BNH L
1.2.2.Gim lu lng
Nguyn nhn do tim:
Do lon nhp: sc bp c tim yu khi nhp tim
>150 l/min
=> thiu oxy => Suy tim.
Bnh l van tim: h van 2 l, hp van /m ch
=> gim lu lng tun hon.
=> thiu oxy => Suy tim.

1- Ri lon hot ng ca tim

1.2.THAY I LU LNG TRONG BNH L
1.2.2.Gim lu lng
Nguyn nhn do tim:
Bnh mng tim: vim mng ngoi tim co
tht, trn dch mng ngoi tim => cn tr hot
ng tim (chn p) => gim lu lng tun hon
suy tim
RL tun hon vnh -> thiu mu nui dng
c tim -> RL chuyn ho c tim -> thoi ho,
hoi t, nhi mu -> suy tim

2-Sinh l bnh suy tim

2.1.nh ngha suy tim:
Suy tim l c tim mt mt phn hay ton b kh
nng co bp y 1 lng mu ra khi tim m
c th yu cu.

2-Sinh l bnh suy tim

2.2.Nguyn nhn
Mi nguyn nhn gy thiu oxy, thiu dinh
dng c tim ->Suy tim
2.2.1. Do tim mch
Trong mt s bnh: bch hu, tinh hng nhit,
ph vim, virus, nhim c thai nghn, ... ->
thoi ho c tim cp=>suy tim
Cc bnh ca tim: bnh van tim, lon nhp tim
nhanh, cc bnh tim bm sinh (thng lin tht,
lin nh...), RL tun hon ng mch vnh.

2-Sinh l bnh suy tim

2.2.1.Do tim mch (tip)
Hu qu: RL dinh dng c tim, gim lu lng
tun hon => thiu oxy,
=> tim hot ng gng sc -> suy tim
Cc bnh mch: tng HA (tng sc cn NVi),
Tng HA cp (vim thn cp, ND thai nghn =>
dn tim cp)
Gim HA cp (sc -> tng nhp, tng sc bp ->
thiu oxy -> suy tim)

2-Sinh l bnh suy tim

2.2.2.Do ngoi tim
Nhim trng: chuyn ho tng cn nhiu oxy ->
tim lm vic tng
Cc bnh phi: hen, vim ph qun mn, bi
phi, x phi ... gy chng ngi cho tim v
thiu oxy => suy tim
Thiu mu: nn tim lm vic nhiu tng lu
lng ->li gy thiu oxy -> tim to -> suy tim.

2-Sinh l bnh suy tim

2.2.2.Do ngoi tim (tip)
Nhng bnh v chuyn ho v dinh dng:
u nng gip trng, tng CH -> tng yu cu
oxy
Thiu nng gip trng (thiu thyroxin, RLCH m
-> x ho ng mch vnh
Thiu B1 (RL h hp t bo -> thiu oxy -> suy
tim) thiu B1 khng to men carboxylaza, khng
c ch cholinesterase -> gim axetylcholin, km
ti to -> RLTK dinh dng c tim -> suy tim.

2-Sinh l bnh suy tim

2.3.C ch bnh sinh ca suy tim
Olson phn loi ST theo RL v ha sinh:
a,Suy tim do RL sn xut nng lng:
Nng lng ly t Glucose, Lipid, Protid... ->
a.pyruvic -> vng Kreb => to nng lng di
dng ATP.
=> Khi RL ging ho glycogen, glucose, a. bo
... -> thiu d tr ATP -> C tim thiu nng
lng -> suy c tim -> suy tim.

2-Sinh l bnh suy tim

2.3.C ch bnh sinh ca suy tim
a,Suy tim do RL sn xut nng lng (tip):
Khi RL chuyn ho v thiu dehydrogenase,
cholinnesterase, phospholipase => qu trnh CH
khng c thc hin -> thiu nng lng ->
suy tim.
Khi thiu Vit. B1, B6, B2: thiu B1 -> gim
carboxylase (cn to axetylCoA t a.pyruvic),
thiu B6 c ch enzyme chuyn amin, thiu B2
gy RL h thng chuyn in t => RL h hp
t bo, thiu nng lng.

2-Sinh l bnh suy tim

2.3.C ch bnh sinh ca suy tim
B, Suy tim do ri lon d tr nng lng
Nng lng sn xut ra c d tr di dng
ATP v phosphocreatinin.
Thiu ATP v phosphocreatinin: do RLCH v
gim creatinin
-> C tim thiu nng lng -> suy c tim ->
suy tim.

2-Sinh l bnh suy tim

2.3.C ch bnh sinh ca suy tim
C, Suy tim do ri lon s dng nng lng
Khi co c tim cc si actin trt ln si myosin
nh ATP v P.Creatinin (ho nng thnh c
nng)
Nu ri lon cu trc ca cc si actin v
myosin s khng co c (RL cu trc do nhin
trng, nhim c (bch hu), hoc hoi t c
tim lan rng do ri lon tun hon vnh).

2-Sinh l bnh suy tim

2.3.C ch bnh sinh ca suy tim
C, Suy tim do ri lon s dng nng lng

Nng Ca++ cao (trong t bo) (10-7) s hot

ho ATPaza (trong myosin) gii phng nng
lng. Khi thiu Ca++ gy gim hot tnh
ATPaza -> RL s dng nng lng (thiu) ->
suy tim.

2-Sinh l bnh suy tim

2.3.C ch bnh sinh ca suy tim
C, Suy tim do ri lon s dng nng lng
(tip)
Khi Ca++ qu cao trong t bo (vo qu nhiu)
gy co c tim v c trn mch lin tc gy ri
lon tin ti v hu ti gy suy tim

2-Sinh l bnh suy tim

2.4.C ch ca nhng biu hin suy tim tri v
phi
Nhng biu hin chnh ca suy tim tri (phi)
Kh th:
Do mu phi lm cng mao mch phi > thiu oxy, CO2, gy chn p ph nang v
kch thch ngn dy X => kh th
Ban m (ng) dy X tng hot ng -> co
tht c ph qun, xut hin c hen tim => kh
th.
Ct dy X ht kh th (hoc tim morphin c
ch dy X).

2-Sinh l bnh suy tim

2.4.C ch ca nhng biu hin suy tim tri v
phi
Nhng biu hin chnh ca suy tim tri (phi)
Ph phi cp:
L bin chng nguy him nht ca suy tim
tri. Suy tim tri mu phi gy tng p lc
thu tnh trong mao mch phi khin nc thot
vo ph nang gy ph phi mn. Nghe phi c
tin rn t 2 th r nn phi.

2-Sinh l bnh suy tim

2.4.C ch ca nhng biu hin suy tim tri v
phi
Nhng biu hin chnh ca suy tim tri (phi)
Ph phi cp thng do tim phi cn hot
ng tt bt cht tng hot ng y mt lng
mu ln ln phi.
Ti phi thnh mao mch b tn thng v
thiu oxy trng din lm thnh mao mch tng
tnh thm, kt hp tng p lc thy tnh
=> mu o vo ph nang gy OAP.

2-Sinh l bnh suy tim

2.4.C ch ca nhng biu hin suy tim tri v
phi
Nhng biu hin chnh ca suy tim tri (phi)
Ph phi cp:
Trong tnh trng RLCH nc mui ni chung
ca ngi suy tim thng c ran m phi.
X tr OAP: ga r gc chi; morphin an thn, c
ch TK; Uabain tr tim, li tiu

2-Sinh l bnh suy tim

Nhng biu hin chnh ca suy tim tri (phi)
Trn dch ph mc
i khi c do tng p lc tnh mch phi. Tnh
mch ph mc v t/m phi v t/m ch trn
trong suy tim mu khng v.
Dung tch sng gim (ph dung sinh hot)
Do hin tng mu phi, c t nc trong
ph nang, gim sc n hi , hn ch thng kh
phi -> gy gim dung tch sng.
Ko di gy x phi.

2-Sinh l bnh suy tim

Nhng biu hin chnh ca suy tim tri (phi)
Biu hin khc
Tc mu tun hon qua phi chm v mch
dn.
Kh th kiu Self - Stocks do thiu oxy no,
gim tnh cm th ca trung khu h hp, mu ti
no chm...

2-Sinh l bnh suy tim

Nhng biu hin chnh ca suy tim phi: (khu
vc t/m ngoi vi)
Th tch mu tng:
Do mu t/m ngoi vi khng v tim c,
mu qua thn t gy gim lc cu thn ( mui
nc):
Do thiu oxy ko di -> kch thch tu tng
sinh hng cu: => th tch mu tuyt i tng.

2-Sinh l bnh suy tim

Nhng biu hin chnh ca suy tim phi: (khu
vc t/m ngoi vi)
Ph :
Dn mch do mu -> HA t/m tng
(>17cmH2O) (gy cn tr s hp thu nc t
gian bo vo lng mch/ P thu tnh tng).
Tn thng thnh mch do thiu oxy: thot
protein (gim Pkeo), protein gim cn do RL
chc nng gan.
mui v nc do u Aldosterol va ADH
->king mui.
Chn p chng ngi lu thng bch huyt.

2-Sinh l bnh suy tim

Nhng biu hin chnh ca suy tim phi: (khu
vc t/m ngoi vi)
Gim bi tit nc tiu:
Do mu qua thn t (do HAmax gim, do
mu t/m, do co mch thn) -> lc t.

2-Sinh l bnh suy tim

Nhng biu hin chnh ca suy tim phi: (khu
vc t/m ngoi vi)
RL chc phn gan
HA t/m tng -> mu gan, cng t/m gan ->
thiu oxy -> thoi ho m -> hnh nh gan ht
cau.
Gan to n xp, x ho gan
Hu qu tun hon gan tr -> c trng/
trn dch mng bng.

2-Sinh l bnh suy tim

Nhng biu hin chnh ca suy tim phi: (khu
vc t/m ngoi vi)
Xanh tm: ngi suy tim nng
Xanh nht di tai, mi v mng tay
C ch: do cc mao mch, t/m dn v tr;
do KL mu lu thng gim, mu, thiu oxy Hb
khng c bo ho vi oxy, Hb kh tng.

2-Sinh l bnh suy tim

Nhng biu hin chnh ca suy tim phi: (khu
vc t/m ngoi vi)
Suy tim phi lu -> suy tim tri = suy tim ton b.
Suy tim ton b c triu chng c STP v ST tri
Luyn tp lm cho kh nng d tr v thch ng
ca tim tng.
Cn chn on sm c ch sinh hot thch
hp tng cung gim cu

3.Ri lon hot ng ca h mch

Biu hin RL qua HA tng hoc gim
HA duy tr c l nh hot ng nhp nhng ca
lu lng tim v sc cn ngoi vi do thn kinh iu
ho.
HA ph thuc hot ng ca tim, h ng mch, h
tnh mch.

3.Ri lon hot ng ca h mch

3.1.NHNG YU T NH HNG N HUYT P
Lu lng tim
Khi lng mu tr v
Lng mu v nhiu lm tim bp mnh (Lut
Starling) -> lu lng tng, lng mch y mu c
khi i v khi v -> HA max, min u tng.
H t/m cha c 65-75% khi lng mu, khi
dn -> HA gim.
Sc bp ca tim
Tim bp mnh -> lu lng tng, mu y lng
mch -> HA max v min tng.

3.Ri lon hot ng ca h mch

Sc cn ngoi vi
l tr lc m tim phi thng mu t tm
tht tri ti tim phi. Ph thuc:
nht ca mu
Tng (bnh tng hng cu, ng mu tng)
-> sc y mnh - HA tng; nht gim (thiu
mu) -> HA gim.

3.Ri lon hot ng ca h mch

Sc cn ngoi vi (tip)
Sc n hi thnh mch
y l yu t chnh nh hng ti sc cn
ngoi vi, khi co mch sc cn ngoi vi tng v
ngc li. Trong bnh x cng ng mch v v
x ng mch -> thnh mch /m cng li -> sc
cn ngoi vi tng v HA tng.

3.Ri lon hot ng ca h mch

3.2.TNG HUYT P: Tng HA triu chng
Tng HA do bnh thn:
T l 10-15% bnh nhn tng HA.
Do bnh nhu m thn hay mch thn: vim cu thn cp,
vim i b thn mn, u thn, lao thn, hp ng mch
thn, t/m thn. C ch
Thn thiu mu -> tng Renin

Hot ho Angiotensinogen

Aldosterol tng
(v thng thn)

Angiotensin 1
Angiotensin 2

Tng THT Na+

Tng gi nc

Tng HA

Co mch

3.Ri lon hot ng ca h mch

Tng HA triu chng
Tng HA do ri lon chuyn ho
Tng HA ngi cao tui VXM, cholesterol
ng lp di ni m /mch ch, /m vnh,
no...
Tuy nhin cholesterol khng phi l nguyn
nhn duy nht gy XVM.
C ngi cholesterol tng nhng khng c
XVM song c ngi cho bnh thng li b
XVM.
Nhiu yu t gy XVM: tn thng thnh
mach, n nhiu Lipit (cholesterol), t vn ng,
cng thng TK.

3.Ri lon hot ng ca h mch

Tng HA triu chng
Tng HA do ri lon ni tit
U tu (li) thng thn (tng tit adrenalin) ->
tng HA.
U v thng thn (HC Cohn) -> tng tit
aldosterol lm tng gi Na+ v lm tng tnh cm
th ca mch vi cc cht gy co mch => tng
HA.

3.Ri lon hot ng ca h mch

3.2.BNH TNG HUYT P

Khi khng tm oc nguyn nhn gy tng HA

nguyn pht.
Thng c xem l do RL ca hot ng thn
kinh trung ng, RL h thng iu ho HA, gm:
H giao cm, thn, ni tit, mch v lin quan
gia cc yu t iu ho ny. Dng thuc an thn
c tc dng tt vi bnh nhn ny.

3.Ri lon hot ng ca h mch

3.2.BNH TNG HUYT P
C ch: Kch thch ni v ngoi qu mc (s
hi, chn thng tm l) -> RL v no (hng
phn v - kit qu v) -> thot c ch di v

-> tng cng di v -> cng giao cm, ni

tit -> ri lon tim mch (tng nhp tim, co
mch) -> tng HA.

3.Ri lon hot ng ca h mch

3.2.BNH TNG HUYT P

Bnh hay gp nhng ngi lm vic tr c, lo

ngh nhiu.
iu kin pht bnh ph thuc: thi gian cng
tc dng ca kch thch, loi thn kinh.

3.Ri lon hot ng ca h mch

Bin chng tng HA

Suy tim tri: do gng sc thng sc cn ngoi

vi -> ph i tht tri.
Suy thn: do thiu mu thn ko di
Mch vnh, mch no: mch b x cng, km
nui dng d v (v mch vnh gy nhi mu
c tim, no gy chy mu no, lt no, cht).

3.Ri lon hot ng ca h mch

Bin chng tng HA

Tng HA to k cho VXM vnh pht trin

(33,6%), tng HA gy tai bin mch vnh cao hn
BT 2,6 -6 ln
Cc bin chng no tim khc nh ri lon nhp
tim, h van ng mch ch c nng, gim th lc
do ph n, x cng, xut huyt ng mch vng
mc

3.Ri lon hot ng ca h mch

GIM HA
Sc

nh ngha: Sc l tnh trng suy sp t ngt

ton b chc phn sng quan trng ca c th
sau mt nguyn nhan bnh l cp tnh nh:
chn thng, mt mu, in git, bng , nhim
trng nhim c... Biu hin ni bt trn lm

sng l hi chng suy sp tun hon, HA tt.

3.Ri lon hot ng ca h mch

3.3.GIM HA
Sc
Phn loi sc
Ngoi khoa: sc chn thng, sc chy mu, sc
bng, sc phi hp...
Ni khoa: sc nhim trng nhim c
Cc yu t nh hng n din bin ca sc:
Tnh cht vt thng: ln, phi hp hay khng
Tnh phn ng ca c th, trng thi ton thn:
i rt, mt mi, cng thng, bnh tt
Cch iu tr kp thi hay khng, cht lng tt
hay khng

3.Ri lon hot ng ca h mch

C ch ca sc: D l nguyn nhn v din bin
ban u ca sc c khc nhau, nhng khi ton
pht th th tt c cc loi sc u c nhng du
hiu chung l c ri lon vi tun hon (hi chng

bn mu, thot huyt tng v ng mu lan to

ni mch) vi hu qu l thiu oxy c bit l no
v tim. Cui cng l tnh trng ri lon chuyn

ho nng, nhim c, nhim toan v cht t bo.

3.Ri lon hot ng ca h mch

C ch ca sc
C nhiu nguyn nhn sc nhng ni bt nht l
sc chn thng, do tnh cht ph bin v tnh
cht nghim trng ca n, nht l i vi b i

chin u.

3.Ri lon hot ng ca h mch

Cc giai on ca sc chn thng: 2 giai
on

Giai on t b p: biu hin 2 trng thi

T b p qu mc v tm thi: (sc cng)
Tng cng s hot ng ton b chc nng
ca c th (hng phn TKTW). BN vt v kch
thch ku au, da nim mc nht, mch nhanh
mnh, HA tng, th nhanh su. G ny thng
khng qu 20 -30.

3.Ri lon hot ng ca h mch

Cc giai on ca sc chn thng:
Giai on t b p: biu hin 2 trng thi
T b p kn o v tm thi: (sc tim): Sc
pht sinh song cn kn o, cha biu hin r. B
thng nng song HA ng mch bnh thng,
mch nhanh yu (100 - 140 l/min).
Sc tim gim KLMLT song nh c ch b p,
co mch nh nn HA /m cn gi c mc bt,
nhng tim phi lm vic gp bi b vo
KLMLT gim.
Do sc tim ch cn 1 chn thng ph, mt
thm mt lng mu nh -> sc nhc xut hin
ngay.

3.Ri lon hot ng ca h mch

Cc giai on ca sc chn thng:
Tm li, sc cng phn ng thch ng huy
ng lc lng gi tr b p. Song sc cng l
mt qu trnh tiu hao nng lng d tr. Nu
sc cng ko di c hi.

3.Ri lon hot ng ca h mch

Giai on mt b: (sc nhc)
Biu hin suy sp ton b chc nng quan
trng ca c th ni ln trng thi c ch h thn
kinh trung ng: BN nm yn, th vi ngoi
cnh, vn tnh hi tr li yu t, sc mt nht
nht, da lnh, th yu, mch nhanh, HA gim,
gim, phn x gim.

3.Ri lon hot ng ca h mch

C ch mt s triu chng trong SCT
Ri lon tun hon/Vi tun hon
Ri lon vi tun hon l yu t bnh sinh
ch yu chi phi qu trnh pht sinh, pht trin
v kt thc ca sc.

3.Ri lon hot ng ca h mch

C ch mt s triu chng trong SCT
Ri lon tun hon (tip):
Trong sc cng di tc dng ca stress chn
thng, catecholamin tng tit gy co mch, co
c tht trc mao mch, co tht phn sau mao
mch, co tht tiu /m, tiu t/m.
Trong li mao mch thiu oxy do thiu mu.
Co c tht tng sc cn ngoi vi -> m shunt
dn mu cho c quan quan trng (no, tim) =
hin tng trung tm ho tun hon.

3.Ri lon hot ng ca h mch

C ch mt s triu chng trong SCT
Ri lon tun hon (tip)
Giai on sc nhc do li mao mch
thiu oxy, nhim toan chuyn ho (CH ym kh)
(lm c tht trc mao mch mt mn cm vi
catecholamin) -> C tht trc mao mch m ra
-> mu vo mao mch nhng khng ra c ->
li v phn sau mao mch vn ng, lc ny
trong li mao mch thiu oxy do mu.

3.Ri lon hot ng ca h mch

C ch mt s triu chng trong SCT
Ri lon tun hon (tip): Hu qu:

p lc thu tnh trong mao mch tng ln ->

thot huyt tng

Do thiu oxy -> tng tnh thm thnh mch > thot huyt tng.

Thot HT -> mu c -> nghn mch -> hoi

t m.

mu h mao mch + thot huyt tng ->

gim KLMLT -> thiu oxy ton thn.

3.Ri lon hot ng ca h mch

Thay i HA
HA /m giai on u tng sau gim. HA tng giai
on cng l do trung khu co mch hng phn (tun
hon), tng tit catecholamin co mch.
Giai on sc nhc HA gim ch yu do gim
KLMLT, ngoi ra cn do suy mch cp (trung khu vn
mch b c ch).

3.Ri lon hot ng ca h mch

Thay i ca mch
Sc cng mch nhanh, do trung khu tim
p nhanh hng phn v do tng tit
catecholamin.

Giai on sc nhc mch nhanh ch yu

do gim KLMLT tim hu nh bp rng. Mch
nhanh > 130-140 l/min. Sc cng nng mch
cng nhanh. Mch trung thnh hn HA.

3.Ri lon hot ng ca h mch

Ri lon h hp
Giai on sc cng h hp nhanh, su
b p do trung khu h hp hng phn.
Nhc: hh nng lon nhp c th pht sinh
h hp chu k -> do trung khu h hp c ch.

3.Ri lon hot ng ca h mch

Ri lon tit niu:
Lng nc tiu gim r rt ch yu do
gim KLMLT, ngoi ra cn do gim lc, ng
thi tng tit ADH, aldosteron -> tng THT

Lng nc tiu/gi -> tin lng ca sc,

quyt nh lng dch cn truyn. C trng
hp suy thn cp.

3.Ri lon hot ng ca h mch

Try mch

L tnh trng dn t ngt h tiu ng mch v

tiu tnh mch, c ch thch nghi cha kp c tc
dng huyt p tt t ngt xung 0, tim bp
rng, thiu oxy no nghim trng, gan thiu oxy
sn xut VDM (Vaso dilatator materiel) gin
mch thm.

3.Ri lon hot ng ca h mch

Try mch
Nguyn nhn : gp trong cc bnh ni khoa :
c ch trung tm vn mch do nhim khun,
ng c lm h hoi thnh mch, c tim.
Do bnh nhn nm lu ngy, thay i t th
t ngt.
Do chc tho nc bng nhanh v nhiu
gin mch ni tng mu ln no t. Thng ch
mc xy sm, chong vng, nhng c khi rt
nng.

3.Ri lon hot ng ca h mch

Ngt
C ch v tin trin :

Do mt nguyn nhn no mu khng ln

c no, no thiu oxy t ngt.
Trc khi ngt bnh nhn c cm gic :
chong vng, xy sm mt mi, chn tay d ri,
tot m hi, au ngc.Sau ng vt xung,
bt tnh, ng t gin, th rt yu

3.Ri lon hot ng ca h mch

Ngt
Nguyn nhn :
Do tim: hng phn thn kinh ph v tim p
chm ngt. Ri lon dn truyn thn kinh gia
nh v tht : Chng Adam Stook, h hi van
tim, tim lon nhp, h van ng mch ch.
Ngoi tim: Qu au n ri lon trung tm
vn mch.
Thay i t th t ngt: do trng lc mch
yu, phn x thn kinh chm.
Khi c chng ngi lu thng mu ln no,
huyt p cao, phng ng mch no.

3.Ri lon hot ng ca h mch

Ngt
L tnh trng bnh l trong ngi bnh b mt
tri gic mt cch t ngt trong mt thi gian
ngn nhng thng l t hi phc, mc d tim
phi hot ng rt yu hay khng hot ng.

Khc hn m (mt tri gic t t ko di v kh t

hi phuc)