BNH N HUYN VNG (HOA MT, CHNG MT)

I.PHN HNH CHNH

-H v tn bnh nhn: TRN TH H.
-Gii: N
-Tui: 66
-a ch: 20/131 Trn Ph, Phc Vnh, Hu
-Ngh nghip: Hu tr
-Ngy gi vo vin: ngy 12/11/2009
-L do vo vin: Chng mt
-S vo vin: 1812
-Ngy thm khm: ngy 13/11/2009
II.BNH S
1.Qu trnh bnh l:
Khi bnh cch y 2 thng vi chng mt, khng st, khng au u, khng nhc u,
khng tai, khng au tai, v khng bun nn, khng nn. Chng mt xut hin t
ngt, tng cn, ko di khong 1 pht, bnh nhn thy mi vt xung quanh mnh xoay
trn, chng mt tng khi bnh nhn hi hp, km ra m hi tay; khi ngi lu ng dy
bnh nhn cng xut hin chng mt, nhm mt th chng mt; lm vic mau mt v
d hi hp, ng lm th hi hp tng v c km theo triu chng kh ng, ng chp
chn, khng su, au lng, mi gi. Bnh nhn iu tr khong 1 thng vi cc thuc
hot huyt dng no, vitamin nhm B, bnh c thuyn gim, ng c nhng khng
ht, thnh thong vn chng mt nn gi xin vo bnh vin y hc c truyn iu tr.
Thm khm khi vo vin:

Mch: 85 ln/pht
Nhit: 370C
Tn s th: 18 ln/pht
Huyt p 130/80 mmHg
Tng trng mp, tnh to, tip xc tt
Hin ti khng chng mt,

Khng au nhc u, khng tai, khng au tai

Nhp tim u, T1, T2 nghe r, khng nghe ting tim bnh l, khng hi
hp, khng kh chu vng ngc, khng au tc ngc
Khng ho, khng kh th, phi trong
Bng mm, gan lch khng s thy
Tiu bnh thng, hai thn khng s thy
Cc c quan khc cha pht hin bnh l

2.Tin s:
-Bn thn:
+Chng mt cch y 3 nm iu tr ty y khi
+Khng c bnh l tai mi hng.
+Khng c chn thng vo u.
-Gia nh: Khng ai mc bnh lin quan
PHN THM KHM TY Y
I.Thm khm tng qut:
-Tng trng mp
-Tnh to, tip xc tt
-Mt hng ho, kt mc mt hng
-Khng ph, khng xut huyt di da
-Tuyn gip khng ln, hch ngoi bin khng s thy
-Mch: 85 ln/pht
-Nhit: 370C
-Tn s th: 18 ln/pht
-Huyt p 130/80 mmHg
II.Thm khm c quan:
1.Tim mch:

-Khng hi hp, khng kh chu vng ngc, khng au tc ngc

-Nhp tim u, tn s 85 ln/pht,
-T1, T2 nghe r, khng nghe ting tim bnh l
2.H hp:
-Lng ngc bnh thng
-Khng ho, khng kh th, nhp th 18 ln/pht
-Khng nghe ran
3.Tiu ha:
-Bng mm, khng chng, khng c u cc
-i tin bnh thng, gan lch khng s thy
4.Thn-tit niu:
-Tiu bnh thng, khng tiu but, tiu rt
-Nc tiu lc trong lc vng, s lng bnh thng khong 1,5 lt/ngy
-Hai thn khng s thy
5.Thn kinh:
-Khng c du thn kinh khu tr
-Vn ng bnh thng
-Khng c ri lon cm gic
-Phn x gn xng t chi bnh thng
6.C xng khp:

-Ct sng khng vo lch

-Khng au c khp
-au lng, mi gi
7.Tai mi hng:
-Khng au tai, khng nhc u
-Cha pht hin bnh l tai mi hng
8.Cc c quan khc:
-Cha pht hin bnh l
III.Cn lm sng
1.Cng thc mu
Ngy 12/11/2009
Hng cu
Hb
Hct
Bch cu
Mid
Lympho
Gran
Tiu cu
2.Nc tiu
Ngy 16/11/2009

3,64 x106/mm3 (bt 3.87 4.91106/mm3)

12,8 g/dl
(bt 12-16g/dl)
38,9 %
(bt 34-44%)
3
3
5,9 x10 /mm
0,5 x103/mm3 chim 8,2%
2,3 x103/mm3 chim 38,9%
3,1 x103/mm3 chim 52,9%
264,103/mm3

Bilirubin
(-)
Urobilinogen
bnh thng
Ketone
(-)
Glucose
bnh thng
Protein
30 mg/dl
Nitrite
(-)
Blood
5-10 ery/ul
pH
7
SG
1.020
Leuko
(-)
3.Xt nghim mu

Ngy 17/11/2009
Glucose
Cholesterol
LDL
HDL
Acid uric
Creatinin
SGOT
SGPT
4.X-quang
Ngy 13/11/2009

6,09 mmol/l
5,04 mmol/l
2,32 mmol/l
1,99 mmol/l
230,36 umol/l
61,64 umol/l
24,84 UI/l
21,45 UI/l

M xoang trn (T), m xoang hm (P)

5.Siu m
Ngy 13/11/2009

Siu m tng qut: Gan nhim m nh

Siu m tim: h van ng mch ch nh

6.ECG
Ngy 13/11/2009
Nhp xoang, tn s 90 ln/pht
Trc trung gian apha=+600
IV.Tm tt bin lun chn on:
Bnh nhn n 66 tui, vo vin v chng mt, qua hi bnh s, thm khm lm sng, cn
lm sng em rt ra cc du chng v hi chng sau:

Hi chng vim xoang

Chng mt tng cn, ko di khong 1 pht, bnh nhn cm thy mi vt
xung quanh xoay trn
Chng mt tng khi bnh nhn hi hp, nhm mt th chng mt
X-quang: M xoang trn (T), m xoang hm (P)
Hi chng thiu mu no cc b thong qua
Chng mt tng cn, dt ngt, ko di khong 1 pht
S lng hng cu gim nh
Siu m c h van ng mch ch nh
Du chng m tnh
Khng au u, khng nhc u
Khng au tai, khng tai, khng st
Khng bun nn, khng nn
Chn on s b: Vim xoang / thiu mu cc b no thong qua
Bin lun:

Bnh nhn n 66 tui vo vin chng mt tng cn, ko di khong 1 pht, khi bnh
cch y 2 thng, bnh nhn cm gic thy mi vt xung quanh mnh xoay trn, nhng
khng nhc u, khng au u, khng au tai, khng tai, khng bun nn v khng
nn. y l chng mt do ri lon tin nh ngoi vi khng phi do tn thng tin nh
trung ng v tn thng tin nh trung ng bnh nhn cng c th c triu chng
chng mt nhng thng km theo au u, ni kh, hoc yu lit chi.
Bnh nhn cng khng c tng huyt p, cholesterol mu bnh thng, ng huyt bnh
thng, khng c biu hin lm sng ca cng gip, bnh nhn cng khng dng cc
thuc khng sinh v cc thuc an thn m c th gy nn biu hin chng mt. Bnh nhn
khng c tng huyt p, protein niu 30mg/dl, y l protein niu sinh l ngi bnh
thng.
Nguyn nhn do ri lon tin nh ngoi vi gy chng mt y l do vim xoang. Mc
d bnh nhn khng c biu hin au cc xoang nh xoang hm: nhc vng m, xoang
trn: nhc gia 2 lng my xoang sng trc: nhc gia 2 mt, xoang sng sau, xoang
bm: nhc trong su, nhc vng gy, cng khng c biu hin nght mi hay chy nc
mi nhng qua x-quang ta c th khng nh l bnh nhn b vim xoang, x-quang c m
xoang trn (T), m xoang hm (P). y l trng hp vim xoang mn tnh, do bnh
khi pht cch y khong 2 thng v cc triu chng rt l nh nhng, ch c biu hin
l chng mt.
Chng mt xut hin t ngt, tng cn, ko di khong 1 pht, khi ngi lu ng dy
bnh nhn cng xut hin chng mt. Nh vy b nh nhn c th b h huyt p khi thay
i t th do c th khng thch nghi kp thi gy thiu mu no thong qua ho c c cn
h huyt khng theo chu ky. iu ny rt ph hp vi thiu mu no thong qua do thay
i t th trn c th c s lng hng cu gim nh (hng cu 3,64 x106/mm3, tiu mu
vi th 5-10 ery/ul. C th xc nh bng cch theo di holter huyt p ho c Monitoring se
pht hi n c nhng cn h huyt p ny.
Biu hin chng mt km hi hp y c th l do phn ng giao cm trc ri lon
tin nh hoc do tnh trng thiu mu no thong qua do h huyt p t th hoc cn h
huyt p khng theo chu ky trn c a gim s lng hng cu km h van ng mch
ch nh, nu c gng sc th cng biu hi n r nht l tri u chng hi h p v chng
m t.
Vy chn on cui cng l vim xoang mn tnh / thiu mu cc b no thong qua.
V. Tin lng:
-Kh quan
VI.iu tr:
Khng sinh, khng vim, chng d ng, tng tun hon no

-Amoxicillin 500mg x 15 vin, ngy 2 vin, sng 1 vin, ti 1 vin

-Metronidazole 500mg x 15 vin, ngy 2 vin, sng 1 vin, ti 1 vin
-Dexamethasone 0,5mg x 10 vin, ngy 3 vin, sng 2 vin, ti 1 vin
-Ginko biloba 40mg x 21 vin, ngy 3 vin, sng 1 vin, chiu 1 vin, ti 1 vin
VII.Phng bnh:
- eo khu trang trc khi ra ng v lm cng vic gp nhiu bi bm. Gi mi trng
xung quanh lun sch se, trnh xa khi bi, cht thi, n ung dinh dng.
- Khi c cc triu chng ban u nh ht hi, chy nc mi, tc mi, cn n ngay
bnh vin, khng nn t mua thuc iu tr.

PHN THM KHM NG Y

I.Vng:
-Tnh to, linh hot
-Sc mt ti nhun, sc mi nhun
-Cht li , ru vng, mng, t, li khng to bu, khng c du rng, khng lch,
khng run
-Th trng mp, da lng nhun, khng ph, khng teo c, chn tay khng run, i ng
bnh thng
-Thi ha nh, khng cu gt, nng ny
II.Vn:
-Ting ni r, c lc
-Khng kh th, hi th khng hi
-Khng ho, khng nc, khng bun nn, khng nn
III.Vn:
-Trong ngi nng, thch mt, khng st
-ng lm th ra m hi tay hn, khng o hn

-n ung bnh thng, khng kht

-Nc tiu lc vng lc trong, thng tiu vng nhiu hn tiu trong, khng tiu m
-i tin khng to khng lng
-Thnh thong chng mt, nhng khng au u, khng au tai, khng tai
-au lng, mi gi, khng au tc hai bn sn
-Khng kh chu vng ngc, khng au ngc, khng au bng
-Kh ng, ng chp chn, khng su
IV.Thit:
-Mch i sc c lc
-Lng bn tay bn chn nng, di mi c khng nng
-Bng khng chng, khng au, khng u cc
-Cc huyt Chng mn, Ky mn, Trung qun, C khuyt, n trung, Thi dng khng
au khi n.
-Huyt Phong tr n au.
V.Bin chng lun tr
Bnh nhn n 66 tui, vo vin v chng mt, qua vng vn vn thit ta rt ra cc du
chng v hi chng sau:
L chng
-Bnh nh hng ti Can, Tm. Can m h biu hin chng mt, trong ngi nng, lng
bn tay chn nng, cht li , ru vng, tiu vng, mch i sc. Tm huyt h biu
hin d hi hp, ng lm th hi hp tng km ra m hi tay, kh ng, ng chp chn,
khng su. Biu hin Thn h ch mc nh ch c biu hin au lng, mi gi, trong
ngi nng, lng bn tay chn nng, cht li , ru vng, tiu vng, mch i sc.
Nhit chng:
-Trong ngi nng, thch mt
-Lng bn tay bn chn nng

-Cht li , ru li vng
-Tiu lc vng lc trong, vng nhiu hn trong
-Mch i sc
H chng
-D hi hp, ng lm th hi hp tng km ra m hi tay
-Kh ng, ng chp chn, khng su
Chn on bnh danh : Huyn vng
Chn on bt cng : L h nhit
*Chn on m dng kh huyt : m, Kh, Huyt
Chn on tng ph, kinh lc : Can Tm Thn
Chn on nguyn nhn : Ni nhn
Php iu tr : T m b Can Thn, dng tm an thn
Huyn l hoa mt chng mt , Vng l chao o nh ngi trn thuyn, hai triu
chng ny thng i chung vi nhau, v vy gi chung l huyn vng. Bnh nhn c triu
chng, chng mt tng cn, h lm vic nhiu th km thm hi hp v ra m hi v khi
nh vy th li xut hin chng mt nn bnh danh y l Huyn vng.
Chn on bt cng l l h nhit. L l v bnh nh hng n tng ph m y l
tng Can v tng Tm. Can m h biu hin, chng mt, trong ngi nng, lng bn tay
chn nng, cht li , ru vng, tiu vng, mch i sc. Tm huyt h biu hin d
hi hp, ng lm th hi hp tng km ra m hi tay. Thn h ch mc nh c biu
hin l au lng, mi gi. Nhit l v bnh nhn c biu hin trong ngi nng, thch mt,
lng bn tay chn nng, tiu lc vng lc trong, vng nhiu hn trong, cht li , ru
li vng, mch i sc.
Chn on phn bit
Nguyn nhn ca chng Huyn vng c th do h c th do thc nhng phn ln l h
chng, thc chng rt t. Thc chng thng l biu hin ca chng hu can ha thng
vim hoc can dng thng cang. H gian lc th th ghi: phong ho giai dng,
dng a kim ho, dng ch h ng, lng dng tng bc tc vi tuyn chuyn
ni phong v ho u thuc dng, dng thng kim ho, dng ch v ng, hai
dng (phong v ha) tng bc vi nhau tt gy ra huyn vng.
Can dng thng can l do can dng nng bc ln qu nhiu, dng thin thnh u,
mt nn ngoi biu hin chng mt cn c thm biu hin u trng, u au, au mt,
trng au vng sn, ng ming, mch huyn, tnh tnh cu gt nng ny. Nu can ha
thnh (can ha tch thnh, can kinh thc ha) th ngoi triu chng ca can dng thng
can ra cn c thm triu chng thin v ha v nhit biu hin au u cng nhiu

hn, au d di, kim mt , tai , c th kim cc chng xut huyt nh nn ra mu,

chy mu cam. Tuy nhin trn bnh nhn ch c biu hin ca chng mt ch khng au
u, au mt, tai , khng cu gt nng ny v khng c cc triu chng khc; triu
chng nhit bnh nhn cng ch mc nh nhng. Nh vy ta thy triu chng bnh
can trn bnh nhn tng i nh nhng ch khng nng n v rm r nn ta c th loi
tr hai nguyn nhn huyn vng thuc thc chng l can dng thng cang v can ha
thng vim ni trn.

Xt nguyn nhn huyn vng do t v h nhc, m trc trung tr. an kh tm php c

vit : v m bt tc huyn ngha l khng c m th khng gy huyn vng. Ty V
h tn th kh huyt khng c ngun m sinh, ty tht kin vn th khng vn ho c
n thnh tinh cht nui c th m ng t li thnh thp thnh m. Ty ch thng, V
ch ging, Ty V h th m thp sinh ra thanh dng khng thng, trc m khng ging
m gy nn huyn vng. Bnh nhn c triu chng huyn vng nhng khng c triu
chng ca Ty V h nh n km, y bng, i tin lng long, u khng nng, mnh
my tay chn khng nng n, khng c m, li khng to bu, khng nht, mch khng
nhu khng hot nn ta cng loi tr nguyn nhn m trc trung tr do Ty V h tn.
Sau khi loi tr cc nguyn nhn trn ta thy bnh cnh bnh nhn ph hp nht vi
chng hu Can m h. Can m h phn ln l do Can huyt h tin trin ln m thnh.
Sch T vn ch chn yu i lun vit : ch phong tc huyn giai vu thuc can ni

cc loi phong gy huyn vng u do can phong sinh ra. Can m h vi biu hin,
chng mt, trong ngi nng, lng bn tay chn nng, cht li , ru vng, tiu vng,
mch i sc.
Bnh huyn vng ch yu l do tng can nhng tng Tm v tng Thn cng ng vai tr
quan trng theo quan h ng hnh tng sinh.
t Qu ng nguyn cho nn Can m h phn ln l do Th n m h tin trin ln m
thnh v can m c da vo s nui dng ca thn thy. V th th n m h se dn n
can m bt tc. Thc t trn b nh nhn ngoi tri u chng m h ta cn thy biu hi n
tri u chng ca th n h l au lng, mi gi. Hn na do b nh nhn tui cao thn tinh
bt tc, tinh khng th ty se km, tinh ty km th khng nui dng c cho no,
v no l b ca ty, nn cng gy ra chng huyn vng.
Can m c sinh Tm ha, Can m bt tc se khng sinh c Can huyt v m l m ca
huyt. Can huyt h th khng sinh c Tm huyt nn b nh nhn c biu hi n d hi
hp, ng lm th hi hp tng km ra m hi. Tinh tin thin ca Th n suy, huyt h u
thin ca Can h, lm cho huyt ca Tm thiu th cng d gy ra chng Huyn Vng.
Tm li bnh l y l Can Thn m h, Tm huyt h.
VII.iu tr
1.Php
Cnh Nhc ton th vit : v h bt tc huyn, v ho bt tc vng, ngha l khng h
th khng chng m t, khng c ho th khng gy chao o vy huyn vng l do h hp
vi ho gy nn, php cha b h ging ho.
Hi Thng Ln ng trong Y trung quan kin vit: bnh chng mt trong phng th
u chia ra phong, hn, th, thp, kh, huyt, m cha, i khng ngoi ch ha.
m huyt hu thin h th ho ng ln, chn thu tin thin suy th ho bc ln, bnh
nh th cha hu thin, bnh nng th cha tin thin.
V th, trong trng hp ny php iu tr l Bnh can tc phong, T m b Can Thn,
dng tm an thn
2.Phng
2.1.Phng huyt
Thng huyt Tc lm khp
Bnh can tc phong: Thi xung, Bch h i, Phng tr (), phong (Tt)
B th n m: Tam m giao, Phc lu, m cc.
B Can m huyt: Tam m giao, Khc tuyn, Can du
Dng Tm huyt: Thiu hi, Tm du
An thn: An min 1, An min 2, N i quan, Thn mn

-Phng huyt 1: Tc lm khp, Thi xung, Bch h i, phong, Tam m giao, Phc lu,
Khc tuyn, Thiu hi, An min 1, N i quan.
-Phng huyt 2: Tc lm khp, Thi xung, Bch h i, Phong tr, Tam m giao, m cc,
Can du, Tm du, An min 2, Thn mn
2.2.Phng thang:
t m b can thn, dng tm an thn trong trng hp ny ti dng bi Lc v Quy
thc gia v
t m b can thn, dng tm an thn, bnh can tc phong trong trng hp ny ti
dng bi K cc a hong hong (Y cp) gia gim.
K cc a hong hong (Y cp) gia gim
1. Thc a
20g (b Thn m)
2. Sn th
16g (b Can m)
3. Hoi sn
12g (b Ty m)
4. an b
08g (thanh Can ha, gim bt tnh n ca Sn th)
5. Phc thn
08g (kin ty an thn)
6. Trch t
08g (t Thn ha, gim bt tnh nn tr ca Thc a)
7. ng quy 16g (b huyt, hot huyt)
8. Bch thc
12g (b Can m, b huyt)
9. K t
12g (t b Can Thn, b huyt, minh mc, nhun Ph)
10. Cc hoa
12g (s tn phong nhit, minh mc, ging p, ch thng)
11. Long nhn
12g (b Tm Ty, dng huyt, an thn, nh ch)
12. To nhn
12g (dng tm an thn)
13. Hong ky
16g (ch kh)
14. ng sm
20g (ch kh)