1

I HC THI NGUYN
TRNG I HC NNG LM
PGS. TS. NGUYN QUANG TUYN - ThS. TRN VN THNG

GIO TRNH

SINH L BNH TH Y
(Gio trnh dng cho h i hc)
NH XUT BN NNG NGHIP
H Ni - 2007
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LI NI U
Gio trnh Sinh l bnh th y c bin son p ng vi nhu cu cp thit v
ti liu hc tp ca sinh vin ngnh Th y trong cc trng i hc thuc khi Nng
nghip, cng nh nng cao cht lng ging dy v hc tp khi p dng phng
php ging dy mi.
Sinh l bnh hc l mn hc nghin cu v nhng thay i chc nng ca c
quan, m v t bo khi c thm bnh, ng thi l mn hc tin tm sng ca ngnh
Th y v cu ni gia cc mn hc c s nh sinh l hc, sinh ha hc, vi sinh vt hc
v cc mn hc lm sng nh bnh ni khoa, bnh k sinh trng, bnh truyn nhim,
bnh sn khoa...
Cng vi mn Gii phu bnh hc, mn Sinh l bnh hc h thng hoa kin thc
cho cc sinh vin ngnh Th y v cn b nghin cu th y v cc quy lut chung ca
qu trnh sinh bnh ng vt, cc bin i bnh l ca qu trnh sinh bnh trong c
th, s thay i ca cc m bo, t bo, c quan, h thng do ri lon chc nng...
ng dng trong cng tc chn on, phng chng bnh cho vt nui, gp phn nng
cao hiu qu chn nui v thc y ngnh chn nui pht trin.
Bin son gio trnh ny, chng ti c gng th hin tnh c bn, tnh khoa hc,
tnh hin i v tnh h thng ca chng trnh mn hc, ng thi c lin h thc tin
nhng do trnh v kh nng c hn nn kh trnh khi nhng thiu st. Chng ti
rt mong nhn c nhng ng gp kin ca ng nghip v bn c trong qu
trnh s dng ti liu ny.
Xin chn thnh cm n!
Tp th tc gi
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Bi m u
NI DUNG V PHNG PHP NGHIN CU MN SINH L BNH TH Y
1. NH NGHA MN HC
Sinh l bnh (PHthophysiology) theo ngha tng qut nht l mn hc v nhng
thay i chc nng ca c th, c quan, m v t bo khi chng b bnh. Sinh l bnh
hc l mt mn khoa hc nghin cu nhng hot ng ca s sng trong c th bnh,
c th l nghin cu nhng bin i bnh l v c nng cc c quan, h thng v m
bo, ng thi nghin cu nhng nguyn nhn, iu kin gy bnh v tm ra quy lut
chung ca s pht sinh, pht trin v kt thc ca qu trnh bnh l.
Mn sinh l gia sc nghin cu tt c c nng, h thng trong c th gia sc (ng
vt) bnh thng v tm ra c quy lut nht nh, cng nh vy trn c th bnh

chng ta cng nghin cu tun t v so snh li vi quy lut bnh thng thy c
nhng thay i nh th no v t rt ra kt lun vi tng trng hp. Chnh v vy
ngi ta thy mi mt bnh c mt quy lut ring v n cng c nhng biu hin bnh
l chung.
V d: Trong tt c cc loi nhim khun chng ta u thy cc qu trnh bnh l
nh vim, st, khi kim tra mu thy bch cu tng v l nhng quy lut chung.
Trong khi bnh dch t ln chng ta thy c th ln st, vim nhng bch cu h;
bnh lao phi chng ta li thy c th vt bnh st lin min, thng hay st vo
bui chiu, ra mi hi nhiu v l nhng quy lut ring.
Nhng quy lut ring to nn nhng bin i trn c quan, t chc gi l qu trnh
bnh l in hnh v cc qu trnh ny to nn bnh tch in hnh.
T nhng quy lut khi qut li v nu ln quy lut hot ng ca tng bnh,
to c s l lun cho cc mn hc lm sng tm bin php khng ch.
2. NI DUNG MN HC
Ni dung ca mn sinh l bnh hc c chia lm ba chng:
Chng 1 : Cc khi nim v quy lut chung v bnh
Bao gm: khi nim v bnh, nguyn nhn gy bnh, sinh bnh hc, c tnh ca
c th i vi s pht bnh (bnh l ca qu trnh min ch).
Chng 2: Sinh l bnh cc qu trnh bnh l chung
Bao gm: ri lon tun hon cc b, ri lon chuyn ha cc cht, vim, ri lon
iu ho thn nhit, qu trnh bnh l ca s pht trin m bo.
Chng 3: Sinh l bnh cc c quan, h thng
Nghin cu ri lon chc nng ca cc c quan, h thng: h thng mu v c
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quan to mu, h tun hon, h h hp, h tiu ha, h tit niu v h thng thn kinh.
Vi nhng ni dung trn mn sinh l bnh hc l mn hc c s ca ngnh th y,
c lin quan cht ch vi nhiu mn hc khc nh: sinh l gia sc, sinh ha hc, dc
l hc, vi sinh vt hc v cc mn lm sng th y nh: bnh ni khoa, chn on bnh,
bnh k sinh trng, bnh truyn nhim, bnh sn khoa...
c bit sinh l bnh v gii phu bnh l hai cu thnh ca mn Bnh l hc, l
hai mn hc c cng chung mt i tng nghin cu nhng sinh l bnh ch yu
nghin cu nhng bin i v c nng, cn gii phu bnh th nghin cu nhng bin
i v hnh thi trn c th bnh.
3. PHNG PHP NGHIN CU MN SINH L BNH TH Y
Phng php nghin cu ca mn sinh l bnh hc l phng php thc nghim,
mt phng php rt khch quan v khoa hc. Phng php ny tin hnh gy bnh
nhn to trn c th ng vt, sau quan st ton b qu trnh din bin ca bnh,
cui cng phn tch v rt ra quy lut chung ca qu trnh bnh l. Trong phng php
thc nghim, thng s dng hai phng php l phng php thc nghim cp tnh
hay cn gi l cp din v phng php thc nghim mn tnh hay cn gi l trng
din.
3.1. Phng php thc nghim cp tnh (cp din)
Phng php ny thng phn tch cc chc nng ca cc c quan ring bit, c
khi c lp ra khi c th nghin cu, tc l lm nhanh c kt qu ngay c th
nm c cc quy lut Ngi ta thng s dng phng php ny trong mt s trng
hp chn on nhanh v dng ging dy cho sinh vin.
V d: Ngi ta thng c lp tim ch hoc c lp mt on rut nghin cu.

u im: phng php ny tng i n gin, quan st bin i v c nng

trong mt thi gian ngn.
Nhc im: Gy tn thng trn c th bnh, kch thch tng c quan ring bit
mt cch nhn to, thm ch cn tch ri mt s c quan khi c th hoc tin hnh
nghin cu di iu kin gy m. Trong nhng iu kin thc nghim nh vy th
khng th biu hin c bn cht ca bnh mt cch y , kt qu thu c khng
st so vi khi con vt hot ng bnh thng.
3.2. Phng php thc nghim mn tnh (trng din)
Phng php thc nghim mn tnh do Pp-lp ra. Phng php ny tin hnh
trn con vt sau khi c phu thut v hon ton hi phc, c th con vt trng
thi tnh to gn nh bnh thng.
V d: ngi ta lm mt ng hng dch v d dy, lm mt ng hng nc
bt.
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- u im: Lm th nghim trn con vt trng thi bnh thng nghin cu c
lu di, chnh xc hn, c th rt ra nhng quy lut bin i c th bnh mt cch
ton din trong sut qu trnh bnh l, tn t ng vt th nghim.
- Nhc im: Ch p dng nghin cu trong mt s trng hp c thi gian
nghin cu lu di.
Nhng ngi ta thng kt hp c hai phng php trn nghin cu qu trnh
bnh mt cch ton din hn.
Ngy nay c nhiu phng php nghin cu tin tin nh: phng php ni soi,
hoc phng php ct lt b c xem c u no khng, phng php dng my siu
m kim tra hot ng ca thai... cng c p dng trong nghin cu sinh l bnh.
Ngoi ra sinh l bnh hc cn ng dng nhng thnh tu v phng php mi nht
ca khoa hc nh: min dch hc, sinh ha hc, phn t hc (nui cy en, ct en)
nghin cu cc qu trnh bnh l.
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Chng 1
CC KHI NIM V QUY LUT CHUNG V BNH
1. KHI NIM V BNH
K t thi nguyn thu ti nay, qua bao ngn nm, khi nim v bnh l bt bin.
iu khng ng m n thay i theo thi gian. Ni chung, s thay i ny
ph thuc ch yu vo hai yu t:
- Trnh vn minh ca x hi ng thi.
- Th gii quan (bao gm c trit hc) ca mi thi i.
Trong mt x hi, c th ng thi xut hin nhiu khi nim v bnh, k c
nhng khi nim i lp nhau. l iu bnh thng ni ln nhng quan im hc
thut khc nhau c th cng tn ti trong khi ch i s ng ng. Tuy nhin, trong lch
s c nhng trng hp quan im chnh thng tm cch n p cc quan im
khc.
Mt quan nim v bnh bao gi cng chi phi cht ch cc nguyn tc cha bnh,
phng bnh. Do vy n c vai tr rt ln trong thc tin.
1.1. Mt s khi nim trong lch s
1.1.1 Thi nguyn thu
Ngi nguyn thu khi bit t duy cho rng bnh l s trng pht ca cc ng siu
linh i vi con ngi v trn th. y c s ln ln gia bn cht ca bnh vi nguyn

nhn gy ra bnh (tr li cu hi "bnh l g" cng ging cu hi "bnh do u"). Khng
th i hi mt quan nim tch cc hn khi trnh con ngi cn qu thp km, vi th
gii quan coi bt c vt g v hin tng no cng c cc lc lng siu linh can thip
vo. ng ch l quan nim ny bc sang th k 21 vn cn tn ti nhng b tc lc
hu hoc mt s b phn dn c trong cc x hi vn minh. Vi quan nim nh vy th
ngi xa cha bnh ch yu bng dng l vt cu xin, c th cu xin trc tip, hoc
thng qua nhng ngi lm ngh m tn d oan. Bao gi cng vy, gi tr ca vt l lun
lun nh hn gi tr ca iu cu xin. Tuy nhin, trn thc t ngi nguyn thu bt
u bit dng thuc, khng phi ch ph mc s phn cho thn linh.
1.1.2. Thi cc nn vn minh c i
Trc cng nguyn nhiu ngn nm, mt s vng trn th gii t trnh vn
minh rt cao so vi mt bng chung. V d: Trung Quc, Hy Lp, La M, Ai Cp hay
n . Trong x hi hi xut hin tn gio, tn ngng, vn hc ngh thut,
khoa hc (gm c y hc v trit hc). Nn y hc lc mt s ni t c
nhng thnh tu ln v y l cng nh v phng php cha bnh v a nhng
quan nim v bnh ca mnh.
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1.1.2.1. Trung Quc c i
Khong hai hay ba ngn nm trc cng nguyn, y hc chnh thng Trung Quc
chu nh hng ln ca trit hc ng thi cho rng vn vt c cu to t nm
nguyn t (Ng hnh: Kali, Mc, Thu, Ho, Th) tn ti di hai mt i lp (m v
dng) trong quan h h tr hoc t ch ln nhau (tng sinh hoc tng khc).
Cc nh y hc c i Trung Quc cho rng bnh l s mt cn bng m dng v
s ri lon quan h tng sinh tng khc ca Ng hnh trong c th. T nguyn
tc cha bnh l iu chnh li, kch thch mt yu (b), ch t mt mnh (t).
Trong thi k ny quan nim v bnh y l duy vt, cc th lc siu linh bt
u b loi tr khi vai tr gy bnh. C nhin, y mi ch l trnh duy vt ht sc
th s (cho rng vt cht ch gm nm nguyn t) v trong nhiu ngn nm, quan nim
ny t ra bt bin, khng h vn dng c cc thnh tu v i ca cc ngnh khoa
hc t nhin khc vo y hc.
Y l Trung Quc c i kh phong ph v cht ch, thc s c vai tr hng dn
cho thc hnh, ng thi c th t ho v tnh bin chng su sc. Tuy nhin, trnh
bin chng y ch l rt chung chung, tru tng. Do vy, y l ch dng li mc
l thuyt (do quan st v suy lun m c) cha th gi l t mc l lun (dng
thc nghim kim tra v chng minh m c).
Y hc v y l Trung Quc c i c nhng ng gp rt ln cho chn on v
cha bnh. nh hng ca n lan c sang phng Ty, xm nhp c vo y l ca mt
nn y hc c chu u. Ngi ta cho rng chnh l thuyt v "bn nguyn t" ca
Pythagore v "bn cht dch" ca Hippocrat cng chu nh hng r rt ca y l Trung
Quc c i.
Tri qua hng ngn nm tn ti v pht trin, nn y hc ny c nhng ng gp
ht sc to ln, vi v s bi thuc phong ph v cng hiu. Tuy nhin, cho n khi ch
ngha t bn chu u bnh trng sang phng ng tm thuc a ng thi mang
theo y hc hin i sang chu - n ch vn dng mc y hc c truyn m cha h
c yu t hin i no.
Nguyn nhn do ch phong kin Trung Quc tn ti qu lu, vi quan nim
"cht m khng ton vn c th" l iu ht sc au kh, nhc nh cho c ngi cht

v thn nhn h. Do vy, mn gii phu khng th ra i. Cc nh y hc ch c th

dng tng tng v suy lun m t cu trc c th. Tip sau l mt chui di
nhng suy lun v suy din, mc d t nhiu c i chiu vi quan st thc tin nhng
khng sao trnh khi sai lm (v khng c thc nghim chng minh). Tuy nhin, y
vn ch l nhng quan st trc tip bng cc gic quan (d rt t m) m khng c trang
thit b h tr nn ch c th dng li hin tng v sau li tip tc dng suy lun
mong hiu c bn cht.
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1.1.2.2. Thi vn minh Hy Lp v La M c i
Mun hn Trung Quc hng ngn nm. Y hc c i ca nhiu nc chu u
cng chu nh hng kh r ca Trung Quc, ni bt nht l Hy Lp -La M c i.
Gm hai trng phi ln:
- Trng phi Pythagore (600 nm trc cng nguyn): da vo trit hc ng
thi cho rng vn vt do bn nguyn t to thnh vi bn tnh cht khc nhau: th
(kh), kh (m), ha (nng), thu (lnh). Trong c th, nu bn yu t ph hp v
t l, tnh cht v s cn bng s to ra sc kho; nu ngc li, s sinh bnh. Cch
cha bnh cng l iu chnh li, b sung ci thiu v yu, loi b ci mnh v tha.
- Trng phi Hippocrat (500 nm trc cng nguyn): khng ch thun tu tip
thu v vn dng trit hc nh trng phi Pythagore m tin b v c th hn, quan
st trc tip trn c th sng. Hippocrat cho rng c th c bn dch, tn ti theo t l
ring, c quan h cn bng vi nhau to ra sc kho, l:
+ Mu : do tim sn xut, mang tnh nng; ng nhn xt rng khi c th lm vo
hon cnh nng (st) th tim p nhanh v mt, da u bng. l do tim tng
cng sn xut mu .
+ Dch nhy: khng mu, do no sn xut, th hin tnh lnh; xut pht t nhn
xt khi c th b lnh th dch mi chy ra rt nhiu, ngc li khi nim dch xut tit
nhiu cng l lc c th nhim lnh.
+ Mu en: do lch sn xut, mang tnh m.
+ Mt vng: do gan sn xut, mang tnh kh.
Bnh l s mt cn bng v t l v quan h gia bn dch . L thuyt ca
Hippocrat c nh hng rt ln i vi y hc chu u thi c i. Bn thn Hippocrat
l nh y hc c truyn v i, c cng lao tt ln; tch y hc khi nh hng ca tn
gio, ch trng chn on bng pht hin triu chng khch quan, cao o c y
hc.
thi k ny quan nim v bnh kh duy vt v bin chng, tuy cn th thin. C
th ni y l c im d t c khi l thuyt cn s si, dng li trnh chung
chung v tru tng. Tuy nhin, nhng quan st trc tip ca Hippocrat li kh c th
nh bn cht dch l c tht v cho php kim chng c. Nh vy, cc th h sau c
iu kin kim tra, sa i v pht trin n, nht l khi phng php thc nghim
c p dng vo y hc, a y hc c truyn tin ln hin i. Chnh v vy, Hippocrat
c tha nhn l ng t ca y hc ni chung c y hc c truyn v hin i.
1.1.2.3. Cc nn vn minh khc
- C Ai Cp: Da vo thuyt Pneuma (sinh kh) cho rng kh em li sinh lc cho
c th. C th phi thng xuyn h hp a sinh kh vo. Bnh l do ht phi kh
xu khng trong sch. T , cc nh y hc ra nhng nguyn tc cha bnh.
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- C n : Y hc chnh thng chu nh hng su sc ca trit hc o Pht cho

rng cuc sng l mt vng lun hi (gm nhiu kip), mi kip tri qua bn giai
on: sinh, lo, bnh, t. Nh vy, bnh l iu khng th trnh khi. Tuy nhin, cc
nh y hc c i n vn sng to c rt nhiu phng thuc cng hiu cha
bnh. o Pht cn cho rng con ngi c linh hn vnh vin tn ti, nu n cn ng
tr trong th xc tn ti tm thi l sng, e do thot khi xc l bnh, thot hn khi
th xc l cht.
1.1.3. Thi k Trung c
Chu u thi k Trung c (th k 4-12) c coi l "m di" v din ra sut 8
th k di s thng tr tn bo v h khc ca nh th, tn gio v ch phong kin.
Nguyn nhn do s cung tn vo nhng l thuyt mang tnh tn gio khin cc gio s
da vo cng quyn sn sng n p khc lit cc kin i lp. Tuy nhin, nguyn
nhn su xa hn l tng lp gio s v phong kin mun bo v lu i c quyn
thng tr ca h.
- Cc quan nim tin b b n p nu tri vi nhng tn iu trong kinh thnh,
khoa hc lm vo tnh trng tr tr v tht li. Cc nh khoa hc tin b b khng b.
- Quan nim chnh thng v bnh t ra rt m mui, khng coi trng cha bng
thuc, thay bng cu xin, y l phi tun theo cc gio l ca nh th, mi v thnh trn
gi mt b phn trong c th, mt s gio s cm c sch thuc... Nhng nh y hc
c quan im tin b b ngc i.
Tuy vy, cui thi Trung c vn lc c c vi quan nim duy vt nhng rt s
si, PHracelsus (1493-1541) cho rng lu hunh c vai tr biu hin sc mnh ca
linh hn, tr tu, cn thu ngn v mui c vai tr trong duy tr sc mnh th cht. Tuy
vy, cc quan im ny khng c coi l chnh thng nn t nh hng trong gii y
hc.
1.1.4. Thi k Phc hng
Th k 16-17, x hi thot khi thn quyn, vn hc ngh thut v khoa hc phc
hng li n r vi nhiu tn tui nh Newton, Descarte, Toricelli, Vesali, Harvey...
Gii phu hc (Vesali, 1414-1564) v Sinh l hc (Harvey, 1578-1657) ra i t nn
mng vng chc y hc t c truyn tin vo thi k hin i. Nhiu thuyt tin b
v y hc lin tip xut hin. Tnh duy vt tuy cn th s, tnh bin chng vn cn my
mc nhng so vi thi k y hc c truyn th c nhng bc tin nhy vt v cht.
thi k ny c c im l:
- Mi thuyt u c th hn trc, gim mc tru tng, khin c th dng
thc nghim kim tra d dng tha nhn hoc bc b; ng thi c tc dng gim
bt tnh ngh thut tng thm tnh khoa hc v tnh chnh xc trong hnh ngh ca
ngi thy thuc.
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- Cc thuyt u c vn dng cc thnh tu mi nht ca cc khoa hc khc nh
co hc, l hc, ha hc, sinh hc, sinh l, gii phu. V d:
+ Thuyt c hc (Descarte): Coi c th nh mt c my, v tim nh ci my bm,
mch mu l cc ng dn; cc xng nh nhng n by v h c nh cc lc. Bnh
c v nh trc trc ca my mc...
+ Thuyt ha hc (Sylvius, 1614-1672): coi bnh tt l do s thay i t l cc
ha cht trong c th, hoc s ri lon ca cc phn ng ha hc.
+ Thuyt lc sng (Stalil, 1660-1734): Cc nh sinh hc hi cho rng cc sinh
vt c nhng hot ng sng v khng b thi ra l nh trong chng c ci gi l lc
sng. Lc sng cng chi phi sc kho v bnh tt ca c th bng lng v cht ca

n.
1.1.5. Thi k th k 18 -19
y l thi k pht trin ca y hc hin i vi s vng mnh ca hai mn Gii
phu hc v Sinh l hc. Nhiu mn y hc v sinh hc ra i. cc nc phng
Ty, y hc c truyn hon ton tin sang thi y hc hin i. Phng php thc
nghim t vt l hc c ng dng mt cch ph bin v c h thng vo y hc
mang li rt nhiu thnh tu. Rt nhiu quan im v bnh ra i, vi c im ni bt
da trn nhng kt qu c thc nghim kim tra v khng nh.
Mt s quan nim ch yu v bnh trong thi k ny l:
- Thuyt bnh l t bo: Wirchow l ngi sng lp mn Gii phu bnh cho rng
bnh l do cc t bo b tn thng, hoc cc t bo tuy lnh mnh nhng thay i v
s lng, v tr v thi im xut hin.
- Thuyt ri lon hng nh ni mi: Claud Benard - nh Sinh l hc thin ti,
ngi sng lp mn y hc thc nghim, tin thn ca mn Sinh l bnh - a thc
nghim vo y hc mt cch h thng v sng to, ra khi nim "hng nh ni
mi" cho rng bnh xut hin khi c ri lon cn bng ny trong c th.
- Mun hn, sang th k 19-20, Frend (1856-1939) v mn cho rng bnh l do
ri lon v mt cn bng gia thc, tim thc, bn nng. Mn Pp-lp lm
dng qu mc cc cng trnh ca ng th cho rng bnh l kt qu ca s ri lon hot
ng phn x ca thn kinh cao cp. Cc khi nim ny c ng gp nht nh
trong mt phm vi no , ng thi cng biu hin nhng thin lch hiu bit v
bnh.
1.1.6. Thi k hin i (Th k 20)
Th k ny l thi k ca in t, ca cc cht cao phn t v cng l thi k ca
sinh hc. Mt s ngnh sinh hc pht trin mnh nh: di truyn hc, min dch hc,
sinh hc phn t... c nh hng ln ti y hc, do cng c nhiu khi nim khc
nhau v bnh.
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Ring Nga, tip thu cc cng trnh ca cc nh khoa hc nh Sechenov, Botkin,
Pp-lp ra hc thuyt thn kinh ca bnh. Theo thuyt ny ni mi v ngoi
cnh l mt khi thng nht, trong hot ng ca thn kinh cao cp ng vai tr
quyt nh i vi kh nng thch ng ca c th (tc ni mi) vi nhng thay i bn
ngoi. S kt hp cht ch gia v no v nhng on di ca h thn kinh, gia h
thng tn hiu th nht v th hai ca ngi, gia thn kinh v ni tit c tc ng
iu ho chnh xc v kp thi mi hot ng ca c th, m bo mi tng quan
chnh xc gia ni mi v ngoi cnh. Bnh tt l do ri lon hot ng phn x ca h
thn kinh, ri lon tng quan gia cc khu vc khc nhau ca h thn kinh. Pp-lp
ch r: "trong ngi bnh c hai qu trnh tn ti song song: qu trnh bo v sinh l
v qu trnh hu hoi bnh l".
Qua cc l lun trn cc nh khoa hc Nga nhn nhn vn bnh tt mt cch
ton din hn. Tuy nhin vn cha gii thch mt cch hon ho khi nim v bnh.
Trong thi k ny, ngnh ha cht, nht l sinh ha pht trin mnh m, ngi ta
nhn thy tnh cht tng i n nh ca cc thnh phn ha hc trong c th. Da
vo Hens Selye a ra kin "Bnh l s ri lon cc kh nng thch nghi". Nghin
cu cc tc ng mnh ca ngoi cnh (stress) th Selye cho rng bao gi c th cng
p li bng nhng thay i ca hot ng ni tit v thn kinh. Theo Selye s mt cn
bng v hip ng gia h no v thng thn th sinh ra bnh gi l bnh thch nghi.

Theo tin ha lun khoa hc th mi sinh vt u bt ngun t mt n bo, sau

phc tp dn thnh c quan, t chc khc nhau, c cc hot ng ring nhng nhm
mc ch chung l duy tr s sng. Do , s ngn cch gia cc b phn (t bo, c
quan), gia c th trong cng ng, gia c th vi thin nhin ch cc tnh cht tng
i, m v thc cht c s lin quan trao i mt thit qua li vi nhau, nh hng ln
nhau. Gia ngoi cnh v c th c s thng nht v c s mu thun, ngoi cnh th
lun lun thay i v c th nh kh nng thch nghi ca mnh m duy tr hng nh
ni mi mt cch tng i, duy tr s sng.
1.2. Quan nim v bnh hin nay
1.2.1. Hiu v bnh qua quan nim sc kho
- T chc Y t th gii (WHO - 1946) a ra nh ngha: "Sc kho l mt tnh
trng thoi mi ton din v th cht, tinh thn v x hi, ch khng ch n thun l
khng c bnh hay tt". y l nh ngha mang tnh mc tiu x hi, phn u,
c chp nhn rng ri.
- Tuy nhin di gc y hc, cn c nhng nh ngha ph hp v cht ch hn.
Cc nh y hc cho rng: "Sc kho l tnh trng lnh ln ca c th v cu trc,
chc nng, cng nh kh nng iu ho gi cn bng ni mi, ph hp v thch nghi
vi s thay i ca hon cnh".
1.2.2. Nhng yu t nh ngha v bnh
12
a s cc tc gi u a vo khi nim bnh nhng yu t sau:
- S tn thng, lch lc, ri lon trong cu trc v chc nng (t mc phn t, t
bo, m, c quan n mc ton c th). ,
- Do nhng nguyn nhn c th, c hi; tm ra hay cha tm ra.
- C th __________c qu trut phn ng nhm loi tr cc tc nhn gy bnh, lp li cn
bng, sa cha tn thng. Trong c th b bnh vn c s duy tr cn bng no ,
mc d n lch ra khi gii hn sinh l. Hu qu ca bnh tu thuc vo tng
quan gia qu trnh ri lon, tn thng v qu trnh phc hi, sa cha.
Bnh lm gim kh nng thch nghi vi ngoi cnh.
- Vi ngi, c tc gi ngh thm: bnh lm gim kh nng lao ng v kh
nng ho nhp x hi.
1.2.3. Mt s nh ngha v bnh
"Bnh l tnh trng tn thng hoc ri lon v cu trc v chc nng, dn ti mt
cn bng ni mi v gim kh nng thch nghi vi ngoi cnh".
- "Bnh l s ri lon cc hot ng sng ca c th v mi tng quan vi ngoi
cnh, dn n gim kh nng lao ng".
"Bnh l s thay i v lng v cht cc hot ng sng ca c th do tn
thng cu trc v ri lon chc nng, gy ra do tc hi t mi trng hoc t bn
trong c th".
- "Bnh l s ri lon i sng bnh thng ca c th sinh vt, do tc ng ca
cc yu t gy bnh khc nhau, gy ra mt qu trnh u tranh phc tp gia hin
tng tn thng bnh l v hin tng phng v sinh l, lm hn ch kh nng thch
nghi ca c th i vi ngoi cnh, lm cho kh nng sn xut v gi tr kinh t b
gim st".
- "Bnh l mt iu kin m mt c th ch ra s sai khc v gii phu, ha
hc, sinh l so vi bnh thng".
- nh ngha "th no l mt bnh" hin nay ang c s dng ph bin l:

"Bnh l bt k s sai lch hoc tn thng no v cu trc v chc nng ca bt k

b phn, c quan, h thng no ca c th biu hin bng cc triu chng c trng
gip cho thy thuc c th chn on xc nh v chn on phn bit, mc d nhiu
khi ta cha r v nguyn nhn, v bnh hc v tin lng" (T in y hc Dorlands,
2000).
2. I CNG V BNH NGUYN HC
2.1. nh ngha
Bnh nguyn hc (Etiology) hay nguyn nhn bnh hc l mn hc nghin cu v
13
nguyn nhn gy bnh, bn cht ca chng, c ch m chng tc ng, ng thi
nghin cu cc iu kin thun li hay khng thun li nguyn nhn trn pht huy
tc dng. Vic nghin cu nguyn nhn gy bnh c ngha rt to ln trong l lun
cng nh trong thc hnh. V l lun n biu hin mt lp trng r rt; v thc hnh
n gip cho vic phng tr c hiu qu. Pp-lp ni: "Vn pht hin ra nguyn
nhn gy bnh l mt vn c bn ca y hc v ch khi no bit r nhng nguyn
nhn gy ra bnh th mi tin hnh iu tr c chnh xc, hn na mi ngn chn
chng t nhp vo c th v iu ny l quan trng bc nht".
2.2. Mt s quan nim sai lm v bnh nguyn hc
c c nhng quan im v khi nim khoa hc ng n nh hin nay, bnh
nguyn hc tri qua mt qu trnh nghin cu lu di v u tranh gay gt gia cc
hc thuyt khc nhau. Trong c mt s hc thuyt sai lm v nguyn nhn bnh hc
nh:
- Thuyt "nguyn nhn n thun" (Pure Etiology) cho rng vi khun l nguyn
nhn ca mi bnh, h c vi khun l c bnh (tc l mi bnh u do mt nguyn
nhn v ch khi no c nguyn nhn th mi c bnh).
Vi thi cc oan, qu nhn mnh n vai tr ca mt nguyn nhn gy ra
bnh l vi khun, thuyt ny b qua vai tr v nh hng ca nhng iu kin khc
thun li cho s pht sinh ca bnh, cng khng ch n c ch bo v ca c th
chng li s t nhp ca cc yu t gy bnh v n cng khng xt n cc nh
hng khc trong bnh nguyn hc.
Thc t cho thy rng, trong nhiu bnh khng pht hin thy vi khun nh bnh
cao huyt p, cc bnh o tc ng ca cc yu t l, ha hc gy nn v ngc li,
trong nhiu trng hp c vi khun nhng li khng thy bnh xut hin, v d: c ti
80-90% g mang vi khun PHsteurella trong ng h hp trn m khng gy bnh
t huyt trng hoc c ti gn 100% vi khun E, cn sng trong rut gi ca ng vt
v ngi m khng gy bnh.
Mt quan nim sai lm, phin din v bnh nguyn hc nh trn, ch ch n
mt nguyn nhn gy bnh, tt nhin cng s dn n sai lm trong cng tc phng
bnh v iu tr bnh. Nh ta bit vic chng li yu t gy bnh, nht l vi khun
mt cch tch cc cng mi ch l mt mt trong cng tc phng bnh v iu tr. Cn
c nhng mt khc cng khng km phn quan trng l to ra nhng iu kin, nhng
hon cnh yu t gy bnh khng pht huy c tc dng nh tng cng sc
khng ca c th, v.v Thuyt "iu kin n thun" (Pure Condition) cho rng bnh
tt l do kt qu tc ng tng hp ca mt s iu kin v cc iu kin c th gy
bnh m khng cn c nguyn nhn c hiu. Quan nim ny l hon ton sai lm, bi
v tng iu kin tch ring ra, cng nh nhiu iu kin kt hp li khng th quyt
nh c s pht sinh ra bnh v tnh c hiu ca bnh, v d: nu khng c vi

14
khun lao th khng c bnh lao. Cc iu kin ch c tc dng to nn c s d dng
cho bnh pht sinh khi c nguyn nhn gy bnh tc ng.
Hc thuyt ny mang tnh cht tiu cc: cng mt lc a ra nhiu iu kin i
hi phi tho mn th mi c th gii quyt c vn bnh tt. V vy n gy tr
ngi cho cng tc phng bnh v tr bnh. N khng phn bit nguyn nhn v iu
kin v cng khng ch r c vai tr ca mi yu t trong qu trnh gy bnh.
Thuyt "th tng" (Constitution) cho rng nguyn nhn gy bnh khng phi t
bn ngoi ti m chnh l do c im ca c th, do th tng ca con vt m ra. y
l quan nim ca thuyt di truyn my mc, n khng k n cc yu t ngoi cnh tc
ng n qu trnh pht trin v di truyn ca sinh vt. Nh vy n chng li vic v
sinh phng dch, bo v sc kho cho gia sc ngn nga bnh tt.
2.3. Quan nim khoa hc v bnh nguyn hc
Mt s quan nim ng n v bnh nguyn hc l phi da vo phng php duy vt
bin chng nu ln c mi quan h ng n gia nguyn nhn v iu kin gy bnh.
2.3.1. Mi quan h gia nguyn nhn v iu kin gy bnh
- Nguyn nhn c vai tr quyt nh v iu kin th pht huy vai tr tc dng ca
nguyn nhn. Nguyn nhn gy bnh l yu t c hi, khi tc ng ln c th s quyt
nh bnh pht sinh v cc c im ca bnh, v d: Bn bnh ca ln (l bnh
ph thng hn, t huyt trng, ng du, dch t) do bn nguyn nhn khc nhau gy
ra v pht sinh ra bnh c biu hin ring.
Nhng yu t gy bnh khi vo c th phi t cng nht nh (c lc,
liu lng cao...). c im ca bnh chnh l do nguyn nhn quyt nh v chnh
da vo nhng c im ca bnh m ta c th khm ph ra nguyn nhn t m
xc nh phng php cn thit iu tr.
Song nguyn nhn gy bnh ch c th pht huy tc dng trong nhng iu kin
c th nht nh, v d: Bnh t huyt trng g pht trin di tc dng ca vi khun
PHsteurella nhng phi c th yu, dinh dng km v c bit l khi thi tit thay
i t ngt. Ngc li, khi c y cc iu kin thun li nhng khng c nguyn
nhn th bnh khng th pht sinh v xy ra c, n ch pht sinh ra bnh khc nh
suy dinh dng, ci xng. Nguyn nhn v nhng iu kin nht nh gy nn mt
bnh c gi chng l nhng yu t bnh nguyn.
- Trong nhng iu kin nht nh, nguyn nhn c th tr thnh iu kin, ngha
l trong nhng hon cnh no , mt s yu t c th l nguyn nhn nhng trong
hon cnh khc n c th tr thnh iu kin. V d: nui dng km l nguyn nhn
ca suy dinh dng, thiu vitamin l nguyn nhn ca bnh thiu vitamin, song c th
li l iu kin cho cc bnh nhim khun pht trin. Hoc bnh ghp t huyt trngdch
t ln, dch t-t huyt trng ln.
15
V d: Khi khu phn n thiu protein s gy nn ph do protein trong huyt thanh
gim m p lc keo da vo nng protein huyt thanh. Nu protein huyt thanh
gim lm cho p lc keo trong mu gim t lm cho nc b y t ng mch ra
ngoi gian bo gy ra hin tng ph (bnh thn), hoc khi thiu vitamin B1 th cng
gy ra ph.
2.3.2. Quy lut nhn qu trong bnh nguyn hc
- Mi bnh (tc l hu qu) u c nguyn nhn nht nh gy ra v nguyn nhn
bao gi cng c trc hu qu. Nguyn nhn gy bnh d t ngoi vo hay t trong ra

u tc ng ln c th sinh ra hu qu l bnh. Bt c mt bnh no cng u c

nguyn nhn nht nh gy nn. Mc d hin nay rt nhiu bnh cha tm c
nguyn nhn nhng ai cng tin rng bt c bnh no cng phi c nguyn nhn.
- C nguyn nhn nhng khng nht thit pht sinh ra hu qu (tc bnh) nu
khng c iu kin thun li.
Nh trn ta ni v mi quan h gia nguyn nhn v iu kin, trong iu
kin pht huy tc dng quyt nh ca nguyn nhn. Song cng cn phi hiu r rng,
trong sinh hc ni chung cng nh trong y hc ni ring, v tnh cht phc tp ca hin
tng sng, phn ng ca sinh vt cn ph thuc vo nhiu yu t m trnh khoa
hc, k thut hin nay cn cha pht hin v kim sot c. Cho nn p ng ca
sinh vt i vi yu t gy bnh c th thay i tu theo iu kin bn ngoi cng nh
bn trong. iu kin bn ngoi th mun hnh mun v, cn iu kin bn trong th v
cng phc tp cho nn tnh phn ng thng thay i theo tng c th. Do vy, cng
mt nguyn nhn trong nhng iu kin nht nh th tc ng gy nn bnh nhng
nhng iu kin khc th li khng gy ra bnh.
Cng mt nguyn nhn, c th c nhng hu qu khc nhau tu theo iu kin, v
d: bnh cm ngi, kh iu kin sng nh nhau nhng tu thuc vo tng c th
m c ngi b nng, c ngi b nh, c ngi khng mc bnh. Cng mt nguyn
nhn tu ni tc ng v tu theo p ng ca c th m hu qu (l bnh) c th khc
nhau, v d: T cu khun c th gy nn p xe khi vo da, gy nn a lng khi vo
rut v gy nhim khun huyt khi vo mu.
- Mt hu qu (triu chng bnh) c th do nhiu nguyn nhn khc nhau gy ra
nh vim, st l nhng qu trnh bnh l in hnh, trong cc triu chng rt d
dng c xc nh song li do rt nhiu nguyn nhn gy nn: cm lnh cng dn n
st; chn thng cng gy nn st. Chnh y l kh khn thng gp khi i t nhng
triu chng ti xc nh c bnh v nguyn nhn gy bnh, i hi phi c phng
php suy lun ng n v logic phn bit gia hin tng v bn cht.
Nh vy mt quan nim khoa hc v bnh nguyn hc phi c tnh cht ton din,
nhn nhn c vai tr ca nguyn nhn, iu kin cng nh th tng. Song mi mt yu
t c tm quan trng v v tr nht nh trong qu trnh gy bnh. Ngn nga nguyn
16
nhn, hn ch tc dng ca iu kin gy bnh, tng cng hot ng tt ca th tng,
l nhng mt hot ng tch cc, l iu kin quan trng trong cng tc iu tr v
phng bnh. iu tr khng ch tm ra c nguyn nhn m cn phi thy c c
nhng iu kin trong bnh cnh din ra.
2.4. Phn loi cc yu t bnh nguyn
2.4.1. Yu t bnh nguyn bn ngoi
2.4.1.1. Yu t c hc
Ch yu l chn thng cho cc m bo v cc c quan, h thng ca c th.
Hu qu ti ch b tn thng, mt mu, nhim khun th pht...v hu qu ton
thn l c th b sc.
2.4.1.2. Yu t l hc
- Nhit :
+ Nu nhit qu 500C c th gy bin tnh cc protein v men trong t bo, nh
hng xu ti chc nng hoc gy cht t bo.
+ Nu nhit qu cao: gy vim, bng hoc chy ti ch tip xc;
+ Nu nhit cao v tc ng ln ton thn: gy nhim nng;

+ Nhit qu lnh gy t cng, hoi t ti ch tip xc hoc gy nhim lnh khi

tc ng ln ton thn.
- Tia phng x:
Gy hu hoi cc men t bo, tc hi tng t nhit trn 500C nhng ch yu l
tc hi ln ADN, nht l khi t bo ang phn chia (nh t bo non tu xng). C
ch tc ng: tia.x vi nng lng mang theo chng to ra cc sn phm ton ha v
cc gc t do, gy ri lon chuyn ha cho t bo, k c gy cht t bo.
- Dng in: tu thuc din tip xc rng hay hp v in tr thp hay cao.
+ Tu thuc vo in p: in p cng cao th cng nguy him, nht l t 220V tr ln.
+ Tu thuc vo dng in: dng mt chiu tc dng rt nhanh; dng xoay chiu:
tn s 25-50 rt nguy him.
+ C th gy bnh ti ch (bng) hay ton thn.
+ Tu thuc c quan (nu dng in qua tim, no gy nguy him; qua c gy co
cng).
+ Tu thuc vo kh nng in ly ca cc dch trong c th.
2.4.1.3. Yu t ha hc v c cht
Tu bn cht ha hc v liu lng ca ha cht m c th gy bnh ti ch (ni
17
tip xc) hay ton thn (khi xm nhp vo c th) vi cc c ch rt khc nhau.
- Hai cch tc ng ch yu l gy tn thng, ph hu (hoi t, tan huyt...),
hoc gy ri lon chuyn ha, suy gim hay kch thch qu mc chc nng c quan
(ng c, suy thn, suy gan, hn m, co git...).
Cc axit mnh, kim mnh v mt s cht khc c th gy bng, chy, hoi t da
v nim mc khi tip xc.
- Nhiu cht c tc dng hu men trong t bo, hoc gy ng c ton thn do lm
ri lon chuyn ha (vi cc c quan ch khc nhau nht l cc c quan tch lu v
o thi chng nh gan, thn) vi mc , hu qu khc nhau.
- Cc cht ha hc bao gm:
+ Cht v c (ch, hp cht thu ngn, arsenic...);
+ Cc cht hu c (benzen, phenylhydrazin, mt s dc cht nu qu liu...); +
Mt s sn phm ca ng vt hay thc vt (nc rn, nc b cp, cht c trong mt c
trm, gan cc, trong mt s nm c, l ngn, l han...).
2.4.1.4. Yu t sinh hc
Bao gm cc loi sinh vt, vi khun, vi rt, k sinh trng, cn trng. Tu theo
nguyn nhn gy bnh m ngi ta xp vo hai loi bnh l:
- Bnh truyn nhim
- Bnh k sinh trng
2.4.2. Yu t bnh nguyn bn trong
2.4.2.1. Yu t di truyn
l nhng bin i bnh l thng qua c ch di truyn t th h trc sang th
h sau qua t bo sinh dc mang n bnh. Qua nghin cu ngi ta thy, mt s
bnh pht sinh l do thiu mt s tin ch huy tng hp nn cc loi men, m thiu cc
men y s pht sinh ra bnh. V d: Bnh phenylxeton niu l do thiu men
pHrahyroxylaza nn phenylalanin khng chuyn thnh tyrxin c m phn hu
thnh phenylxeton v c o thi ra ngoi qua nc tiu.
Yu t di truyn c th cng l iu kin cho bnh pht sinh.
mt s con gi sc ci y khng biu hin ra bnh nhng mang gen ln trong

nhim sc th. V d trn ln mang bnh c k hiu l x+, en khng bnh k hiu l x,
con ci c k. hiu l Xx+, con c khng c bnh c k hiu l XY. Ta c s sau:
18
Nh vy 1/2 s con c (x+Y) sinh ra mc bnh
1/2 s con ci (x+X) sinh ra mang gen bnh
Nu c con c v ci mang n bnh th khi chng giao phi ta c s sau:
Nh vy ta thy: 1/2 s con c sinh ra mc bnh (x+Y)
112 s con ci sinh ra mc bnh (x+x+)
1/2 s con ci sinh ra mang n bnh (x+X)
Tm li ch c 1/4 s con sinh ra l kho mnh v 3/4 s con khc l mc bnh
hoc mang n bnh.
Lu : C mt s trng hp trc khng b bnh nhng do b t bin trn sau
khi b cht phng x hoc b nhim c ha hc tr thnh ngi mang n bnh v
di truyn c.
2.4.2.2. Yu t th tng
Th tng c th nh ngha nh l tng hp cc c im chc nng v hnh thi
ca c th. Nhng c im ny kh bn vng, c hnh thnh trn c s tnh di
truyn v quyt nh nhng.phn ng ca c th i vi tc nhn bn ngoi trong qu
trnh sng. Nh vy th tng c tnh cht rt phc tp trong yu t di truyn ng
vai tr ch cht, quyt nh. Trc mt yu t gy bnh, nhng c th c th tng khc
nhau s c p ng khc nhau hay ni cch khc th tng l c s vt cht ca tnh
phn ng v chu nh hng ca mt s yu t nht nh nh chng loi, gii tnh,
tui tc, hot ng ca h thn kinh, ni tit v mi trng m trong con vt sinh
sng. Cho nn thay i mi trng sng c th lm thay i phn ng tnh ca c th
v do lm thay i phn no th tng.
V d: Bnh chm th tng ging nh bnh Eczema do c th thch hp vi mt
loi nm no , cho nn khng th cha c nhng khng ly lan sang ngi khc,
m n c di truyn t th h ny qua th h khc.
3. I CNG V BNH SINH HC
3.1. nh ngha
19
Bnh sinh hc hay sinh bnh hc (Pathogenesis) l mn khoa hc nghin cu
nhng quy lut c bn ca s pht sinh, pht trin, din bin v kt thc ca mt qu
trnh bnh l hay c ch sinh bnh.
i vi mi mt bnh nh ta bit u c mt nguyn nhn nht nh tc ng
v sau l s pht sinh din bin ca bnh. V vy nm c c ch sinh bnh l yu
cu c bn trong cng tc phng tr bnh, trn c s c th ngn chn sm c
nhng din bin xu ca bnh, hn ch c tc hi, ng thi xc nh nhng bin
php tch cc bo v n vt nui.
3.2. nh hng ca bnh nguyn ti qu trnh bnh sinh
Cng mt yu t bnh nguyn nhng bnh sinh c th thay i tu theo cng ,
liu lng, thi gian tc dng v v tr tc dng ca bnh nguyn.
3.2.1. nh hng ca cng v u lng bnh nguyn
C rt nhiu bng chng v v d trong thc tin ni ln hai yu t ny ca bnh
nguyn nh hng ln ti qu trnh bnh sinh.
Cng tc ng vo mt v tr trn c th nhng cng dng in hoc cc tc
nhn vt l khc nh nhit , tia x, nh sng, lc c hc... mnh hay yu s lm

bnh din ra rt khc nhau.

- Cng mt cht c, cng mt ng xm nhp nhng liu lng khc nhau (ln
hay nh) s gy ra nhng bnh c din bin khc nhau.
- Cng mt loi vi khun, nu c lc hay s lng khc nhau cng lm bnh sinh
din ra khng ging nhau.
Cc tc nhn ha hc v sinh hc khc cng c nh hng tng t.
- Nhng yu t vn khng gy bnh li c th gy bnh nu cng v s lng
t mt ngng no . m thanh c cng cao, hoc khng kh c p lc qu
ngng u tr thnh nhng yu t bnh nguyn rt hiu qu.
3.2.2. Thi gian tc dng ca bnh nguyn
Nhng yu t bnh nguyn c cng cao hay liu lng ln thng ch cn
thi gian ngn cng lm bnh pht sinh. Nu cng thp hn hoc liu lng
nh hn th thng cn thi gian tc ng di hn. Nhng iu ng lu l din bin
ca bnh cng thng thay i.
V d: khi n lc b mc trong thi gian di c th dn ti mc bnh ung th; ting
n d cng khng cao nhng nu c tc ng lin tc ngy m ln c quan thnh
gic s gy bnh v din bin ca bnh khc hn trng hp c th chu mt m thanh
cng qu cao (ting n).
Tng t nh vy, tc dng lp i lp li nhiu ln ca mt yu t bnh nguyn d
cha t ngng cng c th sinh bnh (ln, mt ng).
20
3.2.3. V tr tc dng ca bnh nguyn
Mi c quan ca c th phn ng khc nhau vi cng mt bnh nguyn. Mt
khc, tm quan trng sinh hc ca mi c quan cng khng ging nhau. Do vy, v tr
tc ng ca bnh nguyn trn c th nh hng rt r ti bnh sinh.
Bnh cnh, din bin ca bnh lao rt khc nhau, tu theo l lao phi, lao
xng, lao thn hay lao mng no tuy bnh nguyn l mt.
- Bnh nguyn d cng mt cng v liu lng nhng gy c bnh hay
khng, nng hay nh, cp tnh hay mn tnh cn tu thuc v tr tc ng. nh sng
chi ch gy c bnh nu chiu vo vng mc m khng phi vo u khc. Chn
thng vo u c bnh cnh khc hn vo c bp hay vo xng. Dng in chy
qua tim hoc qua no gy hu qu khc hn qua cc chi.
V d: Bnh lu ngi: khi cu khun lu tc dng ng sinh dc gy vim
mn tnh, cn khi cu khun lu gic mc mt gy vim cp tnh.
3.2.4. ng ly lan ca nguyn nhn bnh trong c th
ng ly lan thng ph thuc vo tnh cht ca nguyn nhn bnh v v tr sinh
bnh. Thng thng bnh nguyn lan theo ba ng chnh: ,
- Lan theo t chc: t ni pht bnh lan rng ra vng ln cn tip gip.
- Lan theo dch th: thng cc yu t bnh nguyn l c t, vi khun, vi rt lan
theo dch lm ba, mu n ton thn.
- Lan theo thn kinh: cc yu t bnh nguyn cn l nhng xung ng au. Cc
loi vi rt nh vi rt bnh di, c t un vn lan theo thn kinh.
Trong thc t khi bnh pht sinh th yu t bnh nguyn c th lan theo nhiu
ng ch khng phi lan theo mt ng ring bit, v trong kt cu t chc ca c
th sinh vt ni no cng c mt cc h thng mch qun, thn kinh v mch lm ba.
V vy, chng ta phi xem xt nhng bnh no lan theo ng no l ch yu bit
v kp thi ngn chn.

3.3. Quan h gia cc b v ton thn trong qu trnh bnh sinh

Theo thuyt thn kinh ca Pp-lp th c th l mt khi thng nht, cc c quan,
m bo u c s lin h cht ch vi nhau v chu s iu tit chung ca thn kinh.
Bt c mt c th no, hot ng no cng u chu s iu tit chung ca v no. V
vy cc qu trnh bnh l d xy ra b phn cc b no cng ph thuc vo trng
thi chung ca c th v ngc li thng qua cung phn x n nh hng ti ton thn.
3.3.1. Mi Lin h gia ton thn v cc b
Ton thn kho mnh th sc khng ti ch cng s tt hn, do yu t gy
bnh kh xm nhp hoc nu c vo c th cng nhanh chng b tiu dit hoc b
o thi ra ngoi. Ngoi ra, ta thy tui c lin quan n sc khng. Tui trng
21
thnh c th kho mnh, vt thng mau lnh, phn ng nhanh, tui gi d mc bnh,
phn ng km, vt thng lu lnh.
3.3.2. Mi lin h gia cc b v ton thn
Bt k mt tn thng no (vim nhim) cc b cng u nh hng ti ton
thn, u tin thy au, c th mt mi, cc cht c ti vim s ngm vo c th
gy trng thi nhim c. Thnh phn ca mu thay i, nu bch cu a nhn trung
tnh m tng ln th nht nh s b vim nhim mt ni no v gy st ton thn,
ng thi lm thay i hot ng ca h thng nc tiu. Nh vy, khi cc b b tn
thng th tt c cc c quan khc tng cng hot ng, c quan h hp thay i, c
quan tiu ha gim, tit sa gim v tt c tp trung lc lng vo u tranh bo v c
th.
V vy c th ni bt k mt qu trnh bnh l no cng biu hin ti ch ca tnh
trng bnh l ton thn.
ngha: Nm c iu ny gip ta chm sc h l tt hn.
3.4. Vng bnh l
Bnh din ra theo trnh t gm cc bc (gi l cc khu) ni tip nhau theo c
ch phn x, khu trc l tin to iu kin cho khu sau hnh thnh v pht trin,
cho ti khi bnh kt thc, nh s sau:
Nhiu trng hp, mt khu no pha sau li tr thnh tin (nui dng)
cho mt khu trc : t hnh thnh mt vng bnh l, vi c im l c kh
nng t duy tr. Vng ny c th din bin cp tnh hoc ko di. Trong a s trng
hp, vng bnh l lm cho qu trnh bnh sinh ngy cng nng hn, c th quan st d
dng qua cc biu hin lm sng. Xem s di y:
Thng th vng bnh l khng t mt i m cn c s can thip. Khi pht hin
vng bnh l cn tm cch ct t nhiu khu, nht l khu chnh.
Sau y l mt vi v d:
- bnh ln ng du mn tnh, vi khun ln ng du gy vim ni tm mc,
lot si van tim, do nh hng ti tun hon chung gy thiu oxy. T thiu oxy gy
22
ri lon chuyn ha ri tc ng tr li gy ph i tim dn n suy tim. Khi suy tim
dn n thiu oxy v lp li thnh vng kn.
- Khi t ngt mt i 20% lng mu, c th s huy ng mt lot bin php do
h giao cm v h tim mch chi phi nhm b p mt phn khi lng mu, duy tr
huyt p mc cn thit ti thiu, m bo c bn v lu lng tun hon v nhu cu
oxy cho cc c quan quan trng nht. C th thch nghi dn, vng bnh l s khng
hnh thnh trong thi gian ch i tu xng sn xut lng hng cu cn thit.

Nu mt ti 40% lng mu, cc bin php trn ch gip c th thch nghi c mt

thi gian ngn v mu thun s pht sinh, h tim mch b qu ti chc nng li km
c nui dng. C th thy huyt p tt dn, mch nhanh v yu dn, km theo tnh
trng l m, da lnh, th trng xu dn i... ra khi tnh trng trn, h giao cm v
tun hon li cng phi tng cng sut. Nh vy vng bnh l hnh thnh.
ngha: Nm c s tin trin ca bnh, ta c th pht hin c khu chnh
trong qu trnh sinh bnh v c tc ng cn thit ngn cn din bin xu ca vng
bnh l.
Qua y thy rng khu chm sc h l nhm ct c vng bnh l i l khu v
cng quan trng.
3.5. Cc hin tng bnh l
Trong mt c th b bnh ta c th nhn thy c nhiu hin tng bnh l khc
nhau. Chng ta cn phi phn bit v xc nh nhng hin tng mt cch chnh
xc. Cc hin tng l:
3.5.1. Phn ng bnh l
Phn ng bnh l l phn ng ca t bo, ca t chc hay c quan i vi tc
nhn gy bnh vi cng v cht lng vt ra ngoi gii hn bnh thng.
V d: Khi b lnh, c th phn ng li bng cch co mch gim thi nhit, tng
sn nhit trong c th, l phn ng sinh l. Nu co mch qu mc dn n thiu
mu t dn n hoi t c. Nhng nu trung tm iu ho nhit b ri lon dn n
hot ng qu mc ca c quan sinh nhit th sinh ra st, cn trong mt s bnh khc
th biu hin ho, nn... ve thc cht l phn ng bo v sinh l nhng nu qu mc
th s gy bnh.
23
3.5.2. Qu trnh bnh l
Qu trnh bnh l l mt phc hp gm nhiu phn ng bnh l.
V d: Trong qu trnh vim ngi ta thy c phn ng vn mch (co, gin mch),
phn ng tng sinh t bo, phn ng ca thn kinh... Trong qu trnh st ngoi phn
ng tng sn nhit cn c nhiu phn ng nhm gim thi nhit.
Quan nim v qu trnh bnh l c tnh cht ng, n bao gm c qu trnh din
bin ca bnh.
3.5.3. Trng thi bnh l
L mt qu trnh bnh l bin chuyn chm, ko di thnh c tt.
V d: Nhng ngi b lit, nhng ngi b vim khp sau khi khi li vt
vim lm cho khp khng c ng c na hoc l vim v lm cho tuyn v teo i
khng cho sa.
3.6. Cc giai on pht trin ca bnh
Trong qu trnh pht trin ca bnh, c th c nhng bin i khc vi khi trng
thi bnh thng. c trng cho nhng bin i l triu chng. Khi cc nguyn
nhn gy bnh tc ng gy nhng bin i trong c th biu hin ra bn ngoi gi l
triu chng. Hoc triu chng l nhng biu hin ca ng vt sng c quan st v
miu t nh b n, a chy, bn chn, mt nc... v l kt qu ca nhng bin i t
chc. Triu chng ca bnh th mun hnh, mun v, n bao gm nhiu bin i v
hot ng, v chc nng, bin i v chuyn ha vt cht, bin i v thn nhit, v h
hp, v tim mch n nhng thay i v thnh phn ca mu, nc tiu v c, s bin
i v hnh thi ca c quan hay t chc.
Triu chng thay i tu theo cc loi bnh khc nhau, tu theo tng giai on

pht trin ca bnh. Triu chng ph thuc vo c im c th vo la tui vo qu

trnh pht trin ca bnh, ph thuc vo mi trng ngoi cnh bn ngoi.
Nhn chung qu trnh pht trin ca bnh khng nhng din bin theo nhng quy
lut nht nh m qu trnh ny cn c tnh cht giai on nht nh. Ngi ta thng
chia ra bn thi k c bn trong qu trnh pht trin ca bnh. S phn chia ny c
ngha quan trng trong nghin cu v gip cho vic phng tr bnh c chnh xc
hn. Tuy nhin, vic nh ra ranh gii cc thi k mt cch r rng chnh xc l rt
kh khn, cho nn s phn chia ra cc thi k cng ch l tng i trong qu trnh
pht trin lin tc ca bnh.
Da vo cc triu chng ngi ta phn chia ra thnh cc thi k pht trin ca
bnh nh sau:
3.6.1. Thi k nung bnh (thi k bnh)
Thi k nung bnh c bt u t khi nguyn nhn bnh xm nhp vo c th
24
hoc l nguyn nhn bnh bt u pht huy tc dng cho n khi m c th c nhng
phn ng u tin. Lc ny nguyn nhn bnh cha s lng v c lc lm cho
bnh pht trin, ng thi sc khng ca c th cn mnh, v th cha c nhng
phn ng biu hin ca bnh. C th cng c th tiu dit nguyn nhn bnh, bnh
khng pht hoc c th tin trin sang mt giai on khc.
Thi k ny di hay ngn l ph thuc vo cc yu t sau y:
- S lng, c lc v cng tc ng ca nguyn nhn bnh.
- Trng thi c th v tnh mn cm ca c th i vi s tc ng ca nguyn
nhn.
- V tr mm bnh xm nhp.
- iu kin ngoi cnh (c iu kin bn ngoi: thi tit kh hu, ch dinh
dng, ch chm sc qun l...).
Bng 1. Thi k bnh ca mt s bnh truyn nhim
Bnh Thi gian bnh
ngn nht
Thi gian
bnh di nht
Thi gian bnh
trung bnh
Nhit thn
Ung kh thn
T huyt trng
Sy thai truyn nhim
Lao
2-4 gi
4-6 gi
4-6 gi
5-7 gi
6-7 ngy
14-15 ngy
14-15 ngy
6-8 ngy
1-2 thng

2-3 thng
2-3 ngy
2-3 ngy
1 -2 ngy
13-14 ngy
15-45 ngy
ngha: Nm c thi k nung bnh, chng ta c bin php phng bnh bng
cch l cch ly cc gia sc cha bit c l lch ca n v nui cch ly trong khong
thi gian mt thng theo di tnh hnh bnh.
3.6.2. Thi k tin pht (thi k tin chng)
Thi k ny bt u t khi c th c nhng phn ng u tin n khi bt u xut
hin nhng triu chng ch yu. giai on ny, nguyn nhn bnh tc ng mnh
lm cho c th thay i ton b cc phn ng, kh nng thch nghi ca con vt gim
st, con vt c mt s biu hin du hiu ca bnh gi l tin chng.
V d: Trng thi con vt thay i r, b n, hay nm, thm ch nm khng yn,
nu o nhp tim c th nhanh, h hp tng, thn nhit cao, sung huyt nim mc...
ngha: Cn c vo triu chng ny ta c bin php h l tt hn, chm sc tt
hn v bc u chn on thm d, da vo dch t hc (ma v, vng, la tui...)
bt u s chn sau ta iu tr thm d. Giai on ny v cng quan trng nn ta
cn ch .
3.6.3. Thi k ton pht
25
Bt u t khi c th c nhng triu chng r rt, triu chng in hnh cho tng
bnh cho n khi c th c nhng chuyn bin nht nh. thi k ny nguyn nhn
bnh pht trin cc , sc khng ca con vt gim, c th c nhng c nng ri
lon nghim trng.
ngha: Da vo cc bnh bit c bin php i ph vi tng bnh mt
theo truyn nhim hc x l, nu vi s lng ln phi bo ngay cho c quan chc
nng cp trn c bin php phng nga.
3.6.4. Thi k kt thc
Thi k ny di hay ngn ch yu ph thuc vo tng loi bnh v c bit l c
s can thip ca Bc s Th y. C th bnh dn dn thuyn gim, cng cc triu
chng gim dn ri mt ht hoc n c th tip tc theo vng bnh l v con vt c th
cht khi b nng hn. Thi k kt thc ca bnh tuy phc tp nhng thng din bin
di ba hnh thc khc nhau:
3.6.4.1. Khi hon ton
Cc nguyn nhn gy bnh b tiu dit hon ton, cc triu chng bnh bin mt,
ri lon v c nng, tn thng v hnh thi t bo, m v cc c quan c phc hi,
c th tr li trng thi bnh thng, kh nng lao ng v nng sut c phc hi
hon ton. Ring i vi mt s bnh truyn nhim th kh nng phn ng ca c th
thay i, pht sinh trng thi min dch i vi bnh va mc (bnh u, bnh t th).
3.6.4.2. Khi khng hon ton
Bnh khng ht hn, cc nguyn nhn bnh b tiu dit nhng khng hon ton,
n c th c tr trong cc t bo, c bit l trong cc t bo thc bo hoc mt khu
vc no m khng pht huy tc dng.
Ngoi ra, khi khng hon ton cn gm:
- li d chng: bnh ht nhng hu qu v gii phu v chc nng th vn

cn lu di (sau vim no tr khn gim st; gy xng lin nhng c d lch, kh

c ng, vim ni tm mc ht nhng li d chng hp van tim, xut huyt no
a n lit mt chi,).
- li trng thi bnh l: din bin rt chm v i khi c th xu i, kh khc
phc. V d: do chn thng, b ct ct mt ngn tay; vt thng cn li so ln...
3.6.4.3. Cht
Cht l giai on cui cng ca s sng, do ri lon cao m c th khng th
thch ng c vi cc iu kin ngoi cnh.
Cht c hai t ra hn l cht sinh l v cht bnh l.
Cht sinh l: do tiu ha nng lng trong qu trnh sng gim dn theo tui tc, gi ci,
suy nhc n mt giai on c th khng c kh nng thch ng c vi yu t ngoi cnh.
26
- Cht bnh l: c th phi tri qua mt qu trnh bnh l do cc nguyn nhn tc
ng gy nhng ri lon nghim trng khng th khi phc c.
Cht l mt qu trnh, trong trng hp in hnh gm cc giai on sau: + Giai
on ngng cui cng: tim v h hp ngng tm thi (trong vng 0,5 - 1 ,5 pht), mt
phn x mt, ng t m rng, v no b c ch, cc hot ng sng u b gii hn.
+ Giai on hp hi: xut hin h hp tr li - th ngp c, tim p yu, phn x
c th xut hin trong thi k ny, hot ng ca tu sng mc ti a duy tr cc
chc nng sinh l, c th ko di thi k ny t mt vi pht n na gi.
+ Giai on cht lm sng: hot ng ca tim, phi ngng, thn kinh trung ng
hon ton b c ch. Thi gian cht lm sng c th ko di 5-6 pht, trong thi gian
c th hi phc c. Cn nu khng hi phc c gi l cht sinh vt.
+ Giai on cht sinh vt: mi kh nng hi phc khng cn na, ri lon ch yu
h thn kinh trung ng. Trong cht sinh vt, cc c quan, t chc trong c th
khng cht cng mt lc m trc tin l h thn kinh cao cp ri n tun hon, h
hp...
Nhng nguyn nhn chnh dn n cht:
+ Ngng hot ng ca tim nh lit tim, v tim, tc mch.
+ Ngng h hp, lit trung khu h hp do xut huyt no, thiu mu hnh tu, b
ng c.
3.7. C ch phc hi sc kho
Sau mt qu trnh bnh l th c th vt bnh c th phc hi c sc kho. Sc
kho ch c phc hi sau khi nguyn nhn gy bnh ngng tc ng, trng thi c
th khi tr li bnh thng, tnh hon chnh v gi tr kinh t ca n c phc hi.
Khi yu t gy bnh tc ng th c th lun lun c phn ng bo v hay thch ng.
C ch ny c vai tr quan trng trong s phc hi sc kho.
V d: Yu t bnh nguyn kch thch ln nim mc ming, khi c th c phn
ng tng tit nc bt v dch nhy. Nu yu t bnh nguyn tc ng vo nim mc
mt th phn ng tit l c tng cng; tc ng vo ng h hp th phn ng ho,
ht hi; tc ng vo ng tiu ha s gy nn.
Trong c th xut hin phn ng min dch khi b nhim khun, phn ng lnh vt
thng, ng mu khi t chc b tn thng, rch nt. C th cn c phn ng b p
nhng c quan c tng cp nh thn, phi, mt. Khi chc nng ca mt trong cp c
quan b tn thng th chc nng ca c quan kia s tng cng hot ng nhm b
p li Ring trong h thng tun hon, khi b mt mu huyt p c khi phc mt
cch nhanh chng do phn ng co huyt qun, tng ht nc vo lng mch, tng nhp

tim v h hp, tng hot ng ca cc c quan to mu, hoc khi hm lng oxy trong
mu gim, gy ri lon trao i cht dn ti s ng cc sn phm trao i trung
27
gian, cc sn phm ny c toan tnh nn lm gim lng kim d tr trong c th, dn
ti hin tng nhim axit, gy ri lon hot ng ca h thng thn kinh trung ng,
ri lon chc nng ca cc c quan khc nh tng h hp nhanh chng o thi axit
hi, tng gi mui kim ti thn iu ho axit - baz.
C ch bo v ca c th khi b nhim khun l tng hot ng ca h thng li
ni mc, tng cng vic to ra khng th, tng hin tng thc bo ca cc bch cu.
Qua cc giai on ca bnh, cng phn ng bo v c th c th khc nhau, c khi
mc cao, khng ng b c hi cho c th nh hin tng st l phn ng bo v
ca c th, n lm tng sinh khng th, tng kh nng thc bo ca bch cu nhng
nu st qu cao c th gy nguy hi n chc nng ca h thn kinh v h tun hon.
H thng thn kinh trung ng c ngha rt ln trong vic bo v c th v trong
qu trnh khi phc sc kho. iu c chng minh trong cc th nghim l khi
gy m c ch v no, cc qu trnh tng sinh v ti sinh u gim, huyt p khi phc
chm sau khi mt mu, gim phn ng min dch...
4. TNH PHN NG CA C TH V BNH L CA QU TRNH MIN
DCH
4.1. Tnh phn ng ca c th
4.1.1. Khi nim v tnh phn ng ca c th
Trc tc ng ca mt kch thch no (gy bnh, hoc khng gy bnh), c
th ng vt p ng li bng mt hay nhiu phn ng. Trc mt kch thch nht
nh, c loi phn ng l chung cho nhiu loi, v d: ng t co nh li khi nh sng
cng chiu vo vng mc; tng glucoza huyt khi au n... C loi phn ng
ch l chung cho cc c th trong mt loi; v c loi phn ng ca c th (khng hon
ton ging nhau gia cc c th ca mt loi). V d, phn ng chung ca mi ngi l
tng nhp tim khi b stress nhng c ngi tng qu nhiu (qu hi hp, lo lng),
ngc li, c ngi li tng rt t. Nu nhiu c th c chung mt phn ng trc mt
kch thch, ngi ta xp h thnh nhm v thnh kiu phn ng.
a s cc phn ng in m du vt di truyn mang tnh bm sinh nhng cng c
nhiu phn ng hnh thnh trong qu trnh sng, chu nh hng ca tui, gii tnh,
trng thi thn kinh-ni tit, mi trng, thi tit,...
Vy tnh phn ng l tp hp cc c im phn ng ca c th trc cc kch
thch ni chung v trc bnh nguyn ni ring. Tnh phn ng khc nhau c th lm
qu trnh bnh sinh mi c th v mi nhm khng ging nhau, a li cc kt qu
khc nhau (tt, xu, nng, nh).
4.1.2. Nhng yu t nh hng n tnh phn ng
4.1.2.1. Thn kinh
- Trng thi v no: Nu v no trng thi hng phn, thng to ra nhng phn
28
ng mnh v nu c ch th ngc li. Con vt b gy m p ng km vi cc kch
thch (tim adrenalin, mt mu,...) so vi khi n cn tnh.
Loi hnh thn kinh: loi hnh thn kinh mnh cn bng th tnh phn ng mnh,
nhanh chng; loi hnh thn kinh mnh khng cn bng th tnh phn ng mnh nhng
ko di; loi hnh thn kinh yu th tnh phn ng yu.
- Vai tr thn kinh thc vt: nu kch thch thn kinh giao cm thy tng qu trnh

trao i cht v tng tnh phn ng ni chung i vi protein l, vi khun, hormon.

Cn nu kch thch thn kinh ph giao cm th s tng cng vic to ra khng th,
tng phn ng bch cu, tng kh nng ngn cn ca gan v h thng bch huyt.
4.1.2.2. Vai tr ni tit
Cc tuyn ni tit nh: tuyn yn, tuyn thng thn, tuyn gip trng, tuyn tu
u nh hng n tnh phn ng ca c th nhng ch yu l tuyn yn v v thng
thn.
Theo nh bc hc Hans Selye: Bt c mt tc ng mnh no tc ng vo c th
u gy ra mt chui phn ng. Chui phn ng ny kt hp vi nhau thnh hi chng
chung m c s hot ng ca n l cc tuyn ni tit. C th l hom lon ca tuyn
yn adrenocorticotropic hormon (ACTH) v v thng thn. Khi b kch thch mnh
th cc trung tm di th tit ra mt s hom lon thn kinh (hay yu t gii phng), cc
hormon ny c dn ti tuyn yn bng ng mu lm tng tit ACTH v cortisol
v sau tit STH dn n kch thch tit ra aldosteron.
* Vai tr ca ACTH v cortisol: c tc dng chng hin tng vim v chng d
ng Chng hin tng vim c hiu hn ch cc phn ng thc bo, c ch pht trin
cc t chc lin kt, t chc ht, gim tnh thm ca thnh mao mch, cho nn lm
gim hin tng ph n v tit dch. Mt khc ngi ta thy n hn ch s hnh thnh
mao mch tn to, gim vim c hiu, lm thoi bin cc t chc bch huyt, lm tan
v cc tng bo, lympho bo dn n gim khng th.
* Vai tr ca STH (Somatotropic hormon) v aldosteron: c tc dng i lp vi
hai nhm hormon trn. STH lm tng qu trnh vim, kch thch t chc lin kt tng
sinh qua chng nhim trng, chng hoi t t chc. STH lm tng t chc bch
huyt, tng tng hp globulin v khng th. Aldosteron ch yu iu ho nc v in
gii, ngc li ca cortisol tng tnh vim, tng sinh cc t chc x non ca t chc
ht, pht trin mnh mao mch, tng cng phn ng thc bo, gi li ton kali v con
natri.
4.1.2.3. La tui
ng vt non, h thn kinh c bit l h thn kinh cao cp cha hon thin cho
nn phn ng gy ri lon iu ho nhit rt mnh, hng ro min dch chng nhim
trng nim mc, da cha hon chnh. ng vt non khng mn cm vi mt s
29
bnh v n c min dch l do c m truyn cho -globulin qua nhau thai hoc
qua sa m, phn ng thc bo ca ng vt non yu.
ng vt trng thnh, tnh phn ng c tng cng pht trin theo s pht
trin hon thin t chc ca c th, c bit l ca h thn kinh v hng ro bo v ca
da, ca nim mc. Kh nng sn xut khng th mnh lit, tnh phn ng mnh m
in hnh, nhiu khi d i, vt thng mau lnh, sc kho nhanh hi phc.
ng vt gi yu, tnh phn ng km v h thn kinh, hng ro phng ng b suy
gim, bnh tin trin khng r rt, khng in hnh, phc hi chm, vt thng kh
lnh, t l cht cao.
4.1.2.4. Yu t v mi trng bn ngoi
Tiu kh hu chung nui nhim lnh lm cho sc khng ca con vt gim dn
n bnh nhim nng.
- Cc ha cht tc dng lu cng gy thay i tnh phn ng.
V d. Ung ru nhiu gy hin tng x gan, vim d dy lm cho kh nng
phng bnh gim, chng vi khun km.

- Tia phng x lm gim sc khng, ch yu l dit t bo gc tu xng.

- Dinh dng: tnh trng dinh dng c nh hng su sc n tnh phn ng ca
c th. i v bnh dch i song song vi nhau.
+ Protein l thnh phn quan trng trong khu phn n ca ng vt. Nu thiu
protein lm pht sinh nhim trng, nu thiu nng dn ti ph, d pht sinh bnh lao.
+ Thiu vitamin A lm gim sc khng ca nim mc, gic mc gy ra mt
lot cc bnh nh vim gic mc, vim hng, nt n da.
+ Thiu vitamin B lm yu cc hot ng thc bo, nh hng n qu trnh oxy
ha ca t bo, lm cho con vt chm ln, gim to mu sinh ra bnh ci cc.
+ Vitamin C y tng sc khng, thiu vitamin C lm gim sc khng,
c bit l trong trng hp nhim khun trong bnh truyn nhim.
+ Vitamin D nh hng ti s mt cn bng khong dn ti bnh ci xng, mm
xng.
Ni chung dinh dng thiu biu hin cc triu chng sau: nhit khng cao
ngay c khi bnh cp tnh nh cm, vim phi, phn ng bch cu yu hoc l khng
c. Hiu gi ngng kt ca cc phn ng huyt thanh hc yu, c khi m tnh. Cc
triu chng lm sng bn ngoi yu km, c th khng nhn thy, bnh tin trin nng
ko di dai dng, t l cht cao. V vy chm sc h l dinh dng tt c tnh quyt
nh tnh phn ng trong qu trnh bnh l.
Ngoi ra yu t gii tnh cng nh hng n c th. Trong y hc, n ng hay
30
mc bnh d dy, lot hnh t trng hn l ph n; n ng hay b nhi mu c tim,
u c phi hn l ph n. ph n hay gp vim v, ti mt, u c v.
4.2. Bnh l ca qu trnh min dch
4.2.1. Khi nim v min dch bnh l
Min dch l trng thi ca ng vt khng mc phi tc ng c hi ca vi sinh
vt, trong khi vi sinh vt gy bnh cho cc loi vt khc hoc cho con vt cng loi,
trong nhng iu kin ly lan hay truyn bnh tng t. Min dch l mt kh nng
khng cng ging nh nhiu kh nng khng khc (vim, su ca c th, trong
nhng trng hp nht nh, phn ng khng c th tr thnh c hi cho c th.
chnh l min dch bnh l.
4.2.2. i cng v p ng min dch
Trc s tn cng ca cc yu t gy bnh bn ngoi, c th sinh vt c mt lot
nhng kh nng khng khng c hiu v c hiu. Kh nng khng khng c
hiu l hng ro vt cht ngn cch bn ngoi v bn trong l da v nim mc, l
cc cht tit nh m hi, dch nhy, l cc t bo chuyn trch bn trong c th nh
cc thc bo v cc cht thot c bit gi l khng th khng c hiu nh b th
lizin, cht propecdin v opsonin.
Kh nng khng c hiu l nhng cht thot gi l khng th c hiu do c
th tng hp sn hay n c sn xut ra di tc ng ca mt s cht gi l khng
nguyn.
4.2.2.1. Khng nguyn
a) Khi nim
Khng nguyn l nhng d cht i vi c th nh vi khun, vi rt, c t...bn
ngoi vo c th ng vt hoc ngi th kch thch c th sn sinh ra nhng cht c
bit c phn ng i lp vi chng gi l khng th. Khng th sinh ra s kt hp mt
cch c hiu vi khng nguyn tng ng.

b) c tnh ca khng nguyn

- Tnh c hiu: c hiu ca khng nguyn l c im nh khng nguyn c
th phn ng mt cch c hiu vi khng th dch th hoc khng th t bo do khng
nguyn c nhm quyt nh. Nhm quyt nh khng nguyn l phn b mt khng
nguyn c kh nng lin kt mt cch c hiu vi phn t khng th hoc t bo
lympho mn cm. Cc axit quan c phn phi trn b mt ca khng nguyn
hnh thnh cc nhm quyt nh; cc nhm ny chi phi cc c quan sinh khng th,
to loi khng th c hiu n khp vi khng nguyn .
- Tnh l ca khng nguyn: Khng nguyn cng khc xa loi sinh vt nhn khng
nguyn bao nhiu th kh nng sinh khng th cng mnh by nhiu. V d: Ly huyt
31
thanh ngi m tim cho b th c tnh khng nguyn mnh hn l khi ly huyt thanh
d tim cho b.
Khng nguyn con vt hon ton khc loi gi l d khng nguyn - l khng
nguyn mnh. Nhng sinh vt cng mt loi c nhng khng nguyn khc nhau gi l
ng khng nguyn. Tuy nhin, tnh cht l ca khng nguyn cng ch l tng i v
nhiu khng nguyn c ng thi trong nhiu sinh vt khc nhau, v d nh khng
nguyn nhm mu B c ngi v c trong ht na, hay khng nguyn H c
trn hng cu ngi v hng cu ln.
- Khng nguyn c phn t lng cao: Thng thng cc khng nguyn c trng
lng phn t ln v thng o thi chm lm tng kh nng mn cm ca c th. V
d: protein ca huyt thanh nh albumin (TLPT: 60.000), IgG (TtPT: 160.000), IgM
(TLPT: 90.000), Cc phn t cc ln nh vi rt thuc l (17.000.000) l nhng cht
khng nguyn mnh.
Khng nguyn phi l nhng cht m c th tiu c nhng li tn ti lu trong
c th. Nhng cht tr khng tiu c nh methyxeluloza khng sinh khng th c l
v c th khng nhn din c cu trc ca cht ny, cho nn khng thng tin cho t
chc c thm quyn tng hp khng th. Nhng cht tiu qu nhanh nh cht c trng
lng phn t nh cng khng c kh nng sinh khng th v chng c o thi ra
ngoi qu sm cng khng kp cho c th nhn din.
c) S phn ca khng nguyn trong c th vt ch
Khng nguyn a vo c th vt ch bng bt c ng no, trc tin xut hin
trong mu ri n mt s t bo. Trong mu, khng nguyn ho tan trong mu (t 1015 pht) sau khuch tn ra khoang gian bo, m khng nguyn h nhanh trong
mu v ko di vi ngy ri t phn hu t t v t nhin bin mt v khng th
bt u xut hin. Sau thy khng nguyn t chc lin vng ni mc trong nhng
hch gn ng xm nhp ca khng nguyn nht ( cc hch bch huyt ngoi vi nu
l tim bp), ri n cc ni khc. Nh vy khng nguyn c t bo ca t chc
ny n i.
d) Nhng yu t nh hng n tnh sinh khng th ca khng nguyn
- Liu lng: Trong min dch vi khun, ngi ta nhn thy tim chng liu nh
v nhiu ln tt hn l tim mt ln liu ln. Trong gy min dch ung th thc
nghim li thy l nu a cc t bo ung th vo hoc qu nhiu hoc qu t th u
khng gy c min dch.
- ng vo ca khng nguyn: khng nguyn c th c a vo bng nhiu
ng khc nhau m vn c th gy c min dch nhng n khng b bin tnh hoc
hu hoi trong khi xm nhp vo c th vt ch. Cc khng nguyn dng bi, bt

phn hoa, khi, c th qua ng h hp. Vi khun, vi rt c th qua da, nim mc h

hp, tiu ha.
32
- Vai tr ca t cht: Tnh khng nguyn ca mt cht c th c tng cng nu
kt hp n vi mt t cht. C ch tc dng cha r rng nhng c th t cht gy vim
ti ch tim lm cho khng nguyn lu tiu v c bit n kch thch mnh c quan sinh
khng th. T cht thng l nhng cht tr kh tiu: du pHrafin, keo phn...
4.2.2.2. Khng th
Khi nim: Khng th l nhng cht thuc loi cu n mch (globulin) c bit
xut hin trong huyt thanh khi mt khng nguyn xm nhp vo c th, c th phn
ng li bng cch sinh ra khng th chng li khng nguyn , lm cho khng nguyn
mt tc dng gy bnh. Tnh cht c bit ca khng th l kt hp vi khng nguyn
sinh ra n.
Trc s xm nhp ca khng nguyn vo c th, vt ch c 2 cch p ng: - p
ng min dch dch th: bng cch tng hp cc khng th ho tan trong huyt thanh.
- p ng min dch qua trung gian t bo tng hp nn khng th c hiu, cc
khng th ny lin kt cht ch trn b mt ca t bo sn xut ra n, khng ho tan
trong huyt thanh gi l khng th c nh (khng nguyn t bo).
a) Khng th dch th
- nh ngha: Khng th dch th c th hiu nh tt c nhng cht dch gip sinh
vt chng li cc yu t c hi xm nhp vo c th.
+ Khng th t nhin (khng th khng c hiu) c sn trong huyt thanh: , ,
lyzin, propecdin, h thng b th (c 9 loi t C1 n C9) dit khun.
+ Khng th c hiu bn cht ca n chnh l -globulin. Globulin min dch "Ig"
(Immunoglobulin) do qu trnh min dch to ra. Theo nh ngha quc t OMS-1994
"Cc globulin min dch l tt c cc protein huyt thanh v protein nc tiu c tnh
cht khng nguyn v cu trc ging nh globulin th c k hiu vit tt l Ig". Nh
vy globulin min dch bao gm cc loi khng th c nhng protein c cu trc ging
nh globulin min dch m n nay cha c bit r.
- Cu trc khng th:
Nh cc phng php v in di, sc k, chit tch, siu ly tm, min dch hp
ph cho n nay ngi ta phn c 5 loi Ig trong khng th dch th.
Tn Trng lng phn t m trong huyt thanh
IgG hay M 150.000 1200-1400 mg%
IgA hay A 170.000 100- 400 IgM - M 900.000 50-200 IgD - D 155.000 3-14 IgE - E 195.000 0,1-0,14 33
- Khi nghin cu sinh thi hc th cu trc ca 5 loi ny u ging nhau, u gm
4 chui a peptit: 2 chui nng H v 2 chui nh L, ni li vi nhau bng "cu ni
disunfua (s-s)" v ngi ta thy rng c tng chui nng ring cho tng loi min dch.
Chui nng Gamma IgG
Chui nng Alpha IgA
Chui nng Muy IgM
Chui nng Delta IgD
Chui nng Epsilon IgE

S cu trc khng th (Theo Bc hc Porter)

(KT: khng th; KN: khng nguyn; KHBT: kt hp b th)
V tr kt hp khng th vi khng nguyn nm gia chui nng v chui nh
u tn cng NH2. Nh vy, trn mt phn t globulin min dch c hai v tr kt hp
khng nguyn. Thng khi kt hp vi khng nguyn th hai u tn cng m rng
ra nh hai cnh tay mt n v khng th c th kt hp vi hai n v khng
nguyn. l trng hp khng th hon ton tc a ha tr (nh IgM). Do khng
nguyn cng c nhiu trung tm hot ng cho nn khi kt hp ny s bt vo nhau
m thnh mt mng li lm cho s kt hp d lng ng trong dung mi di hnh
thc ln bng, kt ta, vn my...
Khi hai cnh khng m rng lm cho mt n v khng th ch c th kt hp vi
1 n v khng nguyn th gi l khng th khng hon ton hay khng th n ha tr.
Cho nn kt hp KN-KT s khng ln lng ng.
- c im v phn loi khng th
Khng th hay globulin min dch l nhng thnh phn ca thot huyt thanh nn
d b nhit (700C), cc cht axit, kim v men ph hu.
IgG: Phn ln khng th l IgG, chng c hot ng hu ch l trung ho c t,
to phn ng ngng kt khi gp khng nguyn tng ng, phn ng opsonin ha v
khi kt hp vi b th th lm tan vi khun. Hot ng gy tn thng cho sinh vt l
to phc hp khng nguyn-khng th v ng li ti cc t chc v gy tn thng ti
ni .
34
IgA: ch yu nm trong thnh phn ca cc dch tit nh sa u, nc bt, dch
rut, v cc hch ngoi tit cha rt nhiu tng bo sn xut IgA. Khng th ny c
kh nng trung ho c t, to phn ng ngng kt v opsonin ha, gip c th chng
li cc khng nguyn c b mt cc nim mc v gi mt vai tr ng k trong min
dch ti ch.
IgM: l loi khng th hnh thnh sm, thng c t l cao khi IgG thp. Loi
khng th ny c hot ng hu ch v gy tn thng gn ging nh IgG.
IgE: l loi khng th thy tng trong cc bnh qu mn nh hen, ni m ay...
Khng th ny tc ng lm thay i tnh thm ca thnh mao mch.
IgD: cho n nay cha bit r tc dng v ang c tip tc nghin cu.
b) Khng th c nh (khng th t bo)
Khng th c nh l nhng khng th c gn ngay trn b mt t bo lympho T
sn xut ra chng. Nhng t bo lympho i t tu xng n tuyn c c hun
luyn thnh t bo lympho T. Hin nay ngi ta cha th tch loi khng th ny ra
khi t bo nn cha bit c cu trc ca n.
Khi gy mn cm cho ng vt bng khng nguyn to min dch c nh (nh
mnh da ghp, vi khun lao) th mt nhm t bo mi sinh sn t t bo tuyn c (T)
c hnh thnh - ngi ta gi chng l t bo effector. Sau khi mn cm khng
nguyn 1 -2 ngy, cc t bo ny xut hin vng tuyn c v cc c quan 1ympho
ngoi bin nh lch, hch (c bit tp trung nhiu vng tu ca lch) - l
nhng effector c hiu.
Mt khc trong qu trnh min dch, mt s thnh phn ca khng th v b th
cng c tc dng hot ha mt s t bo n nhn, i thc bo, t bo Kuppfer. Cc
t bo ny cng tr thnh hot ng nhng khng do s kch thch ca khng nguyn,
ngi ta gi chng l nhm t bo effector khng c hiu.

c) H thng tng hp khng th v s hnh thnh khng th

- H thng min dch
Hin nay, ngi ta bit r l mi t bo t chc lympho u bt ngun t loi t
bo gc ca tu xng gi l t bo M. Trong thi k bo thai, nhng t bo gc M
(muclocyte) s n tr ng ti hai tuyn ngoi vi: tuyn c v tuyn Bursa Fabricius
gia cm (cn cc ng vt c v th c l nhng tuyn tng ng nh mng
Peyer rut v rut tha, amidan...)
Loi t bo tuyn c i ra s n c tr ti vng cn v ca cc hch ngoi vi:
l nhng t bo T v chng ph thuc vo tuyn c. Nu ct b tuyn , qun th
t bo T ny s gim rt r rt (Miller, 1961) v mi p ng min dch qua trung gian
t bo s mt ht (nh phn ng loi mnh ghp d en). Nu em tuyn c ng tin
35
ghp li cho con vt ct b tuyn y th s lng t bo T li tr li nh c cng
nh cc p ng min dch qua trung gian t bo.
Cc t bo lympho T (ch T l ch vit tt ca ch Thymus c ngha l tuyn c)
trong khi di hnh trong mu, nu gp khng nguyn trc tip hoc qua i thc bo
trnh din khng nguyn th n s tr thnh qun th t bo lymph T mn cm v khi
tr v hch ln cn gn nht s bit ha thnh cc nguyn bo ln, phn chia thnh
mt qun th lympno mi, l nhng t bo lympho c hot tnh min dch. Mt s
t bo lympho ny li c th ri hch u tin ny n cc hch khc trong c th
v li sinh ra nhng qun th t bo lympho c hot tnh min dch na. Sau
cng, mt s t bo lympho c hot tnh min dch s lu hnh trong mu ngoi vi, s
n ch c khng nguyn nu cn, to nn p ng min dch qua trung gian t bo.
Ti ch , s kt hp khng nguyn vi t bo T c hot tnh min dch s dn n s
tiu dit khng nguyn nh mt lot nhng cht do cc t bo T ny tit ra, tn chung
gi l lymphkin ng vai tr quan trng trong hin tng di ng chm.
Loi t bo ti Fabricius vo mu ngoi vi th n khu tr ti v ca hch v gi
chung l t bo B (B l ch vit tt ca ch Bursa c ngha l ti) v n ph thuc vo
ti Fabricius. gia cm, nu ct b ti ny, lng t bo B s gim mt, vng v hch
khng c t bo v khng th dch th trong huyt thanh gim r rt, p ng min
dch dch th khng c (Gch, 1953). Khng nguyn khi xm nhp vo c th, b t
bo i thc bo n, ri di chuyn n hch gn nht, y cc t bo lympho B vy
ly, tng sinh pht trin thnh nhng t bo a pyronin v tng bo. S pht trin t
chc ny mnh nht khi khng th c sn xut cao nht.
Nh vy l r rng nhng t bo lympho B v hnh thi bit ha cao nht ca
chng l nhng tng bo, l loi t bo tng hp khng th dch th v chu trch
nhim v p ng min dch dch th. Ngoi ra, h thng t bo lympho T t nhiu
ng vai tr h tr cho h thng B, v trong th nghim ct tuyn c, khng nhng
dng T tuyt sn m c dng B cng gim st hot ng. Khng th dch th khi gp
khng nguyn s sinh ra phc hp khng nguyn-khng th c tc dng trung ho
khng nguyn, tiu dit n v ng thi kch thch mt s t bo khc nh mastocyte,
bch cu i kim tit ra cc ha cht trung gian nh histamin, serotonin... to nn
nhng phn ng thy trong p ng min dch dch th (phn v...).
- S hnh thnh khng th
Trc tc dng kch thch ca khng nguyn, c th sn xut khng th ngay sau
mi tim u tin. Ngi ta c th thy c khng th dch th xut hin trong mu
vo ngy th 4-5 sau khi tim khng nguyn. i vi p ng min dch qua trung

gian t bo th theo a s cc tc gi, phn ng xut hin sm hn, l vo ngy th 3.

T l khng th tng dn vo tun th ba, sau m khng th khng tng v
c th gim dn. Nng khng th trong mu gim dn thay i tu theo loi khng
36
nguyn. Nu sau ba tun li dng khng nguyn kch thch li th khng th c
tng hp nhanh hn v s lng cao hn.
d) Nhng yu t nh hng n qu trnh tng hp khng th
Ngoi nhng yu t thuc v khng nguyn k trn (liu lng, ng vo, t
cht), c mt s yu t sau y nh hng r rt n vic tng hp khng th: Phn
ng th pht (hi tng hay nh)
Tim nhc li khng nguyn cho mt con vt tim mt ln khng nguyn ri
th t l khng th s tng sm v nhiu hn l ln u (c th gp n hn 100 ln).
Cng ca phn ng ln hai tng theo thi gian k t mi tim th nht, n
thi hn ti a l khong 30 ngy trn th v chut. Phn ng ko di t 100 n 300
ngy. Phn ng nh ny c th tn ti nhiu nm sau mi tim th nht. l nh
nhng t bo lympho T hoc B, sau khi tip xc vi khng nguyn, tr thnh nhng t
bo k c khi khng nguyn vo ln sau th s lp tc tng sinh thnh dng t bo
c hot tnh min dch ng o gy nn phn ng nh y.
- Mn cm vi nhiu khng nguyn
Nu tim nhiu khng nguyn ng thi th nhiu loi khng th tng ng cng
ng thi c to ra vi mc ngang bng hoc nhiu hn khi tim khng nguyn
tng loi. l l do ca vic dng nhng vacxin a gi. Tuy nhin, nu cng mt lc
tim khng nguyn liu mnh vi khng nguyn khc liu nh th c th ch c khng
th tng ng vi khng nguyn mnh m thi (cnh tranh khng nguyn). Hin tng
c ch ny thng xy ra nu tnh ha hc ca cc khng nguyn gn nhau.
- Dinh dng v thn kinh ni tit
S tng hp thot ni chung v khng th ni ring, b gim st khi thiu thot
trong ch n nh i lu ngy, trong ri lon hp thu... Trong thc nghim thy
thiu vitamin B v C cng lm gim khng th.
Nh trn ni, tnh phn ng ca con vt quyt nh s hnh thnh khng th
nhiu hay t, lu hay chng, mnh hay yu; m ni n tnh phn ng l ni mt cch
tng hp v hot ng thn kinh ni tit v tnh di truyn ca sinh vt. Ring v ni
tit th n nay, ngi ta bit kh r v vai tr c ch min dch ca trc tuyn ynthng
thn Hon non corticoit tc ng ln t bo ang sinh sn nh t bo lympho T,
n c nh hng lm ngng qu trnh sinh tng hp khng th, lm ngng qu trnh
phng thch ra cht lymphokin.
Tri li aldosteron kch thch ng ha protein tng sn xut ra khng th, m
ngi ta thy phn ng sinh min dch l phn ng sinh hc c lin quan n tnh di
truyn. Cho nn trong thc nghim cng c th to c nhng gia sc sinh khng th
mnh bng cch chn lc nhng gia sc c kh nng sinh min dch cao lm ging.
- Nhng yu t bn ngoi khc
37
Nhng cht thuc chng ung th nh thuc chng phn bo, thuc alkyl ha, tia
phng x... u c tc dng c ch min dch lm gim tng hp khng th
Hin nay ngi ta thy c mt s loi vi rt chng li s min dch nh vi rt HIV
ngi, vi rt IBD gy bnh Gumboro gia cm. Ngoi ra, ngi ta cng thy ch__________t
Prostaglandin c ch t bo lympho T v B tng hp khng th.

Bn cnh , mt s cht gy c ch t chc lin vng ni m nh cc cht mu

trung tnh, cacbon keo... cng c tc dng km hm qu trnh tng hp khng th, c l
thng qua vic c ch cc i thc bo.
e) Nhng gi thuyt v sinh tng hp khng th
- Thuyt thng tin hay thuyt khun
Do Breinl v Haurowitz (1930) xng v nhiu nh nghin cu v sau pht
trin thm nh Alexander (1931), Mudd (1932), PHuling (1940), Bumett v Fenner
(1949), cho rng khng nguyn c tc dng i vi cc t bo c hot tnh min dch
nh l mt ci khun v cc khng th s c sn xut theo kiu cch ca khun .
Ban u, gi thuyt "khun trc tip" c ra cho rng khng nguyn vo nm
trong t bo lymph nh l mt ci khun m phn t globulin phi n ly mu .
Song gi thuyt khng gii thch c nhiu hin tng nh phn ng nh, dung
th v t lit min dch. cho nn nm 1949, Bumett v Fenner ln u tin a ra
thuyt khun gin tip cho rng khng nguyn l mt yu t bn ngoi gy nn s tng
hp mt enzym thch nghi, enzym s xc tc s hnh thnh cc phn t khng th theo
khun kh ca khng nguyn.
- Thuyt chn lc
Cho rng khng th sn c trong c th sinh vt i vi bt k khng nguyn
no c trong thin nhin hay do con ngi sau ny tng hp ra v khi khng nguyn
t nhp vo trong c th th s kt hp vi khng th tng ng lm tng cng qu
trnh sinh tng hp khng th c sn.
Nm 1964, Bumett a ra gi thuyt "chn lc dng t bo" cho rng trong m
tuyn c gm hn 10.000 t bo khc nhau, mi t bo tng trng cho mt dng v
sau ny v c kh nng tim tng i thnh tng bo sn xut ra mt loi khng th.
S dng sinh ra mi loi khng th i vi mi loi khng nguyn c th c (t
khng nguyn, ng khng nguyn v d khng nguyn). Ring i vi khng nguyn
lun lun c mt vi mt m cao nh cc khng nguyn ca bn thn th chng s
ph hu hay c ch cc t bo tng ng ngay t khi cn l bo thai, cho nn c th
bnh thng khng sinh khng th chng cc t khng nguyn. Nhng dng t bo y
c mnh danh l nhng dng cm. Thuyt chn lc dng gii thch c nhiu hin
tng min dch nh dung th min dch, bnh t min dch, khng c gammaglobulin
trong mu... Song v l ch khng thin nhin no c th d on c ht
38
nhng khng nguyn m con ngi tng hp nn.
Sau ny Szilard cho rng ADN trong mi t bo c kh nng to ra mi loi thot
(khong 30 vn loi), mi thot c k hiu trn mt en ca chui ADN gm mt
b phn iu ho, mt b phn c ch. Mi khng nguyn khi vo trong t bo c tc
dng gii c ch cho mt n tng ng v en c t do y s quyt nh tng hp
khng th c hiu tng ng.
Gn y nhng thnh tu nghin cu v cu trc globulin min dch cho thy,
trong cc chui a peptit hnh thnh chui nng cng nh chui nh c mt phn
tn cng NH2 rt thay i v trnh t cc axit quan, phn cn li t thay i, c bit
chnh phn hay thay i ny li l ch khng th kt hp c hiu vi khng nguyn.
Do , nhiu tc gi cho rng nhng t bo sinh khng th u mang hai hoc ba
n n nh chng trnh tng hp mt kiu globulin min dch no nht nh.
ADN ca cc en bn vng v khng b khng nguyn lm bin i. Nhng trong
qu trnh phn bo, cc en c th xy ra nhng bin i bn thn. Nhng bin i

cc giai on nucleotit y do trao i cho gy nn, c th to nn nhng thay i th

t cc axit quan trong phn thay i ca cc chui. Nh vy c th ni, t bo mm
nguyn thu ch c n nh chng trnh sn xut globulin min dch theo mt
qu trnh bnh thng nh sn xut cc loi protein khc m thi nhng s trao i
cho gia cc bn trong phn bo thi k phi sinh sn xut ra rt nhiu cc t
bo lympho c kh nng tng hp nhng globulin min dch tng t, ch khc l
ch c nhng on axit qun khng ging nhau c thch nghi vi nhng khng
nguyn khc nhau.
4.2.2.3. B th
D khng phi do p ng min dch sinh ra nhng b th gi vai tr quan trng
trong phn ng min dch, v n kt hp vi nhiu h thng khng nguyn-khng th
v gip cho vic tiu dit khng nguyn tt hn, nhanh hn. K hiu b th l C, b
th l mt phc hp dch th khng __________c hiu, c t nhin trong c th. l mt h
thng gm chn th men t C1 n C9, tc dng dy truyn theo th t 1-2-3-4-5-6-78-9.
Khi b th lin kt vi phc hp khng nguyn-khng th th pht huy mt lot
nhng tc dng sinh hc ca n:
Tiu khng nguyn b gn khng th c hiu, nht l nu khng nguyn l
t bo. Ln u tin, ngi ta pht hin tc dng ny i vi hng cu. Khi trn hng
cu cu vi khng th chng hng cu cu (cn gi l dung huyt l) th ch c hin
tng ngng kt m khng c tan mu. Nhng nu em cho thm b th vo th mng
hng cu s b b th chc thng, huyt sc t chy ra ngoi.
- Chun b cho hin tng thc bo: mt phc hp khng nguyn-khng th kt
hp b th d c cc t bo nh bch cu a nhn trung tnh, i thc bo... n i
39
hn l khng c b th. Ngoi ra, s hot ha h thng b th ko theo hot ha nhng
h thng ng mu v h thng khn huyt tng lm tng cng hot ng thc bo.
- S kt hp b th vo khng th lm tng cng qu trnh lin hp mt s khng
nguyn tc l y mnh s lin kt khng nguyn-khng th cn t do trong mi
trng, c bit hin tng kt dnh min dch c tng cng.
4.2.2.4. S kt hp khng nguyn v khng th
N l phn ng c bn ca qu trnh min dch.
C ch kt hp: khi em khng th trn cng vi khng nguyn c hiu tng
ng th hai th s kt hp vi nhau, nhiu khi c th nhn thy c bng mt thng
di hnh thc nhng hin tng nh ln bng, kt ta, ngng kt.
Trong trng hp khi khng nguyn-khng th kt hp ri m n li ho tan th c
th dng nhng bin php gin tip nh theo di s tiu th b th, hay hp thu khng
nguyn hoc khng th, trn mt nhng ht nh (hng cu, ht colodion...) lc
khng th hoc khng nguyn s ngng t nhng ht ny. Cn i vi khng th c
nh th ngi ta c th pht hin c bng phn ng qu mn: phn ng qu mn ni
b.
- Kt qu ca s kt hp khng nguyn-khng th thc cht n l mt phn ng
bo v bi v do phn ng ny m khng nguyn mt tnh cht l ha v sinh vt ca
n.
Nu khng nguyn l vi khun, vi rt th khng th s ngng t n li lm cho n
khng sinh si ny n hoc lm cho n b dung gii bi tc ng ca b th hoc n b
tiu dit bi i thc bo.

Nu khng nguyn l c t hay thot l th khng th s kt ta chng li lm mt

tc dng c, cht ta b tiu dit. Do mt tt ny m con ngi ng dng phn ng
min dch trong cng tc phng v cha bnh.
Nhng phn ng kt hp khng nguyn-khng th i khi n lm xut hin mt
lot cc phn ng khc gy hi cho c th.
V d: vim c hiu, ri lon vn mch, co tht c trn, tng sinh t bo. Nhng
phn ng ny v c bn mang tnh cht bo v nhng i khi qu mnh li tr ln c
hi cho c th.
Phn ng kt hp khng nguyn-khng th n cng phng thch ra cc cht trung
gian c hot tnh sinh l, tu theo khng th kt hp vi khng nguyn l khng th
dch th hay khng th c nh.
Cc cht trung gian ca khng th dch th: Khi khng nguyn kt hp vi khng
th dch th u tin l n phng thch ra mt men tiu m diamin-oxydaza, men ny
lm cho mt s cht trong t bo phng thch vo c th gy ra hin tng bnh l:
40
+ Histamin c t bo mastocyte v bch cu i kim tit ra c tc dng tng
tnh thm mao mch v co c trn.
+ Serotonin do tiu cu tit ra lm co c trn, tng tnh thm mao qun.
+ SRS-A (Slow reacting substance of anaphylaxis) do cc t chc phi tit ra c
tc dng nh histamin nhng chm hn
+ Cc khn huyt tng ch yu l bradykinin, kallikinin do cc men tiu m
nh plasmin, trypsin chuyn t cc globulin huyt tng thnh. Chng c tc dng
lm tng sc thm mao qun tc gin mch
- Cc cht trung gian ca khng th c nh: khi khng nguyn gy p ng min
dch qua trung gian t bo th cc khng th c sn xut ra nm ngay trn b mt ca
t ho lympho T l cc khng th c nh. Nu nhng khng th c nh ny gp
nhng khng nguyn ln sau th phn ng kt hp khng nguyn-khng th xy ra v
xy ra ngay trn b mt ca t bo ri n gii phng ra mt s cht c hot tnh sinh l
gi chung l lymphkin m c th k mt s chnh sau:
+ Cht chuyn dng lympho bo LTF (lymphoblastic transforming factor) lm
cho t bo lympho nh thnh nguyn bo v sinh si ny n thm ra.
+ Cht c ch i thc bo MIF (macrophage inhibitor factor) lm cho i thc
bo khng i ra khi c ch kt hp khng nguyn-khng th.
+ Cht hot ha i thc bo MAF (macrophage activator factor) kch thch t bo
i thc bo tng hot ng.
Nhng ha cht trung gian ca khng th dch th cng nh lymphokin, bn thn
lm tng tun hon ti ch v tp trung ti cc kh nng bo v c th (i thc
bo,
ng mu...) nhm nhanh chng tiu v loi khng nguyn ra khi c th. Song
phn ng bo v nhiu khi cng lm cho c th kh chu, i khi nguy him na.
4.2.3. Min dch bnh l i cng
Min dch bnh l bao gm nhng biu hin bnh l ca kt hp khng nguynkhng
th (cn gi l d ng hc) v nhng ri lon qu trnh sn xut khng th.
4.2.3.1. Biu hin bnh l ca kt hp khng ngun - khng th (hin tng qu mn)
Trong phn ng kt hp khng nguyn-khng th khng phi lun lun mang tnh
cht bo v m nhiu khi cn biu hin c hi l chnh. Trng thi c gi l trng
thi qu mn.

Trong thc nghim cng nh trong lm sng, trng thi qu mn thng thng
qua cc giai on:
- Giai on mn cm: tc l lc c th nhn liu mn cm cho n lc c th nhn
41
liu pht hin; thng t ngy th by tr i sau khi nhn liu mn cm.
- Giai on qu mn: Sau khi nhn liu pht hin c th xy ra ngay gi l qu
mn nhanh khi l khng th dch th, c th xy ra chm sau 2-3 ngy gi l qu mn
chm khi l khng th c nh.
- Giai on 3 : gi l giai on gii mn cm, l lc khng nguyn mt tc dng
gy ri lon.
a) Qu mn tc khc
Tu theo loi khng th dch th m c th c nhng hin tng qu mn khc
nhau i t phn ng cc b n nhng biu hin ton thn. Cc tn thng t chc
cng c nhiu kiu khc nhau tu thuc vo bn cht l hc ca khng th v vo ni
xy ra phn ng. Kt hp khng nguyn-khng th dch th to nn phn ng qu mn
nhanh u c mt s nhng c im chung sau y:
Phn ng xy ra nhanh sau khi tim liu khng nguyn pht hin (thi gian c th
tnh bng giy hay pht).
- Kt hp khng nguyn-khng th phng thch ra cc ha cht trung gian c hot
tnh sinh hc nh histamin, serotonin, SRS-A...
- Phn ng qu mn nhanh thng xy ra nhng b phn c nhiu c trn nh
ph qun, thnh mch, thnh rut...
C th c nhng hin tng qu mn nhanh nh sau:
* Hin tng Arthus (sc phn v cc b)
l phn v nhanh ti ch do Arthus tm ra (1905), biu hin vim cc tiu ng
mch (vasculitis), trong phn ng ny khng th lu ng ch yu l IgE v IgM v n
cng c s tham gia ca b th.
Trong thc nghim: nu em tim huyt thanh nga cho th di da nhiu ln,
cch nhau 5-6 ngy th t mi tim th bn, ch sau 15 pht n vi gi l bt u c
phn ng ti ch tim nh vim , ph n, nhiu khi c km theo xut huyt v hoi
t. V mt gii phu bnh th c vim huyt qun, thm nhim bch cu a nhn trung
tnh. C ch sinh bnh ca hin tng ny l do khng nguyn c trng lng phn t
ln cha khuch tn vo trong lng mch kp gp khng th ngay trong gian bo;
phc hp khng nguyn-khng th ny hot ha yu t C3 ca b th lm cho h
thng ng mu v h thng khn hot ng to nn mt vim. Bch cu a nhn do
vim s phng thch ra cc men gy nn tn thng huyt qun.
* Sc phn v, bnh huyt thanh v cc trng thi qu mn khc
Sc phn v c th to thnh trong thc nghim khi ngi ta tim tnh mch cho
ng vt mt loi protein l (lng trng trng, huyt thanh khc loi) gy cho con vt
cht. Sc phn v c nh khoa hc Portier v Richet m t nm 1902 khi tim tinh
42
cht ca mt con hn bin cho ch ln hai, sau ln tim th nht khong 14-15 ngy
th gy cht ch khng bo v c.
Biu hin ca sc phn v l c s khc nhau nhiu loi ng vt, m phn ng
c bn ca sc l s co tht c trn cc b phn ni tng.
V d: chut lang th thy con vt kh th, xanh tm, giy gia ri cht, khi m
thy nhu m phi khng xp do ph __________qun b co tht. ch co tht c trn tnh mch

c bit l tnh mch gan, cho nn ch au, t mu gan, gim huyt p cc c quan
khc dn ti cht. Cn nga, mo, chut nht biu hin ging chut lang. chut
cng tng tnh thm thnh mch dn ti xut huyt, th t mu ng mch phi
gin tm tht phi.
Khi quan st trn knh hin vi cc phc hp khng nguyn - khng th lng ng
trn mao mch phi, ko theo s t tp cc bch cu, cc tiu cu lm tng huyt p
phi hnh thnh cc huyt khi lm cho mu khng lu thng c v li dn ti lp
qun v cht.
ngi c mt trng thi bnh l tng t gi l bnh huyt thanh, gp khi tim
huyt thanh iu tr d loi (huyt thanh nga chng un vn, chng bch hu...). Tt
nhin bnh huyt thanh in hnh xy ra nhng ngi dng huyt thanh iu tr d
loi mt ln trc ri, trong c th sn c khng th chng li. Triu chng xy ra
mnh, rt cp tnh v bnh nhn c th cht do sc. Nhng c loi bnh huyt thanh
xy ra ngay khi tim huyt thanh iu tr ln u tin, triu chng thng xut hin
vo ngy th 6 sau khi tim vi ni mn, pht ban, au khp, i ra albumin.
D ng nhanh l hin tng qu mn tc khc, thng ch xy ra trn ngi mt
cch bt thng. Khng nguyn l loi yu v xm nhp theo ng t nhin (h hp,
tiu ha...) v t t. Biu hin bnh l thng co tht c trn v hi chng vim.
V lm sng, d ng nhanh bao gm rt nhiu bnh cc c quan khc nhau. C
th k mt s trng hp sau:
+ mt: ph mi mt d ng, ph vng mc, vim gic mc d ng.
+ mi: vim mi d ng c ph nim mc tit dch cha nhiu bch cu a axit,
nim mc qu sn, sn si, nu c nhim khun ph th s chy m.
+ tai: vim tai, vim tin nh d ng.
+ phi: hen ph qun (co tht ph qun, ph v tit dch lm hp thm lng ph
qun gy ting rn, kh th, xanh tm, thng xy ra sm trc 20 tui).
+ da: vim da d ng, ni m ay, l sn.
+ ng tiu ha: vim mm, vim d dy, rut, nn theo chu k.
+ khp: vim ph khp, cc th thoi ha khp.
+ thn kinh: nhc u kiu bn thin u thng, co git th ng kinh, st ma
43
(st theo ma v c l khng nguyn l phn hoa, ph nim mc mt, mi, thm nhim
bch cu a axit, tng tit dch).
+ mu: ban xut huyt, gim tiu cu, bch cu.
- V c ch ca sc phn v cng nh bnh huyt thnh hay cc trng thi d ng
nhanh l do kt hp khng nguyn-khng th (IgG, IgM v IgE). Tu theo loi khng
th no ' ch yu m ta c th c bnh cnh lm sng khc nhau. IgE c i tnh mnh
vi t bo nn thng bm vo cc t bo chung quanh cc c trn cho nn nu khng
th ny chim a v tri th cc phn ng xy ra mt t bo v cc biu hin c tnh
cht phn v r rt (co tht c trn, tng tit dch...). Nu l cc khng th IgG, IgM th
ch yu hnh thnh nhng phc hp min dch tun hon trong mu ri lng ng
mt t chc, c quan no to nn mt trng thi bnh l m hin ny cc tc gi gi
l "bnh cc phc hp min dch". Cc phc hp ny lng ng u s ko cc t
bo lymph n v tit ra lymphkin, phc hp cn hot ha C3 ca b th theo
con ng tt, t c th gy tan t bo, ko cc bch cu a nhn trung tnh tit cc
men tiu m, hot ha h thng ng mu, gy ng fibrin ti ch v phng thch cc
khn huyt tng. Tt c nhng thay i ny s gy vim ti ch.

D ng thuc: mt s thuc khi vo c th c kh nng gn vi protein ca c th to

thnh mt khng nguyn hon ton, kch thch c th sinh khng th dch th hay t bo.
V d: thuc penicilin khi vo c th thoi ha thnh nhm penicilloyl gy d ng
nhanh c th lm cht ngi.
b) Qu mn chm tr
Hin tng qu mn chm tr cng nm trong min dch qua trung gian t bo.
l phn ng c bit da, xy ra 24-48 gi sau khi c th mn cm c tip xc vi
khng nguyn c hiu. Trong mu ca c th b qu mn chm tr khng pht hin
c khng th dch th __________cho nn khng truyn th ng bng huyt thanh c.
Nhng khng nguyn gy ra qu mn chm tr rt khc nhau nhng thng l nhng
khng nguyn khng ho tan, t c kh nng khuch tn trong ton c th vt ch, v
d nh nhng khng nguyn t bo.
Sau y l lit k mt s khng nguyn gy qu mn chm tr hay gp:
- Khng nguyn vi sinh vt: Tuberculin (lao); typhoidin (thng hn); c t bch
hu trong phn ng Schick; Vi rt u; khng nguyn nm: histoplasmin,
coccidiomicin; khng nguyn n bo (bnh do leishmania).
- Khng nguyn cn trng: dch tit ca mui, ong.
- Khng nguyn t chc d loi (trong phn ng loi thi mnh ghp).
- Bn khng nguyn gy d ng do tip xc nh ha cht.
- Mt s t khng nguyn trong bnh t min.
44
in hnh trong d ng chm l phn ng tuberculin. Sau 48 gi khi tim ni b
0,1ml tuberculin th nu c phn ng, vt ch c th st nh, ch tim s vim ,
cng; v mt gii phu bnh l th c thm nhim t bo lymph quanh v bn trong
cc mao qun. Phn ng ny cng c th truyn th ng bng hn dch t bo lymph
mn cam.
D ng chm do ha cht xy ra khi tip xc nhiu ln vi ha cht nh thuc, cht
do, cao su, x phng th b ni mn, sung huyt, ni phng gy hin tng vim kiu
eczema. Ti ch vim c tn thng ni b, ph t bo v thm nhim bch cu n nhn.
C ch sinh bnh ca phn ng d ng chm: Khng nguyn khi gp t bo
lymph mn cm th sinh ra hai kt qu:
+ Kt hp khng nguyn-khng th hot ha b th ko theo hot ha h thng ng
mu v khn huyt tng nh trong kt hp khng nguyn vi khng th dch th.
+ Kt hp lm t bo lymph tit ra nhng lymphkin to nn mt lot cc
phn ng t bo (c ch d tn, hot ha i thc bo, chuyn dng lymph bo...).
Phn ng loi thi mnh ghp: Trn c th ng vt khi tin hnh ghp cc t
chc m cc t chc l d en th s xy ra phn ng loi thi t chc ghp ra khi
vt ch, hin tng gi l hin tng loi thi mnh ghp.
Trong qu trnh thc hin khi ghp mt t chc cho vt ch m khc trn ngi ta
nhn thy sau 1 -2 ngy mnh ghp lin v chung sng vi vt ch nhng m ko di 1
-2 tun ch ghp thm nhim cc t bo lympho T, cc i thc bo, lm cc mch
qun ti ch ghp c hin tng ng mu, hnh thnh cc huyt khi gy tc mch,
ph, mnh ghp khng c nui dng hoi t v bong khi vt ch, nu tip tc
ghp li th mnh ghp li bong nhanh hn.
Hin nay ngi ta c th ghp da, ghp thn cho cc c th v mnh ghp chnh l
ca c th hoc mnh ghp ng tin vi vt ch (ghp ca hai vt sinh i cng
trng). Vic ghp da, ghp thn phi c k thut tin tin, dng cc phng php c

ch min dch bng cc ha cht, cc tia phng x th mnh ghp tn ti c lu hn.

Bng 2. So snh s khc nhau gia qu mn tc khc v qu mn chm tr
Qu mn tc khc Qu mn chm tr
- Xy ra nhanh
- Khng th dch th
- Ho cht trung gian
-Truyn th ng bng huyt thanh
- Phc hp KN-KT i ti u gy
bnh ti
- Loi: Phn v. d ng nhanh
- Xy ra chm
- Khng th c nh trn t bo
- Lymphokin
- Truyn th ng bng hn dch t bo
- KN-t bo mn cm gy bnh ti ch c
khng nguyn
- Loi: D ng chm, loi ghp
45
4.2.3.2. Ri lon qu trnh sn xut khng th
a) Thiu nng min dch
L trng thi bnh l trong p ng min ch ca c th gim st hoc khng
c. S thiu ht ny c th ton b hay b phn i vi min dch dch th hoc i
vi min dch qua trung gian t bo thi. N c th l bm sinh hay mc phi, hay l
thiu ht khng c hiu nh thiu b th.
- Suy gim min ch bm sinh:
+ C th ng vt sinh ra thiu t bo M hoc l t bo ny c rt , n gim ton
b c hai loi t bo lympho B v T. Trong c th hu nh hon ton khng c t chc
dng lymph, trong mu khng c globulin min dch. Cc phn ng p ng min
dch dch th v min dch t bo u khng thy c. Cho nn con vt d b cht v
nhim trng.
+ Thiu t bo lympho T: khng c tuyn hay c m khng c tiu th Hassal nn h
thng lymph T khng c, nhng phn ng min dch qua trung gian t bo khng c,
nhng phn ng min dch dch th vn cn. Con vt cng hay b nhim khun m cht.
+ Thiu t bo lympho B: Biu hin ngay trong huyt thanh thiu gamma
globulin. Bnh ny ngi ta thy cng c th do di truyn m thiu B lympho bo, t
ngi ta thy bn loi khng th IgM, IgA, IgD, IgE khng c, cn IgG c t bng
10% bnh thng dn n khng c p ng min dch dch th, lm c th lun
nhim bnh, nu c b sung y-globulin cng ch ko di trong vi thng.
- Suy gim min dch do tc ng t bn ngoi
+ Do nhim cc vi rt m n xm nhim vo h thng min dch ( ngi nhim
vi rt HIV - Hu man Immunodeficiency Virus) gy bnh AIDS (Acquired
lmmunodeficiency Syndrome).
Vi rt: IBD virus (Infectious Bursal Disease), vi rt leuko, vi rt Marek tn cng
ti fabricius.
+ Ngoi ra mt s vi rt khng tn cng vo h thng min dch nhng ng vai
tr tng phm nh vi rt Ca r ch, vi rt dch t ln, vi rt dch t tru b lm gim
sc khng ca c th.

+ Suy gim h thng min dch cn do cc hch ung th nh u c tnh dng

lympho, u tu xng.
+ Cc ha cht c v c v hu c u tc ng lm dit t bo, chng phn bo,
chng chuyn ha.
+ Cc cht phng x vi liu ln: tia X, tia .
+ Dinh dng: i, h thn, a chy mnh, x gan c chng... u c kh nng
lm suy gim min dch.
46
b) Dung np min dch
Tc l hin tng khng c min dch c hiu i vi mt s khng nguyn, m
cc khng nguyn ny xm nhp vo c th vt ch t lc min dch cha trng
thnh: giai on bo thai, s sinh; ln sau xm nhp vo c th vt ch th vt ch
khng sn xut ra khng th chng li khng nguyn .
Trong t nhin hin tng dung np min dch xy ra hai tr hoc hai vt sinh
i ng tin cng trng do Owen tm ra nm 1950.
Trong thc nghim nh khoa hc Medawar (1951) ly t bo lch, tu, hch
ca ging chut CBA c mu lng nu tim vo thai 7 ngy ca ging chut A c mu
lng trng. Sau khi chut A ra i v trng thnh c hai thng th ng ly da
chut CBA nu ghp ln trn nhng con chut A trng c chun b ny. Vic
ghp thnh cng; tri li nhm i chng gm nhng con chut A khng chun b
th mnh ghp b loi thi nh ghp d loi khc.
Ngi ta c th a khng nguyn cng vi cc cht c ch min dch th c hin
tng dung np min dch khng lu. Cn nu a khng nguyn qu t hoc qu cao
th c th khng sn sinh ra khng th gi l hin tng c ch min dch.
C ch ca hin tng dung np min dch: Nhiu tc gi cho rng: khi a
mt khng nguyn vo c th trong thi k bo thai (min dch cha trng thnh) cho
nn khi tip xc vi khng nguyn n khng th phn bit c l khng nguyn
ca bn thn hay ca c th khc, do khng sn sinh ra khng th m cn coi l
thnh phn ca bn thn mnh, do vy khi a khng nguyn vo c th khng
sn sinh ra khng th m dung np khng nguyn .
c) Suy gim b th (Complement deficiencies)
Ch thy ngi, chut lang, chut nht v th. ngi trong thnh phn thiu
C5, C3 do ti nhim khun nhiu ln v hin tng ny ch thy mt s c th;
chut nht thy thiu C5; chut lang thy thiu C4; th thy thiu CO, biu hin l
tng nhim trng, gim sc khng.
d) Gim chc nng thc bo ca i thc bo (Macrophage) v tiu thc bo
(Microphage).
Ch yu l do thiu men NADPH oxydaza trong cc t bo thc bo lm cho cc
chc nng tiu t bo ca t bo thc bo gim (thy xut hin ngi).
e) Ri lon sn xut khng th.
Bnh t min dch: l hin tng c bit ca c th sn xut ra khng th hoc
sn xut ra cc t bo lympho T min dch chng li m bo hay l cc c quan l
thnh phn ca chnh mnh.
mt s bnh: vim cu thn do c th sn xut ra khng th chng li mng c
47
bn gy vim thn, hoc bnh vim tinh hon v tinh trng hoc vim khp dng thp.
V ngi ta c th gy bnh thc nghim bng cch (ng Mansugi) dng huyt thanh

vt c khng th chng thn th tim cho th dn n lm vim thn th. Cn ng

Cavelti dng thn th cng vi c t ca lin cu khun tim cho th gy vim thn
th.
V c ch, c nhiu gi thuyt gii thch hin tng ny nh:
- Khng nguyn l cng c cu trc vi khng nguyn ca bn thn hoc l c cu
trc gn ging cho nn c th sn sinh ra khng th chng li khng nguyn l, ng
thi dn ti chng li chnh bn thn n.
- C s gii c ch dng lympho b cm cng l do nhim khun, m cc dng
lympho b cm t sinh ra khng th.
Hin nay ngi ta gii thch c th do yu t di truyn c lin quan n bnh sinh
t mn cm. Cn gn y ngi ta li cho rng c s ri lon cn bng gia lympho
bo T v lympho bo B sinh ra khng th chng li bn thn.
Ri lon globulin min ch l bnh c tnh m n sn xut ra globulin c bit (in
c bit) c cu trc gn ging IgA, IgE, IgG, IgD, IgM nhng khng c kh nng p
ng min dch, v th c th d b nhim khun (thng gp nhng ngi gi m
pht hin ra bng phng php in di).
48
Chng 2
SINH L BNH CC QU TRNH BNH L CHUNG
1. RI LON TUN HON CC B
Tun hon trong cc c quan v trong cc t chc cng c th thay i trong
nhng iu kin sinh l khc nhau. Khi mt c quan no tng hot ng th tun
hon ni cng tng cng. V d: Khi c bp lm vic nhiu th lng mu ti cc
c tng ln gp bi hoc khi tiu ha thc n d dy th mu ti d dy tng ln.
Tun hon cc b mi c quan v t chc lin quan cht ch ti tun hon
chung ca ton c th. Nu lng mu tng c quan t chc no th lng mu
ni khc s gim i. Cho nn trong trng hp sinh l bnh thng s thay i ch
nm trong lnh vc dao ng sinh l bnh thng v nhanh chng hi phc tr li bnh
thng. Trong trng hp bnh l s thay i, ri lon tun hon phi do nguyn nhn
hoc bn trong hoc bn ngoi kch thch. Ri lon tun hon cc b c th biu hin
qua ri lon tun hon chung ca h tim mch v ngc li ri lon tun hon chung
cng c th dn ti nhng bin i tun hon ca tng c quan hay b phn no
trong c th.
S iu khin tun hon, trng lc mch qun gin tip l h thn kinh thng qua
dch th l tit t ca tuyn thng thn, tuyn yn. V vy ri lon tun hon cc
b c th xy ra do ri lon chc nng ca bn cu i no, ca cc trung khu thc vt
v cc u mt thn kinh thc vt ngoi vi nm trn cc mch qun.
Cc cht c hot tnh sinh l trong c th tit ra trong qu trnh min dch, qu
trnh vim nh: axetylcholin, cc quan nh: histamin, typHmin, adenosin triphosphat,
axit lactic... cc cht ny tc ng ln mch qun thng qua cung phn x hoc gin
tip tc ng ln thn kinh co c mch qun nh hng n trng lc mch qun.
V d: histamin gy co cc tiu ng mch, gin cc mao mch; axetylcholin gy
gin tiu ng mch; adrenalin gy co mch da v gin mch vnh.
Ri lon tun hon cc b c th xut hin do thay i thnh phn cc cht in
gii, nng axit, c bit l nng ca con H+. Khi tng axit ng mch gin,
cn khi tng kim ng mch co, vi tnh mch th ngc li tng axit co mch,
tng kim gin mch. Ri lon tun hon cc b thng mang nhng c tnh khc

nhau, thng biu hin mt s hin tng sau y:

1.1. Sung huyt cc b (local Hypercmia)
Sung huyt l hin tng tng lng mu c quan, t chc cc b trong c th.
C hai loi sung huyt: sung huyt ng mch v sung huyt tnh mnh
1.1.1. Sung huyt ng mch (Artenal Hyperemia)
49
1.1.1.1. Khi nim
Mu ng mch y c quan, b phn no trong c th do cc tiu ng
mch, mao mch gin ra mu dn vo nhiu, trong khi dng mu chuyn i (v
tim) vn bnh thng.
V d: vim , i nng mt , xu h mt , bng, xoa du nng, ngm chn
vo nc nng... do sung huyt ng mch.
1.1.1.2. Nguyn nhn gy sung huyt ng mch
Do nhng kch thch nh: c hc (khi mt b phn no trong c th b tc
ng bi mt lc c hc th ti ni s b sung huyt ng mch), ha hc, l hc
(cc tia phng x tc ng; trong c th ni no b kim hoc a xt mnh tc ng th
ni b sung huyt ng mch), sinh vt hc (do tc ng ca c t vi khun);
- Do tng mn cm ca mch qun i vi kch thch bnh thng (mn cm d
ng mn cm vi nh sng);
- Do tc ng trc tip ln thn kinh iu khin mch qun, trung khu vn mch
hoc thn kinh thc vt.
1.1.1.3. Biu hin bn ngoi ca sung huyt ng mch
- Ni sung huyt c mu xut hin do tng hm lng mu ng mch, m
mu ng mch mang nhiu oxy nn mu ti;
- Cc ng mch, tiu ng mch, tiu mao mch gin rt rng;
Tng s lng mch qun c th nhn thy;
Bt c mch t cc ng mch nh do mu cha y trong mch qun v huyt
p tng;
- Tng nhit ni sung huyt do tng dng mu n v tng qu trnh trao i Vng sung huyt hi sng do gin mch tng to lm ba, c khi c au do thn kinh
cm gic b kch thch.
1.1.1.4. C ch sung huyt ng mch
- C ch phn x thn kinh: sung huyt pht sinh do tc ng kch thch vo c
quan nhn cm, cc yu t l ha hc tc ng nn b phn ni ngoi cm th thng
qua cung phn x iu khin thn kinh co gin mch, lm gin cc tiu ng mch,
mao mch, c ch thn kinh co mch. Kch thch lu c th gy lit cc c co mch.
- C ch tn thng thn kinh: do thn kinh co mch b tn thng nh lit thn
kinh co mch ngoi vi hay tn thng trung khu, trong thc nghim nu ct thn kinh
giao cm c th hoc ct b hch giao cm c gy sung huyt mt na u tng
ng biu hin tai th.
1.1.1.5. Hu qu
50
- Hu qu tt: Ni sung huyt lng mu c dn n nhiu t tng cng
qu trnh trao i cht, lng oxy c tng v cht dinh dng cng tng hn bnh
thng t c nng hot ng ca t chc cng c tng cng. Bn cnh n
cn tng cng chng c v thi cht c. Trong trng hp c th b bnh l th
sung huyt ng mnh l phn ng thch ng ca c th i vi qu trnh bnh, c

bit n c ngha ln trong vic thnh lp tun hon nhnh bn, do c th cung cp
lng mu cho c quan b,bnh.
- Hu qu xu: Nu sung huyt lu gy hin tng xut huyt, m c bit nu
xut huyt no d gy hin tng t vong. Sung huyt chn p c nng ca cc c
quan khc. Sung huyt lan rng th gy bn huyt mt s c quan khc. Nu sung
huyt ng mch ko di gy sung huyt tnh mch.
1.1.2. Sung huyt tnh mch (Venous Hyperemia hay Congestion)
Hin tng sung huyt tnh mch c th xy ra bt c b phn no trong c th,
c th biu hin cp tnh hay mn tnh.
1.1.2.1. Khi nim
Sung huyt tnh mch l hin tng xy ra khi cc dng mu chy v tim b tr
ngi nhng lng mu ng mch ti vn khng thay i.
Khi sung huyt tnh mch biu hin gin mch qun n cc v hay ph do
mu dn tnh mch nhiu, do p lc thu tnh c xu th tc ng vo thnh mch
qun, oxy n nui dng tnh mch km dn ti t bo b tn thng lm cho t chc
lin kt, t bo gin ra lm thot nc ra ngoi.
1.1.2.2. Nguyn nhn gy sung huyt tnh mch
- Cn tr dng mu v tim do huyt khi trong lng tnh mch hoc tc mch do
lp qun;
- Tnh mch b chn p do u so, do thai nghn, do tri buc...;
- Do tng tnh thm thnh mch, nc trong lng mch qun ra ngoi nhiu (trong
vim, trong ng c);
- Bnh tim trong trng hp tn thng tm tht phi dng mu chy v tim
chm, mu trong cc tnh mch chi phn thp ca c th;
- Ri lon chc nng ca phi kt hp vi s thay i p sut trong cn tr mu v
tnh mch ch gy sung huyt tnh mch cc phn thp ca c th.
1.1.2.3. Biu hin bn ngoi ca sung huyt tnh mch
- Ni sung huyt tnh mch c mu xanh tm (cyanosis) do mu ng thiu oxy,
cacbonhemoglobin tng cao trong mu.
- Nhit ni sung huyt h do chuyn ha km dn n to nhit km, mch
51
qun gin lm tng thi nhit, ri lon trao i cht, gim to nhit.
Th tch c quan b sung huyt tng ln, mch qun gin ht mc li cha y.
mu, trong t chc dch thm xut v cc thnh phn ca mu thm ra gy ph n,
mt tnh n hi nn n tay vo li vt lm.
1.1.2.4. Hu qu
- T sung huyt tnh mch c th dn ti mu tnh mch (venous stasis) t
dn ti ri lon dinh dng t chc, ri lon cc qu trnh oxy ha, tr cc sn phm
c gy nhim c v dn ti qu trnh hoi t t chc, cc t bo nhu m b chn p
gy ri lon dinh dng dn ti teo (atrophy), pht trin t chc x lm cho c quan
dy ln v cng (nh gan, phi thn).
- c bit ri lon hot ng ca h thng tim mch dn ti tc cc tnh mch ln,
huyt khi tnh mch ca, tnh mch ca c th gin khi lng mu ln dn vo xut
hin sung huyt tnh mch xoang bng, lm gim huyt p ng mch gy ri lon
hot ng ca tim phi v cc c quan khc do thiu mu. c bit thiu mu v no
c th dn ti gy lit h hp gy t vong.
Tuy nhin trong mt trng mc no sung huyt tnh mch cng c nhng nh

hng tt, v d: Lm chm qu trnh nhim khun bng cch to nn mt sung huyt
tnh mch mt b phn no gy bt li cho s pht trin ca vi sinh vt.
1.2. huyt (Stasis)
1.2.1. Khi nim
huyt l dng mu ngng chy li trong cc mao qun, tiu ng mch v
tnh mch nh cng vi hin tng gin mch qu mc, cha y cc t bo mu c
bit l cc hng cu kt dnh li vi nhau thnh tng chui.
1.2.2. C ch
Khi mu cc t chc ni mu ri lon trao i cht nghim trng, cc sn
phm chuyn ha trung gian tch t (axit hu c, cc cht c hot tnh sinh l:
histamin). Mt mt lm gim trng lc mch qun gy gin mch, mt khc lm tn
thng thnh mch, nc thot ra ngoi lm mu c c v mt na cc cht mang
tnh cht toan tnh tc ng lm cho t bo ni mc huyt qun trng to, nc ra
ngoi lm mch qun xp dn ti mu.
1.2.3. Hu qu
- Nu mu trong thi gian ngn, thnh mch v cc thnh phn ca mu chn
bin i nghim trng, tun hon c th hi phc li c th dn dn cc dch thm
xut ra ngoi c hp thu, mu li c lu thng.
- Cn nu nh ri lon trm trng v dinh dng v nghim trng v chc nng
th dn n xut hin hoi t t chc. Nu mu cc c quan quan trng nh no,
52
lim th d t vong.
1 3. Thiu mu cc b (Ischemia)
1.3.1. Khi nim
L hin tng gim hay hon ton nh ch lng mu ng mch ti mt c quan
hay mt b phn no trong c th. Cng c trng hp l thiu mu ton thn th
hin cc b.
1.3.2. Nguyn nhn
N c th xut hin do cc ng mch b chn p hoc b tc do huyt khi, lp
qun, o co tht ng mch, hoc do x cng ng mch hoc l kch thch thn kinh
co mch pht sinh mt co tht trong lng mch qun hp mu t dn vo hoc do tng
kch t nh vasopressin hay cn gi l ADH (antidiuretic hormon) v adrenalin cng
gy co mch dn n thiu mu...
1.3.3. Biu hin ca thiu mu cc b
- Thng cc c quan, t chc thiu mu b nht nht do cc mch qun v cc
mao mch nh co li. Gia sc biu hin r nht l mt, mi, mm, nim mc.
- Nhit h do trao i cht gim.
- Gim th tch ca cc c quan v thiu lng mu v lng lympho.
Cm gic au t, cc u mt thn kinh b kch thch, do ri lon dinh dng tch
t sn phm trao i trung gian.
- Gim hot ng ca c quan do thiu mu, thiu dinh dng dn n ri lon
dinh dng t bo v c th dn ti lit, c bit c tim v cc c quan xoang bng.
Trng hp thiu mu v no dn ti lit h hp v nu thiu mu nhiu dn n t
vong.
1.3.4. Hu qu ca thiu mu cc b
Ph thuc vo cc yu t sau:
- Tc gy thiu mu hoc thi gian gy thiu mu cng nhanh th hu qu cng

xu bi l cc tun hon nhnh bn cha kp thnh lp dn n d gy hoi t t chc.

- Tun hon nhnh bn c c thnh lp hay khng: thng cc ng mch cc
c quan nh no, tim th t c tun hon nhnh bn cho nn khi thiu mu rt nguy
him c th gy t vong. Nhng ni khc: mng v cc chi th ng mch c nhiu
nhnh bn, do khi xy ra thiu mu cc b, tun hon nhnh bn s pht trin v
thng khng gy nguy him lm.
- Trng thi ca thnh mch qun c nh hng ln bi v khi ng mch c bnh
bin nh x cng ng mch lm mt tnh n hi, do vy khi xy ra thiu mu nhng
ni kh thnh lp tun hon nhnh bn.
53
- Do tnh mn cm ca t chc: Trong c th th thn kinh mn cm nht vi s
thiu mu sau n cc c quan ni tng ri n cc c quan khc.
1.4. Nhi huyt (Infarction)
1.4.1. Khi nim
Nhi huyt l hin tng hoi t t chc mt vng no do mch qun b tc
nghn m tun hon nhnh bn khng hi phc li c (trong trng hp do huyt
khi lp qun, hay co mch trong mt thi gian di)
V d: Bnh dch t ln lch nhi huyt hnh rng ca.
1.4..2. C ch pht sinh nhi huyt
Pht sinh nhi huyt l do s thiu mu, thiu oxy t chc b hoi t. Nhi
huyt thng c hai dng: nhi huyt trng (nhi huyt do thiu mu) v nhi huyt
(nhi huyt do xut huyt).
- Nhi huyt trng thng xut hin thn, lch, tim, no, nhng ni m tun
hon nhnh bn pht trin t, ni hoi t c mu trng xm thng do thiu mu, cc
mch qun co tht mu b y khi vng hoi t ra cc t chc xung quanh.
- Nhi huyt thng gp phi, rut cng i khi thy no, n c to ra
do s xm nhp ca mu vo vng hoi t theo tun hon nhnh bn, cng c trng
hp l do tng huyt p tnh mch, mu theo ng mao tnh mch dn ti nhng
tun hon nhnh bn khng khi phc c m tri li b tc ng ln thnh
mch do ri lon dinh dng lm cho tnh thm thnh mch tng, hng cu v cc
thnh phn ca mu t lng mch thot ra vng hoi t v nhum vng hoi t.
1.4.3. Hu qu
Nhi huyt dn ti ri lon chc nng ca c quan hay t chc. Thng di tc
ng ca cc men, nu nhi huyt nh c th tan ra to thnh so hoc nu b nhim
khun to thnh m.
1.5. Xut huyt (Hemorrhage)
1.5.1. Khi nim
Mu phi chy ra ngoi huyt qun hay tim vo t chc xung quanh gi l xut
huyt hay chy mu. Nu chy mu ra ngoi c th gi l xut huyt ngoi, nu chy
mu vo trong c th gi l xut huyt ni, nu xut huyt ni no gy nn bin
chng chn p vo no rt nguy him.
C nhiu loi xut huyt: xut huyt ng mch, xut huyt tnh mch, xut huyt
mao mch, xut huyt nhu m. Xut huyt tnh mch c bit hay mt s cn bng ca
mu, n cng dn n thiu mu ton b c th.
1.5.2. Nguyn nhn gy xut huyt
54
Nguyn nhn sinh l: gp trong hnh kinh

Nguyn nhn bnh l:

+ Nhng tc ng c hc lm t hoc rch thnh mch qun.
+ Hoi t hoc s ph hu thnh mch mu gy xut huyt.
+ Vim lot thnh mch qun (vim lot thnh d dy c th dn ti vim lot
thnh mch gy xut huyt), bnh truyn nhim nh lao, t th, ng th... Ngoi ra,
cc mao mch b vi khun tc ng vo thnh mch lm v cc thnh mch gy xut
huyt, v d gp trong bnh dch t ln.
+ c t gy tn thng biu m mao mch gy xut huyt gm cc c t a sen,
phi pho tc ng lm tng tnh thm thnh mch dn ti rch mch lm xut huyt;
c t sinh ra bi nhim trng huyt nh trong bnh dch t, bnh t huyt trng, bnh
ung kh thn; nhim c cy dng x diu hu; thiu vitamin C.
+ Ri lon qu trnh ng mu l nguyn nhn th pht gy xut huyt.
+ Nhng bin i bnh l thnh mch nh x cng, thoi ha c th t rch
gy xut huyt.
+ Ri lon hot ng cung cp mu cho mch qun dn ti ri lon dinh dng
tng tnh thm thnh mch.
+ Xut huyt cn c th xut hin do ri lon thn kinh v ni tit nh tng huyt
p t gy tng tnh thm thnh mch v c th dn ti xut huyt.
1.5.3. Hu qu
- Nu xut huyt ni c bit l xut huyt nhng c quan trng yu: tim, no
th d dn n t vong.
- Ph thuc vo khi lng mu mt, nu mt t 40-80% tng lng mu ca c
th th dn n cht.
Ph thuc vo tc mu chy, nu tc mt mu cng nhanh th cng nguy
him, nu mt khong mt phn t tng lng mu trong c th trong thi gian ngn
th rt nguy him c th s b cht.
1.5.4. Cc kiu xut huyt
Xut huyt lm tm (Petechial hemonhage): xut hin ging nh nhng u inh
ghim nh li ti v kch thc t 1-2 mm.
- Xut huyt thnh vt (Ecchymotic hemonhage): xut hin trn nhng b mt
ln hn v kch thc t 2-3 ci.
- Xut huyt dng bn chi (Phim brush hemonhage): l dng xut huyt thnh vt
rng v nhn ging nh nhng vt sn trn t chc.
55
1.6. Huyt khi (Thrombosis)
1.6.1. Khi nim
L mt qu trnh m lng mch qun hay trong xoang tim mt c th sng cc
thnh phn ca mu kt hp li vi nhau thnh mt khi c lm tr ngi qu trnh lu
thng mu.
1.6.2. iu kin hnh thnh huyt khi
S hnh thnh huyt khi cn c 3 iu kin:
Tn thng thnh mch v t bo ni mc huyt qun lm cho mt trong ca
thnh mch tr nn th nhm, lm cho cc thnh phn ca mu d sa lng, lm dnh
cc tiu cu, bch cu. Thnh mch c th b tn thng do nhiu nguyn nhn nh
yu t c hc, l hc, nhim trng, nhim c, x cng mch, do huyt, do vim, do
d ng. Mt trong ca mch qun cha mt lp fibrin, mng fibrin ny c tc dng lm
gim nht ca mu, lm t cc t bo ni mc huyt qun bng huyt tng v

chng s ng mu. Ngi ta thy lp fibrin ny tng ln trong lng mch qun c
tnh cht chng ng mu nhng ng thi tng t thnh mch, kt qu l tng p
lc b mt keo gia cc t bo ni mc vi cc thnh phn ca mu.
- Thay i huyt ng hc v tnh cht dng chy: Thay i tc dng mu nh
khi mch qun b chn p lm cho mu li, tc chy chm li hoc lm mt s
chy m m. Chy cun lm cho cc bch cu, tiu cu b cun li di vo thnh
mch c th gy tn thng thnh mch v ph v bch cu, tiu cu, hoc ng
knh lng mch thay i, hng mu chy thay i u l nhng yu t nh hng n
s thay i huyt ng hc v cc tnh cht chy ca dng mu, to iu kin cho
huyt khi hnh thnh.
- Thay i tnh cht ca mu c th l nhn t ban u hay l nhn t dn dt n
huyt khi: men trong mu tng ln, trong thc nghim tim e, men pepsin, pepton,
gelatin th s hnh thnh huyt khi rt nhanh.
V d: nga gp bnh thrombosis Colic do k sinh trng di hnh gy tn thng
ng mch trc mng treo (Strongylus vulgaris) gy bnh au bng dn n cht,
hoc l qu chn do huyt khi ng mch chi trc.
1.6.3. Hu qu ca huyt khi
- Gy tr ngi tun hon t nh hng ti dinh dng ca t chc, v vy
nhng huyt khi nhng huyt qun cng ln th hu qu cng nghim trng.
Huyt khi tnh mch hay gy mu, ph v c th gy co mch phn x.
- Nu nh huyt khi xy ra ' cc huyt qun cung cp mu cho cc c quan
quan trng nh no th d dn n t vong.
Huyt khi hnh thnh nhanh, tun hon nhnh bn cha kp thnh lp th s gy
56
ri lon tun hon cc b.
- Huyt khi c th ri thnh mch di chuyn i ni khc v gy hin tng lp
qun.
- Nu nh phn huyt khi b nhim trng s lm cho c th b nhim trng v c
th nhim trng ton thn.
* Tuy nhin hu qu ca huyt khi cn ph thuc vo cc yu t sau:
- Huyt qun hnh thnh nn huyt khi: nu huyt qun hnh thnh nn huyt
khi nhng ni quan trng (tim, no) th hu qu rt xu d gy t vong.
- Tc hnh thnh huyt khi: nu tc ny cng nhanh th hu qu cng xu
bi v tun hon nhnh bn cha kp thnh lp.
Huyt khi ny c tr thnh vt lp (lp qun) hay khng.
1.7. Lp qun (Embolism)
1.7.1. Khi nim
Khi huyt qun hoc lm ba qun b bt li bi mt vt m bnh thng khng c
th ngi ta gi l lp qun.
1.7.2. Nguyn nhn gy lp qun
1.7.2.1. Nguyn nhn bn trong
Lp qun do huyt khi: Dng lp qun ny thng do huyt khi c hnh
thnh cc van tim v nht l van hai l.
- Lp qun do t bo m: Trng hp ny xy ra thng do b gy xng ng
hoc t chc m b tn thng cc t bo m di chuyn trong mu v gy lp qun.
- Lp qun do t bo thng l t bo nhng ni b tn thng i vo ng
mch, c mu a i n cc mao qun v gy lp qun.

Trong thc t nguyn nhn bn trong ny t gy ra hin tng lp qun.

1.7.2.2. Nguyn nhn bn ngoi
- Lp qun do bt kh: Trng hp ny do qu trnh tim tnh mch khng y ht
bt kh ra ngoi m tim c bt kh vo mu. Do mch mu b rch nhng vn phng
ln khng xp xung, khng kh s lt vo hnh thnh cc bt kh v di chuyn theo
mu gy lp qun, thng gy lp qun ng mch phi hoc cc nhnh nh ng
mch phi.
Lp qun do vi khun: khi ca nhng t bo vi khun thnh thong c tch ri
ra i vo trong dng chy tnh mch t t chc nhim nng mm bnh v tr thnh vt
lp cc mao mch.
- Lp qun do s di cn ca u trng k sinh trng: nguyn nhn ny t.
57
1.7.3. Phn loi lp qun
Cn c vo phng hng di chuyn ca vt lp m ngi ta chia lp qun thnh
3 loi chnh:
- Lp qun h tiu tun hon: loi ny hin tng lp xut pht t tnh mch ca
hoc t tim. Lp qun loi ny gy ri lon tun hon v h hp, nu nh lp qun
ng mch phi th lc u tim p nhanh, giai on sau gim, huyt p h, h hp
chm li v cui cng tun hon cng dng v con vt cht.
- Lp qun h i tun hon: loi lp qun ny thng c xut pht t tim tri,
t h thng ng mch, i khi t tnh mch phi chuyn sang. Nhn chung lp qun
dng ny tng i nguy him.
- Lp qun tnh mch ca: dng ny th vt lp xut pht t nhnh ca tnh mch
ca, thng loi ny rt t gp v nu gp th rt nguy him v mu li tnh
mch ca, cho nn mu v tim t dn n huyt p h, thiu mu no, h hp nhanh
sau h hp ngng v con vt cng cht rt nhanh.
1.7.4. Hu qu
Ph thuc vo cc yu t sau:
- Ni pht sinh lp qun: nu lp qun m pht sinh nhng ni quan trng (nh
tim, no) th hu qu xu d t vong. Lp qun m pht sinh vng chi th t nguy
him. Hnh thnh tun hon nhnh bn: nu nh tun hon nhnh bn m pht trin th
hu qu t nguy him.
- Ph thuc vo tnh cht vt lp: nu nh vt lp l t bo ung th, l k sinh
trng hay vi trng th khng nhng gy hin tng lp qun m con gy bnh th pht.
- Tnh cht ca tng c quan: nu c quan no c tnh cm th mnh khi sinh lp
qun s rt nguy him (tim, no, thn).
Lp qun c th dn n thiu mu, nhi huyt dn n hoi t.
2. RI LON CHUYN HA CC CHT
Chuyn ha cc cht bao gm tt c cc qu trnh l ha xy ra trong c th
thc hin hai qu trnh ng ha v d ha m c th phi ly nng lng v nguyn
liu t bn ngoi iu chnh v ti to gip cho s sng tn ti v pht trin. S mt
cn bng gia hai qu trnh ng ha v d ha chnh l s ri lon chuyn ha cc
cht.
2.1. Ri lon chuyn ha gluxit
2.1.1. i cng
2.1.1.1. Vai tr ca gluxit i vi c th
Gluxit l ngun nng lng ch yu v trc tip cho mi hot ng ca mi t

58
bo, m v c quan ca c th. Gluxit cng l ngun nng lng d tr quan trng
nht s dng ngay ca c th di dng glycogen.
ngi v ng vt cao cp, gluxit tn ti di ba dng ch yu:
- Dng d tr: glycogen tp trung nhiu gan v c
- Dng vn chuyn: glucoza trong mu v cc dch gian bo
- Dng tham gia cu to t bo v cc cht khc: Pentoza trong thnh phn axit
nucleic (ADN, ARN), gluxit phc tp tham gia cu to mng t bo, mng cc bo
quan (glucoprotein, glycolipit). Axit hyaluronic l mt disaccarit c trong dch thu
tinh th ca mt, trong cung rau, c tc dng ngn chn s xm nhp ca cc cht c
hi. HepHrin l mt mucopolysaccarit c tc dng chng ng mu. Condroitin l mt
mucopolysaccarit axit c nhiu trong sn, cc m lin kt ca da, gn, van tim, thnh
ng mch...
Chuyn ha gluxit cung cp nhiu sn phm trung gian quan trng, lin quan cht
ch vi chuyn ha cc cht khc, l ngun to lipit v mt s axit quan ca c th.
2.1.1.2. ng i ca glulxit trong c th
Tt c cc loi gluxit u c chuyn ha thnh ng n trong ng tiu ha v
c hp thu vo mu vi nhng tc khc nhau (theo th t galactoza, glucoza,
fructoza, pentoza). Ring ng vt n c c bit l loi nhai li i b phn ng
c hp thu dng axit bo bay hi. Cc ng n (monosaccarit) c hp th
ngay on u ca rut non theo hai c ch: (1) Khuch tn th ng: Do s chnh
lch nng ca cc monosaccarit c trong lng rut so vi trong t bo ca mng
rut. (2) Vn chuyn tch cc: rut non, glucoza, galactoza c hp thu rt nhanh
qua mng ca t bo thnh rut. Tc hp thu ph thuc vo s c mt ca con natri.
Nng lng cung cp cho s vn chuyn tch cc ny, chnh l nng lng vn chuyn
ton natri qua mng y t bo nng nhi trong t bo lun lun thp.
Sau khi hp thu, cc ng n theo h thng tnh mch ca n gan v phn ln
c gi li y chuyn thnh dng cao phn t: glycogen d tr. Gan l c quan
d tr gluxit quan trng nht ca c th duy tr cn bng ng huyt.
Glucoza mu khuch tn t do qua thnh mch vo gian bo. Mt s t bo nh
hng cu, t bo gan, t bo no, glucoza thm vo mt cch d dng, khng cn s c
mt ca insulin. Hu ht cc t bo khc, mun thu nhn c glucoza i hi phi c
insulin. Trong t bo, glucoza c chuyn ngay thnh glucoza-6-phosphat nh men
hexokinaza v sau bin thnh nng lng (ATP) s dng cho hot ng ca t
bo. T glucoza i vo chu trnh chuyn ha cc cht. Cc ng n khc
fructoza, galactoza cng u phi chuyn ha thnh glucoza-6-phosphat (G-6-P) nh
men hexokinaza.
Tu theo nhu cu, tu loi t bo m glocoza-6-phosphat c th i theo cc con
59
ng khc nhau:
- Tng hp thnh glycogen d tr: ch yu gan v c.
- Kh phosphat cung cp li glucoza cho mu: xy ra gan.
- Thoi bin thnh axit pyruvic ri axetyl CoA i vo chu trnh Krebs cho nng
lng, CO2 v H2O: Xy ra ty lp th ca mi t bo.
- Tham gia chu trnh pentoza to ra axit bo: xy ra gan v m m vi s h tr
ca insulin.
2.1.1.3. iu ho cn bng glucoza my

Mc glucoza huyt phn nh s cung cp v tiu th cng nh phn nh s iu

ho ca thn kinh v ni tit. Bt c mt loi gia sc no hay ngi cng c hm
lng glucoza huyt hng nh. Mc glucoza huyt tng i hng nh dao ng
trong khong 100-160 mt%, ring b ci tit sa dao ng trong khong 40-60 mt
(ngun gc glucoza huyt ca loi nhai li ch yu t axit bo bay hi do ln men
xenluloza to thnh). Tuy vy, loi nhai li vn m bo c nng lng cn thit
cho c th bi v axit axetic hp thu d c c th trc tip oxy ha cho ra nng
lng. S cn bng glucoza mu ph thuc vo hai ngun: ,
60
a) Ngun b sung
- Gluxit thc n: sau ba n glucoza huyt tng ln trong mu.
- Glycogen gan l ngun b sung trc tip.
- Glycogen c l ngun b sung gin tip v glycogen c cn phi chuyn
thnh axit lactic sau a v gan chuyn thnh glycogen gan v tr thnh ngun b
sung.
b) Ngun tiu th
- Glucoza i vo chu trnh Krebs phn hu cho ra nng lng.
- Glucoza phn hu tng hp nn cc cht khc: protein, m khi tha.
- Nu glucoza qu cao trong mu trong thi gian ngn th n b o thi theo
ng triu.
c) S iu ho ca thn kinh v ni tit
* Vai tr iu ho ca ni tit: Mt s ni tit t c tc dng ln mt s men
chuyn ha gluxit nn nh hng n mc glucoza mu. C hai nhm i lp: mt bn
l insulin lm gim g~ucoza mu v mt bn l mt tp hp gm nhiu ni tit t v
mt s cht khc c tc dng lm tng glucoza mu.
- Insulin: do t bo beta ca o tu tit ra c tc dng lm gim glucoza mu
nhanh v mnh. Insulin lm glucoza nhanh chng vo t bo v nhanh chng c s
dng nh thoi ha cho nng lng, tng hp glycogen, tng hp lm, axit quan.
Chc nng ca insulin bao gm:
+ Hot ha hexokinaza lm glucoza nhanh chng vo t bo.
+ Tng kh nng thm ton kali v phosphat v c vo t bo, to iu kin thun
li cho qu trnh phosphoryl ha v s dng glucoza.
+ Trc tip chuyn glycogen synteraza t dng khng hot ng sang dng hot
ng tng hp glycogen t glucoza.
+ c ch mt s enzym xc tc tn to ng nh pyruvat cacboxylaza.
+ Gn vi th th c hiu trn mng t bo ch to nn cht trung gian l
oligoglycopeptit c tc dng vn chuyn glucoza vo t bo.
+ Lm gim thoi ha cc cht c kh nng to ra glucoza nh: glycogen, lm, thot.
- H i khng vi insulin: C tc dng lm tng glucoza mu.
+ Adrenalin: kch thch to adenosin monophosphat (AMP) vng ca t bo ch,
tng hot ha men phosphorylaza gan lm tng thoi ha glycogen to glucoza.
+ Glucagon l hom lon do t bo alpha o tu tit ra, c tc dng tng t nh
adrenalin nhng mnh hn v ko di hn. Glucagon cn kch thch phn hu m do
61
men lipHza c hot ha bi AMP vng.
+ Glucocorticoit: ngn cn glucoza thm vo t bo (tr t bo no). Tng hot
ha glucoza-6-phosphataza lm tng gii phng glucoza gan vo mu. Tng tn to

glucoza t thot.
+ Tyroxin: tng hp thu ng rut, tng phn hu glycogen.
+ Growth hormon (GH): tng thoi ha glycogen bng cch c ch men
hexokinaza.
GH cn hot ha insulinaza.
+ Insulinaza v khng th chng insulin: trc tip phn hu insulin.
* S iu ha ca thn kinh:
- Th nghim c in ca Claude Bemard: ng chm vo no thiu bn gy
tng ng huyt. Beykov gy c tng ng huyt thng phn x c iu kin.
- ng huyt tng trong mt s trng hp mang phn v no v h giao cm
(hi hp, xc ng, stress).
- Vai tr ca vng di i: n nay ngi ta d pht hin c hai trung tm (A
v B) vng di i tham gia iu ho ng huyt thng qua ni tit.
Trung tm A: gm.nhng t bo thn kinh, khng c mt insulin vn thu nhn
c glucoza t mu. Trung. tm ny i din cho cc t bo khng cn insuhn vn
thu nhn c glucoza nh: t bo no, gan, hng cu. Khi glucoza mu gim xung
th trung tm A b kch thch. lm tng tit glucagon, adrenalin, ACTH
(Adenocorticotropic hormon), LMH (Lipid mobilising hormon) tng to glucoza.
Trung tm B: i din cho tt c cc t bo ( cn li ca c th phi c insulin mi
thu nhn c glucoza. Cc t bo ny s dng i xc th xe ton nh l mt ngun b
sung quan trng. Khi thiu. insulin, trung tm B s huy ng mi c ch ni tit lm
glucoza mu tng cao, thm vo t bo nh s chnh lch ln v nng glucoza
trong v ngoi t bo.
2.1.2. Ri lon cn ha gluxit
2.1.2.1. Ri lon glucoza mu
a) Gim glucoza mu
Tu theo tng ti gia sc (mc glucoza mu tng loi khc nhau) lng glucoza
mu phi gim di mc bnh thng tc l di mc 100-160 m v b ci phi
di mc 40-60 mg% th c biu hin ca gim glucoza mu.
Nguyn nhn:
- Gim ngun b sung t rut do thc n a vo l loi thc n km phm cht,
khu phn khng m bo lng gluxlt (i n), do cc bnh ng tiu ha m
62
thc n khng hp thu qua nim mc rut.
- Do ri lon d tr gan nh hng ti ngun b sung trc tip glycogen do cc
bnh gn nh x gan, vim gan, teo gan. thoi ha nhu m gan. Do ng glycogen
ti gan v thc n thiu men phosphorylaza lm ch glycogen khng chuyn ha ra
khi gan c. Do thiu men amylo 1-6- glucosidaza gy ng glycngen gan lm
cho gan b suy, gan to.
- Do tng mc tiu th: sau mt qu trnh tiu th glucoza huyt: co c mnh,
rung c st cao dai dng, bnh c tnh nh ung th do ri lon qu trnh phosphoryl
ha ng thn lm cho thn khng ti hp thu c ng.
- Do ri lon iu ho thn kinh v ni tit: c ch ph giao cm gim tit
glucagon, adrenalin, tng tit insulin.
Hu qu:
- Kch thch gy cm gic i do thiu glucoza-6-phosphat trong t bo.
- Kch thch giao cm gy tim p nhanh, run ry chn tay, v m hi.

- Rut tng co bp, d dy tng tit dch, mt hoa, r ri chn tay, c th b xu.
- Khi glucoza mu gim nng, cc t bo thiu nng lng, cc chc phn b ri
lon, nht l t bo no, tim... con vt c th b hn m. Trng hp gim glucoza mu
nng v t ngt, c th b co git, hn m, cht.
b) Tng glucoza mu
Do glucoza tng qu mc bnh thng.
Nguyn nhn: thng ngc vi tnh trng gim glucoza mu trn.
- Xy ra trong v sau ba n nht l khi n nhiu disaccarit v monosaccarit.
- Gim tiu th: trng hp thiu oxy (ngt, gy m). Thiu vitamin Bl: Bl l
coenzym ca nhiu enzym kh cacboxyl oxy ha axit pyruvic v axit alpha
cetoglutaric. Thiu B1 gy tr axit pyruvic.
- Hng phn thn kinh nht l h giao cm (tc gin, hi hp)
- U no, trung tm B km nhy cm vi insulin.
- Bnh ni tit: gim tit insulin, tng tit cc hormon i lp, tng hot tnh
insulinaza, c khng th chng insulin.
Hu qu: Tng glucoza mu ni chung khng c g c cho t bo nhng n lm
tng p lc thm thu gy i nhiu, mt Na v K v c bit khi lng glucoza qu
cao vt qu ngng hp thu ca thn s gy ra glucoza niu. Tng glucoza mu do
ri lon ni tit, nht l ri lon bi tit insulin ca t bo be ta o tu th ri lon
chuyn ha gluxit rt trm trng, thng gp trong bnh tiu ng.
63
2.2. Ri lon chuyn ha lipit
2.2.1. i cng
2.2.1.1. Vai tr ca lipit trong c th
- Lipit l ngun nng lng trc tip cng nh ngun nng lng d tr ln nht
ca c __________th. Tu theo loi ng vt m lng lipit d tr trong c th n khc nhau. V
d: ln lng lipit d tr rt nhiu so vi loi nhai li.
- Lipit tham gia vo cu trc t bo, tham gia vo qu trnh sinh l trong c th,
ho tan mt s vitamin (A, D, E, K).
- M cn tham gia gi nhit, nht l lp m di da.
- M cn cung cp nc cho c th. V d: khi chuyn ha 100 gam m cho ta
107 gam nc.
2.2.1.2. Qu trnh chuyn ha bnh thng ca lipit
Lipit trong c th gm c ba nhm chnh: Triglyxerit, Phospholipit v Cholesterol.
a) Hp th lipit
Lipit do thc n cung cp s c hp thu ti rut v hp thu ch yu l phn trn
ca rut non. Lipit thc n c tiu ha ngay t t trng: lipHza ca tu v rut lm
t ton b hay mt phn s dy ni este (tch axit bo thnh dng t do) hp thu
vo c th theo tnh mch ca (qua gan). Tuy nhin, phn quan trng nht lipit c
hp thu nh mui mt: c tc dng bin lipit thnh dng nh tng vi ng knh ht
0,4 micron (gi l chylomicron) c th hp thu theo ng mch bch huyt rut vo
tun hon chung (khng qua gan).
b)T chc m
Cc t bo m tp hp li thnh t chc m nm ri rc ti nhiu ch trong c th
tu theo tng loi ng vt: ln m nm di da, trong xoang bng; gia cm m
nm ch yu trong xoang bng. M ca mi loi ng vt c mt c im ring,
thnh phn ca n khc nhau, nng chy ca n cng khc nhau.

V d: M b nng chy 42 - 490C; m d, cu. nng chy 44 - 500C; m ln

nng chy 36 - 460C; m ngng nng chy 26 - 340C.
Lng m trong thnh phn t bo tng i khng thay i nhng lng m d
tr c th thay i nhiu ph thuc vo dinh dng, tnh bit, tui, ging v th cht
ca ng vt.
Trc kia ngi ta quan nim m nm trong kho d tr khng c s chuyn ha,
hin nay ngi ta nghin cu bng cch nh du vi phng x ng v v thy rng
m chuyn ha rt mnh. ngi nng 60 kg mi ngy thay i chng 1,5 kg m.
trong khi ch n vo c 60g m v 400g gluxit (400g gluxit tng ng vi 150g
64
m). Nh vy chng t 90% m thay i trong ngy l do mu a n v li tr v
mu. Loi nhai li li dng axit axetic v mt phn axit butyric tng hp m, b s
dng axit bo bay hi tng hp m sa.
c) Lipit trong mu
Lipit mu phn nh mt vn chuyn rt mnh m lipit t nhiu ngun khc nhau.
Lipit hp thu t ng tiu ha (triglyxerit), lipit iu t kho d tr ra (Free Fatty Acids =
FFA) v lipit mi sinh ra (phospholipit, cholesterol). Khi vo trong mu lipit kt hp vi
protein ca huyt tng thnh phc hp lipoprotein, ch yu l FFA i vi albumin,
phospholipit vi a-globulin, cholesterol vi -globulin v lipit trung tnh vi -globulin.
d) Chuyn ha lipit
Lipit trong mu c oxy ha ti cc c quan, t chc s dng nh c, thn, nht
l gan. Axit bo v phospholipit c ct dn thnh nhng mu 2C, ri kt hp vi
CoA thnh axetyl-CoA t , hoc i vo chu trnh Krebs, hoc hnh thnh th xe ton
ri tip tc phn gii thnh CO2 v H2O. Cho nn thiu hoc ri lon chuyn ha
gluxt s hnh thnh qu nhiu th xe ton dn n tnh trng c th nhim c axit.
e) iu ho cn bng chuyn ha m
Bnh thng lng m trong c th thay i t nu nh ta vn gi khu phn n
cng nh ch sinh hot, hot ng bnh thng th lng m khng thay i my v
c s cn bng. S cn bng ny gm hai h thng:
* H thng sinh m
H thng ny hon ton ph thuc vo insulin. Khi insulin tc ng th tng cng
tng hp m t gluxit, insulin cn c ch cc qu trnh thu phn m c bit l
triglyxerit. Lipocain cng c tc dng ging insulin.
* H thng tiu m
Hormon catecolamin tc ng ch yu l hot ha men lipaza trong t bo, lm
tng thu phn m, ng thi n c ch tng hp axit bo.
- Cortisol v hormon tyroxin c tc dng ging catecolamin.
- Tuyn yn c hormon ACTH v GH c tc dng lm gim t chc m, tng m
huyt thc..y qu trnh oxy ha m lm m di da gim.
- V t iu m.c tc dng tng m gan v cc th xe ton, gim glucoza mu v
gim trng lng c th.
- Glucag(m c tc dng tng t nh catecolamin tng hot tnh ca lipHza, gim
axit bo.
2.2.2. Ri hon chuyn ha lipit
2.2.2.1. Ri lon cn bng lipit
65
a) Bo ph

L s tch lu qu nhiu m so vi mc bnh thng trong.t -chc m, c 'th

pht sinh do mt trong ba c t bnh l sau:
- Do n qu nhiu.
- Do gim huy ng.
- Do tng tng hp m.t gluxit.
Trong chn nui do mun ca con ngi, ngi ta c th tc ng ln gia sc
gy tnh trng bo nh thin hon, gim vn ng, tng khu phn v bo.
i vi ngi. sau mt s trng thi bnh l c lin quan n no nh vim no,
chn thng vng h khu no... bnh nhn t nhin n ung rt nhiu, tng cn
nhanh, tch m khp ni trong c th nhng hot ng thn kinh, tr tu li km i.
Hu qu ca bo ph: Kh nng lao ng s gim, m bc quanh ph tng, nht l
tim, lm suy yu cc c quan, con vt d b x m mch, tiu ng.
b) Gy
M khng tch li c trong c th nguyn nhn do:
- Do thiu cng cp m ch yu l i n
- Do tng s ng nh trong st, nhim trng ko di, ung th vo giai on cui,
a chy, cc bnh k sinh trng.
- Ri lon hot ng ca thn kinh v ni tit.
+ Thn kinh lun lun cng thng b kch thch mnh gy mt cm gic lo lng,
bn chn, kh ng, tiu hao nng lng qu mc.
+ Ni tit nh bnh u nng tuyt gip (bnh Basedow hay Graves), tng cng
chuyn ha c bn nh n nhiu, ung nhiu nhng c th vn gy. Do thiu nng
tuyn yn cng gy cho con vt gy cm.
Hu qu ca gy dn ti suy kit, gim nng lng d tr, km sc chu ng, sc
khng km, kh nng lao ng gim.
c) Tng lipit mu
Khi hm lng m trung tnh trong mu tng ln qu mc bnh thng gi l tng
lipit mu.
- Tng lipit mu do n ung: Sau khi n 2 gi th lipit bt u tng, cao nht sau 45 gi, tr li bnh thng sau 7-8 gi, trong triglyxerit tng sm v cao nht, sau
l phospholipit v cui cng l cholesterol. Lipit mu tng cn ph thuc vo:
+ Loi ng vt: ng vt n c lipit mu tng chm nhng ko di.
+ Loi m trong thnh phn thc n a vo: m thc vt tng nhanh (v hp thu
66
nhanh) hn l m ng vt.
- Tng lipit mu do huy ng: M t cc kho d tr c huy ng nhiu ra mu,
hoc c tng tng hp t gluxit, vt qu kh nng tiu th ca t chc li trong
mu.
- Tng lipit mu do ri lon trao i gluxit: khi ri lon trao i gluxit (trong bnh
tiu ng), i gluxit hng phn thn kinh, u nng tuyn yn, tuyn gip, tuyt
thng thn.
- Tng lipit mu cn do gim chuyn vn hoc s dng v lipHza b c ch, vim
gai cp tnh vng da do tc mt, ng c ru, thuc m, phospho, tetraclorua cacbon.
d) M ha gan
l tnh trng t bo gan b tch ng mt lng lipit ln v ko di, nh hnl
xu ti chc nng chung ca gan.
Gan l c quan ng hng u c th trong vic tng hp v oxy ha lipit (gm

cc axit bo, glyxerit, phospholipit, cholesterol, cc lipoprotein, th xe ton...). Lipit n

vo hoc iu ng t m m hoc tn to t gluxit... u c mt t bo gan v c
a ra ngoi (n ni s dng) di dng lipo-protein hoc th xetonic. Nu mt cn
bng gia lng lipit vo t bo gan v lng lipit iu ra khi gan th m s tch li
trong t bo gan.
Nu lng m tch li gan nhng cha nh hng n chc nng ca gan gi l
thm nhim m (infiltration): tm thi, c th phc hi hon ton; cn nu m gan
lu chn p t bo gan lm cho gan mt kh nng hot ng, t bo gan thoi ha bin
thnh m gi l thoi ha m (degeneration), xu hng tin ti x gan. M ha gan
mu sc thay i: mu hi vng, phng v bng, khi dng dao ct ta thy c ht m
dnh vo dao.
C hai nguyn nhn lm m ha gan:
- Do ri lon chuyn ha gluxit, lm tng cng trao i lipit v vy m c huy
ng qu nhiu li trong gan.
- Trong c th thiu cc cht hng m methionin, chon, betain lm tr ngi tng
hp lipo-protein chuyn m ra khi gan.
Mt khc khi b ng c hoc thiu oxy ti gan th n c ch qu trnh chuyn ha
m ti gan lm m li.
e) Ri lon chuyn ha cholesterol
Trong c th c hai loi cholesterol: cholesterol t do v cholesterol este ha, t l
gia chng l 1/3. Gan l ni ch yu thc hin cc phn ng este ha ny, v vy
cholesterol este ha trong mu biu hin chc phn ca gan.
ng vt n c, cholesterol c tng hp trong c th, ng vt n tht, ngoi
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cholesterol c tng hp trong c th cn c cholesterol c trong thc n.
Cholesterol tham gia vo qu trnh hnh thnh cc steroit v axit mt.
Tng cholesterol mu c th gp:
+ Sau khi n thc n giu cholesterol nh trong trng, du gan c, gan...
+ Do km o thi, li trong c th: vng da tc mt
+ Tng huy ng: tng cng vi lipit mu gp trong bnh tiu ng, tu, hi
chng thn h.
+ Do thoi bin chm: thiu nng tuyn gip, tch ng glycogen trong t bo gan.
Hu qu: Cholesterol mu tng cao v ko di s xm nhp vo cc t bo lm ri
lon chc phn ca cc t bo cc c quan gy bnh u vng, x gan v nng nht l x
va ng mch
Gim cholesterol mu thng gp trong trng hp cholesterol b o thi qu
nhiu, gim hp thu (trong bnh l amip giai on u, bnh vim rut gi, thiu mu,
bnh basedow...)
2.3. Ri lon chuyn ha thot
2.3.1. i cng
2.3.1.1. Vai tr ca thot trong c th
Protit l cht to hnh khng th thay th ca c th. Qu trnh sng l s thoi ha
v tn to thng xuyn ca thot. Protit c mt trong mi thnh phn ca tt c cc t
bo, cc m, cc c quan, cc dch th ca c th. Do vy, thot c vai tr ht sc quan
trng trong cc hot ng sinh l cng nh trong cc qu trnh bnh l. C th ni mi
protein trong c th thc hin mt chc nng nht nh: cu trc, iu ho, xc tc,
vn chuyn...

- Chc nng cu trc: Protit l cht to nn nhn, nguyn sinh cht v mng t
bo, xy dng cc m, cc c quan, gip c th vn ng v chng c hc. Co c
c thc hin bi s chuyn ng ca hai si thot: actm v miosm. Da, c, xng,
gn, dy chng c cu to bi nhiu loi thot si nh: collagen, eslatin, keratin
gip c th chng cc tc nhn c hc.
- Chc nng iu ho, cn bng ni mi: tt c cc phn ng ha hc cng nh
cc qu trnh sinh hc: ng mu, chy mu, hot ng ca h thng b th, h thng
khn...xy ra trong c th u c hot ha v iu ho bi cc thot c bit gi l
enzym. Cc hormon tham gia vo tnh phn ng ca c th, iu chnh chc nng ca
nhiu c quan cng l thot. Protit tham gia kim sot thng tin di truyn, gip cho cc
t bo trng thnh v bit ha.
- Chc nng vn chuyn cc cht: Hemoglobin vn chuyn O2, CO2; lipo-protein
vn chuyn lipit; albumin vn chuyn bilirubin, axit bo; transferin vn chuyn st;
68
seruloplasmin vn chuyn Cu...
- Chc nng bo v: khng th cng l protein chng cc khng nguyn gy bnh.
- Protit cng c vai tr l ngun nng lng cho c th khi khng lipit v
gluxit.
Tt c cc loi thot u c to nn do s kt hp khc nhau ca 22 axit qun
c bn. c im ca thot mang tnh cht c trng ca tng loi, tng ging, thm
ch tng loi c th m biu hin r trong phn ng min dch.
2.3.1.2. ng i ca thot trong c th
Protit trong ng tiu ha c cc men phn gii thnh cc axit qun t c
hp thu vo mu. Trong c th phn ln axit quan c s dng ti gan v tu
xng, ngoi ra thot ca bn thn cng t phn hu i cho ra cc axit quan s
dng.
Trao i thot c biu hin bng cn bng nh, khi lng thot n vo c th
bng lng thot m c th thi ra ngoi gi l cn bng u v thot. Nu lng thot
ly vo t thc n nhiu hn lng thot thi ra ngoi gi l cn bng dng v nh (
gia sc non, hoc con vt ang c cha, ng vt sau mt qu trnh m khi ang phc
hi sc kho). Cn bng m th hin khi lng thot thi ra ngoi nhiu hn lng
thot n vo c th ( ngi m khng n c, bnh ng rut).
Vy mun duy tr cn bng no cn c mt mc thot ti thiu nht nh, mc
thot ti thiu ny khc nhau tu loi gia sc: cu, ln l 1 gam; nga 0,7 - 0,8 gam;
b 0,6 thot trn mt kilogam th trng trong mt ngy m.
2.3.1.3. S iu ho ca thn kinh v ni tit
Tc dng iu ho chuyn ha thot lin quan cht ch vi chuyn ha gluxit v
lipit.
- Insulin c tc dng c ch hnh thnh gluxit t thot nn hormon ny c tc dng
gim phn hu thot.
- Hormon tuyn gip gy tng chuyn ha t chc ngoi vi, tng nhu cu v nng
lng, cho nn nu tng gluxit trong thc n th gim phn hu thot, nu nh trong
khu phn thc n thiu gluxit th s phn hu thot c tng cng.
Hormon thng thn tng phn hy thot v to glycogen ti gan v tt nhin
ACTH c tc dng tng t.
- STH tng tng hp thot, gim axit quan v m trong mu, gim thi nh lm
cho cn bng cht ny dng tnh. Do c th tch lu nhiu thot m pht trin nhanh

chng.
- Androgen tng tng hp thot nht l c (do gim thi creatinin).
69
2.3.2. Ri lon chuyn ha thot
Cc sn phm chuyn ha ca thot thng c vo mu, cho nn thot huyt
tng phn nh kh trung thc thot ca ton c th. Ri lon chuyn ha thot bao
gm ri lon tng hp s lng, cc thnh phn thot v ri lon tng hp v cht.
2.3.2.1. Ri lon tng hp s lng thot
a) Tng tng hp chung
Biu hin tng s ng ha axit qun mnh hn qu trnh d ha, cn bng nh
dng tnh, c th pht trin. Gp trong thi k trng thnh, ang tp luyn, thi k
bnh phc bnh. Trong qu trnh bnh l: gp khi cng tuyn yn.
b) Tng tng hp ti ch
Gp trong ph i c quan, trong sinh l gp ngi tp th hnh, tp t; trong
bnh l: ung th, ph i tim do suy tim. Ph i tim c hai loi:
- Ph i tim sinh l: tim pht trin cn i vi pht trin c th.
- Ph i tim bnh l: do thiu oxy mt cn i.
V vy ph i c quan trong cc b cng c th cn bng ng trong c th m
tnh.
70
c) Gim tng hp chung
Gp khi c th b i lu ngy, suy dinh dng, hoc gp trong cc bnh ng
tiu ha mn tnh hoc bnh tiu ng, trng hp bng, l d c m. Trong sinh l:
tui gi cn bng nh m tnh.
d) Gim tng hp cc b
C quan khng pht trin: teo c, suy tu, tc mch, hoi t c quan...
2.3.2.2. Ri lon thot huyt tng
Protit huyt tng c ngun gc ch yu t gan (95% albumin, 85% globulin), sau
l h ni mc vng m ngoi gan (globulin) v t mt s t chc khc (men,
hormon, kch t...). Cho nn thnh phn thot huyt tng rt phc tp (khong 30
thnh phn khc nhau).
a) Vai tr ca thot huyt tng:
- Cung cp axit quan cho c th: thot huyt tng cng b ging ha trong ng
tiu ha, cc axit quan tr v mu c th ti s dng. V vy, lng thot huyt
tng biu th cho lng thot ton c th.
- To p lc keo, c tc dng gi nc, do tham gia vo chuyn ha nc v
in giai.
- Tham gia vn chuyn cc ni tit t, sn phm v nguyn liu chuyn ha, mt
s yu t vi lng nh Fe, Cu...
- Bo v c th chng nhim khun, nhim c.
Huyt tng cn cha mt s thot c vai tr c bit: l mt s men tham gia
chuyn ha cc cht, cc yu t ng mu, cc b th...
b) Gim lng thot huyt tng
Gim lng thot huyt tng phn nh tnh trng gim thot chung ca c th.
- Nguyn nhn:
+ Do cung cp thc n khng , b i lu ngy
+ Do gim tng hp chung trong cc bnh nh x gan, suy gan.

+ Do tng s dng gp trong mt s trng hp nh hn gn vt thng, ung th,

ri lon chuyn ha gluxit (tiu ng).
+ Do mt thot ra ngoi gp trong trng hp bng, hi chng thn h, cc l d,
m...
- Biu hin v hu qu:
V lm sng thy st cn, c teo nh, gim trng lc, thiu mu, vt thng lu
lnh, c th b ph. Khi xt nghim thy thot huyt tng gim, trong t l v s
71
lng albumin gim phn nh trung thnh mc thiu protein ton thn.
Gim thot huyt tng ko di s dn n suy dinh dng, ci xng, d b
nhim khun, sc khng gim, nng sut lao ng gim st.
c) Tng lng lt,t huyt tng
Trng hp ny t gp, thng do tng phn ng sau khi mt mu, c th b mt
nc, a chy, mu b c c.
d) Thay i thnh phn thot huyt tng
- Albumin: m bo 80% p lc keo ca mu, gim trong tt c nhng trng hp
gim thot huyt tng nh gim tng hp o cung cp khng (i), do tn thng
c quan (bnh gan lan trn ko di) hay tng tiu th albumin nh mt ra ngoi trong
bnh thn.
- -globulin: tng trong cc trng hp vim cp, vim mn, hoi t t chc (nhi
mu), ri lon chuyn ha (hi chng thn h, thn nhim bt). -globulin tng lm
nht ca mu tng, tc lng mu tng.
- -globulin c vai tr quan trng trong vn chuyn lipit. Do , cc trng hp
tng lipit mu nh tiu ng, tc mt, hi chng thn h, x cng mch u c tng
- globulin.
- -globulin l khng th, do vy tng trong mu khi nhim khun, qu mn cm,
u tng bo... u tng -globulin.
2.3.2.3. Ri lon chuyn ha trang gian thot
Ri lon chuyn ha trung gian thot th hin tc phn hu thot cho axit
qun b chm li, xy ra c th c trng thi bnh l nh t chc thiu oxy, vim lan
trn mn tnh km theo hoi t t chc v.v...
Cc dng petit phc tp b li trong t chc vo mu kch thch cc c quan
nhn cm mch qun gy ri lon tun hon, tng tnh thm mao mch, h huyt p
v nhiu hin tng c tnh cht d ng khc.
a) Ri lon kh amin
Bnh thng cc phn ng kh quan cho cc xeto-axit
R-CH-COOH + 1/2 O2 R-CO-COOH + NH3
NH2 xto-axit
Phn ng ny b c ch khi thiu men apo-enzim lm cho men kh quan oxydaza
b phn hu hoc khng hot ng dn n phn ng trn khng thc hin c dn
ti ng quan, lm cho quan tng ln trong mu dn n quan niu (thng bnh
gan, thiu vitamin C).
b) Ri lon chuyn ha amin
72
Qu trnh chuyn ha quan xy ra di s xc tc ca men transaminaza, men ny
hot ng c nh c vitamin B6, v vy khi thiu vitamin B6 tc chuyn ha
gim.

c) Ri lon kh cacboxyl
Cc axit quan trong c th sinh vt c kh cacboxyl cho cc quan tng ng.
V d:
Cc quan rt c, bnh thng di nh hng ca men aminooxydaza c gii
c gan, rut v cc t chc khc hoc kt hp vi thot ca t chc chuyn
thnh trng thi khng hot ng, khi ri lon qu trnh trn thng gy nhim c
quan (khi tng cng kh cacboxyl).
Cc t chc da, c, phi thiu mu, hoc b tn thng sn sinh rt nhiu
histamin, x thn thi k cui c th b nhim c tyramin.
d) Ri lon chuyn ha NH3
Bnh thng NH3 c thi qua ng nc tiu v phn ln c gan chuyn
ha thnh m, nu gan b bnh th amoniac tng ln trong mu gy hin tng nhim
c, c bit l nhim c thn kinh.
2.3.2.4. S thay i ca m phi thot
gia sc hm lng m phi thot khng cao lm, trung bnh vo khong 10-60
m trong bao gm m, axit c v m cn.
m phi thot tng ln trong mt s trng thi khc nhau nh teo gan, st, nn
nng, a chy nng, bng nng. c bit cc bnh thn nh vim trn, qu trnh siu
lc ca thn gim nn m phi thot tng trong mu. Bnh thng ch chim khong
20- 60% nhng cng c th tng ln ti 100-600% gy hin tng ng c.
2.3.2.5. Ri lon trao i thot nhn
Protit nhn l hp cht cc axit nucleic vi thot. Khi phn hu th thot c qu
trnh chuyn ha nh trn. Cn axit nucleic th to thnh phn v pirimidin v cui
cng to thnh cc axit c theo nc tiu thi ra ngoi.
73
Ri lon thi axit c gp trong bnh Gt (Gom), thng gp hin tng lng
ng cc tinh th, mui mt nam cc t chc sn, bao khp, gn ch, g. Khi c s
lng ng cc mui ca axit trc gy hin tng vim cp tnh lm bin dng khp,
kch thch au lm ri lon chc nng ca khp. Cng c khi gp axit c lng ng
trn tng mc cc c quan ni tng hnh thnh mt lp ct trng trn mng tng
mc. Hin tng tng axit c trong mu ch gp khi n qu nhiu axit nhn hoc kh
nng bi tit ca thn km, cng c trng hp lng ng axit c khi nng ca n
bnh thng.
Ngoi ra ngi ta cho rng cc t chc sn, bao khp c tnh cht l ha hc c
bit, dch t chc vn chuyn trong cc t chc ny rt chm nn axit c d lng
ng.
2.4. Ri lon chuyn ha nc v in gii
2.4.1. i cng
2.4.1.1. Vai tr ca nc v in gii
Nc v cc cht in gii l thnh phn khng th thiu c mi t bo, sinh
vt. Trong c th, mi phn ng sinh ha, mi hot ng din ra u khng th thiu
nc v mui. Chuyn ha ca chng, nc v cc cht in gii lin quan cht ch
vi nhau. Khi ri lon chuyn ha nc th chuyn ha mui cng ri lon v ngc
li.
Nc: chim t 60-80% trng lng c th v l dung mi cho tt c cc cht.
Khng c phn ng sinh ha hc no xy ra trong c th m khng c nc. Vai
tr ca nc l:

- Duy tr khi lng tun hon, qua gp phn duy tr huyt p.

- Lm dung mi cho mi cht dinh dng, chuyn ha v o thi, vn chuyn cc
cht trong c th ng thi trao i chng vi ngoi mi.
- Lm mi trng cho mi phn ng ha hc, ng thi trc tip tham gia tht s
phn ng (thu phn, oxy ha, s ngm nc ca protein v keo...).
- Gim ma st gia cc mng.
- Tham gia iu ho nhit.
Cc cht in gii: bao gm cc chun: Na+, Ca++, K+, Mg++, Fe++... v anion: Cl-,
HCO3-' HPO4 ""tham gia vo nhiu hot ng ca c th, v d: Ca++ i vi dn
truyn thn kinh; K+, Mg++, Na+ trong chuyn ha nng lng; Fe++ trong vn chuyn
oxy; Cl' i vi toan d dy... Tuy nhin vai tr quan trng ca cc cht in gii
l:
- Quyt nh ch yu p lc thm thu ca c th m vai tr quan trng nht l
Na+, K+, Cl-, HCO3-
74
- Tham gia cc h thng m ca c th, quyt nh s iu ho pa ni mi.
Bi vy, mt in gii hay ng u gy nhng ri lon bnh l.
2.4.1.2. S phn b nc v cc cht in gii trong c th
ba khu vc: trong lng mch, gian bo v t bo
Bng 3. S phn b nc v cc cht in gii
Cc cht Lng mch Gian bo T bo
Nc (tnh = % khi lng) 5 15 50
Cation Na+
K+
Ca++
Mg++
Anion ClHCO3
-

PO4
---

SO4
--

147 mEq
4531 09 mEq
28 21140 mEq
3.8 45114 mEq
29 2-

110 mEq
1.50 228 15 mEq
10 140 10 Axit hu c 3 mEq 3,2 mEq 40 mEq
Protien 16 mEq 10 mEq 65 mEq
Ghi ch: mEp : milli equivalent (Mui ng lng) l mt n v dng o nng cc
cht in gii. N ch ra hot ng ha hc hoc kh nng kt hp ca 1 nguyn t ha hc c
lin quan n hot ng ca 1 m Hydro. V vy, 1 mEq tng ng vi 1 mg Hydro (1 mole)
hoc 23 mg Na+, 39 mg K+.
S khc bit gia ba khu vc l do mt s yu t quyt nh sau:
- Do p lc keo (protein trong lng mch cao hn ngoi gian bo) v p lc
thm thu (nng Na+ trong t bo thp hn ngoi t bo, cn ton K+ trong t bo
cao hn ngoi t bo; Cl-, HCO3
- nm ngoi t bo cao hn; PO4
--, trong t bo cao
hn ngoi t bo). Ngoi ra cn ph thuc vo:
- Cu trc mng t bo: hot ng ca mng duy tr s chnh lch gia cc chun
Na+ v K+ v anion Cl-, PO4
---, ngi ta cho rng con Na+ c tc dng nh mt ci bm
"bm Na" v xu hng ca n l y ton Na+ ra ngoi t bo, ko ton K+ vo trong t
bo. Nng lng cn thit cho hot ng l ATP cung cp. Cc con ny c tc dng
75
vn chuyn c nc qua mng t bo do s chnh lch ca p sut thm thu: bn
no c p lc thm thu cao nc v bn . V d: khi n nhiu mui, p lc thm
thu bn ngoi tng, nc bn trong t bo b rt ra lm t bo mt nc, sinh ra kht.
Hot ng ca mng t bo nh mt mng khng thm, khi mng b ng c hoc
l t bo b tn thng th s chnh lch trn gim hoc mt i gy tnh trng bnh l.
- Thnh mch: l mng ngn cch cho php mi phn t nh i qua tr phn t
ln nh protein, v vy cc cht in gii khng chnh lch nhau nhiu. S vn chuyn
nc gia trong v ngoi lng mch l do s cn bng gia lc thu tnh (c xu hng
y nc ra ngoi) v lc keo (do albumin m nhim, ht nc ngoi vo). Ngoi
ra nc cn theo ng mch bch huyt vo tnh mch ch. Vai tr ca thnh
mch c coi nh mng bn thm, khi tng tnh thm th cn bng trn b ph v (gp
trong vim).
- Da v nim mc: l mng ngn cch gia ngoi mi v c th. S trao i
nc v cc cht in gii di hnh thc n ung vo v bi tit ra ngoi. Nhu cu
nc tu theo loi ng vt, la tui v iu kin ngoi cnh tc ng.
2.4.1.3. S iu ho chuyn ha nc v in gii
Nc v cc cht in gii duy tr s hng nh ni mi theo hai mt: th tch dch
th v ng trng (do tng lng in gii quyt nh).
Theo c ch ca thn kinh v ni tit.

a) iu ho ca thn kinh
- Cm gic kht: Thn kinh c tc dng iu ho thng qua cm gic kht nhp
nc vo c th. Cm gic kht xut hin khi: mt mu, ra mi hi, khi n qu mn, a
chy, dn n lm tng p lc thm thu ngoi gian bo. Nc t trong t bo rt ra
ngoi, kch thch vo c quan cm th ti t bo v truyn xung ng ln kch thch
vo trung khu kht nhn bng gia nm vng di i, buc con vt phi tm nc
ung. Nc ung vo s lm cho p lc thm thu tr v ng trng, con vt s mt
cm gic kht
Ngi ta lm th nghim: kch thch vo trung khu n ung ca con vt th lm con
vt ung nc mi cho ti khi ng c v nc, ngc li ngi ta ct b trung khu
ny i khi tim cho con vt mt lng mui cao th con vt vn khng ung nc.
Thn kinh cn c c quan cm th:
+ i vi p lc thm thu xoang ng mch cnh v nhn trn th, trong
trng hp ny lng nc i vo t gy tng tit ADH l hormon chng li niu tng
hp thu nc.
+ i vi khi lng nc cc tnh mch ln, vch nh phi v thn c t bo
cn cu thn. Khi huyt p h t bo cn cu thn tit ra mt cht re nin vo mu kch
76
thch h thng: angiotensin 1 lm tng tit aldosteron v angiotensin 2 dn n tng
huyt p do c ch vic thi nc ra ngoi v co mch.
b) iu ho ca ni tit
Rt nhiu ni tit t tham gia vo qu trnh chuyn ha nc v cc cht in gii
nh hormon sinh dc ci (gi nc), hom lon tuyn gip khi thiu nng th gi nc.
Nhng tc dng mnh m nht l hormon aldosteron ca tuyn thng thn v hormon
ADH ca thu sau tuyn yn.
- ADH c tit ra t thu sau tuyn yn gy ti hp thu nc ng thn xa v
ng gp (hom lon chng li niu). ADH c vai tr rt ln iu tit lng nc trong
c th khi tha cng nh khi thiu. Tc nhn kch thch tit ADH l tnh trng tng p
lc thm thu ca mu v gian bo vi b phn cm th ri rc nhiu ni trong c th:
vng di i, gan, phi, xoang ng mch cnh, vch ng mch ch, vch tm nh
phi... chng rt nhy, c th cm th c s tng gim 1% p lc thm thu, bo
v tuyn yn tit ra hay ngng tit ADH.
- Aldosteron l hormon c tc dng iu ho bi tit Na+ mnh nht ca v thng
thn. C tc dng gim tit Na+ nc bt, m hi v ch yu ng thn xa, ng
thi phn no lm tng tit K+. Aldosteron c vai tr quyt nh trong iu ho lng
nghi v khu trong c th thng qua iu ho p lc thm thu. Aldosteron c th do
cc yu t sau y kch thch:
+ Gim khi lng nc ngoi t bo
+ Gim natri khu vc ngoi bo, kch thch tuyn tng sn xut hormon tc
dng ln v thng thn.
+ Tng tit h re nin - angiotensin
Ngoi ra aldosteron cn c vai tr trong s duy tr khi lng nc v huyt p.
2.4.2. Ri lon chuyn ha nc v in gii
2.4.2.1. Ri lon cn bng nc
a) Mt nc trong c th
77
Mt nc xy ra khi mt cn bng gia lng nc nhp v xut hoc do cung

cp khng hoc do mt ra ngoi qu nhiu. Mt nc m trng lng c th gim

5% th cc du hiu ri lon bt u xut hin, khi mt 20-25% lng nc th rt
nguy him v cc ri lon huyt ng v chuyn ha u rt nng v hnh thnh
vng bnh l vng chc. Triu chng chung ca mt nc l trng mt, da kh, li
kh, gim tit niu, ri lon tun hon v ri lon chuyn ha.
Mt s trng hp mt nc:
- Mt nc do ra m hi
- Mt nc trong st: Khi st, thn nhit tng, qu trnh chuyn ha cc cht,
chuyn ha nng lng tng, hot ng ca cc c quan tng dn n nhu cu oxy
tng, lng CO2 o thi tng. Do vy con vt phi th tng. Nhit tng lm bo
ho hi nc trong hi th cng tng. Khi st lng nc mt theo hi th c th gp
mi ln bnh thng. Cui cn st con vt v mi hi nhiu. Nh vy trong st, mt
nc ch yu theo ng h hp v sau l m hi.
- Mt nc do nn: thng km theo mt HCl gy nhim c kim.
- Mt nc do thn: gp trong i nht, vic b khi lng nc v in gii
tng i d dng, t gy ri lon chuyn ha, in gii v thng bng axit-baz.
- Mt nc do a chy
+ Mt nc qua ng tiu ha do bn thn c th khng hp thu c v do tit
dch qu nhiu: a chy mt nc cn km theo mt kim dn n nhim c axit. Khi
lng nc trong c th mt i mu c c dn n huyt p h lm ri lon tun hon
nghim trng, con vt c th cht do tru tim mch.
+ Do thiu mu v thn lm cho thn lc km, thm ch khng lc dn n thiu
niu, v niu, lm tr cc cht c gy nhim c.
+ Mt cc cht in gii qua ng tiu ha dn n ri lon trao i cc cht
in gii, nhc trng gy c t bo.
b) Ph, thng
Ph l tnh trng tch nc qu mc bnh thng trong gian bo, cn thng l khi
c nc tch trong cc h t nhin (mng phi, mng tim, h bng...).
C ch ph:
- Tng p lc thu tnh lm cho nc b y ra khi lng mch nhiu hn lng
nc tr v do p lc thm thu keo ca protein. C ch ny c vai tr quan trng
trong: ph do suy tim phi (ph ton thn, vng thp), suy tim tri (ph phi), chn p
tnh mch (vim tc, co tht), bng nc (cn tr h tnh mch ca, x gan), ph y
mt (trong cao huyt p).
- Gim p lc thm thu keo huyt tng: p lc thm thu keo do protein chi
78
phi, trong ring vai tr ca albumin l 80%. Khi p lc ny gim, nc trong
mch b p lc thu tnh y ra nhiu gy ph. C ch ny gp trong mi loi ph c
gim protein huyt tng nh ph do suy dinh dng, suy gan, x gan, thn nhim m
(o thi nhiu protein), suy kit (ng th, bng...).
- Tng tnh thm mch (vi protein): protein thot qua vch mch ra ngoi gian
bo, lm p lc thm thu keo hai bn trit tiu ln nhau, do p lc thu tinh t do
y nc ra. C ch ny tham gia trong cc loi ph: do d ng (xut hin cc cht gy
tng tnh thm thnh mch), do cn trng t, trong vim, trong ph phi, trong cc
trng hp thiu oxy hoc ng c...
- Tng p lc thm thu: gy u trng, do gi nc. C quan o thi mui
ch yu l thn, vi s iu. ho ca aldosteron bi vy ph loi ny hay gp trong:

vim thn, suy thn mn v cp.

- Tc mch bch huyt: lng nc ra khi mao mch tr v bng ng bch
huyt khng ng k, v vy nu tc gy ph th c c im sau: ph chm chp, t
chc x kp pht trin nu ph ko di, gp trong: vim bch mch ko di, tc ng
bch huyt, bnh giun ch... gy ph a phng.
Ph c hai loi: ph ton thn v ph cc b. Ph ton thn tng lng nc trong
c th tng ln, cn ph cc b l do s phn b nc khng u nhng tng lng
nc khng tng.
- Ph ton thn chia lm ba loi:
+ Ph do thn: vim thn cp do tng nng p lc thm thu, gim p lc keo
v do h thn nhim m, ch yu do gim p lc keo.
+ Ph do gan: ch yu do gim p lc keo theo hai c ch
Gan tn thng khng tng hp c protein vo huyt thanh
X gan c chng: protein trong lng mch thot vo dch bng.
+ Ph do tim: do p lc thu tnh tng trong cc tnh mch ch l ch yu, do
tr tun hon c bit l tim phi.
- Ph cc b: Do nhng c ch cc b gy ra: di ng, vim, cn trng t (lm
tng tnh thm cc b), chn voi, vim mch bch huyt (do tc cc mch bch huyt
cc b), ph phi, ph chi di (do tng p lc thu tnh cc b).
2.4.2.2. Ri lon cn bng in gii
a) Ri lon cn bng natri
Natri l con ch yu ca khu vc ngoi t bo (140 mEq/l, gp 7 ln ni bo), n
lin quan cht ch vi Cl-, HCO3
-, vai tr ca n l cn bng p sut thm thu v tham
gia vo qu trnh cn bng axit-baz. Chuyn ha ca natri chu s iu ho ca
hormon thng thn.
79
- Gim natri huyt tng: thng mt natri qua ng tiu ha, nc tiu v m
hi, cn ch n thiu natri thng khng gy nn ri lon, bi v thn c kh
nng ti hp thu b cho ch thiu. Nguyn nhn tiu ha do nn, l d, ht dch trong
tc rut, nht l a chy. Trong bnh thn, thn thoi ha knh (cc cht nhim sc th
t bo thoi ha thnh cht trong sut nh knh, ch yu do ri lon protein m ra), c
bit khi c kt hp vi nhim c axit th c gim natri huyt do thn khng ti hp
thu c natri.
Hu qu: gy nhc trng dch gian bo lm cho nc i vc trong t bo, gim
d tr kim, gim khi lng mu, gim huyt p c th dn n tru tim mch, lm
thiu niu, gy suy thn v lm tng m huyt gi. C th ph no, v hng cu, K+ c
th b ko ra khi t bo, nh hng n co bp c, bi hoi, tim yu...
- Tng natri huyt tng: thng t xy ra, ch thy mt s bnh ni tit, v d:
u nng tuyn thng thn hoc tim nhiu ACTH hoc cortizol, n nhiu mui Nht.
Hu qu: gi nc, ph, tng huyt p m c ch cho l do phng ni mc lm
hp lng mch v tng hot tnh catecholamin. Cn c th gy mt nc t bo.
b) Ri lon cn bng kali
ton kali l con ch yu trong khu vc t bo, n cng tham gia vo trng lc ca
c cc phn x v gn.
- Gim kali huyt tng: tc l nng ln K+ trong mu gim di mc bnh
thng km theo triu chng thn kinh nh mi c, mt phn x gn, lit chi, tc rut.

c bit l triu chng tim mch, gim huyt p, tim p nhanh.

Nguyn nhn gim kali do a chy, dng thuc ty nhiu, dng thuc li tiu qu
mc. Trong mt s bnh lm cho khu chuyn t mu vo trong t bo qu nhiu, lm
gim kali huyt (khi tim insulin chng bnh tiu ng lm cho protein vo trong t
bo nhanh ko theo khu vo trong t bo).
- Tng kali huyt tng: l tnh trng rt nguy him c khi lin quan ti tnh mng
v c nguy c ngng tim, triu chng ch yu l mt mi, lit nho c; nhng quan
trng nht l triu chng tim: tim p chm, ting kh, rung tm tht, tru mch v dn
ti ngng p.
Nguyn nhn tng kali huyt
+ Do sc v mt nc nhiu.
+ Do tng c trong v ngoi t bo trong trng hp cc t bo b phn hu (trong
trng hp nhim trng, nhim c, nhim toan nng). Ngoi ra thiu nng thng
thn, dng thuc li tiu chng aldosteron.
2.5. Ri lon cn bng axit- baz
2.5.1. ngha ca cn bng axit-baz
80
Cn bng axit-baz hng nh 7,4 + 0,05. Cc qu trnh chuyn ha trong c th
lun to ra cc axit c nh: anhydrit cacbonic, axit pyruvic, axit lactic... v vy trong
c th phi c mt qu trnh kim ha v nh hot ng ca ba h thng trung ho l
h thng m, phi v thn.
2.5.2. H thng iu ho cn bng axit-baz
2.5.2.1. Cc h thng m
- Mt h thng m trong huyt tng hoc t bo gm c hai cu phn, l:
- Mt axit yu: v d: H2CO3, NaH2PO4 Ngoi ra protein trong mi trng cng
th hin tnh axit yu ca n (k hiu H-proteinat), cng nh vy l hemoglobin v
oxyhemoglobin (k hiu H-Hb v H-HbO2)
- Mui ca axit trn vi mt kim mnh, v d Na+, K+, Ca+, Mg+, NH4. Trong thc
t, huyt tng th Na+ c nng cao nht, v vy n tham gia ch yu vo cc h
thng m, cn trong t bo l K+. Cc chun khc ch c mt vai tr khng ng k.
H thng m trong huyt tng:
Hot ng ca h m:
- Axit (t s) ca h m tham gia trung ho cc cht kim nu chng xut hin
trong c th, cn mui baz (mu s) tham gia trung ho cc axit nu chng xut hin.
V d: h m H2CO3/NaHCO3 ca huyt tng hot ng nh sau: khi t bo o
thi ra axit lactic, mui baz ca h thng m s tham gia phn ng trung ho lm
cho axit lactic bin thnh mui lactat (trung tnh) v xut hin axit ca h thng m,
tc axit cacbonic (yu).
Nh vy, sau phn ng m, mt axit mnh (lactic) b trung ho i, thay vo l
mt axit yu hn (cacbonic), nh pH ca huyt tng ch gim t. Cng tng t,
nu mt cht kim xut hin trong mu, n s b axit (H2CO3). Ca h thng m trung
ho, ng thi thay vo l mt mui kim yu (NaHCO3), khin pH t b tng.
Tnh cht ca h thng m:
- Khi h thng m c lng axit (t s) bng lng mui kim (mu s) th hiu
81
sut m ca n cao nht (t l 1/1).
- T l gia axit v mui kim ca mt h thng m quyt nh pH m n duy tr.

 duy tr pH ca huyt tng lun lun bng 7,4 th trong h thng m mui kim
phi nhiu hn axit. Do , huyt tng, h m H2CO3/NaHCO3 Phi c t s 1/20;
cn h m phosphat NaH2PO4/Na2HPO4 phi c t s 1/4. Nh vy cc h thng m
ni chung c hiu sut khng ln.
- Lng tuyt i ca axit v mui kim trong h thng m ni ln dung lng
m ca h thng .
- D tr kim ca mu l tng s mui kim ca cc h thng m trong mu, ni
ln kh nng (dung lng) trung ho axit ca chng.
- H bicacbonat H2CO3/ NaHCO3 c hiu sut thp nhng b li n c dung lng
ln nht trong huyt tng (v HCO3- huyt tng ti 28 mEq, ch thua Cl- = 109
mEq). u im c bit ca h ny l axit H2CO3 c th phn ly to ra CO2, o
thi phi. Nh vy, sau mi phn ng m, n nhanh chng lp li c t l 1/20
va b ph v. Dung lng ln nn mu s NaHCO3 ca n trn thc t c xem nh
d tr kim ca mu.
- H phosphat NaH2PO4/Na2HPO4 c hiu sut kh hn nhng dung lng
huyt tng khng cao (2 mEq) nn t quan trng. Trong t bo th n l mt h m
chnh v dung lng ln (140 mEq), nht l t bo ng thn.
H proteinat: mi trng axit, protein th hin tnh kim v ngc li. V vy
chng c vai tr m nhng yu, b li chng c s lng kh trong huyt tng
(16mEp) v nht l trong t bo (65 mEq), nn n cng c vai tr m ng k.
- H H-Hb/K-Hb v H-HbO2/K-HbO2 ca hng cu c dung lng rt ln nn c
vai tr quan trng nht trong o thi axit cacbonic.
2.5.2.2. iu ho ca h hp
Cc axit yu (H2CO3) do qu trnh m hnh thnh, cng nh kh CO2 do qu trnh
chuyn ha to ra c thi qua ng h hp nh hot ng ca h thng m H
trong hng cu phi hp vi natri hydrocacbonat.
Ti phi: pH cc m c xu hng h thp v cc sn phm o thi t t bo. S
c mt ca hng cu to ra s kim ha rt mnh: KHbO2 (kim mnh) s phn ly (do
pH thp) to ra KHb v O2 (vo t bo). Cng lc CO2 ca huyt tng (do t bo
thi ra hoc to ra t phn ng m) s vo hng cu to ra H2CO3, kt hp vi KHb
to HHb (axit yu) v KHCO3, KHCO3 Phn ly cho HCO3
- ra dch k m (v huyt
tng) kt hp vi Na+ to thnh mui kim NaHCO3, ng thi n nhn Cl- vo
hng cu (to ra KCl). Nh mt Cl- v to thm NaHCO3 nn lm tng pH dch k
m.
Ti phi: S o thi mnh m CO2 lm pH y c xu hng tng ln nhng
82
c iu chnh bng cc phn ng ngc li:
- Oxy t huyt tng vo hng cu, to ra axit mnh HHbO2, cht ny y H2CO3
ra khi mui ca n (KHCO3) v phn ly thnh CO2 thi ra phi.
- Cl ra khi hng cu lm toan ha huyt tng.
Trung tm h hp rt nhy cm vi CO2:
Khi c th tch nhiu CO2 s lm pH gim, ch cn pH gim ti 7,33 l trung tm
h hp b kch thch mnh, tng thng kh, nh vy CO2 c o thi cho ti khi t l
H2CO3/ NaHCO3 tr v tr gi 1/20. Ngc li, khi H2CO3 gim hoc NaHCO3 tng,
pH s c xu hng tng (kim ho) th trung tm h hp b c ch, th chm. CO2 tch
li cho n khi t s nng ln n 1/20. iu ng lu , m bo o thi CO2 tt

th hot ng ca trung tm h hp, chc nng h tun hon, h hp, s lng v cht
lng Hb cng phi tt.
2.5.2.3. iu ho ca thn
iu ho h hp ch o thi c kh CO2, song c th vn mt gc kim natri
ca bicacbonat nu khng c hot ng ca thn nhm gi li mui ny khi cn thit.
83
y natri c thay bng H+, K+ hay NH4
+ nh hot ng ca t bo ng thn.
- i Na2HPO4 thnh NaH2PO4 nh vy gi c mt ion Na+
- Sn xut ra ion mun (NH4
+) thay vo mt gc natri.
2.5.3. Ri lon cn bng ax-baz
Khi c ri lon cn bng gia hai qu trnh axit ha v kim ha c th s b
nhim c axit hoc nhim c kim.
2.5.3.1. Nhim c axit
Nhim axit l tnh trng cc axit thm nhp vo huyt tng hoc tnh trng huyt
tng b mt cc mui kim lm cho pH c xu hng gim xung.
Xy ra khi qu trnh axit ha mnh hn qu trnh kim ha. Khi pH cha gim
(7,4) song lng kim d tr gim i gi l nhim axit cn b, cn nhim axit khi
84
pH gim di 7,4 v lng kim d tr gim khng cn trung ho gi l nhim axit
mt b.
Nguyn nhn:
- C th sn xut ra nhiu axit c nh do tng cng hot ng, cc qu trnh
chuyn ha mnh hn kh nng m ca phi v thn.
- Do n ung nhiu cht axit.
- tr axit c nh do ri lon c ch iu ho.
- tr CO2 lm tng axit cacbonic trong mu.
- Mt qu trnh kim.
Biu hin: thng kh tng tng thi kh CO2 ra, cn thn tng cng gi
bicacbonat bng tng thi ton H+, cho nn nc tiu axit do c nhiu phosphat axit v
NH3.
a) Nhim c axit hi
L do tr kh CO2 trong c th lm thay i t s H2CO3/NaHCO3 v pha t s.
Nhim axit hi sinh l nh: trong gic ng, trung tm h hp km nhy cm vi
CO2 khin cht ny tch li v hi tng trong mu; hoc trong lao ng nng CO2 to
ra vt qu kh nng o thi. Ni chung s tch ng cha n mc gim pH.
Nhim axit hi bnh l, gp trong khi dng cc loi thuc c ch h hp (thuc
ng, morphin) m c ch ging nh khi ng v nht l trong cc bnh cn tr thng
kh nh x phi, tc ph qun, lit c h hp, suy tim...
Nu nhim axit hi ko di dn ti lng Na+ huyt do gi nhiu natri thn.
b) Nhim c axit c nh
Do tng lng axit c nh trong mu, m nguyn nhn ch yu l:
- Nhim axit chuyn ha nh trong bnh i tho ng, ri lon chuyn ha, sn
xut ra nhiu sn phm axit nh th x ton, khi st nhim khun.
Nhim axit do mt kim m in hnh l do ri lon tiu ha, nht l a chy, nn,
tc rut.

- Nhim axit do suy thn khng gi c cn bng con H+, cc sn phm axit tch
li trong c th.
2.5.3.2. Nhim c kim
a) Nhim c kim hi
Khi tng thng kh qu nhiu lm cho c th thi qu nhiu CO2 nn t s
H2CO3/NaHCO3 nghing v mu s. Thng do trung tm h hp b kch thch gp
trong st, bnh vim no, u no, ng c.
85
b) Nhim c kim c nh
Xy ra khi mt ton H+ c th gp do:
- Sau khi n c th tit nhiu HClI m cha kp ti hp thu.
- Sau khi ung nhiu thuc chng axit.
- Dng nhiu thuc li niu chng Clo trong teo thn mn tnh.
3. SINH L BNH QU TRNH VIM
3.1. Khi nim v vim
Vim l nhng phn ng vn mch v t bo ca t chc sng i vi kch thch
c hi. Vim l mt phn ng ti ch ca mch mu, ca t chc lin kt, ca h thn
kinh i vi nhn t gy bnh v mi lin h ca n i vi tnh phn ng. Vim gm
ba hin tng ng thi tn ti v lin quan cht ch vi nhau: ri lon tun hon; ri
lon chuyn ha v tn thng t chc; t bo tng sinh.
Chc nng ca phn ng vim:
- Pha long cc cht kch thch gy vim (bng hin tng sung huyt v dch r vim);
- Khoanh vng cc cht kch thch gy vim;
- Ph hu cc cht kch thch gy vim;
- Loi b cc cht kch thch gy vim;
Hi phc v thay th cc t bo t chc b tn thng.
3.2. Nguyn nhn gy vim
Nguyn nhn gy vim thng rt phc tp v i khi cng kh pht hin. Ngi
ta thng phn ra thnh hai loi nguyn nhn bn trong v nguyn nhn bn ngoi.
3.2.1. Nguyn nhn bn ngoi
- Do cc loi vi sinh vt: vi khun, vi rt, k sinh trng, amp, cn trng... u c
th gy vim cho c th gia sc do c lc cng nh do s tc ng c gii ca chng.
Vi khun gy vim thng c ba loi:
+ Loi vi khun ha m: loi ny thng gy vim ha m i vi t bo t chc
c th gia sc, thng thy nht l Staphylococcus, Streptococcus, E. con.
+ Loi vi khun gy thi ra: thng chng gy qu trnh thi ra i vi t bo
t chc v gy nhim trng ton thn nh cc loi trc khun gy hoi th sinh hi.
+ Loi vi khun gy nhim trng c bit: ch yu l nhng loi vi khun gy
hin tng truyn nhim vt thng nh vi khun un vn (Clostridium tetani), vi
khun nhit thn (Bacillus anthracis), vi khun t th (Malleomyces mali).
- Do c gii: do nhng chn thng v c gii nh gia sc b nh p, trt ng,
86
gia sc hc, cn x ln nhau gy nn nhng tn thng bn ngoi c th dn n vim.
- Do vt l: gia sc b cc nhn t vt l nh nhit , in, cc loi tia phng x
(tia t ngoi, tia hng ngoi, tia ton) tc ng gy vim. Vi nhit cao gy bng v
nhit thp b pht cc.
Do ha hc: cc cht axit, kim mnh, mui ca kali loi nng.

3.2.2. Nguyn nhn bn trong

- Hin tng hoi t t chc, xut huyt, tc mch, ri lon thn kinh dinh dng
(vim do tc ng mch).
- Do vim c hiu, do phn ng kt hp khng nguyn-khng th: phn ng
tuberculin, vim, hin tng Arthus, vim cu thn...
Trong thc t hai nguyn nhn ny kh phn bit, thng nguyn nhn bn ngoi
tc ng dn ti nhng bin i, m nhng bin i li to ra nguyn nhn bn
trong. V vy cn nghin cu tng trng hp c th xc nh nguyn nhn no l
ch yu.
3.3. Biu hin ca vim
Cn c vo nhng biu hin bn ngoi ca vim, ngi ta m t vim c nhng
biu hin sau:
- (Redness): mu sc trn b mt vng vim thay i tu theo s pht trin ca
chng vim. Giai on u tt c cc mch mu u c hin tng sung huyt, trong
cc mch qun (mao mch, nhng mch mu nh) u cha y mu nn vng vim
c mu ti Sau mch mu gin ra, mu li (sung huyt tnh mch) do lu
lng mu chy chm, t chc thiu oxy, vng vim chuyn sang mu tm bm.
- Sng (Swelling): do dch r vim, bch cu, hng cu thm ra t chc. Mch
mu b sung huyt, mu dn v t chc vng vim. Ngoi ra cn do hin tng tng
sinh t bo t chc gy nn.
- Nng (Heat): do c hin tng sung huyt cc b, qu trnh trao i cht vng
vim tng ln, nhit lng sn sinh ra mnh lm cho t chc vng vim b vim nng
hn bnh thng.
- au (Pain): do u mt thn kinh cm gic vng vim b dch r vim (trong dch
r vim c nhiu ton H+, kch thch t bo t chc v t bo t chc b dch r vim
chn p gy nn. Mc au khng ging nhau, n ph thuc vo tnh cht ca t bo
t chc, mc phn b ca thn kinh cm gic n vng vim. V d vim da,
mng xng cm gic au r rt hn vim cc t chc khc.
- Ri lon chc nng (Loss of Function): khi b vim thng lm cho c nng
vng vim b gim nh vim khp, vim c, s vn ng ca khp xng v ca c b
tr ngi, con vt s b qu, i ng kh khn. Nhng cng c trng hp t chc b
87
vim nhng hot ng ca c nng li mnh ln nh vim tuyn nc bt, nc bt li
tit ra nhiu hn bnh thng.
3.4. Nhng bin i ch yu trong vim
Ti vim, c b ba bin i ch yu sau y:
- Ri lon tun hon
- Ri lon chuyn ha v tn thng t chc
- Tng sinh t bo
S phn chia nh vy c tnh cht tng i cho d hiu nhng trn thc t
chng an xen v lin quan cht ch vi nhau.
3.4.1. Ri lon tun hon ti vim
Thng xut hin sm, d nhn thy nht; xy ra ngay sau khi yu t gy vim tc
ng ln c th. Conheim m t hin tng ny khi ng gy vim thc nghim trn
mng treo rut ch, hoc mng chn ch. Theo ng c th nhn thy bn hin tng
sau y ca ri lon tun hon l ri lon vn mch, to dch r vim, bch cu xuyn
mch v hin tng thc bo.

3.4.1.1. Ri lon vn mch

Ngay sau yu t gy vim tc ng, ti ch ln lt c cc hin tng:
- Co mch: xy ra rt sm v rt ngn c tnh phn x, do thn kinh co mch hng
phn lm cc tiu ng mch co li. Hin tng ny ch kp quan st khi gy vim
thc nghim. V lm sng, n t c ngha nhng v sinh hc nu khng c n th
khng c chui phn ng dy chuyn tip theo: gin tiu ng mch, to sung huyt
ng mch.
- Sung huyt ng mch: xy ra ngay sau co mch, thot u do c ch thn kinh
v sau c duy tr v pht trin bng c ch th dch. Thn kinh gin mch b
hng phn lm gin cc mao ng mch, mu ti nhiu, huyt p tng gy nng v
vim. tnh trng hng phn ny do phn x si trc. C ch gin mch th dch l do
tc dng l ha ca cc sn phm t vim nh tng ton H+, K+, tng cc cht nh
histamin, polypeptit...
- Sung huyt tnh mch: khi qu trnh thc bo bt u yu i a n gim sung
huyt ng mch chuyn dn sang sung huyt tnh mch. Lc ny cc mao tnh mch
gin rng, dng mu chy theo nhp tim, sau chm dn, c hin tng ong a, ri
cui cng ngng li. C ch l thn kinh vn mch b t lit, cc cht gy gin mch
li nhiu hn ti vim. Trn lm sng, xc nh sung huyt tnh mch bng cc du
hiu bn ngoi: vim bt nng, t mu ti sang mu tm sm, ph gim, cm
gic au gim chuyn sang au m . Vai tr sinh l ca sung huyt tnh mch l dn
sch vim, chun b cho qu trnh sa cha v c lp vim, ngn cn s lan rng
88
ca tc nhn gy bnh.
- mu: Sau sung huyt tnh mch l giai on mu m c ch l do:
+ Thn kinh vn mch ca huyt qun b t lit, tc dng ca nhng cht gin
mch nh histamin, prostaglandin (PG), leucotrien (LT)... lm tng tnh thm n mc
mu qunh c. nht mu tng rt cao, to ma st ln.
+ Bch cu bm vo thnh mch nhiu hn, cn tr lu thng mu.
+ T bo ni m hot ha v ph i, xut hin nhiu phn t bm dnh lm cho s
vn chuyn mu kh khn.
+ Nc trn vo t chc k gy ph, chn p vo thnh mch.
+ Hnh thnh huyt khi trong lng mch gy tc mch.
Hin tng mu c vai tr c lp vim, khin yu t gy bnh khng th lan
rng, ng thi tng cng qu trnh sa cha.
3.4.1.2. Hnh thnh dch r vim (Exudation)
Dch r vim l cc sn phm xut tit ti vim xut hin ngay t khi sung huyt
ng mch bao gm nc, cc thnh phn hu hnh v thnh phn ho tan. Trong
ng ch nht l cc cht c hot tnh sinh r.
* C ch hnh thnh dch r vim:
Dch r vim c hnh thnh do ba yu t chnh:
- Do tng p lc thu tnh trong cc mch mu ti vim, c vai tr ch yu giai
on sung huyt ng mch, gy ph ti vim.
- Do tng p lc keo: cc cht c hot tnh nh con H+, NO (nc oxit), histamin,
PG (prostaglandin) tc ng vo thnh mch lm gin cc khe gia cc t bo ni
m thnh mch, lm tng thm mch, gy thot protein (v c cc thnh phn hu
hnh). C vai tr rt ln giai on sung huyt tnh mch v lm cho dch r vim giu
protein. Tng p lc thm thu trong vim, hu qu ca s tch li cc con v ha

cht phn t nh. C vai tr gy ph rt quan trng trong giai on mu.

* Thnh phn v tnh cht dch r vim:
Tu theo nguyn nhn gy vim v giai on vim m tnh cht, mu sc v thnh
phn dch r vim c khc nhau. Dch r vim khc dch thm bi nng protein cao,
giu cc. thnh phn hu hnh, ng thi tng lng axit lactic, xetonic, do pH ca
dch r vim gim.
Ni chung dch r vim gm hai thnh phn ch yu:
- Cc thnh phn bnh thng t mu thot ra nh nc, mui, protein huyt
tng, cc thnh phn hu hnh ca mu tch li vim.
89
Protein huyt tng thot ra ngoi theo trnh t t nh n ln qua qu trnh pht
trin ca vim: ban u l albumin, sau n globulin, gm cc sng th c tc dng
cng thc bo chng li tc nhn gy vim v cui cng l fibrinogen gip lm ng
dch r vim v to hng ro bo v vim khng lan rng.
Thnh phn hu hnh gm hng cu, tiu cu v ch yu l bch cu (bch cu i
toan, bch cu i kim, bch cu a nhn trung tnh, i thc bo, lm ba cu v t bo
plasma). Tu theo tnh cht v cc giai on ca vim m s lng v loi bch cu
thot ra ngoi t chc cng khc nhau. Vim t huyt th c rt bch cu, tri li
vim m li c rt nhiu, nht l bch cu a nhn trung tnh. Bch cu ny phn ln
cht do mi trng qu axit, khi bch cu cht s gii phng ra nhiu men c tc dng
ph hu t chc.
- Thnh phn th hai bao gm cc cht mi c hnh thnh, do ri lon chuyn
ha v tn thng t chc, c th k:
+ Cc ha cht trung gian nh histamin, serotonin, axetylcholin.
+ Cc khn huyt tng, l cc protein c khi lng phn t nh t 8-12 axit
quan do ri lon protein. Chng c tc dng gin mch, gy au, cht in hnh
thng gp l bradykinin.
+ Cc cht chit t dch r c hot tnh sinh l nh leucotaxin lm tng thm mch
v ha ng ng bch cu; leucotrien, sn phm chuyn ha ca axit arachidonic; cc
cytokin IL 1,6 v 8 (RJ: interleukin) t i thc bo v t bo ni m hot ha. Cht
gy st, gm Il-l, PG, TNF (tumor necrosis factor).
+ Cc axit nhn: trong vim cc axit nhn v dn xut ca chng tng r rt. Cc
cht ny u lm tng thm mch, gy ha ng ng bch cu, kch thch xuyn mch
ca bch cu, kch thch sn xut bch cu, ti to m, tng sinh khng th.
+ Cc men: do hu hoi t bo nn ti vim c nhiu men thuc nhm
hydrolaza, ngoi ra cn c hyaluronidaza c tc dng hu axit hyaluronic l thnh
phn c bn ca thnh mch lm tng thm mch.
Dch r vim c tnh cht bo v nhng nu lng qu nhiu s gy chn p m
xung quanh gy au nhc, hoc hn ch hot ng ca cc c quan nh khi trn dch
mng tim, mng phi.
3.4.1.3. Bch cu xuyn mch
Hin tng bch cu chui ra khi lng mch chuyn dch vo vim gi l hin
tng bch cu xuyn mch.
Ngi ta chia qu trnh bch cu xuyn mch ra lm ba giai on:
- Bch cu p st vo trong cc thnh mch.
- Bch cu lch qua thnh ca ni mc huyt qun.
90

- Bch cu vn ng ti vim.
C ch gii thch hin tng ny n nay cha r rng, song Cohnheim
quan st thy hin tng trn mng rut ch. Khi tc ng vo vim th dng mu
chy chm, thnh mch mu gin, ngi ta thy rng bch cu bm st thnh mch th
chn gi lch qua cc khe h ri xuyn qua lp bao x ca thnh mch lt vo vim.
Hin tng bch cu b thu ht, vn ng ti vim gi l ha ng ng
(chemotaxis). Metnhicp ng dng hin tng ny gii thch hin tng bch
cu xuyn mch. Bn cht ca hin tng ha ng ng n nay cn cha r nhng
Metnhicp cho rng l s hng phn ca cc nguyn sinh cht t bo bi cc cht
ha ng ng, hng phn lan rng ra khp t bo gy nn phn ng vn ng v
hng t bo tin ti cht . Cc cht c tc dng ht bch cu c gi l ha ng
ng dng i vi bch cu nh: polysaccarit ca phn ln cc vi khun, cc sn
phm phn gii ti vim nh leucotaxin, polypeptit, pepton. Cn cc cht c tc
dng y ngc bch cu ra khi i tng gi l ha ng ng m nh: clorofoc,
benzin, lizin.
Trc kia ngi ta a ra cc thuyt sau gii thch hin tng bch cu xuyn
mch:
- Do sc cng b mt: t bo trong vim cha ton H+ mi trng toan tnh v ni
no thnh mch gn vim sc cng b mt gim, nguyn sinh cht t bo thnh mch
lch v pha vim thu ht bch cu vo vim.
- Do in tch: ti vim bch cu tham gia vo phn ng thc bo, khi tham gia
ri n c th tr v mu hoc tng sinh ti ch hoc n b tiu dit. Khi bch cu cht
bn thn n cng gii phng ra nhiu men hydrolaza. Cc men ny c tc dng dit vi
khun, n kch thch lm tng tnh thm thnh mch, tn thng cc t chc, ri lon
dng mu, ri lon b th, hot ha khn ca huyt tng lm tng tnh thm thnh
mch ln.
3.4.1.4. Hin tng thc bo
l hin tng bch cu thit v tiu ha cc sinh vt, cc t bo hay cc cht
khc khi xm nhp vo c th. C ba thnh phn tham gia vo hin tng thc bo: t
bo thc bo, i tng thc bo v mi trng thc bo.
- T bo thc bo: Thc bo l hin tng c bn ca s tiu ha sinh vt n
bo. Khi sinh vt tin ha th c s bit ha nn ng vt ch c mt s t bo c
chc nng thc bo l:
+ Tiu thc bo (bch cu a nhn trung tnh v mt s t ca bch cu i toan) c
kh nng tiu c vt nh nh vi khun, cc mnh ca t bo.
+ i thc bo (cc t bo n nhn ln - Monocyte) lu ng trong mu v
nhng t bo ca h vng mc ni m (t bo vch phi, t bo Kuppfer).
91
Ti vim bch cu c hot ha, khi c hot ha kh nng thc bo ca
chng tng ln r rt, v hnh thi cc bch cu ny ln hn cc bch cu bnh thng,
cha nhiu cc ty lp th (Mitochodria), ngoi ra cn cha nhiu lyzosom, li golgi,
riboxom. V hnh thi hc m ni cc t bo bch cu ny tng ln c v protein, ATP,
cc men tiu ha v k c glycogen cng tng.
Qu trnh thc bo din ra nh sau: mi u t bo thc bo tip cn i tng
thc bo, sau bao vy ri na cc i tng thc bo.
- i tng thc bo bao gm tt c cc vi khun, cc mnh t bo b hu hoi
vim v cc cht l nh mnh cacbon, bi than, cht mu.... Khi t bo thc bo cc

i tng thc bo c nm kh nng c th xy ra:

+ i tng c th b tiu ha nh cc men tiu ha ca t bo thc bo tit ra
(men tiu ha ng, m, m ca t bo).
+ i tng c th khng b tiu ha m tn ti mi trong t bo thc bo nh cc
mnh cacbon tm thy trong cc t bo thc bo vch phi hoc cht hemosiderin
trong gan bnh x gan nhim sc.
+ i tng khng b phn hu m n theo t bo thc bo i ti nhng ni khc
gp c hi n li ra khi t bo thc bo gy ra vim mi.
+ Nu qu c i tng thc bo c th lm cht t bo thc bo (chng lao c,
lin cu khun c).
+ i tng thc bo nm lu trong t bo thc bo khng tiu, sau t bo
thc bo li nh ra (nh t chc hoi t kh i).
- Mi trng thc bo: l mi trng xy ra hin tng thc bo, nh hng n
kh nng thc bo trong c yu t tng cng thc bo, c yu t c ch thc bo.
Bng 4. Cc yu tng cng v c ch thc bo
Yu t tng cng thc bo Yu t c ch thc bo
Nhit 37-390C
pH trung tnh
Trong huyt tng c b th
Hin tng opsonin ha huyt tng
Cc ion Ca++, Na+
Cafein
Nhit > 400C
pH < 6,6
Mi trng c phng x mnh
Nhiu cht nhy d dy bao
Cc loi thuc ng, thuc m
Corticoit
3.4.2. Ri lon chuyn ha v tn thng t chc
Hai hin tng ny c lin quan mt thit vi nhau, to ra nhng sn phm nh
hng n qu trnh vim.
92
3.4.2.1. Ri lon chuyn ho
Ti vim, qu trnh oxy ha tng ln mnh, nhu cu oxy tng nhng v c ri
lon tun hon, s cung cp oxy khng cho nn chuyn ha vim ch yu l
chuyn ha ym kh v gy nn hng lot cc ri lon v chuyn ha gluxit, lipit v
thot.
a) Ri lon chuyn ha gluxit
Chuyn ha ng tng mnh ch yu l chuyn ha ym kh cho nn axit lactic
tng ln trong mu ti vim. Mt s tc gi cho rng ng tng ti ch l do t chc
khng s dng c ng v c tng phn hu cc polysaccarit (do men amylaza ca
vim tng).
b) Ri lon chuyn ha lipit
Do ri lon chuyn ha ng ko theo chuyn ha m d dang v nhu cu nng
lng tng chuyn ha khng kp dn n cc t bo m b phn hu hng lot lm
cho axit bo v th xe ton u tng, rt nhiu t bo b ph v, cc men tiu ha phng
thch ra rt nhiu.

c) Ri lon chuyn ha thot

Ti vim chuyn ha thot cng khng hon ton, cc lng thot trung gian
nh albumoza, dipeptit, polypeptit, axit quan tng ln nhiu. Nguyn nhn ch yu ca
n l o cc men tiu ha thot phng thch t t bo v vi khun cht ti vim, cng
do hu qu ca ri lon chuyn ha ng trn.
3.4.2.2. Tn thng t chc
Ti vim tn thng t chc c chia lm hai loi:
Tn thng tin pht do nguyn nhn gy vim to ra. Phi c tn thng tin
pht th mi pht trin thnh vim
- Tn thng th pht do nhng ri lon ti vim gy nn.
V d: Khi yu t lm t bo tn thng, vi khun cht s gii phng ra cc men
ti vim dn n tiu hu t bo.
Tn thng tin pht: tu theo cng ca nguyn nhn gy vim m tn
thng c th rt nh (kali chm, try xc...) hoc rt ln (dp nt do chn thng,
nhim khun c lc cao...) gy hoi t t bo t hay nhiu.
Tn thng th pht: rt quan trng v n ph thuc khng nhng vo cng
ca nguyn nhn m cn vo mc phn ng ca c th. Phn ng ca mch mu,
ca cc t bo thc bo, ca s hnh thnh dch r vim... tuy c tc dng khu tr v
loi tr yu t gy bnh, song chnh nhng phn ng bo v ny, tu mc , li gy
ra mu, li to ra nhiu cht c kh nng lm thiu dng, tn thng v hoi t t
bo.
93
3.4.2.3. Nhng sn phm c hot tnh sinh l
Qu trnh ri lon chuyn ha v tn thng t chc s to ra rt nhiu cht c
hot tnh sinh l ti vim v ng mt vai tr nht nh trng qu trnh vim.
a) Nhng cht ha hc trung gian
Nhng cht ny chng c tc dng chung l gy gin mch v tng tnh thm
thnh mch.
Histamin c phng thch nhiu trong t chc sau bng, sau nhim khun hay
sau phn v, r nht l trong vim thc nghim khi tim turpentin vo ph mc.
Histamin gy gin cc ng mch, lm tng tnh thm thnh mao mch v tnh mch.
- Axetylcholin (cng ph giao cm) gy gin mch, tng tnh thm gy dch r
vim, thy c nhiu trong mu t vim ra. Sau vi ngy khi vim xut hin th
lng axetylcholin gim dn v mt hn.
- Serotonin c rt nhiu trong t bo mast nm quanh cc huyt qun c tc dng
tng tnh thm thnh mch rt mnh, gy ph mnh hn 200 ln so vi histamin.
Serotonin c dng gii thch vim d ng, thy chut trng v ging ny khng
phn ng vi histamin.
Anaphylotoxins l nhn t kch thch gii phng histamin.
- Prostaglandins kch thch gii phng histamin v v vy n hot ng rt sm
trong qu trnh vim.
- Cc khn c mt trong plasma-alpha-2-globulins trong mt hnh thc khng hot
ng nh nhng kininogen v l nhng ha cht trung gin c tim nng nht.
- Plasmin gii phng cc khn v b th.
b) Polypeptit v thot c hot tnh sinh l
Ngi ta pht hin ra c nhiu cht c hot tnh sinh l trong dch r vim,
lm nh hng su sc n qu trnh vim nh phn ng huyt qun, tnh thm thnh

mch, bch cu xuyn mch, thc bo v qu trnh hi phc t chc. Nhng cht l:
- Leucotaxin: c tc dng tng tnh thm thnh mch, ko bch cu xuyn mch.
- Pyrexin c tc dng gy st.
- Necrosin c tc dng hu thot, gy tn thng ni m v gy huyt khi.
- Mt s tc gi nh __________Spector, Miles, Witheim cho thy protein huyt tng di tc
dng ca trypsin hay mt s men dung gii protein khc c th phng thch nhng cht
polypeptit gm t 8 n 14 axit quan, c tc dng gy gin mch, gy au v ngi ta
gi chung l khn huyt tng. Tc dng ca khn ging nh tc dng ca histamin.
Chng lm co c trn ph tng nhng lm gin c trn thnh mch v do lm tng
tnh thm thnh mch. Chng gy au v ko bch cu ti ch t chc tn thng.
94
c) Tng cc men phn hu
Do hu hoi t chc v dung gii bch cu m phng thch rt nhiu men trong
vim. ng ch nht l men hyaluronidaza c tc dng ph hu axit hyaluronic, mt
thnh phn quan trng ca cht c bn thnh mch. Theo mt s tc gi th vim
chuyn men ny t dng khng hot ng sang dng hot ng, s bin cht c bn t
th ng sang th lng, do tnh thm thnh mch s tng.
d) Tng axit nhn
Do hu hoi t bo nn lng axit nhn tng ln r rt trong vim. Axit nhn
nht l cc dn xut ca n (ADP, AMP) gy gin mch vi nng rt thp (1.1006),
tng bch cu xuyn mch v thu ht bch cu ti vim, kch thch to bch cu,
tng kh nng thc bo, tng sc khng ca c th chng vim, kch thch tng sinh
t bo, hn gn tn thng.
3.4.2.4. Hu qu ca ri lon chuyn ha v tn thng t chc
- Nhim axit: Ri lon chuyn ha gy tch li trong vim lng ln cc cht
nh axit lactic, th x ton lm tng nng ln H+, gy trng thi nhim axit. Mc
nhim axit ph thuc vo tnh cht ca qu trnh vim: vim m cp tnh c nhim axit
nhiu hn (pH gim ti 6,5-5,5) l vim mn tnh (pH 7,1-6,5).
Tng p lc thm thu v p lc keo ti vim: Do tng tnh thm thnh mch,
thot huyt tng thot vo trong vim, do tng phn hu t chc ti nn tp
trung nhiu sn phm chuyn ha d dang c phn t lng cn ln (polypeptit,
albumin..), cc con nh K+, Cl-, SO4-- tng. Tt c nhng yu t lm tng p lc
keo v p lc thm thu ti vim.
- Cm gic au do nhiu yu t gy nn: C quan cm th thn kinh b chn p do
sung huyt, huyt, ph n, cho nn khi tho m vim, cm gic au gim i r rt.
i khi vim ang khu tr m tr nn lan trn nh rut tha hoi t, cm gic au
gim i t ngt lm tin lng, chn on c th sai lch.
- Ph n: Ph n ti vim l do tng tnh thm thnh mch, tng huyt p do
sung huyt, tng p lc keo v p lc thm thu ti vim, tr tun hon mu cng
nh tun hon bch huyt. Phn ng vim cng mnh th ph n tng.
- Nhit tng: Nhit tng ti vim l do tng tun hon, tng chuyn ha to
nhiu nng lng, nht l giai on sung huyt ng mch (oxy c cung cp nhiu
nn cc qu trnh oxy ha tng).
Tm li tc nhn gy vim gy ra hng lot nhng bin i, m sm nht l ri
lon tun hon. Nhng bin i tc ng ln nhau hnh thnh nhng vng bnh l,
c th tm tt theo s sau:
95

3.4.3. Tng sinh t bo

Tng sinh t bo l t bo mi c to ra do tc dng kch thch ca mt s sn
phm trong qu trnh vim. Qu trnh tng sinh t bo din bin ng thi vi ri lon
tun hon v ri lon chuyn ha, song tu tng giai on ca qu trnh vim m tc
tng sinh v loi t bo tng sinh c khc nhau.
Trong qu trnh vim, tng sinh t bo din bin nh sau:
- Giai on u ch yu l tng sinh bch cu, nht l bch cu a nhn trung tnh,
biu hin r nht khi vim cp tnh.
- Giai on hai l giai on tng sinh ton din bch cu, cc thnh phn ca mu...
- Giai on ba l giai on phc hi, ch yu l tng sinh t chc ht lm lnh
vt thng v to so.
* Nguyn nhn tng sinh t bo:
Nguyn nhn chnh do hu qu ca phn ng tun hon v phn ng t bo c
bit l khi tn thng t chc, cc t bo bch cu ra vim, khi cht i to ra mt s
cht lm tng sinh t chc.
* Chc nng tng sinh t bo:
Tng sinh bch cu n nhn v i thc bo c tc dng dn dp o thi cc sn
phm do vim, lm sch cc t chc vim. Mt khc chnh bn thn n cng c
knh thch tng sinh v bin dng thnh cc t chc ht giu nng lng, giu mch
qun v cc t chc si thay th dn cc t chc hoi t to so v lm lnh vt
thng. Nu t chc tng sinh tt vt thng chng lnh v to thnh vt so nng, khi
tn thng qu ln, rng th t chc x pht trin mnh to thnh so ln, nu t chc
vim lu, c nhiu men hydrolaza tc ng ln t chc so lm cho so nhn nhm co
ko gy bin dng.
96
3.5. Quan h gia phn ng vim v c th
3.5.1. nh hng ca c th vi phn ng vim
- Trng thi thn kinh c nh hng su sc ti qu trnh pht sinh, pht trin ca
vim. Ngi hoc ng vt c thn kinh trng thi c ch th phn ng vim yu,
nh ngi gi phn ng vim yu hn ngi tr, khi phong b thn kinh, gy m hoc
tim morphin lm gim phn ng vim mt cch r rt. Trng thi thn kinh cn nh
hng r n qu trnh tit dch r vim v hin tng thc bo: nu gy m th dch r
vim gim r rt. Dng phn x c iu kin c th gy tng bch cu, tng thc bo;
thuc ng lm gim thc bo; cafein li lm tng thc bo,...
- Ni tit c nh hng n phn ng vim. Cc ni tit t c nh hng r rt
n phn ng vim, nht l ni tit tuyn yn v thng thn. nh hng ca ni tit
c hai mt:
+ Loi lm tng phn ng vim nh: STH v aldosteron c tc dng lm tng tnh
thm thnh mch.
+ Loi lm gim phn ng vim nh: Cortisol, hydrocortisol c ch tit dch r, c
ch thot bch cu, c ch thc bo, lm chm qu trnh thnh so.
- nh hng ca h mc vng m: h ny tham gia vo qu trnh sinh khng th
chng hin tng vim tng sinh, thc bo c bit l lm nhim v dn dp vt
thng lm cho vt thng chng lnh.
3.5.2. Phn ng vim nh hng n ton c th
- Ti ch: gy au, lm bin i hnh thi (v d: vim qu nng vm hng ta phi
m kh qun th, vim rut thng gy vim dnh hoc vim ni tm mc lm cho

van tim bin i hnh thi), lm hn ch c nng ch vim hoc mt hn.

- Ton thn:
+ Sm nht l gy nh hng ti h thn kinh lm c th mt mi, r.
+ nh hng ti ri lon tiu ho: gim tit dch cc men tiu ha gy trng thi
kh tiu gim hp th.
+nh hng ti tit niu lm thay i thnh phn, s lng nc tiu tu theo cc
bnh.
+ nh hng ti c quan iu ho nhit: st, thay i tun hon cng nh nhp h
hp, thay i thnh phn ca mu c bit s lng bch cu tng, cng c th thay
i protein huyt.
T nhng ri lon trn c th dn ti vng xon bnh l, v vy khi nghin cu
vim ta phi tm hiu nh hng ti ch th no, ton thn ra sao, tm hiu vng xon
bnh l th no tm ra ch t ph ct t vng xon bnh l.
97
3.6. Phn loi vim
3.6.1. Theo thi gian v tin trin ca vim
- Vim qu cp tnh: tc nhn gy vim l cc k mnh hoc l t chc v c quan
rt mn cm vi kch thch. Qu trnh bnh xy ra cc k nhanh ko di ch trong mt
vi gi. V d: bnh ung kh thn, ph u c tnh.
- Vim cp tnh: c im ca loi vim ny thi gian ngn, bnh xut hin kch
lit phn ng ca mch mu rt r c bit l s thm thu ca thnh mch mu tng
rt mnh. Nhng sn vt trung gian sn sinh trong qu trnh vim kt hp vi c t
ca vi sinh vt s lm cho t bo ca t chc b hoi t, then dung gii protein s lm
tan t chc hoi t. Trong vim xut hin nhiu bch cu a nhn trung tnh. Thi
gian tin trin ca vim cp tnh t vi ngy n vi tun.
- Vim cp tnh: c nhng c im trung gian gia vim cp tnh v vim mn
tnh. N tin trin khng chm lm nhng cng khng mnh lit. Hin tng thu
thng v sung huyt khng r lm, t bo trong vim ch yu l lm ba cu,
plasmocyte v i thc bo.
- Vim mn tnh: thng do vim cp tnh ko di gy nn hoc khi pht sinh
vim tin trin tng i chm. Qu trnh vim tin trin chm ch yu l do dinh
dng ca t bo t chc b tr ngi. T bo trong vim ch yu l bch cu n nhn,
lm ba cu v i thc bo.
3.6.2. Theo phm vi ca vim
- Vim k nh vim k thn mn tnh, vim k phi.
- Vim nhu m nh vim nhu m gan, vim nhu m thn
3.6.3. Theo thnh phn chnh ca dch r vim
- Vim thanh dch: xut hin khi thnh phn chnh ca dch r vim l bch huyt
v huyt tng, v d: bnh l mm long mng.
- Vim cam: xut hin trn b mt nim mc ca cc c quan t chc, thnh phn
chnh ca dch r vim l dch nhy, v d: vim rut cam.
- Vim t huyt (vim fibrin): xut hin khi thnh phn chnh ca dch r vim l
fibrin.
- Vim ha m: l loi vim trong dch r vim c nhiu bch cu, ch yu l bch
cu a nhn trung tnh t mu n v mt phn do t chc sinh ra.
- Vim xut huyt: xut hin khi thnh phn chnh ca dch r vim l hng cu, v
d: nhim trng xut huyt trong bnh do PHsteurella gy ra.

- Vim dng lympho: xut hin khi thnh phn chnh ca dch r vim l
lymphocyte (t bo lympho).
98
- Vim d ng l mt phn ng ca c th i vi mt protein m n c mn
cm vi c th trc . N l mt loi phn ng c bit ca c th m dch r
vim c th l thanh dch, fibrin, m hoc hng cu.
3.6.4. Theo d tt hoc d chng ca vim
- Vim tng sn: l mt chng vim c c im l tng sn t bo qu mc. V
d: bnh vim rut ko di v nguy him.
- Vim ph i: l mt loi vim m kch thc ca nhng t bo tng ln trong
mt khu vc vim.
- Vim teo t: l chng vim m kch thc ca t chc v t bo b teo i mnh
m. V d: vim mi mn tnh ln.
- Vim tc nghn: xut hin khi cu trc no (tiu cu thn, mch mu v ph
qun) trong mt khu vc b ph hu bi vim.
- Vim dnh: l loi vim c s dnh ca mt t chc ny vi mt t chc khc
bng cc di ca t chc lin kt t huyt trng. Cc di c sinh ra khi dch r
vim c t chc ha.
3.6.5. Phn loi vim da trn c quan v t chc vim
Vim da, vim mng phi, vim phi, vim ngoi tm mc, vim thn, vim da,
vim tuyn v, vim khp, vim rut, vim gan, vim mng no, vim d dy...
3.7. ngha ca vim
Nhn chung vim l phn ng bo v c th v thc cht n lm tng tun hon ti
ch, tng chuyn ha to nhiu nng lng cho phn ng bo b c th (tng thc bo,
tng m bo, kch thch to thnh so). V nguyn tc ta tn trng phn ng vim
nhng nu vim nng v ko di gy nhiu nh hng xu, cc cht mi sinh ra trong
vim gy hi cho tnh mng con vt, ri lon chuyn ha lan rng, tn thng lan
rng dn n mt lc no cn phi ngn chn bng cch chng nguyn nhn gy
vim, ngn nga phn ng st, nht l cn st di, ct cn au, gii phng dch r
vim, chng xut tit dch r vim.
4. SINH L BNH IU HO THN NHIT - ST
4.1. i cng v cn bng thn nhit
ng vt ni chung, ngi ta chia lm hai loi:
- ng vt mu lnh gi l ng vt bin nhit, gm cc loi ng vt khng
xng sng v c xng sng cp thp: c, ch, loi b st. Thn nhit cc loi ng
vt ny hon ton ph thuc vo s thay i ca nhit mi trng bn ngoi, chng
khng c kh nng iu ho nhit.
- ng vt mu nng gi l ng vt ng nhit gm chim v loi c v. Thn
99
nhit ca cc ng vt ny tng i hng nh v c lp vi nhit ca mi trng
nhng n cn ph thuc vo loi, ging, c th ring bit (ng vt non thn nhit
thng cao hn) v thi gian trong mt ngy m (bui sng thn nhit thp hn bnh
thng v bui chiu thn nhit cao hn bnh thng). Thm ch nhit tng b
phn c th cng khng ging nhau. ng vt ng nhit c s hng nh tng i
l nh hai qu trnh iu ho nhit l qu trnh sn nhit v qu trnh thi nhit.
4.1.1. Qu trnh sn nhit (Qu trnh iu ho ha hc)
Qu trnh sn nhit l qu trnh iu ho ha hc do chuyn ha cc cht to nn.

Khi nhit mi trng gim th sn nhit tng, khi nhit mi trng tng th
sn nhit gim v nh c qu trnh iu ho sn nhit m mc chuyn ha ti t bo
v t chc c tin hnh ph hp vi nhu cu c th v nhit mi trng.
Cc cht oxy ha trong t bo s sinh ra nhit ln v n ph thuc vo thc n ca
tng loi gia sc. Bn cnh thc n, s co c tc l hot ng ca c th cng nh
hng ti nhit . Ngoi thc n v lao ng, s to nhit cn t nhiu chu nh
hng ca hormon: adrenalin, noradrenalin lm tng to nhit nhng ngn hn;
tyroxin cng lm tng sn nhit song ko di hn. Song song vi qu trnh sn nhit
th c qu trnh thi nhit ng thi xy ra.
4.1.2. Qu trnh thi nhit (Qu trnh iu ho vt l)
L qu trnh lm mt nhit ca c th ra mi trng bn ngoi, bao gm:
4.1.2.1. Truyn nhit
L s tip thu nhit ca c th bi cc vt c nhit thp hn khi tip xc vi
c th nh: khng kh, qun o, thc n...
4.1.2.2. Khuch tn nhit
Tc l kh nng to nhit ca c th con vt vo mi trng xung quanh, ph
thuc vo nhit ca mi trng. Ring hin tng truyn nhit v khuch tn nhit
chim khong 65% lng nhit thi ra ngoi, n ph thuc vo cu trc ca da, lng,
m ca c th.
4.1.2.3. Bc nhit
L hin tng mt nhit do bc hi nc qua da v nim mc ng h hp,
chim khong 30% lng nhit thi ra hng ngy. V d: 1g nc bc hi ly i 0,6
Kcal.
Ngoi ra, c th cn thi nhit qua phn v nc tiu, mt nhit hm nng thc
n v hi th, s mt nhit ny rt t khng ng k.
Tm li nhng hin tng thi nhit trn cn ph thuc vo cu trc ca da, t
chc di da ca cc loi ng vt khc nhau (v d: lp da dy lng, lp m di da
dy th s thi nhit qua s khuch tn v bc nhit qua da km), h thng mao qun
100
di da cng c tc dng iu ho nhit r rt, khi thn nhit tng cc mao qun gin
v khi nhit bn ngoi thp mao qun co li. Ngoi ra cn ph thuc vo mi
trng bn ngoi, ni m t, thong gi, m cao th s thi nhit bng truyn
nhit, khuch tn nhit cng mnh.
4.1.3. Trung tm iu ho nhit
Nm phn trc ca vng di i, gm hai phn:
- Phn ch huy to nhit: khi b kch thch lm tng chuyn ha v to nhit thng
qua h giao cm, tu thng thn v tuyn gip.
- Phn ch huy thi nhit: b kch thch th lm tng thi nhit thng qua h ph
giao cm, gin mch da v tit m hi; khi b tn thng gy tng thn nhit.
Nh vy trung tm iu ho nhit chi phi c hai qu trnh, da ng thi vo hai
ngun thng tin:
(1) Nhit mi trng tc ng ln b phn th cm da (v trong su) truyn
ln trung tm.
(2) Nhit dng mu qua trung tm
Trong qu trnh tin ha ca sinh vt v tin ha c th vai tr ca iu ha ha
hc gim dn v ngha ca iu ha vt l tng ln, ng vt cng cao cp, iu ha
vt l cng pht trin.

Bng 5. Tm tt nhng c ch lm tng gim sn nhit hoc tng gim thi nhit
Nhng c ch m lnh tng cng
Run ry
i
Tng hot ng
Tng tit TSH, noradrenalin, adrenalin
Tng sn nhit
Co mch di da
Nm co qup
Sn gai c
Gim sn nhit
Nhng c ch m nng tng cng
Gin mch di da
mi hi
Tng h hp
Tng thi nhit
Chn n
Th , bt ng
Gim tit TSH
Gim thi nhit
101
4.2. Ri lon thn nhit
Ri lon thn nhit l hu qu ca mt cn bng gia hai qu trnh sn nhit v
thi nhit, s mt cn bng ny gy nn hai trng thi khc nhau, gim thn nhit v
tng thn nhit.
4.2.1. Gim thn nhit (Hypothermia)
Gim thn nhit l tnh trng mt nhiu nhit ca c th gy ri lon cn bng gia
thi nhit v sn nhit lm cho thn nhit gim xung, t s sn nhit/thi nhit <1.
- Trong sinh l gp nhng ng vt ng ng.
- Gim thn nhit nhn to cha bnh: phu thut gan, bng nng: khi h nhit
bng cch gy m, c ch thn kinh trung ng v chm , ngm c th vo .
- Gim thn nhit bnh l thng do nhng nguyn nhn sau:
Nhng yu t bn ngoi: nhit mi trng bn ngoi qu thp, m cao, c
gi la, mt s cc ha dc tc ng hoc tn thng do phng x lm cho c th
mt nhit.
Nhng yu t bn trong: gp trong trng hp mt mu, ri lon chuyn ha
nghim trng lm gim qu trnh chuyn ha dn n nhit gim. Cc gia sc non
d nhim lnh hn gia sc ln. Ln b nhim lnh nhanh hn i gia sc, gia cm c
sc khng mnh vi nhim lnh. c bit ngng vn gi c thn nhit trong 3
gi khi nhit ngoi l - 900C n - 1 200C, g gi c 3 gi nhit -300C, cn
vt chu c -400C. Cc loi gia sc ln chu lnh km nht.
* Nhng ri lon ca c th khi b gim thn nhit
Khi b nhim lnh, phn ng ca c th qua ba thi k:
- Thi k u l thi k hng phn: C th vn ng tt c h thng thch ng
phng ng duy tr thn nhit, mch ngoi vi co li, lm gim thi nhit, tng tit
Adrenalin lm tng chuyn ha trong c th, tng ng huyt, rng mnh tng sn
nhit (tng vn ng run, run ry chn tay, lp cp rng, sn gai c). Ngoi ra ta thy

tng trng lc c, tun hon tng, h hp tng, kh nng hp thu oxy tng ph hp
vi yu cu tng chuyn ha v tng vn ng c.
Tt c nhng phn ng trn pht sinh theo c ch phn x, tng hot ng ca h
thn kinh giao cm v ca h ni tit nhng chu s iu khin ca trung tm iu ho
nhit, nu trung tm b c ch th cc phn ng ny khng xy ra.
- Thi k hai l thi k c ch. do tc ng lu ca lnh c th b mt nhit lin
tc, nhng phn ng trn b gim st, tim p chm, h hp chm, oxy gim dn n
chuyn ha d dang, thiu oxy chuyn ha ym kh lm tch t cc sn phm c gy
nhim c ton thn.
Thi k ba l thi k kit qu: thi k ny cc chc phn sinh l b suy sp hon
102
ton, con vt hn m, tim ch rung tm nh v tm tht, cht do lit h hp.
4.2.2. Tng thn nhit (Hyperthermia)
Thn nhit tng l tnh trng c th tch lu nhit, do hn ch qu trnh thi nhit
vo mi trng hoc do tng sn nhit cng c khi phi hp c hai.
Thn nhit tng ln qu mc bnh thng do mt s nguyn nhn sau:
- Tng sn nhit gp trong bnh chuyn ha c bn tng.
- Tng sn nhit trong qu trnh vim.
- Do gim thi nhit khi nhit mi trng qu cao, m cao, iu ho thng
kh km dn n c ch qu trnh bc nhit, truyn nhit, khuch tn nhit hay gp khi
chuyn ch gia sc trong nhng toa xe cht chi, thng kh km dn n cm nng.
Gp khi thi tit nng nng, nh sng mt tri chiu trc tip vo c th gy cm nng
(tng thn nhit v sung huyt no).
- Do tng sn nhit, gim thi nhit, y l mt trng thi c bit, hu qu ca ri
lon trung tm iu ho nhit v gi l hin tng st.
4.3. St (Fever hay pyrexia)
4.3.1. nh ngha
St l trng thi c th ch ng tng thn nhit do trung tm iu ho nhit b tc
ng bi cc nhn t gi l cht gy st, a n kt qu tng sn nhit kt hp vi
gim thi nhit.
St c th gp trong nhim khun, ung th, hu hoi m, hu hoi bch cu,... vi
tiu chun l tng sn nhit ng thi vi hn ch mt nhit.
4.3.2. Nguyn nhn gy st
4.3.2.1. St do nhim khun
Nhim khun l nguyn nhn ph bin nht, a s cc bnh nhim khun v vi rt
u st Nhng c mt s bnh nhim khun khng st nh ly amip, giang mai, thm
ch c khi thn nhit li gim nh trong bnh t ngi.
Trong trng hp nhim khun, st xut hin ch yu l do tc dng ca c t vi
khun, ngoi ra bn thn vi khun v cc sn phm hot ng sng ca chng cng
nh cc sn phm ca hu hoi t chc v t bo u c kh nng gy st.
V d: V cc vi khun c cht polysaccarit v lipopolysaccarit c tc dng gy
st rt mnh, cht pyrexin (ly t mi trng nui cy vi khun Salmonella abortus e
qui) em tim vo tnh mch th vi liu lng rt nh: 0,003 microgam cho 1 kg c
th c th gy st ko di hng gi.
4.3.2.2. St khng do nhim khun
103
- Protit l t ngoi a vo hoc ni sinh do phn hu thot ca c th to nn:

xut huyt ni, hoi t t chc, gy xng, bng, vim.

- Do mui: khi a mt lng mui u trng vo c th s gy st. Ngi ta cho
rng khi mui u trng vo c th lm bin tnh thot ca c th thnh loi thot l
dn n gy st.
- Do tc dng ca dc cht: Mt s cht c tc dng kch thch trung tm iu
ho nhit, hn ch thi nhit nh: cafein, phenatriin, adrenalin c ch qu trnh thi
nhit.
- Do thn kinh: do cc phn x au qu mc, v d: si thn, si mt, si bng
quang, do thn kinh b tn thng nh u no, chy mu no.
4.3.3. Cc giai on ca qu trnh st
4.3.3.1. Giai on st tng
Cc phn ng sn nhit tng v thi nhit gim do t s sn nhit/thi nhit > 1.
Phn ng tng thn nhit u tin l run ry, sn da g, rung c; mt khc phn
ng gim thi nhit l co mch di da, da ti nht, co qup ngi, khng tit m hi,
mu dn vo ni tng nn tng tiu tin.
4.3.3.2. Giai on sti ng
T s sn nhit/thi nhit =l. Lc ny sn nhit vn cao hn bnh thng, song
song vi sn nhit l thi nhit cng tng hn bnh thng, tng gin mch ton thn,
da tr nn v nhit ngoi vi tng. Mt thng bng mi xut hin nhng mc
mi cao hn.
4.3.3.3. Giai on st li
T s sn nhit/thi nhit < 1 , nhit dn dn v 370C, giai on ny ra m hi
nhiu, h hp tng, mch ngoi vi gin to iu kin cho s bc nhit tng ln. Nh
th, thi nhit mnh hn sn nhit, nhit h xung cho n khi cn bng lc u
c lp li v thn nhit tr li bnh thng.
V d: Khi dng pyrexin kch thch vo c th lm ri lon trung tm iu ho
nhit dn n sn nhit tng, thi nhit gim (khi i vi trung tm iu ho nhit
vn cm thy lnh) nn tip tc tng sn nhit n khi nhit ln ti 400C, lc ny
trung tm iu ho nhit bnh thng v vy thit lp cn bng mi tng sn nhit v
thi nhit mc cao. Khi cht kch thch khng cn tc ng na, tng thi nhit,
104
gim sn nhit, trung tm iu ho nhit tr li bnh thng cho ti khi 370C th tr li
cn bng sinh l sn nhit/thi nhit = 1.
4.3.4. C ch st
4.3.4.1. St l do ri lon chc nng ca trung tm iu ho nhit, lm thay i
mi tng quan gia sn nhit v thi nhit
Ngi ta cho rng di nh hng ca cht gy st, tnh cm th ca trung tm
iu ho nhit i vi kch thch nng gim xung, tri li kch thch lnh tng ln do
trung tm iu ho nhit tng sn nhit gy st. Khi st mc cao thn nhit
tng c th thit lp cn bng mi (cn bng bnh l) tng sn nhit v tng thi nhit.
Khi cht gy st gim kch thch hoc khng kch thch na th trung tm iu ho
nhit tr li bnh thng, khi nhit cao s kch thch trung tm ny gy tng thi
nhit v gim sn nhit cho nhit tr li bnh thng.
4.3.4.2. C ch tc dng ca cht gy st
- Hin nay cha bit tc dng ca cht gy st nh th no, c kin cho rng
cht gy st tc ng ln trung tm iu ho nhit thng qua mt cht gy st ni sinh
l bch cu a nhn trung tnh tit ra.

C kin khc li cho rng cc cht gy st tc ng ln trung tm iu ho nhit

nhng trc tin tc ng vo b phn cm th ti ch, t gy xung ng thn kinh
ln trung tm iu ho nhit lm ri lon gia hai qu trnh sn nhit v thi nhit.
Ngi ta th nghim tim mt cht gy st ln cc vng khc nhau trn th v thu
c kt qu sau:
Bng 6. Kt qu th nghim thm cht gy st cho th
Ni tim Thi gian cht gy st xut
hin trong mu
Thi gian xut hin
cn st Mc st
Di da
Thn
Khp
Trung bnh
Sm nht
Chm nht
Trung bnh
Chm nht
Sm nht
+
++
+++
Qua bng trn ta thy cht gy st tc ng nhanh hay chm, cng mnh hay
yu cn ph thuc vo cc b phn cm th ti ch t to ra cc xung ng thn
kinh tc ng ln trung tm iu ho nhit.
Th nghim khc: Ct dy thn kinh i ca th ri tim cht gy st th cn st
xut hin t ti a 10 - 20 gi, trong khi trn th bnh thng ch sau 1 gi st
xut hin v chm nht l 10 gi cn st t ti a.
Ngi ta gii thch nh sau: Cc cht gy st khi vo c quan cm th vo mu i ti
khp c th, tc dng ln c quan cm th v trc tip tc ng ln thn kinh iu ho
nhit gy hng phn v hng phn mnh nht l trc v trong cn st lm tng sn nhit.
105
4.3.4.3. Vai tr ca v no trong qu trnh st
Ri lon iu ho nhit trong st ph thuc vo vai tr ca v no. V no iu
ho hot ng ca cc trung tm di v. Trn thc nghim ngi ta thy gia sc
ph v no th phn ng st pht sinh rt mnh. Trong thc t gia sc non v no
cha pht trin nn phn ng st rt l mnh. Nu dng thuc c ch (brmmua) v
no th phn ng st xy ra chm. Cn nu tim cafein trc khi gy st th phn ng
st rt mnh.
4.3.4.4. Vai tr ca ni tit
Trong thc nghim nu ct b tuyn yn, h khu no th phn ng st gim,
hormon ca tuyn thng thn c th gy c cn st nh adrenalin, noradrenalin.

4.3.5. Cc kiu st
Khi st th cng v tnh cht ca cn st n ph thuc vo c im ca
loi, ging, tui v c th tng b phn.
4.3.5.1. Theo cng st

- St nh tng ln 10C
- St va tng ln 20C
- St nng tng ln 30C
- Nu st >30C l st rt nng.
4.3.5.2. Theo ng biu din nhit ,
- St lin tc: Trong cn st gia bui sng v bui chiu khng chnh lch
nhau qu lc
106

- St dao ng: sng v chiu chnh lch nhau >10C.

- St cch qung: st v khng st xen k nhau, c th ngy st v ngy
khng st gi l st cch nht, cn hai ngy st mt ngy khng st gi l st
cch qung.
- St hi qui: thi gian st v khng st ko di ri mi lp i lp li theo mt qui
lut nht nh.
Ngoi ra cn c mt loi st na l st khng in hnh (Atypical Fever) thy
bnh t th ngn.
4.3.6. Ri lon chuyn ha trong st
4.3.6.1. Ri lon chuyn ha nng lng
Trong tt c ctrng hp st u c tng chuyn ha v nng lng. Trong thc
nghim nu nhit tng ln lc th chuyn ha tng 3,3% v nhu cu oxy tng t 510%.
4.3.6.2. Tng chuyn ha gluxit
u tin lng d tr glycogen gim, glucoza mu tng, thm ch c c trng
hp tng glucoza niu, axit lactic trong mu cng tng ln. Nu ko di c th c th
nhim toan. Vy khi st ngi ta c th b sung glucoza trc tip.
4.3.6.3. Tng chuyn hoa lipit
Ch tng mnh khi st cao v ko di, lng d tr glycogen gim lm cho lipit
huyt tng, xut hin th xe ton huyt.
4.3.6.4. Chuyn ha protit
Chuyn ha thot tng ln trong trng hp st cao v c bit trong trng hp
nhim c, nhim trng, c th khng hp thu c thc n, cho nn phi phn hu
m, m, no o thi qua nc tiu nhiu. V th khi st cao c th truyn m. Nhu
cu vitamin c bit l vitamin B v C: vitamin B ch tham gia vo qu trnh b tr
cho cc qu trnh chuyn ha, vitamin C cng cn tng.
- Chuyn ha mui v nc: Trong giai on u v giai on hai ca st chuyn
ha nc v mui gim, cn giai on ba chuyn ha tng.
4.3.7. Ri lon chc nng cc c quan
- Ri lon thn kinh: thng h thn kinh hng phn sau th c ch biu hin:
u tin r, mt mi, nu nng c th b co git.
Ri lon tun hon: tim p nhanh, nu nhit tng ln lc th tim p tng ln
10 nhp, huyt p giai on u tng ln do tim p nhanh, co mch ngoi vi, giai on
sau tr li bnh thng. Thnh phn ca mu c nhng thay i, trong huyt tng
tng cc sn phm ca qu trnh phn gii, ca qu trnh trao i cht lm cho nng
107
axit tng trong mu, gim lng kim d tr, c bit bch cu thay i: tng bch cu
a nhn trung tnh trong vim cp tnh, tng bch cu n nhn trong vim mn tnh.

Trong mu c th xut hin thnh phn l, vi khun, c t vi khun, -globulin cng

tng ln.
- Ri lon h hp: H hp tng nhanh, ngoi nhim v tng nhanh do nhu cu oxy
v nhu cu thi CO2 cn nhu cu thi nhit.
- Ri lon tiu ho: Cm gic n ung biu hin sm nht trong ri lon tiu ho:
gia sc b n, ming kh, gim tit dch tiu ha, gim hp thu cc cht dinh dng,
ty theo tng trng hp m gim nhu ng hay tng nhu ng.
Ri lon tit niu: do ri lon tun hon v c t ca vi khun trong nhim khun
m chc nng ca thn thay i. Trc khi st giai on u c hin tng tch nhit,
co mch ngoi vi dn n gim thi nc tiu, giai on hai tit t v giai on ba tr
li bnh thng. Cht lng nc tiu cng thay i tu theo tng bnh.
- Ri lon ni tit: ni chung khi st hot ng ca ni tit u tng ln c bit l
trc h khu no v thng no.
Ri lon chuyn ha gan: chuyn ha ti gan tng ln 30-40%, cc chc nng
khc ca gan u tng ln.
4.3.8. ngha ca st
St l phn ng thch ng ton thn mang tnh cht bo v: N hn ch c qu
trnh nhim khun (tc nhn ph bin gy su v khi st c tng s lng v cht lng
bch cu, tng kh nng thc bo, tng kh nng sn xut khng th v b th, tng
kh nng chng c v kh c ca gan, tng chuyn ha, tng chc nng to mu,
tng hot ng cc chc nng sinh l khc. Trn c s to ra nhiu lin kt giu
nng lng lm cho c th mau chng c hi phc.
Trong y hc ngi ta s dng phn ng st nhn to iu tr nhiu bnh: bnh
thn kinh, bnh vim khp mn tnh, bnh hen, lot d dy, tng huyt p. Do vy cn
phi tn trng khi st nh.
Ngc li ngn chn nhng bin chng c hi khi st cao th phi dng cc
phng php ct cn st. Trong iu tr phi tm ra c cc nguyn nhn gy ra
st iu tr c hiu qu.
108
Chng 3
SINH L BNH CC C QUAN H THNG
1. SINH L BNH H THNG MU
1.1. i cng
Mu l mt t chc lng lu thng trong h thng tim mch, lin lc mt thit vi
tt c cc c quan b phn trong c th. Mu lm nhiu v cung cp cc cht dinh
dng v oxy cho c th, ng thi thanh tr cc cht c v kh CO2. Mu cn ng
vai tr bo v c th, iu ho thn nhit (co mch, gin mch), cn bng nc v cc
cht in gii, iu khin tt c cc hot ng sng ca c th thng qua thn kinh v
th dch. Mc d t cc c quan v cc b phn ca c th a vo mu rt nhiu cc
tp cht nhng mu vn gi c thnh phn ca n mt gii hn nht nh, l s
cn bng tng i lun lun c m bo nh c ch phn x thn kinh phc tp.
V vy, mu chnh l tm gng phn nh hot ng sinh l cng nh bnh l ca c
th. Cho nn nhng bin i ca mu cng nh hng rt ln n hot ng sng ca
c th.
1.2. Ri lon ca mu
1.2.1. S thay i v khi lng mu
Khi lng mu ca gia sc chim t 5-9% ton b khi lng c th, trong

55- 60% l th dch (huyt tng), 40-45% l thnh phn hu hnh (bao gm hng cu,
bch cu tiu cu) Tu thuc vo cc loi gia sc v cc c th khc nhau m khi
lng mu cng nh thnh phn ca mu thay i cht t.
1.2.1.1. Khi lng mu tng (hypervolumer)
Khi lng mu c th tng ton b trong trng hp tip mu, hoc lao ng
nng mu t cc c quan d tr vo vng tun hon, trong trng hp ny c th
d iu chnh tr li bnh thng.
- Khi lng mu tng ch tng hng cu gp bnh tim, phi, ng vt vng
ni cao do c th thiu oxy kch thch cc c quan to mu tng sn xut hng cu a
vo vng tun hon. S lng hng cu c th tng gp hai ln bnh thng.
- Tng khi lng ca mu ch tng huyt tng, thng xy ra gia sc mc
bnh thn, thiu mu, mt mu, gy i lu... trong cc trng hp ny thnh phn hu
hnh trong mu rt t gi l chng mu long.
1.2.1.2. Khi lng mu gim
- Mu c th gim ton b trong trng hp mt mu: mt ton b c huyt tng
ln mu lm cho khi lng mu gim xung, khi c th c nhng phn ng bo v
c th:
109
+ Co mch ngoi vi lm thu hp vt rch, lm mu chy ra ngoi chm hn, ng
thi gi cho huyt p khng b h.
+ Ht nc gian bo vo lng mch gi huyt p khng tt v lm cho
tun hon c th lu thng c.
+ Tit ra cc men ng mu mc ch l bt cc mch qun v tc l hnh thnh
nn cc huyt khi (cc nt Hayem)
Ngoi ra ph hp c th gim hot ng gim tiu th oxy ti thiu.
Nu mt mt khi lng mu t th c th s dn dn khi phc li c, c bit
c quan to mu tu xng tng sinh ra hng cu b p. Nu mt mt khi
lng mu ln, nhanh th nhng phn ng trn khng th p ng kp gy tnh trng
sc o mt mu, ch yu l tru tim mch.
Gim khi lng mu ch yu do gim hng cu, v d: truyn mu khc nhm,
hoc hng cu b dung gii do k sinh trng, vi trng dn n thiu oxy, ch c phn
ng tng snh hng cu a vo vng tun hon.
Gim khi lng mu do gim huyt tng gp trong trng hp nh nn, ma,
bng nng, ra m hi, a chy nng t lm cho mu c c, tru tim mch, mt cc
cht in gii v n c th gy sc.
Gim khi lng mu trong vng tun hon do gin mch t ngt, v d: ng c
histamin, nm c, a sen, thu ngn. Khi b ng c ni b tc ng ng c gin
mch, cn ni khng b nhim c gy mt phn x co tht rt mnh lm cho nc
thot ra ngoi, c trng hp ph hu thnh mch rt nhanh.
1.2.2. Ri ton thnh phn hu hnh ca mu
1.2.2.1. Hng cu (Erythrocytes)
Hng cu c sn xut trong tu xng, khi trng thnh c a vo mu lu
thng trong h tun hon. Hng cu lm nhim v vn chuyn oxy v kh CO2 tham
gia vo qu trnh h hp. Hng cu sng trung bnh khong t 100 - 120 ngy k t
khi tu xng ra mu ngoi vi. Hng cu gi c tiu hu trong h vng mc ni
m ch yu lch, gan v tu xng.
S lng hng cu trong mu ngoi vi tng i hng nh, dao ng t 3,7 triu

n 4,2 triu, tu theo tng loi, ging v gii tnh ca gia sc. Nh vo s hng nh
ny m khi xt nghim mu ngi ta bit c hng cu tng ln hay gim i. Vic to
hng cu thn c hormon erythropoietin, khi tit ra n kch thch tu xng sn sinh
ra hng cu.
110
Bng 7. S lng hng cu mt s loi gia sc gia cm
(VT: triu/1ml mu)
Loi S lng hng cu Loi S lng hng cu
Nga
Tru
B
Cu
D
7-11
3,2 - 6,7
5-8
9-13
12-13
Ln
Ch
Mo
Th
G
5-8
5-8
6-9
5-7
2-5
1.2.2.2. Chng tng hng cu
L hin tng s lng hng cu tng ln trong mt n v khi lng mu.
C th do mt s yu t thng thng sau y:
- Do thiu oxy: khi thiu oxy tu xng b kch thch tng sinh hng cu. Gp
trong cc trng thi bnh l do cc bnh tim, phi, mch, trong trng hp b
ng c...
- Do thn kinh: thn kinh b kch thch cao vo cc vng, c bit l cc vng
no thn kinh trung ng
- Do kch thch ca hormon: hormon h no, hormon sinh dc, hon non do thn
tit ra (erythropoietin).
1.2.2.3. Thiu mu (Anemia)
Thiu mu l tnh trng mu b gim hoc s lng hng cu hoc hemoglobin
hoc gim c hai. l s mt cn bng gia hai qu trnh sinh sn v hu hoi hng
cu. C th qu trnh hu mnh hn qu trnh sinh, qu trnh hu tng, qu trnh sinh
gim hoc phi hp c hai.
a) Thiu mu do xut huyt
Khi xut huyt c th c cc phn x bo v nh co mch, tng nhp tim, tng co
bp tim, tng phn phi li mu, tng h hp, tng ht nc gian bo vo lng mch.
Nhng khi mt nhiu mu th c th khng th thch ng ni, lm vo tnh trng sc

gi l sc chy mu (khi mt t 30-40% th tch mu).

Thiu mu do mt mu l mt hin tng thiu mu nhc sc, tc l cc hng
cu bt mu nht (do thiu st, thiu hemoglobin), ngoi ra cn nhiu hng cu non
a vo vng tun hon, nhng hng cu ny bt mu baz gi l hng cu a baz.
b) Thiu mu do dung huyt
L hin tng hng cu b v do mt s nguyn nhn vi khun, k sinh trng
ng mu, ng c thuc Sulfamid, ng c cc cht c nh phenol, ch, anilin,...
111
Thiu mu dung huyt, do khng mt mu ra ngoi, khng mt st nn c nhng
c im sau:
- Thiu mu ng sc.
- Trong mu ngoi vi c nhiu hng cu li, nhiu nguyn hng cu a sc v a axit.
- Xut hin hemoglobin niu.
- Bilirubin t do trong mu tng r rt.
- Km theo hin tng vng da nh.
- St trong mu tng, hemoglobin t do trong huyt thanh tng.
c) Thiu mu do ri lon chc nng ca c quan to mu
Loi ny phc tp v do nhiu nguyn nhn.
- Do dinh dng: khu phn n c th thiu nhiu loi hoc tng loi nh thiu Fe,
hoc do hp thu km, hoc do bnh gan, hoc thiu st do thiu vitamin C.
- Thiu thot: do dinh dng hoc qu trnh hp thu thot km, c th thiu
nguyn liu c bn ca axit quan to hng cu hoc thiu thot do tiu hao thot
qu mc.
- Thiu mu do thiu vitamin: thiu vitamin C (cn thit cho vic hp thu st),
thiu vitamin B12 v axit folic cn thit cho vic to hng cu, nu thiu B12 gi l
thiu mu c tnh. c im ca loi thiu mu ny l xut hin hng cu a sc, xut
hin hng cu khng l, st trong huyt thanh tng.
- Nu thiu mu do tu xng khng hot ng gp trong trng hp tu xng
b ct ha, u c tnh, bnh c tnh ung th tu xng hoc l thuc c ch tu xng
hot ng: cloroxit, sulfamid, hin tng phng x cng c ch tu xng hot ng
km. c im ca loi thiu mu ny l thiu ng sc hay l nhc sc, hng cu b,
t t bo non, ch yu l tu xng khng sinh ra c t bo mu.
d) Nhng hot ng thch nghi ca c th khi thiu mu
Tt c nhng hot ng ca c th u nhm duy tr cho c th khi b thiu oxy
n mc nguy him. C th l c:
- Tng cng h hp: do lng hng cu gim nht l mt mu do xut huyt cp,
ng thi do nhu cu tn dng oxy cao hn lm cho nng oxy gim, oxy trong t
chc gim, t kch thch trung tm h hp lm tng nhp h hp.
Tng lu lng tun hon nh nhng c ch sau y:
+ Tng nhp tim v tng sc co bp ca tim: thnh phn oxy trong mu gim nn
cc phn x t xoang ng mch cnh, cung ng mch ch v cc phn x ngay c
tim kch thch trung tm tim mch lm tng nhp v sc co bp ca tim.
112
+ Do iu ng khi mu d tr lch, gan vo vng tun hon, ng thi c s
phn phi li mu (gim mu ngoi vi, tng mu tim v no).
+ V thiu mu nn nc gian bo c ht vo lng mch lm cho mu long,
gim nht, sc cn ngoi vi gim, lm mu d lu thng v tc tun hon tng.

- Tng kh nng tn dng oxy ca t chc: Ch s tn dng oxy trong ton b c

th bng 30%, lc lm vic nng c th tng ln 60%, tim ch s s dng 67%, no
62%, c 60% nh vy oxy c tn dng mc cao. Khi c th thiu mu ch s
oxy chung c th ln n 85%, cao hn c cc c quan trn. Do tim, no v c khi
thiu mu l nhng c quan b ri lon u tin lm vo tnh trng thiu oxy.
- Tu xng tng cng sn xut hng cu a vo vng tun hon, biu hin
trong mu ngoi vi xut hin nhiu hng cu non, hng cu li, hng cu cn nhn.
1.2.2.4. Bch cu (Lellkocytes)
a) Khi nim v t chc bch cu
Da vo hnh thi ca bch cu m ngi ta chia bch cu lm hai dng sau:
- Bch cu c ht (Granulocyte)
+ Bch cu a nhn trung tnh (Neurophil)
+ Bch cu i toan (hay toan tnh) (Eosinophil)
+ Bch cu i kim (hay kim tnh) (Basophil)
- Bch cu khng ht (Agranulocyte)
+ Lympho bo (Lymphocyte)
+ T bo plasma
+ T bo Mast
+ Bch cu n nhn (Monocyte hay Macrophage)
* Bch cu c ht
Bch cu c ht c sinh ra, trng thnh trong tu xng v phng thch vo
vng tun hon. Trong nguyn sinh cht ca bch cu loi ny bao gm nhng ht c
bit bt mu trung tnh, axit hoc baz v nh ngi ta chia ra lm ba loi bch cu:
trung tnh, i toan v i kim. Nhn ca bch cu ny bin i dn t non ti gi tc l
t trn to ri b dn v cui cng chia thnh tng t (a nhn). Bch cu nhn c
hnh a l giai on trung gian gia non v gi.
- Bch cu a nhn trung tnh (Neurophil): c cha nhiu men tiu ha thot,
gluxit, oxydaza, peroxydaza v nht l phosphataza kim. Do c nhiu loi men nn
bch cu trung tnh lm nhim v thc bo bo v c th. Ngoi ra n cn tham gia
vo qu trnh gy st, thng qua cht gy st ni sinh.
113
Bch cu i toan (Eosinophil): bch cu ny cng c nhiu loi men trong bo
tng lm nhim v thc bo, c bit thc bo cc phc hp khng nguyn-khng th
trong cc phn ng d ng. N tham gia vo s iu ho min dch bng cch c ch
hin tng phn v thng qua c ch tit histaminaza (men ph hu histamin).
Hormon Glucocorticosteroit v ACTH l hai yu t chnh iu ho v lm gim bch
cu i toan.
- Bch cu i kim (Basophil): giu heparin v histamin c vai tr trong iu ho
tnh thm thnh mch, ng mu v phn ng d ng.
* Bch cu khng ht
- Lymphocyte c sinh ra cc hch lm ba, tu xng, lch, tuyn c, gan, ti
Fabricius v h thng li ni m. Hai chc nng chnh ca lymphocyte l duy tr tt
c cc loi khng th cho p ng min dch dch th v p ng min dch t bo.
- T bo Plasma c to thnh bi qu trnh trng thnh hay bin chuyn t
lymphocyte B. Chc nng ca chng l sn xut v duy tr khng th, chng c mt
nhiu trong mt s loi vim mn tnh.
- Monocyte hay Macrophage c sinh ra t t bo ngun c bit tu xng di

chuyn trong mu mt thi gian ngn, ri ti cc t chc lm nhim v thc bo v

c gi l t bo thc bo.
- T bo Mast: c lin quan vi bch cu i kim v c chc nng hnh thnh
khng th.
b) Ri lon to bch cu
* Ri lon v s lng bch cu
Bch cu c nhiu chc nng khc nhau nhng ch yu l bo v c th. Ri lon
bch cu l s lng bch cu tng, s lng bch cu gim v bnh c quan to
bch cu.
- Tng bch cu: l hin tng s lng bch cu tng ln trong mt n v khi
lng mu, tu theo tng loi gia sc.
Tng bch cu sinh l
+ Sau ba n bch cu t ti mc ti a sau 2-3 gi, nu thc n c nhiu thot
th s lng bch cu a nhn trung tnh tng nhiu, c bit l nga v ch bch cu
tng sau ba n rt r.
+ Tng bch cu sau hot ng c hc: sau lm vic bch cu tng rt r, ch yu
l tng lymphocyte, bch cu trung tnh.
+ Tng bch cu khi gia sc c thai: bch cu a nhn trung tnh tng ln, sau khi
mt tun con m vn tng bch cu sau mi tr li bnh thng. Do khi ngi c thai
tng cng ni tit dn n tng cng hot ng ca t chc c th (t chc bch cu).
114
Tng bch cu bnh l.
y l trng thi c nh trong nhim bnh truyn nhim, v vy l mt ch s cn
thit trong chn on nhng n cng ph thuc vo tnh cht ca bnh v trng thi c
th.
V d: Bnh dch t ln, bch cu khng tng m bch cu cn gim hoc mt
s c th qu yu d c kch thch bnh th bch cu cng khng tng.
Bch cu cn tng do tc ng ca mt s thuc nh: long no, antypirin,
adrenalin, hoc do tc ng khc nh tia phng x, a mt lng thot l vo c th,
hoc sau khi mt mu th bch cu tng. Bch cu tng c th tng tng loi mt.
+ Tng bch cu a nhn trung tnh: trong trng hp nhim khun cp tnh,
nhim c cc cht c ch, thu ngn, nc c rn, cc sn phm phn gii nh hu
huyt, bng, u c tnh ang pht trin mnh. Khi tng bch cu a nhn trung tnh, khi
kim tra ngi ta lu hng nhn ca bch cu, nu tng m c nhiu nhn non
(bch cu u, bch cu gy l bch cu non), ch tiu tng bch cu nhn chuyn
sang tri th tin lng tt. Nu xem nhn bch cu nhiu mi, t th ch tiu nhn
bch cu chuyn sang phi l tng sinh km dn n tin lng km, khng tt.
+ Tng bch cu toan tnh: t l bch cu toan tnh trong mu t so vi bch cu
a nhn trung tnh, thng gp trong bnh k sinh trng, cc bnh d ng pht ban,
bnh ngoi da c tnh cht d ng nh eczema, c bit l trong bnh ln ng du,
bch cu toan tnh tng 45% (toan tnh mang tnh cht gii c chng histamin).
+ Tng bch cu kim tnh: rt t gp, thng gp trong bnh bch cu tu, bnh
a chy mu ngi.
+ Tng lm ba cu (lymphocyte): t l lm ba cu tru b chim cao. Bnh
thng gp cc bnh mn tnh: lao, giang mai ngi, giai on lnh bnh lm ba
cu cng tng. c bit gia cm bnh Marek v Leuco, lm ba cu tng mnh (trong
bnh Leuco tng lymphoblast non, cn bnh Marek tng lymphocyte gm ba loi to,

va v nh).
+ Ngoi ra cn tng t bo n nhn: xut hin nhiu bnh nhim khun mn
tnh nh bnh lao, bnh t th, bnh sy thai truyn nhim v trong cc thi k lnh
bnh (l cc i thc bo dn dp).
+ Xut hin t chc bo (histiocyte): khi t chc lin vng kch thch.
- Gim bch cu: l hin tng s lng bch cu gim i trong mt n v khi
lng mu, tu tng loi ng vt.
+ Gim bch cu ton b: trong bnh dch t ln, trong trng hp ng c: asen,
benzen, sulfamid, hoc trong trng hp chiu tia phng x: tia rn ghen.
+ Gim bch cu trung tnh ch yu do c quan to mu b c ch.
115
+ Gim bch cu toan tnh thy cc giai on pht trin ton din ca bnh.
+ Gim lymphocyte do c quan min dch b c ch nh bnh AIDS ngi,
bnh Gumboro g, ngoi ra cn do cht phng x.
+ Gim bch cu n nhn do c th suy kit, suy dinh dng, gim sc khng
chung.
* Ri lon v cht lng bch cu ch yu biu hin bnh bch cu.
- Bnh Leuko.
c im: Bnh Leuko ging mt qu trnh u c tnh gm 3 c im chnh.
+ Hin tng qu sn: t chc bch cu tng sinh qu mc ln t cc t chc ln
cn, c ch cc hot ng chung.
+ Hin tng d sn (cc t bo khng bit ho): sinh ra cc bch cu c bit t
ging bch cu bnh thng, biu hin l thay i hnh thi ca nhn v nguyn sinh
cht, cho nn khng th xc nh c dng bch cu, v th ngi ta gi chung l
bch cu non leukoblast.
+ Hin tng lon sn tc l sn xut bch cu nhng ni bt thng (v d: u
bch huyt di da lymphodermic) hoc l nang kn lm ba c pht trin thnh c
quan to bch cu.
Kt qu ca ba c im trn l a vo dng mu ngoi vi rt nhiu bch cu non
cha hon chnh trong khi cc dng khc li b gim nh thiu mu gim tiu cu.
C nhiu loi bnh bch cu:
- Bch cu dng tu (Myeloleucose)
- Bch cu dng lympho (lympholeucose)
- Bch cu dng lin vng (Reticulose)
Nguyn nhn v c ch
Hin nay ngi ta cho n l bnh ung th da vo l thuyt ung th, bnh bch
cu c nhng yu t sau y:
(1) Tng sinh cc t chc to huyt to ra t bo mi km chu ng, khng hon
chnh v bit ha.
(2) Gia sc b bnh ri lon trao i cht nghim trng.
(3) Cc cht xut hin trong bnh bch cu c tnh cht cng ging cc cht trong
bnh ung th.
(4) Hu qu iu tr cng ging nh bnh ung th (cng phi dng cc ha cht c
ch s pht trin ca t bo, dng tia phng x chiu c ch s pht trin t bo th
cng thy c hiu qu).
116
Tm li: Bnh bch cu, cc loi bch cu khng in hnh, kh phn bit c

cc loi bch cu, kh nng thc bo v to khng th gim. Hin nay v nguyn nhn
gy bnh ngi ta cha tm c nguyn nhn g chung c nhng ring l tng bnh
th ngi ta thy (v d nh vi rt leuko). Mt s trng hp nu chiu tia phng x
lu hoc dng ha cht: methyl clokintrena, benzopinena s dng nhiu cng gy ung
th v bnh bch cu ( ngi Trong bnh bch cu thy ri lon chc nng v tnh
phn ng l r nht. Bch cu ch yu gi chc nng to khng th v thc bo do
khi gim bch cu xut hin cc hin tng vim, lot, hoi t t chc v nhim trng
mu. Ri lon qu trnh trao i cht do gim hot tnh ca cc men trong t bo. c
bit hng cu v tiu cu gim cho nn va gy thiu mu, va d xut huyt. Bch
cu c th thm ln vo cc c quan t chc, bin t chc thnh t chc ca bch
cu lm cho chc nng ca c quan gim sau mt.
1.2.2.5. Tiu cu (Platelet hay thrombocyte)
Tiu cu l thnh phn hu hnh nh nht ca mu c tn l Platelet hay
thrombocyte. Tiu cu c to ra trong nguyn sinh cht ca nhng t bo
Megakaryocyte ca tu xng v c a vo vng tun hon mu. Tiu cu tit ra
thrombokinaza c tc dng ng mu.
S lng tiu cu thay i c lin quan ti qu trnh bnh l ca cc c quan to
mu:
- S lng tiu cu gim.gp trong bnh thiu mu c tnh, bnh gim bch cu v
mt s bnh truyn nhim (thiu mu truyn nhim nga, bnh xut huyt im), gp
trong trng hp ng c benzen, bnh nhim x (chiu tia rn ghen, phng x nng)
Hu qu ca gim tiu cu l gim qu trnh ng mu (xut hin chy mu di da,
nim mc d dy, rut).
- S lng tiu cu tng gp khi mt nc, mu b c c, trong qu trnh hi phc
ca bnh truyn nhim, trong trng hp thiu mu dai dng th tiu cu tng, tng c
t bo m (megakaryocyte) ca tiu cu do tu xng tng sinh.
1.2.3. Ri lon qu trnh ng mu
1.2.3.1. Kh nng lm ng mu l c ch bo v sinh hc, bo v cho c th
khi b mt mu khi b cc yu tkllc nhau gy tn thng
Qu trnh ng mu gm ba giai on:
- Giai on mt: l s tng quan v ha sinh rt phc tp, to ra hot tnh ca
men thrombokinaza th thromboplastin v tiu cu kt hp vi s tc ng tng h
gia chng vi protein ca huyt tng.
- Giai on hai: thrombin c hot ha trong huyt tng t prothrombin, hot
ha prothrombin c s tham gia ca con Ca2+, men thrombokinaza hot ha v protein
ca huyt tng.
117
- Giai on ba: thrombin chuyn fibrinogen thnh fibrin c th ho tan, sau
fibrin c th ho tan di s tham gia ca con Ca2+ v yu t n nh fibrin (yu t
XIII) tr thnh dng si fibrin khng ho tan (ti mu si t huyt).
1.2.3.2. Qu trnh chng ng mu
Ngc li vi qu trnh ng mu l qu trnh chng ng mu, bao gm cc yu
t sau tham gia:
- HepHrin l cht chng ng mu c to ra gan, phi v trong cc t bo m
quanh cc huyt qun.
- Fibrinolysin (plasmin) lm tan fibrin.
- Hng lot cc cht thot ngn cn s to ra thrombin v thromboplastin, phn

hu fibrinogen dn ti chng ng mu.

S ng mu v chng ng mu l hai h thng lin quan n nhau, tc ng
tng h vi nhau, n c tc dng lm cho mu c th lng v lu thng c. S
iu tit chung ca hai h thng ny l c ch iu ho ca thn kinh v th dch.
1.2.3.3. Ri lon ng mu
Ri lon s ng mu cng c th do nhiu nguyn nhn gy nn tng hoc gim
tc ng mu. Tc ng mu ca cc loi ng vt khc nhau cng khc nhau (
nga tc ng mu chm hn so vi cu, ch v cc loi th nui ly lng nh
chn, co...).
- Tc ng mu chm c th gp:
+ Ri lon h thng prothrombin v fibrinogen do cc bnh ti gan.
+ mt vi bnh thiu mu lm gim bch cu hoc thiu cht phylochinol vo
c th.
+ Thiu tiu cu trong chong (sc) qu mn, bnh huyt thanh, u c tnh lm
gim ton Ca2+.
+ Tng to cc cht chng ng mu nh heparin.
Gim tc ng mu thng trng lp vi s tng tnh thm thnh mch dn ti
hin tng xut huyt trong cc t chc khc nhau nh trong st xut huyt, thiu mu
truyn nhim nga, hong n, chy mu chn rng...
- Tc ng mu nhanh: thng gp khi mu b c c, trong bnh vim phi,
bnh thn cp tnh v trong mt s trng thi bnh l. Thng ph hp vi s hu hoi
t chc (st cao).
Tng tc ng mu thng do tn thng thnh mch, cc dch th vo mu
mang theo nhiu thromboplastin, tha ton Ca2+ v phylochinol vo c th. Tc
ng mu nhanh d gy hin tng huyt khi dn ti lp qun, nhi huyt.
118
2. SINH L BNH TUN HON
2.1. i cng
B my tun hon gm tim v h thng mch c chc nng ti mu y v
lin tc cho mi t bo nhm to ra mi trng sng thun li cho chng, khi chng
trng thi ngh cng nh khi chng hot ng cng cao nht.
Chc nng tun hon bao gm:
(1) Cung cp cc cht dinh dng, m bo nng khng gim trong mi trng
quanh t bo;
(2) Mang i cc cht do t bo o thi, sao cho nng chng khng tng;
(3) a cc hormon t tuyn ti t bo.
Nh vy, h tun hon to iu kin cc t bo d dng trao i cht vi mi
trng xung quanh chng, gm tip nhn v o thi.
Ton c th cng nh tng t bo ca n lun lun thay i cng hot ng
thch nghi vi iu kin sng, ko theo s thay i nhu cu trao i cht, do vy h
tun hon cng phi thch nghi theo. S ph hp gia lng mu c cung cp vi
nhu cu trao i ca t bo ph thuc vo kh nng thch nghi ca h tun hon, tc l
kh nng tng nng sut ca tim v mch.
Kh nng thch nghi ca h tun hon l rt ln. V d: n c th tng chc nng
ln 8 - 10 ln lc c th hot ng th lc ti a so vi lc c th hon ton ngh
ngi bnh thng, hay 12-15 ln ngi c luyn tp. l nh s phi hp ca
tim, mch, h hp v gan. Tim v mch m bo s lng mu; cn h hp v gan

m bo cht lng mu.

S d h tun hon thc hin c nhng chc nng trn l nh s hot ng nhp
nhng ca tim v mch. H thng tim mch c th hot ng tng hay gim thch
nghi vi nhu cu lun thay i ca c th l nh s iu khin ca h thn kinh - th
dch ngay trn c quan tun hon v thn kinh trung ng.
Ri lon tun hon s dn ti ri lon hng lot cc chc nng khc ca cc c
quan, h thng trong c th, lm gim tnh thch nghi ca c th i vi mi trng
ngoi, c bit ngng tun hon c th s cht. Bnh l ca h tun hon ch yu ph
thuc vo hot ng ca tim v mch. Ri lon tun hon gp trong hu ht cc bnh
ca tim, mch, h hp v h thn kinh. Ngoi ra, cc c quan h thng khc nh: gan,
thn, ni tit,... cng c nhng nh hng nht nh n hot ng ca tim v mch.
2.2. Ri lon tun hon ph thuc vo tim v mch
2.2.1. Ri lon hot ng ca tim
2.2.1.1.. Thay i lu lng
119
a) Lu lng mu tng
- Tng nhp ch yu do nhu cu c th v n ph thuc vo cc phn x sau:
+ Phn x Marey: Khi huyt p xoang ng mch cnh v cung ng mch ch
gim (trong sc chy mu nng, mt nc nghim trng...) tc ng ln c quan cm
th cung ng mch ch v xoang ng mch cnh t kch thch ln trung khu
tim mch lm cho tim p nhanh nhm khi phc huyt p.
+ Phn x Bainbridge: Khi huyt p nh phi tng (trong suy tim) tc ng ln
c quan cm th t kch thch ln trung khu tim mch lm cho tim p nhanh
tng huyt p.
+ Phn x Alam-smirk: Khi mu c tim khng , gy trng thi thiu oxy c
tim kch thch tim p nhanh cung cp oxy cho c tim.
- Tng co bp: l tng c mt lng mu nhiu nht t tim i vo mch qun.
Do vy tng nhp v tng co bp lm cho lu lng mu tng ln.
b) Lu lng mu gim
Tc l gim nhp v gim co bp c th do cc nguyn nhn sau y:
- Gim chuyn ha lm thiu nng tuyn gip, nhu cu v oxy t.
- Do tru mch gy gim t ngt dn n hin tng sc do lu lng mu i cc
ni thp.
- Lon nhp: tim p nhanh nhng sc co bp qu yu nn lng mu ra khi tim
t, dn ti lu lng mu gim.
- Do h hp van tim: mc d co bp rt mnh nhng lng mu vo trong ng
mch t.
Ngoi ra, trong cc bnh nh vim ngoi tm mc, vim c tim, vim mng phi,
vim bao tim do ngoi vt... lm gim p lc co bp ca tim dn n gim lu lng
mu.
c) Gin tim
L tnh trng t bo c tim gin di ra hn trc. C hai loi gin tim:
- Gin tim sinh l: tim c th gin tng lu lng, tim cng gin to ht mu
cng nhiu tng sc cha ng ca qu tim, ng thi co bp mnh tng mt lng
mu ln vo vng tun hon: thy vn ng vin th thao rn luyn tt, tim co bp
cht gin rng.
Gin tim bnh l: thng gp trong suy tim khi sc co bp ca c tim gim do

bnh ca h tim mch hay do nhng nguyn nhn ngoi tim mch. y l trng hp
th ng, do c tim yu mm, gim trng lc c tim, sc co bp ca tim yu nn
mu li trong tim gy gin tim.
120
d) Tim ph i (thnh c tim to ln)
L tnh trng mi si c tim to ra (tng ng knh) khin vch qu tim dy ln,
tc l tng khi lng hn trc.
S gin tim sau mt thi gian di, nu tim tng cng gin rng v co bp mnh
th si c tim to ra dn n hin tng tim ph i. Cng c th do trng lc ca c
tim cng mnh th sc co bp cng kho v nh vy tim s ph i. Tim ph i sc co
bp ca tim tng, do tim ph i l c ch thch nghi quan trng ca tim trong iu
kin sinh l cng nh trong bnh l.
- Ph i sinh l: gp nhng c th vn ng nhiu nn t l trng lng ca tim
v trng lng c th khng thay i.
- Ph i bnh l: gp trong cc bnh tim mch (bnh v van tim, bnh huyt p
cao). c im ca ph i bnh l l trng lng ca c tim khng tng ng vi
trng lng ca c th. Cng c trng hp tim ph i ng tm, c tim tng cng
hot ng u; ph i khng ng tm do ph i mt phn ca tim v phn tng
cng hot ng.
Tim ph i l mt bin php thch nghi quan trng ca tim. Song tim ph i qu
mc s dn ti suy c tim.
2.2.1.2. Suy tim (Heart Failure)
L trng thi bnh l khi tim mt i mt phn hoc ton b kh nng co bp
y ra khi tim mt lng mu thch hp vi s i hi ca c th.
a) Nguyn nhn gy suy tim
- Do bnh h tim mch:
+ Do nhim c, nhim khun v cc c t tc ng ln tim gy ri lon chuyn
ha c tim, thm ch gy tn thng c tim dn dn dn ti suy tim.
+ Do cc loi bnh tim: suy tun hon mch vnh, bnh van tim, ri lon nhp
tim, cc bnh tim bm sinh, v.v. lm tr ngi n hot ng ca tim dn ti thiu oxy
cho ton b c th trong c c tim gy ri lon chuyn ha c tim dn ti suy
tim.
+ Cc bnh mch: huyt p cao cng gy tr ngi n c tim v tim phi co bp
mnh dn ti ph i v dn dn dn n suy tim.
- Nguyn nhn ngoi tim:
+ Nhim trng: gy tng chuyn ha, nhu cu oxy cao, bt tim tng hot ng c
th dn ti suy tim.
+ Nhng bnh phi: hen suyn, kh ph nang, x phi, vim phi mn,... lm
cn tr ti tun hon phi gy trng thi thiu oxy dn ti suy tim phi.
121
+ Thiu mu: khi thiu mu buc tim phi tng cng hot ng b p v nhu
cu oxy ca c th. S tng hot ng lin tc nh vy s dn n suy tim.
+ Nhng bnh v chuyn ha v dinh dng nh: u nng tuyn gip lm tng
chuyn ha c bn, tng nhu cu v oxy. Thiu vitamin B1 cng gy ri lon tng hp
axetyl-CoA dn ti ri lon to nng lng, nh hng ti s co c ca tim.
b) C ch ca suy tim
Cho ti nay gii thch mt cch tng tn v c ch suy tim th ngi ta cha

tm ra c mt gi thuyt no tho mn, song suy tim thng xy ra do my l do

sau:
- Tn thng nguyn pht: thiu mu cung cp cho c tim, cc c t hu hoi c
tim.
Tn thng th pht: sau khi c tim lm vic qu sc m vic cung cp oxy v
dinh dng t, oxy thiu c tim yu dn v suy kit.
- Ri lon chuyn ha ti c tim: l yu t bnh sinh ch yu ca suy tim. Qu
trnh chuyn ha c tim din ra ba giai on: sn xut nng lng, bo qun nng
lng v s dng nng lng. Nu mt trong ba giai on b ri lon kh nng co
bp ca tim gim dn n suy tim.
+ Suy tim do ri lon to nng lng: hu qu ca ri lon chuyn ha dn n ri
lon to nng lng, c bit ri lon chuyn ha gluxit, lipit, thot, cc cht in gii,
vitamin, men.
+ Suy tim do ri lon s dng nng lng: Co c tim ch pht sinh khi ha nng
chuyn thnh c nng (s dng nng lng co c). C tim c th gim co bp do
ri lon s dng nng lng hoc hoi t c tim lan rng, c tim khng c kh nng
s dng nng lng hoc do gim hot tnh ca men ATP-aza (trong myosin) hn
ch gii phng nng lng t ATP. Cc con Ca++, M rt cn cho s hot ng ca
men ATP-aza, nu thiu ton Ca++ s lm gim hot tnh ca men ATP-aza dn ti ri
lon s dng nng lng pht sinh suy tim.
c) Ri lon ch tiu hot ng ca tim khi suy tim
Gim lu lng: khi suy tim kh nng co bp ca tim gim, mu ng trong tm
tht vo vng tun hon t.
- Th tch mu tng: khi suy tim khng y ht mu ra khi tim, mu tr v tim
khng y , b li h tnh mch, mu qua thn t nn t lc cu thn, gim gi
nc v mui do th tch mu tng.
- Gim lc mu chy: kh nng co bp ca tim gim nn mu chy chm, c
bit mu b li phi khi suy tim tri v mu li trong h tnh mch ngoi vi khi
suy tim phi.
122
- Thay i huyt p: trong suy tim huyt p ng mch gim do lu lng mu
gim v mch ngoi vi gin, cn huyt p tnh mch tng v mu li tnh mch
(phi v ngoi vi).
- Cng v hiu sut ca tim gim:
Cng ca tim c tnh bng cng thc: W = QP trong , W l cng ca tim; Q
l lng mu phng ra; P l huyt p ng mch.
Trong suy tim lng mu tng ra gim, huyt p gim nn cng ca tim gim. Khi
tim suy cng sut ca tim gim ng thi, tim p nhanh, tiu th oxy nhiu hn, kt
qu l hiu sut ca tim gim.
d) Cc biu hin ra bn ngoi ca suy tim
- Nhng biu hin chnh ca suy tim tri (Left-sided heart failure):
+ Kh th biu hin th nng, nhanh c cm gic ngt: hin tng kh th do tim
tri suy, co bp yu khng y ht mu ra khi tim dn dn pht sinh mu phi,
chn p ln ph nang gy kh th.
+ Ph phi: mu li phi lm tng p lc thu tinh, nc thot ra ph nang gy
ph phi.
+ Trao i kh gim: do mu nn tnh n hi ca phi gim, lm cho lng

khng kh trao i phi gim. Suy tim tri ko di c th dn ti x phi (do tr

tun hon dn ti ri lon trao i cht phi, tch lu sn phm chuyn ha trung
gian, nng axit tng to iu kin cho t chc x pht trin).
- Nhng biu hin chnh ca suy tim phi (Right-sided heart failure):
+ Ri lon chc nng ca gan: khi suy tim phi gy mu ti gan, gan to ra, tun
hon ri lon dn ti ri lon trao i cht ti gan. T bo nhu m gan thoi ha m
dn dn cng dn ti x gan.
+ Ri lon tit niu: lu lng mu qua thn gim, huyt p tnh mch tng lm
gim p lc lc cu thn gy gim lng nc tiu.
+ Ph trong suy tim do nhiu yu t gy nn:
Huyt p tnh mch tng lm cho nc thot khi lng mch ra ngoi nhiu.
Gim p lc keo: do gan gim tng hp protein huyt tng v mu ri lon
chuyn ha gan.
Nc tch li ko theo mui do gim lc cu thn.
+ Hin tng xanh tm: triu chng ny hay gp c th suy tim nng v mu
khng lu thng nn nng cacbon hemoglobin tng, ngc li oxy t bo ho, cc
mao tnh mch b gin, mu.
2.2.2. Ri lon hot ng ca mch mu
123
Mch mu ng vai tr quan trng trong hot ng ca h tun hon. Ri lon
mch mu thng do s thay i tnh cht c l hc ca thnh mch bao gm:
- nhn ca lng mch qun.
- bn ca thnh mch.
- Tnh cht n hi ca mch.
- Sc cng ca mch qun.
Nhng ri lon ny biu hin c th ln s thay i ca huyt p.
Ri lon iu ho huyt p
a) Trng hp sinh l bnh thng
m bo c hot ng bnh thng ca cc c quan t chc th huyt p
ng mch phi gi mt mc nht nh. Mc huyt p ph thuc vo nhng yu t
sau y:
- Khi lng mu tun hon: khi lng mu tng th huyt p tng, cn khi
lng mu gim th huyt p gim.
- S hot ng ca tim: tim tng hot ng th huyt p tng v ngc li.
- Tnh n hi ca mch qun n lm cho dng mu chy theo nhp p ca tim v
n phn phi u ti cc mao mch. Nu tnh n hi gim (mch gin khng co) mu
tr s cn tr vic chuyn t ng nng ca tim thnh th nng ca thnh mch
trng thi gin do sng mch gy nn, v th mch qun kh tr li th ban u.
- Trng lc ca thnh mch qun: trng lc thnh mch qun c iu tit bi
c ch ca thn kinh v ni tit. Cc yu t vasopressin, histamin, re nin... tc ng ln
thnh mch qun thng qua cc u mt thn kinh ca thn kinh vn mch. Mc huyt
p m gi c mc nht nh u do iu ho t ng ca trng lc thnh
mch. Trong c th mun kim tra mc huyt p bng phn x ti vng cung ng
mch ch v xoang ng mch cnh v cc c quan cm th khp ni trong c th.
Sc cn ngoi vi: tc l sc cn mu trong mch qun ti cc tiu ng mch v mao
ng mch. Khi co cc tiu ng mch ny th sc cn tng ln cn khi gin cc
tiu ng mch ny th sc cn gim v huyt p gim.

Huyt p c hng nh tng i ng vt cao cp l do s tham gia ca v

no, ca trung tm vn mch vng hypothalamus v hnh tu.
124
Bng 8. Huyt p ng vt bnh thng
Huyt p ng mch (ct mmHg)
Loi ng vt
Cc i Cc tiu Mch
Huyt p tnh mch
mm (ct trc)
Nga-La
Tru-B
Lc
D-Cu
Ln trng thnh
Ch
100-120
110-140
130-155
112-120
135-155
120-140
35-50
35-50
50-75
50-65
45-55
30-40
60-70
90
80
50-55
90-100
90-100
80-130
80-130
220-280
90-115
90-110
90-110
(Theo ti liu Sinh l ng vt nng nghip, A.A MypHBear 1977)

b) Bnh l ca huyt p
- Tng huyt p do nhiu qu trnh bnh l sau:
+ Gin tip kch thch cc trung tm vn mch (v d: khi ngt CO2 tng cng
kch thch, do nhim c ch, strychnin gy ri lon h thn kinh trung ng dn ti ri
lon cc vng phn x nh cung ng mch ch, xoang ng mch cnh).
+ Ri lon ni tit: u nng tuyn thng thn, tuyn gip (tng catecalamin,
aldosteron, ACTH, vasopressin, tng tyroxin).
+ Qu trnh bnh l thn nh vim thn cp tnh, vim thn mn tnh, do ni tit

t re nin kch thch h thng tng huyt p.

Khu chnh trong bnh tng huyt p l s ri lon c trn ca vng tun hon ln
lm thay i tnh cht l hc ca thnh mch qun, n hi v sc cng ca mch
quan.
+ Do ri lon trao i cholesterol l mt yu t lm thay i tnh n hi ca
mch v sc cng ca mch, ng thi lm tng sc cn ngoi vi.
+ Bnh tng huyt p cng c th do nhng nguyn nhn di truyn l tng hot
tnh ca c ch vn mch.
- Gim huyt p:
Khi huyt p gim th xut hin gim trng lc ca ng mch v tiu ng
mch do mt s l do sau:
+ Gim hot ng ca tim.
+ Lit trung tm vn mch v cc hch thn kinh thc vt ngoi vi ca h thn kinh.
+ Ri lon h thng ni tit.
+ Gim khi lng mu tun hon.
125
+ Gim trng lc ca cc mao mch qun ngoi vi.
Gim huyt p mn tnh c th do cc qu trnh bnh l di tc ng ca cc c
t ca vi khun (trong nhim khun) lm cho c th suy kit. ng vt c th do i,
nui dng km, thiu dinh dng, thiu vitamin. Khi gim huyt p cao dn ti
gim ton b hot ng sng ca c th gy trng thi bnh l gi l sc (shock).
- Sc (shock).
Trong tt c cc trng hp sc u thy huyt p gim nghim trng. Sc c th
do nhiu nguyn nhn gy ra: chn thng, sau phu thut, sau khi mt mu, sc do
ni c t, sc phn v, sc do in git, sc do truyn mu.
Trong thc nghim ngi ta c th gy sc chn thng din bin qua cc giai
on sau:
+ Giai on hng phn c tnh cht tm thi (ngn) biu hin tng hot ng ton
b chc nng ca c th: tim p nhanh, h hp tng, huyt p tng, con vt ku la vt
v.
+ Giai on sc: ton b c th b c ch, v no b c ch v c ch lan to ti
cc trung tm di v, ton b c th suy sp, tim p chm, h hp gim, huyt p
gim, cc phn x u gim, thng con vt khng hi phc c dn ti t vong (do
thiu oxy cao , ri lon trao i cht cao dn ti nhim c axit v cht)
- Tru mch
L tnh trng suy mch cp do trung tm vn mch b c ch su sc dn ti gin
mch ton b, mu t v tim, khng ln no gy thiu mu no, c ch v no v cc
trung tm di v no t c ch hot ng sng ca c th dn ti nhim c axit.
Mt khc do ri lon chuyn ha dn ti nhim c axit. Gan khi thiu mu dn ti
thiu oxy nghim trng v tit ra cht gy gin mch VDM (Vaso-dilatator-material)
lm cho mch cng gin, mu nng v nhim c cng nng.
Tru mch c th do nhiu nguyn nhn:
+ Do nhim trng, do c t ca vi khun v cc sn phm trong qu trnh sng
ca vi khun tc ng ln thnh mch, trung tm vn mch v c tim.
+ Do chc tho hi trong bnh chng hi d c mt cch t ngt v vy mch
mu thnh bng c gii phng t ngt gin qu mc, mu dn v ni tng gy
thiu mu no.

+ Do leo cao hoc ht th khng kh thiu oxy c th pht sinh tru mch, gim
huyt p.
+ Do thay i t th nh nm lu, ng ln t ngt gy thiu mu no v mu
dn xung pha di c th theo trng lng m cc trung khu thch nghi khng kp
a mu ln no.
126
- Ngt
L trng thi bnh l m lm cho con vt mt tri gic bt thnh lnh trong mt thi
gian ngn, sau t hi phc li c. C ch ch yu ca n l t ngt thiu mu
no.
c im ca ngt l gim ton b chc nng ca ton b c th khng th p
ng vi cc kch thch bn ngoi, c vn nho. Trong mt vi pht nu mu no khng
hi phc, thiu mu ko di dn ti cht.
- X cng mch
Gim tnh n hi thnh mch do cc nguyn nhn sau:
+ Lng ng cholesterol trong thnh mch.
+ Do lng ng can xi.
+ Lng ng cht knh.
C ba nguyn nhn trn u xut pht t ri lon chuyn ha thnh mch lm thay
i tnh cht l ha. Ri lon chuyn ha thnh mch do nhim c t thc n a
vo, hoc k sinh trng di hnh, vim c bit tru b hay can xi ha thnh mch.
Hu qu:
- X cng mch d to thnh huyt khi.
- Hp lng mch qun cn tr lu thng mu d dn ti ph i tim.
- X cng mch lm tng huyt p.
3. SINH L BNH H HP
3.1. i cng
B my h hp l c quan ch yu ca c th lm nhim v trao i kh gia c
th v mi trng bn ngoi. Nh c s trao i m c th sng hp thu c oxy
v thi kh cacbonic ra bn ngoi.
Vai tr ca h hp v cng quan trng i vi c th sng, thng qua trao i kh
cn bng kim toan, iu ho thn nhit, nu h thng h hp ngng hot ng qu 5
pht l c th c th b hu dit. Trung tm h hp nm hnh no v cu no (bao
gm trung tm ht vo, trung tm th ra v trung tm iu chnh) c chc nng iu
ho h hp t ng, cn v no chi phi h hp gng sc. Trung tm ny rt nhy cm
i vi s thay i m CO2, O2, pH v c nhit ca mu qua no.
Ngoi trung tm ni trn, chc phn h hp cn chu s iu ho ca cc c quan
cm th ti xoang ng mch cnh, quai ng mch ch, ca cc dy cm th ngoi vi
ti da, ti c v nht l chu s iu ho ca v no.
H hp l qu trnh trao i kh ca sinh vt vi mi trng bn ngoi nhm cung
127
cp oxy cho c th v o thi kh cacbonic khi c th.
Qu trnh h hp gm bn giai on chnh:
- Giai on thng kh (hay cn gi l h hp ngoi): l giai on thc hin s trao
i kh gia ph nang vi ngoi mi, th hin bng hai ng tc lun phin ht vo v
th ra. Trong ng tc ht vo cc c h hp co li lm cho lng ngc gin n, nh vy
to ra p lc m trong ph nang (so vi p lc kh quyn) c tc dng a khng kh

vo phi. Chc nng ca thng kh l i mi khng kh ph nang PCO2 kh

cn khi tng ln v PO2 khi gim xung.
- Giai on khuch tn: Bn cht l s trao i kh th ng gia ph nang vi
mu (qua mt cu trc gi l mng khuch tn, gm vch ph nang v vch mao
mch...). Mc chnh lch p sut cht kh hai bn mng, tng din tch vch ph nang,
dy ca n v ho tan tng cht kh quyt nh tc khuch tn mi loi kh.
- Giai on vn chuyn: l qu trnh mu em oxy t phi ti cc t bo, ng
thi em kh CO2 t t bo theo chiu ngc li ti phi. Hiu qa ca giai on
vn chuyn ph thuc vo chc nng mu v tun hon.
- Trao i qua mng t bo v h hp t bo: H hp t bo l s dng oxy trong
t bo to ra nng lng cho hot ng t bo. Ti mng t bo, c s thu nhn oxy
v o thi CO2. Qu trnh trao i kh ny ph thuc vo phn p mi cht kh hai
bn mng t bo, thc cht l ph thuc vo cng h hp bn trong t bo. Mc
tiu th oxy (lm gim po2 trong t bo) quyt nh tc oxy t mu vo t bo. Nu
h hp t bo gim cng th d mu c y oxy, t bo cng khng th tip
tc tip nhn.
3.2. Ri lon h hp
3.2.1. Ri lon qu trnh thng kh
3.2.1.1. Ri lon thng kh do thay i khng kh ht th
Bnh thng khng kh ht vo gm 20,96% oxy v 0,04% CO2, khi thay i
thnh phn khng kh lng oxy gim, CO2 tng cng vi lng NH3 v hi nc,...
(trong iu kin v sinh km, chung tri b, thiu s thng thong) oxy cung cp t s
dn ti trng thi ngt.
V d: Lng CO2 chim 6-8% gy kh th, CO2 chim 8-10% gy ngt, cn CO2
chim 15-20% gy ngt c ch ton thn, tim p chm, huyt p gim dn ti hn
m, cn khi lng CO2 chim ti 30% gia sc cht do t lit h hp.
Ngt l tnh trng bnh l xy ra do thiu oxy trong thnh phn khng kh th.
Ngt c th do nhng nguyn nhn sau y gy ra:
- Do khng kh xung quanh khng c thay i, kh cacbonic th ra cng ngy
cng tch li, oxy cng ngy cng t i.
128
- Do chng ngi trn ng kh qun nh tht c, bp c, co tht kh qun phn
x
- Do ph nang b trn y nhng cht dch nh trong ph phi cp, hay xp xung
nh trong xp phi.
Qu trnh ngt thng chia ra lm ba giai on:
+ Giai on hng phn: trung tm h hp b kch thch cao do kh cacbonic
tng v oxy gim trong mu, con vt th su v nhanh, tip theo l kh th vo.
Trung tm vn mch cng b kch thch nn tim p nhanh, huyt p cao, tip theo h
hp chm li, kh th ra, co git ton thn, co bp c trn gy a i.
+ Giai on c ch. h hp b ngng li v c nhng lc ngng th hn, huyt p
h do trung tm h hp b c ch bi m kh cacbonic qu cao trong mu.
+ Giai on suy sp ton thn: trung tm h hp, vn mch u b c ch mt
cch su sc bi m kh cacbonic tng cao trong mu. Do cc phn x mt,
ng t gin, c mm nho, huyt p gim, co bp tim rt chm v yu. Th ngp c,
ri ngng hn.
Ngoi tnh trng ngt trn ta cn thy mt tnh trng khc xy ra nhng vng

ni cao nn cn gi l "bnh ni cao". Khi ln vng cao t l cc thnh phn khng kh

khng thay i nhng p lc khng kh gim, nn p lc ring phn ca tng cht kh
cng gim theo.
V d: Khi p lc khng kh xung 600 mmHg (bnh thng 760 mmHg) th p
lc oxy ch cn 600 x 20,96% = 126 mmHg, p lc oxy gim nh vy gy nn tnh
trng thiu oxy v gy hin tng th nhanh giai on u. Nhng khi th nhanh s
o thi nhiu kh cacbonic, lng CO2 trong mu gim lm cc trung tm h hp kh
b kch thch nn tip theo thi k th nhanh l thi k th chm v yu.
i vi nhng c th hot ng nhiu cc vng ni cao c th dn ti hin
tng nhim c axit.
3.2.1.2. Ri lon thng kh do cc bnh ca b my h hp
B my h hp hot ng bnh thng m bo cho khng kh t ngoi n ph
nang v ngc li khi trao i th t ph nang ra ngoi. S hot ng nhp nhng
l nh cc c h hp vn ng, p lc ca lng ngc v s lu thng ca kh qun, ph
qun.
- Bnh lit c h hp: Cc c h hp c th b lit do tn thng thn kinh tu
sng (c honh, c gian sn, c c) hoc do vim nhiu dy thn kinh, bnh gy tn
thng ct sng vo khu vc c, lng hoc do cc bnh c ngc. Khi lit mt phn
th thng kh gim v khng biu hin r rt. Nu lit ton b c h hp con vt s cht
do ngt.
129
- Tn thng lng ngc: Lng ngc tn thng s nh hng ti p lc ca lng
ngc nh gy xng, vo ct sng), c bit l trn kh, trn dch ph mc. Trn kh
lng ngc do tn thng lm cho xoang ngc thng vi kh tri, mt p lc m, phi
b xp hn ch din tch h hp. Trn dch lng ngc: dch ph hoc dch r vim hoc
mu (do xut huyt ni) tch trong xoang ngc, chn p ln phi hn ch tnh n hi
ca phi.
- Tr ngi ng h hp:
+ Tr ngi ng h hp trn khi b vim ph, u so, d vt chn p ng h
hp trn. Kh qun, ph qun b vim, gy ph, sng nim mc lng kh qun, ph
qun lm cho tit din lng kh qun, ph qun b hp li hoc trong hen suyn, vim
mn tnh kh qun dy, xut tit dch r vim lm hp, c bt cc kh qun. Bnh nguy
him nht l bnh bch hu, bnh CRD, bnh u th ming, bnh Newcastle, vim
thanh kh qun truyn nhim. c bit do cc vt l ri vo kh qun. Cc nguyn nhn
trn cn tr thng kh gy kh th.
+ Tr ngi ng h hp di: ch yu l vim phi (trong bnh t huyt trng
ln), ph nang v cc vi ph nang b tn thng, dch r vim v dch ph xut tit lm
ng c cc ph nang v vi ph nang, khng kh khng lt vo ph nang, khng tip
xc c vi li mao mch. Ri lon h hp trong bnh suyn ln c ch ch yu
gy kh th l do cc c trn ph qun v vi ph qun co tht kt hp vi ph n v
xut tit cht dch lm cn tr thng kh gy thiu oxy trng din. Tr ngi thng kh
ng h hp di ngoi vic gy ri lon thng kh cn tr kh vo ph nang cn nh
hng ti c qu trnh khuch tn ca O2 v CO2.
3.2.2. Ri lon qu trnh khuch tn
3.2.2.1. Cc yu t nh hng n qu trnh khuch tn
a) Din tch khuch tn
Din tch khuch tn l b mt ph nang tip xc vi mao mch phi nh tnh n

hi ca nhu m phi v sc cng b mt ca mng cht nhy trng bn trong ph nang

c tc dng lm tng sc n hi ca phi.
b) Mng khuch tn
Mng khuch tn bao gm nm lp: lp mng t bo, lp khe t bo, lp mng
mao mch, lp huyt tng v hng cu. Oxy phi xuyn qua nm lp ny lt vo
trong hng cu. Trn thc t lp mng khuch tn gm ba lp chnh l lp nc trng
bn trong t bo, lp mng t bo v thnh mch ca mao mch phi. C ba lp to
thnh mt mng gi l mng trao i, dy 4. Cc cht kh mun khuch tn qua
mng trao i phi c ho tan trong cc lp nc ny. ho tan ca kh CO2 ln
hn ho tan ca O2 24 ln v(kh nng khuch tn ca kh CO2 >O2 20 ln.
c) Hiu s khuch tn
130
Kh nng khuch tn ca phi cn ph thuc vo p lc kh hai vng ph bo v
mao mch phi.
- Ti phi
Ph bo
Thnh t bo
Thnh mao mch
Trong tnh mch
-Ti m bo cc c quan
Mu ng mch
Thnh mao mc
T bo m bo
Do s chnh lch trn m O2 t phi c th khuch tn vo mu, ri t mu ng
mch vo cc t bo ca cc c quan, t chc. Ngc li kh CO2 t t bo ca cc c
quan t chc vo mu v t mu tnh mch khuch tn vo ph nang tng ra ngoi.
3.2.2.2. Nhng tnh trng bnh l phi nh hng n qu trnh khuch tn
a) Kh ph nang
Bnh ny lm cho cc ph nang cng to, tnh n hi b gim v:
- Din tch khuch tn b thu hp khi b kh ph nang, mt s ph nang cng to,
chn p cc ph nang khc v chn p mch qun lm mt s ph nang b xp, mu
khng lu thng c.
- Mng khuch tn dy to ra do t chc x pht trin quanh cc ph bo (khi kh
ph, mu khng lu thng gy ri lon dinh dng t chc, ri lon chuyn ha, to
iu kin cho t chc x pht trin, gy x ha phi). Mng khuch tn dy tr ngi
vic khuch tn kh.
- Hiu s khuch tn gim, tnh n hi ca nhu m phi gim, ph dung cn tng
ln, khng kh khng tng ra ht nm li trong ph nang nhiu, oxy ht vo t li
phi pha trn vi mt lng kh cn ln nn phn p oxy vo phi gim r rt gy
gim hiu s khuch tn.
b) Bnh vim phi thu
Mt vng phi (hay mt thu phi) b vim, b ng c, c ri lon tun hon,
ri lon trao i cht nn nh hng trc tip n qu trnh khuch tn.
Din tch khuch tn gim do phn phi b vim hon ton khng tham gia g vo
131
qu trnh khuch tn, cc vng phi xung quanh vim cng gim din tch khuch
tn do sung huyt, do vim kch thch au, qu trnh h hp nng, gim tnh n hi,

lm din tch cn li cng b hn ch.

- Mng khuch tn thay i do vim, vng vim v vng xung quanh ph n, ph
nhiu dch r vim lm cho mng dy, cc kh kh ho tan.
Hiu s khuch tn gim ch yu kch thch au, vt khng th su mnh nn kh
ht vo t, tng ra t, kh cn cn li pha trn vi khng kh mi vo lm cho phn p
oxy gim nn hiu s khuch tn gim.
c) Bnh ph phi
Xy ra khi dch huyt thanh trn vo cc ph bo, gian bo chung quanh nhu m phi:
- Din tch khuch tn gim rt mnh do dch nc ph chim ch ca khng kh
trong cc ph nang.
- Mng khuch tn dy v khi ph mng ph nang b bao ph c mt lp bt v
nc ph dy.
- Hiu s khuch tn gim v ton b ph nang cha y dch, lng oxy trong
khng kh khng th vo ph nang c, do hiu s khuch tn hu nh khng c.
3.2.3. Ri lon qu trnh vn chuyn oxy do mu v tun hon
3.2.3.1. Do mu
Ri lon qu trnh vn chuyn oxy do mu ch yu l thiu mu. Khi thiu mu
tc l thiu hng cu, cho nn hng cu cn li khng kh nng vn chuyn oxy
theo nhu cu c th. Hoc khi ri lon hemoglobin trong hng cu nh b ng c,
lon hemoglobin... hemoglobin mt kh nng kt hp vi oxy cng khng m bo
c nhu cu c th.
3.2.3.2. Do tun hon
Cc bnh gy ri lon tun hon: bnh h tim mch, bnh v phi (suy tim, h
hp van tim, ph phi, vim phi...) gy tr tun hon khng vn chuyn oxy y
cho cc c quan t chc.
Mt khc mt s bnh nh thng lin nh, lin tht, ng mch ch vi ng mch
phi cng lm cho mu pha trn t bo ho nn vn chuyn t oxy cho t chc.
3.2.4. Ri lon qu trnh h hp t bo
3.2.4.1. H hp t bo bnh thng
H hp t bo l giai on cui cng ca qu trnh h hp m cng l giai on
phc tp nht. u vo ca n gm oxy v cc cht dinh dng cha nng lng, c
hai u do tun hon a ti. u ra ca n gm nng lng (c t bo s dng cho
cc hot ng sng ca mnh), kh CO2 v nc.
132
Nh vy, sn phm u vo v u ra ca s oxy ha cht dinh dng trong t bo
cng ging nh s dt chy cc cht hu c trong khng kh. Tuy nhin, s oxy ha
trong t bo c thc hin qua nhiu bc. Nng lng c gii phng dn dn
di dng ATP ch khng bin tt c thnh nhit. Kh CO2 trong h hp t bo c
to ra t s kh cacboxyl ca axit hu c nh men decacboxylaza xc tc (ch yu
chu trnh Krebs).
Nc c to thnh t mt dy chuyn phn ng bao gm qu trnh tch dn
hydr ra khi c cht, vn chuyn H2 qua mt chui cc cht trung gian i n oxy.
Trong qu trnh ny c hydr v oxy phn t u hot ha chuyn thnh dng ton H+,
O-- nh h thng vn chuyn in t; cc con H+, O- c hot ng ha hc rt mnh v
gp nhau to thnh nc.
Trong qu trnh vn chuyn hyr ti oxy to thnh nc gii phng rt nhiu
nng lng cho c th. Qu trnh tch H2 ra khi c cht vn chuyn H2 n O2 to

thnh H2O v cho nng lng l mt dy chuyn phc tp v nh mt h thng enzym

h hp ca ty lp th.
- Cc enzym tch hydr (dehydrogenaza): c chc nng xc tc phn ng tch H2
(mang nng lng) khi c cht; ch yu c thc hin trong chu trnh Krebs.
- Cac enzym ca chng l FMN (flavin mononucleotit), FAD (flavin adenin
dinucleotit), NAD (nicotinatriit adenin dinucleotit hay coenzym I), NADP
(nicotinatriit adenin dinucleotit phosphat hay coenzym II). y chnh l cc nhm c
kh nng tip nhn hydro t c cht.
- Cc enzym vn chuyn hyr: c chc nng xc tc phn ng chuyn hydr va
c tch ra t c cht ti giai on sau ca qu trnh h hp. Chng cng c cc
coenzym l FMN, FAD, NAD, NADP do vy cng c kh nng nhn hydro v sau
chuyn giao cho bc sau. Hydro c ton ha (thnh Hi v tch ra mt in t: H+
c a ti oxy to thnh nc, cn in t c chuyn qua nhiu enzym khc
gi l enzym chuyn in t.
- Cc enzym vn chuyn in t: rt nhiu nhng ch yu l cc cht c tn
cytochrom (a, b, c). l nhng enzym c cha st dng oxy ha (Fe+++) v khi
nhn in t n tr thnh st dng kh (Fe++). Chnh trong qu trnh chuyn hydro
v chuyn in t, nng lng c gii phng ra, mt na tch vo ATP, cn na kia
thnh nhit (hiu sut ~50%).
Tm li, dy chuyn h hp t bo din ra mt cch rt phc tp, c nu khi
133
qut trong hnh sau:
3.2.4.2. Ri lon h hp t bo
- Do thiu c cht: Thiu c cht ( m tch H2) xy ra ch yu khi c ri lon
cc thu ca chu trnh Krebs. Nh trn ni, chu trnh ny ngoi vic m nhim qu
rnh cacboxyl ha cn cung cp thm 10 cp hydro cho qu trnh phosphoryl oxy ha.
nh vy, n l ngun cung cp c cht chnh cho dy truyn h hp. Tnh trng ny c
h gp trong ri lon chuyn ha gluxit nh h ng huyt trong bnh tiu ng.
- Do thiu cc enzym h hp: Nhiu enzym h hp ch hot ng khi c cc
coenzym. l loi phn ng chuyn nhm, trng hp v nht l oxy ha kh. Cc
coenzym thng c cha vitamin trong thnh phn cu trc nht l nhm vitamin B.
Vitamin B1 (thiamin) l coenzym ca men cocacboxylaza tham gia vo qu trnh
kh cacboxyl cc axit alpha xem nh axit pyruvic hay axit alpha xto-glutaric. Thiu
vitamin oi ny sinh ra ri lon hot ng ca chu trnh Krebs v t dn n ri
lon h hp t bo.
Vitamin B2 (ribonavin) l thnh phn ca nhiu men chuyn hydro. N kt hp
vi )hosphat hnh thnh FMN v FAD. Nu thiu, cc men tch hydro v chuyn
hydro, s gim hot tnh v lm xut hin nhiu triu chng c trng ca bnh.
Vitamin PP (niacin): nu thiu, cc men c NAD v NADP s gim hot tnh.
Thiu Vitamin B6 (Pyridoxin): y l vitamin tham gia nhm cc nhm
otransaminaza, cocacboxylaza, cokinureninaza.
Thiu st: khng nhng gy gim tng hp hemoglobin, myoglobin m cn nh
tng xu ti cc cytochrom trong chui h hp t bo.
- Do men h hp b c ch do ng c: Cc men ni chung v men h hp ni
ring, rt l b mt hot tnh do nhng cht c khc nhau. Cc loi thuc ng
bacbituric, cht c ca c (rotenon), mt s steroit v cht c thu ngn tc dng vo
khu tch hydro t c cht. Cc cht xyanua, fluorua tc dng ln men chuyn hydro,

cn nhng cht hydro sunfua, oxit cacbon, CN- tc dng trn men chuyn in t
134
nhng mi khc nhau.
3.3. Hu qu ca ri lon h hp
3.3.1. Thiu oxy
Ri lon h hp trong v ngoi u gy hu qu i oxy t chc. T chc thiu
oxy dn ti ri lon chuyn la, tch t cc sn phm c gy nhim c t bo. Cc
sn phm toan tnh kch thch pht trin tng sinh t chc x, lm x cng cc c
quan, t chc.
V d: Suy tim phi dn ti x gan: do suy tim lm mu ti gan dn ti thiu
oxy, dn n ri lon chuyn ha cc cht t tch t nhiu sn phm gy c, kch
thch pht trin nhiu t chc x lm cho b mt gan g gh (ch lm l do pht trin
t chc x cn ch li l cc nhu m gan).
3.3.2. Xanh tm
Xanh tm l trng thi bnh l xut hin khi no lng hemoglobin khng oxy ha
tng ti cc mao mch ca da v nim mc; biu hin bng mt mu xanh xm.
Bnh thmg mu ng mch c bo ho gn ht vi oxy, ch cn 5% l
khng. Bn tnh mch c nhiu hemoglobin khng bo ha oxy, n 30%. V nu coi
nh mao mch l gia th lng hemoglobin kh oxy ti y l s trung bnh ca hai
s trn:
Hb ng mch kh oxy + Hb tnh mch kh oxy = (5% + 30%)/2 = 17,5%.
Theo Lundsgaard th xanh tm s xut hin khi no lng hemoglobin kh oxy ti
mao mch ln ti 30-35%. Cho nn trong bt c trng hp no lm cho mu ng
mch khng bo ho oxy hay khng c oxy ha th lng hemoglobin khng oxy
ha ti mao mch tng gy nn hin tng xanh tm.
3.3.3. Ri lon nhp h hp
Nhp h hp l s ln th ra ht vo trong 1 pht.
Bng 9. Tn s h hp ca mt s loi gia sc
Loi Tn s h hp
(ln/pht) Loi Tn s h hp
(ln/pht)
Nga
B
Ln
D
Cu
Lc
Nai
8-16
10-30
20-30
10-18
10-20
5-12
8-16
Ngh
Ch

Mo
Th
G
B cu
Chut bch ln
30-40
10-30
10-25
10-25
22-25
50-70
100- 150
135
- Ri lon nhp h hp
+ Th su nhanh: ngha l tng c tn s h hp v bin , l nhng hot ng
b trong sinh l gp khi lao ng nng, vn ng c nhiu. Trong bnh l gp nh st
cao, trong cc hi chng au bng, thiu mu no kch thch au hoc do thnh phn
khng kh thiu CO2.
+ Th nng nhanh: ngha l tng tn s gim bin , thng gp mt s bnh
phi nh vim phi, ph phi, vim ph qun phi hoc au cc c quan bn cnh
hoc trong trng hp gim p lc m (bnh chng hi d c).
+ Th su n c (ht vo su v kh): gp trong cc trng hp vim cc ph
qun hoc trong sc d ng co tht ph qun, bnh vim ph vm hng, mt s bnh
nh nhit thn, dch t ln, bnh u (nht l u g), niucatxn g th mng gi, cc
bnh k sinh trng nh giun phi.
+ Th ra rt kh gp bnh kh ph khng kh ng trong phi, cc kh qun
nh b co tht hoc ri lon trung khu iu ho.
- Th chu k: ngha l tnh hng phn ca trung khu h hp gim qu thp vi
CO2 nn pht sinh ra mt hnh thc h hp c bit c chu k gi l h hp chu k.
+ Th kiu Chay-stc (Chayne-stoker): h hp ngng, CO2 tch t kch
thch trung tm h hp, h hp li bt u t t hot ng nhanh dn. Khi h hp hot
ng nhanh tng CO2 ra, lng CO2 trong mu gim li khng kch thch trung
tm h hp nn h hp li gim hot ng cho ti khi ngng hn. Sau mt thi gian
ngng hot ng h hp, CO2 li tch kch thch trung tm h hp, h hp li bt
u t t hot ng nhanh dn... C nh vy to thnh mt chu k.
+ Kiu th Bit: trung tm h hp gim cao hn kiu trn, tnh mn cm ca
trung tm h hp vi CO2 gim n cao cho nn thi gian ngng th ko di lu
tch lu lng CO2 kh nhiu mi c kh nng kch thch ni trung tm h hp lm
vic khi b my h hp hot ng nhanh tng CO2 ra. Khi CO2 gim hot ng
h hp li ngng v tip theo l giai on ngng di.
+ Th kiu Ktsmau (Kussmau): kiu th ny ch biu hin lc hp hi, th tng
136
nhp n c. Kiu th ny trung tm h hp hon ton b c ch khng mn cm vi
CO2. H hp ch hot ng c do hnh tu iu khin nn kiu th ny cn gi l
th ngp c, th n c.
3.4. Hot ng thch nghi ca c th khi thiu oxy
3.4.1. Thch nghi ca phi

Phi l c quan ch yu m nhim cung cp oxy cho c th. Nu nh thiu oxy

th phi phi thch nghi b p li lng oxy thiu:
- Do m oxy gim trong mu nn kch thch ln b phn nhn cm ca huyt
qun, ch yu l cung ng mch ch v xoang ng mch cnh, t kch thch ln
trung khu h hp gy th nhanh v su. Mc ch ca th nhanh v su l tng thng
kh b p lng oxy thiu.
Mt khc, khi oxy gim, kh CO2 tng trong mu trc tip kch thch vo trung
tm h hp gy th nhanh v su v cng nhm tng thng kh.
3.4.2. Thch nghi ca tun hon
Tim lm nhim v y mu i nhn oxy phi v a n t chc nui c th.
- Do tng cng h hp nn tng cng sc ht ca lng ngc, lm cho lng
mu v tim nhiu hn, mu tun hon tng, m bo cho nhu cu oxy ca c th.
Lng oxy trong mu gim, kh cacbonic trong mu tng tc dng ln c quan
cm th thnh mch v no lm tng nhp tim v tng tc tun hon.
3.4.3. Thch nghi ca mu
S vn chuyn oxy do hemoglobin ca mu m nhim, cho nn khi thiu mu
cng phi thch nghi b.
- S phn b li mu: khi thiu oxy, mu ch tp trung vo nui dng nhng c
quan quan trng nh tim, no, cn da v c th t hn.
- Thay i pH mu lm cho mt s men tng cng hot ng gip cho qu trnh
tng hp v phn ly oxyhemoglobin d dng hn.
- Tng cng kh nng kt hp gia hemoglobin v oxy cng tng hn trong iu
kin phn p oxy thp.
3.4.4. Thch nghi ca t chc
- Cc men t chc tng cng hot ng cho oxyhemoglobin d tch oxy ra s
dng cho t chc, lm cho cc qu trnh chuyn ha tng.
- Tng cng qu trnh chuyn ha k kh
- Tng chu ng ca t chc khi thiu oxy.
Tm li: Tt c cc thch ng trn u chu s iu khin chung ca v no v cc
137
phn x c iu kin khc nhau ca mt c th sng trng thi bnh thng cng nh
trng thi sinh l.
4. SINH L BNH TIU HO
4.1. i cng
ng tiu ha gi vai tr quan trng trong i sng hng ngy, nhm mc ch
cung cp cc cht dinh dng v mui khong cho c th. V vy ri lon tiu ha nh
hng r rt ln chc nng khc nhau ca c th v ngc li. Trong khi nghin cu
trng thi bnh l ca ng tiu ha, cn ch ti bn chc phn chnh ca n l:
- Chc phn co bp, c nhim v nho trn, nghin nt v y thc n t trn
xung di.
- Chc phn tit dch, nhm chuyn thc n th thnh nhng cht c th hp thu
c qua mng rut.
- Chc phn hp thu, c nhim v a nhng thc n c tiu ha qua nim
mc rut vo trong mu.
- Chc phn bi tit, nhm a mt s cht cn o thi ra khi c th v ng
thi lm nhim v bo v ng tiu ha.
4.2. Ri lon cm gic n ung

Khi ri lon cm gic n ung u phn nh s ri lon mt trong nhng chc

nng hot ng sng ca c th, trong c c ri lon tiu ha. Cm gic i c
gy nn bng s kch thch cc c quan cm th trong ca b my tiu ha v c
truyn n trung khu n ung no v hnh tu. Trng thi bnh l ca cm gic n
ch yu l gim cm gic n n b n hon ton.
- Tng cm gic n ch gp gia sc hi phc sau mt qu trnh bnh l di hoc
sau mt thi gian di phi nhn i nhng cm gic ny dn dn s tr li bnh thng.
Tng cm gic n khc vi cc qu trnh bnh l do ri lon trao i cht (bnh i
tho ng) cng gy thm n nhiu v chuyn ha c bn cao, n nhiu ung nhiu
nhng li i nhiu, c th gy hay mt s bnh k sinh trng, thiu khong...
- Thng gia sc hay gp hin tng t n hay b n, v d: trong khi gia sc st
cao, trong tn thng d dy, rut, hoc trng thi bnh l h thn kinh. Gia sc c
th b n hon ton (anorexia) trong mt thi gian di, gy cm, suy kit dn n cht.
Mt s gia sc t n kt hp vi ri lon trao i cht khong gy bnh ci xng,
mm xng.
- Tng cm gic kht (polydipsia): thng gp gia sc khng c cung cp
nc y trong khu phn n, cng c mt s dng do tn thng h thn kinh
trung ng, hay mt s qu trnh bnh l gy mt nc c th (a chy nng, nn nng,
ra m hi nhiu, tch nc xoang phi, xoang bng, i tho ng...). Trong nhng
138
trng hp nh vy, c th mt nc kh t, kch thch c quan cm th t bo gy
cm gic kht.
- Gim ung nc (adipsia): thng do bnh ng tiu ha khng gy a chy,
b n v ung, cng c th do tn thng xng hm, rng, c hm, li, nim
mc xoang ming, hng, hoc ph mi, li, con vt khng th ung c. c bit b
n v ung lu thng gia sc bnh thn kinh trung ng nh vim no tu, vim
mng no, u no, ph no.
4.3. Ri lon tiu ha xoang ming
4.3.1. Chc nng nghin thc n
Nghin thc n trong xoang ming c ngha rt ln trong qu trnh tiu ha.
Thc n khng c nghin k s nh hng n qu trnh tiu ha d dy, lm tn
thng nim mc thc qun d dy, gy nn cc qu trnh vim nhim, dn n kch
thch tng tit dch v nh hng hot ng co bp ca d dy rut. Thc n khng
c nghin ch yu do ri lon nhai.
Hin tng nhai b c ch bi cm gic au khi tn thng li, nim mc ming,
li, au rng, bin dng xng hm trn, hm di (trong bnh vim teo mi truyn
nhim ca ln, do di truyn ngn hm trn ca b).
Nghin thc n cng c th b nh tr do ph nim mc vm hng, lm cho hai
hm khng khp kn li, hoc rung hm lp cp trong bnh vim no tu truyn nhim
nga, cng hm trong bnh un vn, lit thn kinh mt trong bnh di.
4.3.2. Chc nng thit
Ri lon chc nng thit thng gp trong bnh vim ph hng, d vt vo hng, u
vm hng (trong bnh nhit thn, t huyt trng, ng c mui), lit c hng (do
bnh di, vim no tu, bnh c tht). Ri lon chc nng nut c th lm cho thc n
ri vo ph qun, kh qun phi, kch thch phn x co tht kh qun lm cho gia sc
ngt v c th cht.
4.3.3. Chc nng tit nc bt

Gia sc tit lng nc bt rt ln, v d: cu tit 6-8 lt trong mt ngy m, tru

b tit 50-60 lt trong mt ngy m, lng nc bt tit ra ph thuc vo thc n a
vo xoang ming, trng thi ca tuyn nc bt v h thn kinh iu tit. Ri lon tit
nc bt thng biu hin:
- Tng tit nc bt: thng do vim nim mc xoang ming (b tn thng, b
ng c, vi sinh vt tc ng trong bnh l mm long mng tru b. Tng tit nc
bt cn c th do bnh h thn kinh, khi lng nc bt c th tng t 6-8 ln bnh
thng, hoc trong bnh di, bnh c tht cng c th tng tit. gia sc cha cng
c th tng tit.
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- Gim tit nc bt: hin tng gim tit nc bt r nht l tc ng dn nc
bt. Ngoi ra khi c th mt nc trong cc trng hp nh bng phm vi ln, a
chy, i ng.
C th do i lu di lm cho tuyn nc bt teo khng tit dch. Nc bt tit t
dn n kh nua, t lng kim trn trong thc n khng trung ho lng axit
d dy dn ti gim tiu ha.
4.4. Ri lon chc nng ca thc qun
Chc nng ch yu ca thc qun l vn chuyn thc n t xoang ming n d
dy. S vn chuyn thc n dc theo thc qun c th ri lon trong cc trng hp
sau:
Vim, ph thnh thc qun, d vt ri vo thnh thc qun, so u thc qun. Tt
c cc l do trn lm co lng thc qun, thc n khng c chuyn vn, li ti ch
hp, t ln men thi, kch thch ngc li thc qun gy co bp mnh c th gy v
thc qun.
Ri lon vn chuyn thc n cng c th do thc qun b co hp (do thn kinh m
tu b kch thch mnh) hoc co hp do n phi thc n nc ung qu lnh, hoc bt
pht cm gic au khi co bp vo cc thc n qu cng, hoc lit thc qun c th o
thn kinh trung ng, hoc thn kinh thc vt ngoi vi b nhim c ch, c tht.
4.5. Ri lon tiu ha d dy
gia sc d dy c chia lm hai loi: d dy n v d dy kp.
D dy bn ti gm c: d c, d t ong, d l sch v d mi kh.
4.5.1. Ri lon tiu ha d dy trc ca loi nhai li
S tiu ha ca d dy trc ch yu da vo cc vi sinh vt (cc vi khun, cc
nguyn sinh ng vt, cc men, nm), chng tiu ha bt ng, n phn hu xenlulo,
gluxit thnh axit bo bay hi, axit lactic.
Tiu ha protein nh men proteaza ca vi sinh vt tch cc polypeptit thnh cc
axit quan, mt phn axit quan c hp thu, mt phn c kh quan nh men
diaminlaza thnh amoniac, c bit loi nhai li h vi sinh vt trong d c cn c th
phn gii cc cht c cha nh phi thot (m) to thnh CO2 v NH3. Vi sinh vt trong
d c t s dng NH3 tng hp nn axit quan ca bn thn ri thnh thot ca bn
thn vi sinh vt T vi sinh vt cng vi thc n d c chuyn xung d mi kh
do tc dng ca HCl v dch v, vi sinh vt b tiu dit v tr thnh ngun dinh dng
cho gia sc.
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Chnh nh vai tr chuyn ha trung gian ca vi sinh vt m gi tr ca protein thc
n c nng cao. Ngoi thot, vi sinh vt cn tng hp c cc loi vitamin nh
vitamin B12 (hm lng co ban trong d c ph thuc vo co ban trong t).

4.5.1.1. Ri lon cn bng sinh ha hc

a) Tha axit lactic trong d c
Khi gia sc n nhiu thc n giu ng, v d: c ci, bp ci, n nhiu la, ng...
Qua qu trnh chuyn ha gluxit to ra nhiu axit lactic lm cho lng axit trong
d c tng ln, ngm vo mu, cn phn ln tc ng c ch d c, t km hm s
vn chuyn thc n xung cc phn di, mt mt tng p sut thm thu d c lm
cho qu trnh ln men sinh hi trong d c tng ln dn ti hin tng chng hi d
c, khi thc n c chuyn xung rut cng b gim tiu ha rut.
b) Cc bnh xeton huyt
Lng xe ton lun lun c mt vi mt lng rt t trong mu loi nhai li. Khi
m cc xeto-axit tng ln trong d c, c bit l axit butyric tng ln trong cc trng
hp gia sc n cc loi thc n chua (c chua, ng chua, li da chua. Khi
chua tt cho ra nhiu axit lactic, cn chua khng tt cho ra nhiu axit butyric).
Ri lon trao i ng, m, cc qu trnh trao i m trong c th tng ln c
bit l ng vt cao sn, ng vt bo dn ti to nhiu xe ton huyt dn n c
nhiu xe ton sa v xe ton niu.
- Do nhu cu ng vt cao sn i hi cao nhng thnh phn thc n a vo
khng cn i nh hng ti vi sinh vt trong d c lm gim qu trnh tiu ha ca vi
sinh vt, lm tng cng chuyn ha m dn n tng cng xe ton sa.
- Do ri lon ni tit c bit l h thng tuyn yn, tuyn thng thn gy tng
cng qu trnh trao i, ng vt cao sn nhu cu cao thc n a vo khng m
141
bo dn ti tng cng chuyn ha m dn ti xe ton huyt.
- Do gim hot ng ca tuyn thng thn dn ti ri lon chuyn ha, tng
cng trao i m, gim chuyn ha ng dn ti xe ton huyt.
* Biu hin ca xe ton huyt.
- Gia sc t nhin km n
- Sn lng sa gim
- Gim trng lng c th
- Ri lon thn kinh.
Nu bnh ko di lm gim chc nng ca gan dn n gan nhim c gy thoi
ha m (thn cng c trng hp thoi ha m).
Gia sc biu hin nhim c: chy nc bt, gim nhai li, gim nhu ng d c,
to bn phn kh, gim hot ng ca h tim mch (mch yu lon nhp tim), nu th
h hp th th kiu nng, th p bng, con vt km vn ng, thch nm kh ng dy,
c th nhn thy co git tng nhm c, nu nng con vt hn m ri cht.
Cng c trng hp bin chng cc xe ton kch thch gy vim v, vim t cung,
u nang bung trng lm gim kh nng ti sn xut.
c) To nhiu NH3 trong d c
NH3 c to thnh do s phn hu ca thot v cc sn phm no phi thot trong
d c. Vi sinh vt s dng NH3 to thnh thot cho bn thn, cho nn NH3 c th
tng ln trong d c do ch nui dng cha ng nh b sung m phi thot qu
nhiu sinh ra nhiu NH3. Khi NH3 trong d c tng, mt mt c hp thu vo mu ti
gan tng hp thnh m, mt phn na ngm vo mu n tuyn nc bt, t nc
bt li tr li d c, cn phn rt ln vo mu theo nc tiu ra ngoi.
Khi hm lng amoniac qu cao, cc qu trnh trn khng kp s dng gy
nhim c cho c th, NH3 qu nhiu trong mu n kt hp cht ch vi Hb to thnh

cht kim hematin, cht ny c ch qu trnh chuyn ha oxy ca Hb, ng thi kch
thch vo thn kinh gy tng mn cm lm cc c rung, tng tit nc bt, lm
hng phn trung tm h hp gy hin tng kh th, c ch d c gy chng hi, gia
sc c th cht do lit h hp.
d) Ng c Nitrit
Tc l trong thc n cha nhiu nht: rau rm, rau mui ( ngi n rau mui
khng ng c ngay m xanh xao mt mu). Nitrit ng c ngm ngay vo mu kch
thch thn kinh trung ng v trung tm vn mch lm ri lon tun hon v thay i
hng phn ca n, kt hp vi hng cu to thnh Methemoglobin dn ti ri lon
chuyn ha h hp.
142
4.5.1.2. Ri lon hp thu d trc
D c hp thu nc, Ca+, Mg++, K+, Coban, cc axit bo bay hi, quan t do, axit
lactic, NH3, glucoza, CO2 s hp thu d trc c bit l d t ong v d l sch
(ngi ta thy d l sch hp thu 100 lt th dch/ngy, d trc hp thu 60-70%
dch th a vo.
- Tc dng ca hp th:
+ Lm gim p sut thm thu.
+ Lm cho thc n vn chuyn xung d dy c c hn, v hnh trung lm tng
nng axit ln.
+ Lm cho nhu ng ca d trc d dng.
- Qu trnh hp thu ph thuc vo hormon ni tit vo thn kinh vo khu phn
n. Nu tuyn thng thn tng tit th qu trnh hp thu tng, nu c kch thch au th
gim hp thu, nu khu phn n tng lng mui gim hp thu.
4.5.1.3. Ri lon chc nng vn ng
Ri lon chc nng vn ng c mt s trng hp sau:
- Sa gin d trc
- Gim trng lc
- Chng hi d c (TympHnia)
+ Chng hi cp tnh.
+ Chng hi mn tnh.
* Chng hi cp tnh:
- Nguyn nhn: ch yu do thc n ln men sinh hi nhanh v d c gin ra cp
tnh: n c h u, hoc dy lc, c non, c ti thc n cha nhiu cht c saponin,
cc loi men, mc, cc sn phm phn hu thi ra ca thc n v ng vt. T dn
ti rt d ln men v sinh hi. Mt khc b sau khi n lm vic qu nng v mt mi
hoc do k pht do lit d t ong, vim d t ong, vim phc mc, lit tc thc qun.
- C ch: bnh thng qu trnh ln men sinh hi thot ra ngoi d c theo cc qu
trnh sau:
+ cng vi c nhai li
+ Thm vo mu
+ Hi theo rut gi, sau i tin ra ngoi.
Nu c th tnh trng bnh l cc qu trnh trn b tr ngi kt hp vi thc n
ln men sinh hi nhanh lm cho d c cng cha y hi lm p sut cao, khi p sut
cao gy p lc chn p cc mch qun n nui c thnh d c dn ti ri lon tun
143
hon thnh d c gy tn thng v lit. Mt khc p sut ln trong d c lm bin

dng lng ngc c ch h hp, chn p ln tnh mch v ng mch cnh, kch thch
ln thn kinh trung ng.
- Biu hin: con vt bt an, nu chng hi nhanh v cp tnh biu hin cm gic
kh th h ming th li, nhn vo tch mch c thy c hin tng sung huyt tnh
mch cnh.
X l: Cho gia sc ung ru ti, dng rm tr st d c, cho gia sc ngi b kt
kch thch h hp. Nu bnh nng c th dng tro ca chc d v gii phng hi
ra t t
* Chng hi mn tnh:
T cp tnh thuyn chuyn gim dn tc ng lp i lp li tr thnh mn tnh ko
di hng thng dn ti con vt gy cm, suy dinh dng v c th dn n cht. N
cng c th chuyn thnh cp tnh pht trin mnh v con vt c th ngt do ngt th.
4.5.2. Ri lon tiu ha d dy (d mi kh)
D dy c nhim v nho trn thc n thc n ngm vo dch v do chnh bn
thn tit ra v tiu ha mt phn thc n.
4.5.2.1. Ri lon chc nng co bp
Thng biu hin tng hay gim v trng lc v nhu ng, ph thuc vo thc
n, do thn kinh, do axit trong dch v.
Tng co bp ch yu do thc n cha nhiu axit, c t hoc l mt cn bng thn
kinh thc vt, cng ph giao cm, c ch giao cm hoc tu sng b kch thch bi
histamin v chon, hoc do phn x tc h v kch thch co bp tng cng y thc n
xung.
- Gim co bp: do tc h v tr thc n lu, do thn kinh c ch thn kinh ph
giao cam.
Trong th nghim: ct dy thn kinh s 10 (m tu) d dy v rut bp xung do
mt trng lc.
Khi axit cao trong dch v khng gy c phn x m h v hoc do lot d
dy, t trng gy phn x chm m h v cho nn nhu ng gim.
4.5.2.2. Ri lon chc nng tit dch
Hot ng dch v ca d dy chia lm ba thi k:
- Thi k phn x thn kinh: khi gia sc nhn thy thc n, ngi thy thc n, thc
n ri vo xoang ming kch thch nim mc ming gy mt phn x lm cho d dy
tit dch v.
Thi k phn x ha hc - thn kinh: Khi thc n xung ti d dy, thc n trc
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tip tc dng vo vng tuyn ca d dy, mt phn thc n ngm vo mu kch thch
thn kinh n ung gy tit dch v d dy.
- Thi k thn kinh ni tit: khi thc n xung ti nim mc rut, kch thch rut
tit dch trong c gastrin, m gastrin kch thch d dy tit HCl hot ha men
pepsin. Nu lng HCl ln cao tc dng ngc li c ch gastrin. Bn thn d dy khi
lng HCl tng cao n tit ra secretin c ch tit dch v, rut HCl kch thch rut tit
ra secretin v dch rut ni chung.
Khi ri lon th:
a) Tng tit dch v
Thng km theo tng lng HCl: gp trong trng hp vim cam, ung th, lot
d dy hoc kch thch t ni khc: vim rut, tc mt, tn thng ngoi da (eczema,
gh), thn kinh cng thng tng tit dch v.

b Gim tit dch v

Km theo gim lng HCl: b au, thn kinh giao cm hng phn khi st, ri lon
thn kinh dinh dng, vim teo d dy, mt nc, i n, thiu cc vitamin, cc bnh
ni tit thiu nng tuyn gip, thiu nng tuyn thng thn. Trong bnh bm sinh
nh: ln con s sinh tit dch v d dy t, lng HCl t, phng chng cho n sa
chua tng lng axit ln.
4.6. Ri lon tiu ha rut
Rut gi vai tr quan trng trong b my tiu ha. y thc n c chuyn
hon ton thnh nhng cht hp thu c.
Ri lon chc nng tiu ha rut c th l nhng ri lon v tit dch, ri lon co
bp rut, ri lon hp thu v bi tit
4.6.1. Ri lon chc nng tit dch rut
4.6.1.1. Ri lon tit dch rut
* Cc yu t tc ng gy tit dch rut
- Nhng kch thch ca thc n v cc sn phm tiu ha (cc trng thi v cc qu
trnh tiu ha d dy).
- Thn kinh v ni tit (cc qu trnh ri lon nh hng ti thn kinh gim tit
dch v cc stress ca mi trng: thi tit, nng, lnh... thng qua trc h no v th
dch).
* Dch rut bao gm cc men tiu ho:
- Tiu ha thot: men tripsin, nucleotidaza, proteaza.
- Tiu ha gluxit: mantoza, saccaroza (invectaza), cacbohydraza.
145
- Tiu ha m: lipHza, phosphataza, steraza
Cc kch t rut:
- Gastrin tng tit HCl, dch v.
- Secretin: kch thch tuyn tu tit dch.
- Cholecystokinin: kch thch co bp ti mt.
- Entenocrasin kch thch bn thn rut cc men tiu ha vo.
mt s loi ng vt cn c men Pamcreozynin kch thch lm tng cc loi
men dch v.
* Nguyn nhn gy ri lon tit dch:
- Ri lon chc nng ca thn kinh.
- Cc qu trnh bnh l vim, ung th.
- Do ri lon tit dch v.
- Do dinh dng.
Ri lon tit dch rut thng biu hin:
- Tng tit dch: ch yu do rut b kch thch bi yu t c hc, ha hc, nhit ,
vi sinh vt v tit dch nhiu nht c bit lm cho vim rut, lot rut (khi vim tng
tit dch ln 8 ln) dn n a chy.
- Gim tit dch: vim rut mn tnh lm teo rut, cc qu trnh bnh l khc: st,
au t ni khc.
Hu qu gim tit dch gy a chy l ch yu dn n suy dinh dng.
4.6.1.2. Ri lon tit mt
Trong mt bao gm axit mt v mui mt. Ri lon tit mt do:
- Tc mt (vim, u so, si, giun chui ng mt, vim nim mc t trng)
- Do thiu mt (thiu mu, bnh gan, gim co bp ti mt).

Hu qu:
- Ri lon tiu ha m dn ti ri lon protein do m bc protein xung quanh.
- Mt cn bng h vi sinh vt (v mt ngoi tc dng tiu ha cn c tc dng st
trng).
- Ri lon hp thu mt s vitamin.
4.6.1.3. Ri lon tit dch tu
Dch tu gm ba loi men chnh: Tiu ha protein gm tripsinogen,
kaliotnpsinogen bin thot thnh polypeptit; cacboxylaza v aminopeptidaza bin
146
polypeptit thnh axit quan, nucleaza bin axit nucleic thnh nucleozit; tiu ha gluxit
l men amylaza; tiu ha lipit l men lipaza.
S tit dch ca tuyn tu c iu tit theo thn kinh v ni tit.
Nu kch thch thn kinh ni tng gim tit dch tu (thn kinh s 10, m tu), cc
kch t do t trng tit ra secretin. Gim tit dch tu dn ti gim tiu ha v suy dinh
dng.
4.6.2. Ri lon chc nng co bp ca rut
Co bp rut theo ba loi:
- Vn ng theo kiu chia t mt.
- Vn ng theo kiu nhu ng ln sng.
- Vn ng theo kiu con lc.
Ba cch vn ng ny lm xo trn thc n v tng thc n t trn xung. Thng
ri lon chc nng vn ng v ri lon chc nng tit dch gy nn:
4.6.2.1. Hi chng a chy
a chy l hin tng a nhanh. nhiu ln, trong phn c nhiu nc do rut tng
cng co bp v tit dch.
C ch:
- Do thc n khng tiu rut lm p lc thm thu tng cao hn trong mu v t
chc s ko nc vo trong lng rut hoc khi c vim rut ng c do thc n, dch
nhy ca rut vi nc c th tng gp 80 ln so vi bnh thng. Lng dch trong
rut tng ln s kch thch rut tng co bp sinh ra a chy.
- Do gim hp thu cng n a chy v lng nc do n ung a vo cng vi
dch tit ca rut trong mt ngy c th ln ti 10 lt (tru b c th hn). Phn ln
nc li hp thu ti rut do ch cn gim ti hp thu rut l lng nc trong lng
rut s tng hn bnh thng.
- Tng co bp rut th nim mc rut b kch thch s gy tng co bp lm cho cc
cht cha nhanh chng b y ra ngoi gy a chy.
Hu qu ca a chy:
- i vi a chy cp tnh: C th mt nc qua phn nhiu, nhanh ko theo mt
lng mui khong. Trc tin gy gim tun hon, gim huyt p c th dn n tru
tim mch do mu b mt nc c c. ng thi c th mt mui kim ca dch tu,
dch mt v rut dn ti nhim axit. T gim tun hon dn n ri lon chuyn ha
cc cht, t chc thiu oxy tng cng chuyn ha ym kh lm cho tnh trng nhim
axit tng ln gy nhim c thn kinh, gin mch, thc y thm qu trnh ri lon
huyt ng hc, hnh thnh vng xon bnh l ngy cng trm trng.
147
- i vi a chy mn tnh: khng gy tnh trng mt nc mt mui song ko di
ri lon hp thu, c th thiu thot, vitamin, mui can xi cui cng dn n suy dinh

dng, thiu mu, ci xng.

V vy i vi a chy cp tnh, ngoi vic iu tr nguyn nhn cn phi truyn
nc v mui, ng thi chng tru tim mch. Cn i vi a chy mn tnh, ngoi
vic iu tr nguyn nhn cn phi chng suy dinh dng bng cch c ch n tng
cng cht dinh dng, vitamin mt cch cn i.
4.6.2.2. Hi chng tc rut
l tnh trng bnh l xy ra khi mt on rut b tc khng lu thng c.
Nguyn nhn: c th do cc yu t c hc nh tht rut, vn rut, lng rut, tc do
bi giun, u chn p. Mt khc cn do yu t thn kinh nh mt cn bng thn kinh
thc vt nh cng thn kinh s X gy co tht mt on rut hoc do lit thn kinh
gin mt on rut dn ti kch thch au.
C ch: Khi mt on rut b tc th phn trn ch tc tng cng co bp, mc
ch lm thng ch tc cho nn gy cn au d di, tng t theo nhu ng rut to
nn hin tng rn b thnh bng (au bng nga) khi nhn nghing. Tip theo l
rut chng hi do cc vi sinh vt ln men, hp thu gim, tr cc tit dch ca rut
do gim hp thu v trn dch t mu vo lng rut. Nguyn nhn gy cht ch yu do
mt nc v thn kinh b kch thch do rut cng gy ra.
Hu qu:
- Khi tc rut non phn trn th hu qu trc tin l mt nc v mt mui do
nn nhiu, mt nc km theo mt HCl cho nn gy hin tng nhim kim.
- Khi tc t trng nn km c dch rut kim tnh cho nn s b nhim c axit.
Ngoi ra mt nc mu c c gy ri lon tun hon, huyt p gim, mu qua thn t
lc t gy thiu niu hoc v niu, m cao.
- Khi tc phn thp nh rut gi th triu chng yu hn nhng tnh trng nhim
c li mnh hn.
- Yu t cng rut do tc tc ng ln thn kinh thnh rut v bng cng c
tc dng gy ri lon tun hon v gy cht.
4.6.2.3. To bn
To bn l trng thi bnh l ph bin phn tc trc trng khng tng ra khi c
th c, phn kh, ln nhn tng cc theo khun rut.
Nguyn nhn:
- C th do c hc tr ngi trn ng o thi phn, v d: u, so, d vt, co tht
lng rut.
148
- Do ch n t x nhiu tinh lm cho th tch phn nh khng kch thch vo
nim mc trc trng co bp tng phn ra ngoi.
- Do kch thch au n c ch phn x tng phn ra ngoi v phn x m hu mn.
Hu qu: Phn lu tr lu trong trc trng sinh ra cc sn phm c indol, scatol
t ngm vo mu gy ri lon chuyn ha, lm mt phn x n ngon, mt phn x
tit dch. Khi phn lu lm sa trc trng chn p tnh mch trc trng gy sung huyt
tnh mch trc trng dn n xut hin bnh tr.
4.6.3. Ri lon chc nng hp thu rut
- C th do nhng nguyn nhn ri lon hp thu ti ng tiu ha nh cc bnh
d dy, gan, mt, tu v ti rut.
- Do nhim cc cht c nh n phi c c, c t aflatoxin, nm mc... cng
gy a chy vim xut huyt.
- Do ri lon tun hon ti rut, nh tc mch (do k sinh trng nga thng cc

bi giun gy tc mch mng treo rut nga gy cn au bng d di).

- Cc vi sinh vt theo thc n v nc ung vo trong c th E. con, Salmonella,
cc trng ym kh, cc nm c, coronavirus, rotavirus, vi rt dch t ln.
- Do yu t ni tit nh thiu nng tuyn gip trng, tuyn thng thn gy gim
hp thu
- Do ri lon thn kinh X lm gim nhu ng rut gy nhim khun dn n km
hp thu.
c bit qu trnh hp thu xy ra ch yu rut non trong mt s bnh ca gia sc
nh Colibacillosis, Salmonella, a phn trng lm teo nim mc rut, teo lng rung lm
cho din tch hp thu gim. Cng l nguyn nhn gy km hp thu dn ti suy dinh
dng, ci cc, t km hp thu cn dn ti nhiu trng thi bnh l khc nh thiu
vitamin D gy ci xng, thiu vitamin C gy thiu Fe, thiu mu nhc sc. Thiu
vitamin nhm B (B1, B12) gy thiu mu c tnh, ph, vim. Thiu vitamin A gy vim
nim mc da, mt kh. Thiu vitamin K gy xut huyt. Thiu vitamin E nh hng
n chc nng sinh dc...
5. SINH L BNH CHC NNG GAN
5.1. i cng
Gan l mt c quan ln nht trong c th, m nhim nhiu chc nng quan trng
v phc tp. Gan l mt t chc nhu m nhng li c cu trc c bit gm ba loi cu
trc: t chc nhu m, t chc lin vng xen k (Riticuloendothelium) vi t chc nhu
m v h thng ng gm mch mu v ng mt.
Gan ng v tr ca ng, ni lin ng tiu ha vi ton b c th. Gan tch lu
v chuyn ha hu ht cc cht c hp thu rut vo v cung cp nhng cht cn
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thit cho c th. Cc chc nng ca gan c thc hin nh hai loi t bo (t bo nhu
m gan v t bo Kuppfer thuc h thng lin vng ni mc v nh mt lng mu
qua gan rt ln (mi pht gan nhn 1500 ml mu). Cho nn gan va c v tr xung yu
(v gan l ca ng) va c cu to phc tp gm nhiu t chc khc nhau v chc nng
ca n v cng quan trng v phc tp v vy d b tn thng nhng gan cng c kh
nng hot ng b v ti sinh ca t bo gan rt mnh. Cc chc nng ca gan c mi
lin quan vi nhau rt cht ch, ri lon mt chc nng ny ko theo ri lon chc
nng khc lm cho hnh nh bnh l thm phc tp.
5.2. Nguyn nhn gy ri lon chc nng gan
Do gan v tr ca ng ca c th nn cc yu t gy bnh v ng xm nhp
ca cc yu t vo c th rt d dng.
5.2.1. Cc yu t gy bnh
- Do gan b nhim khun c bit l do vi rt gy vim gan B, C, vi khun theo
amip ln gan lm thnh p xe gan.
- Do k sinh trng lm x gan nh sn l gan tru b, cc u trng giun a di cn
vo gan v.v...
- Do nhim c: do gia sc n phi cc loi c c, nm c, cc kali loi ch,
ng, do dng CO4 ty sn l gan. Cc cht ny nu nng c th gy hoi t gan,
nh ko di c th dn ti thoi ha m, x gan,...
- Do thiu dinh dng: do ch n ung cc khu phn n khng cn i.
V d: Trn thc nghim c th gy x gan bng cch cho gia sc n thiu protein
c bit thiu cystin th s gy c x gan in hnh, ngi ta cng nui chut
trng bng thc n c nhiu m, t thot t 1,5 tun n hai nm th thy c hin tng

thm nhim m gan v x gan ca.

- Do ri lon tun hon ti gan nh khi b bnh tim, phi v cc bnh ca c quan
khc.
- Do cc qu trnh bnh l gy ri lon chuyn ha dn ti gan thoi ha m do
chuyn ha m tng.
Ngoi ra do ri lon chuyn ha ng dn ti x gan, ri lon chuyn ha st cng
dn n x gan nhim st.
Mt s bnh ni tit cng nh hng ti gan, ri lon thn kinh vn mch lm
mu dn ti x gan. Cc sn phm trung gian nh histamin, serotonin lm co tht c
vng tnh mch trn gan lm tng p lc tnh mch ca gy ri lon tun hon gan dn
ti x gan.
5.2.2. ng xm nhp ca yu t gy bnh
Cc yu t gy bnh c th xm nhp vo gan bng nhiu ng:
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- ng tnh mch ca: Yu t gy bnh t ng tiu ha (cc vi khun, c t vi
khun, k sinh trng, cc c t trong thc n). ng ny l chnh v quan trng nht.
V d vim gan do trc khun E. con, thoi ha m gan do ng c phosphat, x gan
do ru...
- ng ng dn mt: Vim ng dn mt do vi khun dn n ri lon chc nng
gan v x gan. K sinh trng nh giun, sn cng theo ng ny ln gan gy tc mt
cp tnh hoc to thnh kn, p xe chn p tnh mch trn gan, tnh mch trung tm
tiu thu gy mu gan a n thiu oxy v x gan.
- ng tun hon mu: Cc vi khun, vi rt theo tun hon mu ti gan nh lao,
nhim khun huyt, vim gan do vi rt B...Ng c thuc m nh clorofoc... cng theo
ng ny ti gan v gy thoi ha m gan.
- ng bch huyt: nh a mp t rut ti gan gy vim m.
- ng thn kinh: Trong thc nghim khi kch thch thn kinh giao cm bng
c th gy xut huyt ti gan dn n gy ri lon chc nng gn.
5.3. Ri lon chc nng gan
5.3.1. Ri lon chuyn ha do bnh gan
5.3.1.1. Ri lon chuyn ha protit
Gan l ni phn ha cc thot t ng tiu ha ti v tng hp cc thot cho huyt
tng. Khi ri lon chuyn ha thng biu hin:
- Khi gan b tn thng kh nng chuyn ha thot ti gan gim i n khng phn
hu c thot t ng tiu ha vo gan dn ti i thng vo mu gy nhim c c
th, cho nn trong mu thy diamin, polypeptit, cc axit qun sau thi qua ng
niu.
- Gim kh nng tng hp thot c bit l gim tng hp albumin, khi nhim
khun tng tng hp y-globulin. Nhng ni chung thot huyt tng trong bnh gan
u h, cc yu t ng mu gim d gy xut huyt di da v chy mu.
5.3.1.2. Ri lon chuyn ha lipit
Gan c nhim v va phn hu lipit li va tng hp lipit theo nhu cu c th.
Axit bo v glyxeron c phn hu cho nng lng v th xe ton. Gan cng tng hp
lipit t nhng phc hp 2,3 cacbon cng nh tng hp cholesterol v qu "nh este ha
cng c tin hnh ti gan.
Khi gan c ri lon thy c nhng biu hin sau:
- Tch m gan: do nhim c thiu cht hng m, ch n nhiu m qu (do

chuyn ha m gan gim r rt, khng oxy ha, khng a ra khi gan lm cho gan
nhim m, mt khc kh nng a m ra khi gan gim dn ti thm nhim m gan).
151
- Lng m trong c th st nhanh do thiu cung cp v gim tng hp.
- Lng m lu hnh trong mu gim.
Cholesterol ton phn c th gim hoc khng gim nhng cholesterol este ha
gim r rt do gan thiu men este ha.
Trong trng hp tc mt th lng m cng nh cholesterol trong mu u tng.
C ch do nhng cht ny mt phn c o thi ra rut qua ng mt, nay b gi
li, mt khc do mui mt trong mu lm cho chng d tan trong mu hn. Nhng
c ch chnh tng cholesterol l do c ch qu trnh tng hp axit mt lm cho
cholesterol tha tng trong mu (bnh thng axit mt c tng hp t cholesterol
m ra; khi tc mt, chng b li v c ch phn hi qu trnh tng hp ).
- S hp thu cc vitamin tan trong m gim (vitamin A, D, E, K v gim hp thu
m rut, d tr vitamin trong gan gim nh gim caroten, vitamin Bi2 dn ti chm
ln hay thiu mu, gim vitamin K lm cho cu to prothrombin km sinh ra chy
mu.
5.3.1.3. Ri lon chuyn ha gluxit
Gan l ni tng hp v phn hu gluxit rt mnh nhm cung cp glucoza cho t
chc v gi mc glucoza huyt hng nh.
Glucoza tng hp ti gan t nhiu loi gluxit khc nhau nh galactoza (nh men
galactokinaza), fructoza (nh men fructokinaza) v glucoza hp thu t ng tiu ha
vo, t glycogen tch sn trong gan (nh men phosphataza), nhng sn phm ging
ha ca bn thn n (nh axit lactic, axit pyruvic) v t lipit. Khi gan b bnh thng
thy biu hin sau:
- Gim d tr glycogen gan khi d b h ng huyt.
- Kh nng chuyn cc loi galactoza, fructoza thnh glucoza gim.
Tng cc sn phm chuyn ha trung gian ca gluxit trong mu nh axit lactic,
axit pyruvic (v gan thiu nng nu khng s dng c vitamin B hnh thnh
Coenzym phospho ha a nhng sn phm trn vo vng Krebs).
5.3.1.4. Ri lon chuyn ha nc v mu khng
Bnh thng gan khng c chc nng trc tip trong chuyn ha nc v mui
khong nhng gan c tc dng gin tip n chuyn ha nc v mui khong thng
qua s thay i p lc keo, p lc thu tnh v phn hu hormon.
- Trong x gan tng p lc tnh mch ca (tng p lc thu tnh) cng c tc dng
y nc ra khi lng mch gy ph thng nng hn.
- Trong suy gan cc hormon (ADH) b tch li, gim hm lng nc tiu gi
nc gy ph, aldosteron (gi Na ti thn) v oestrogen (gi nc trong m bo) u
c tc dng gi nc mui gy ph. T dn ti hin tng bng nc, thiu niu,
152
tng cm gic kht, h huyt p...
5.3.2. Ri lon chc nng chng c ca gan
Chc nng chng c ca gan c thc hin bng nhng phn ng sinh ha, kt
hp. Gan c kh nng trung ho cc cht c ni ti cng nh ngoi lai nh n trung
ho v phn hu cc hormon (v cc tuyn ni tit tit ra hormon hng ngy gi cho
ni mi c mt lng tit t hng nh), cc c t ca vi khun, cc cht c t ng
tiu ha vo, cc cht c c sn sinh trong chuyn ha ca c th.

5.3.2.1. i vi cc hormon
- Khi x gan th gan mt kh nng trung ho hormon sinh dc Oestrogen. Kch
c t bnh thng cng phi phn hu nhng khng phn hu c, theo c ch phn
hi n kch thch vo c quan sinh dc khng tit ra kch t sinh dc dn ti mt kch
dc tnh lm teo tinh hon dn ti v sinh.
- Gi hormon ca v thng thn c tc dng gi ngi ng thi ko theo c
nc.
- Hormon chng li tiu ca tuyn yn (ADH) khng phn hu ti gan nn gi
nc v mui gy nn thiu niu.
5.3.2.2. i vi vi khun
- Gan b bnh kh nng thc bo ca t bo Kuppfer b mt. Th nghim tim mt
cht mu vo tnh mch dn ti gan, sau a mt lng vi khun vo th t bo
Kuppfer khng cn kh nng thc bo v cht mu c nh t bo Kuppfer (khi ct gan
v soi ln knh hin vi thy t bo Kuppfer cha y cht mu).
- Gan l ni xy ra cc phn ng sinh ha nn i vi vi khun mt kh nng to
ra khng th.
5.3.2.3. i vi cht c
Gim kh nng chuyn ha cc cht c thnh cht khng c hoc l cc cht
km c v d: ru, cn, bnh thng b oxy ha nhng gan b bnh khng oxy ha,
Fethidin bnh thng th phn hu nhng khi gan b bnh th khng c phn hu,
gim s kt hp nh vi bilirubin t do, amoniac, axit benzoic, cc sn phn c ca
vi khun ng rut...
5.3.3. Ri lon chc nng cu to mt v bi tit mt
5.3.3.1. Chuyn ha sc t mt
Sc t mt c to ra do s phn hu hemoglobin (hng cu v phng thch ra)
v mt phn do nhn porphyrin trc tip hnh thnh gi l bilirubin t do __________vo mu
theo huyt tng ti gan c kt hp vi axit uridin-diphospho-glucuronic nh men
glucuronyl-transferaza hnh thnh bilirubin kt hp v uridin-diphosphat-glucoza.
153
rut bilirubin kt hp c kh oxy thnh Urobilinogen v Stercobilinogen bi
vi khun ng rut, ch c 1/10 Urobilinogen li c ti hp thu ti rut vo mu ri
li tr v gan c gan gi li ti bi tit ra, l chu trnh gan mt ca sc t mt.
Urobilinogen v Stercobilinogen rut tip tc oxy ha thnh Urobilin v
Stercobilin ca phn.
5.3.3.2. Ri lon chuyn ha sc t mt
Biu hin r nht l vng da (hong n). Vng da l tnh trng bnh l xy ra khi
sc t mt trong mu cao hn bnh thng v ngm vo da v nim mc.
C ba loi vng da:
- Vng da do nguyn nhn trc gan (do hu huyt, tan mu v dung huyt):
Loi vng da ny do c th c hin tng tng cng dung huyt gii phng nhiu
hemoglobin lm cho bilirubin t do tng ln trong mu.
Nguyn nhn c th do nhim trng: lin cu trng gy dung huyt, cc bnh k
sinh trng ng mu, cc ha cht lm dung huyt (sulfamid, phenylhydrazin, truyn
mu khc loi).
c im ca loi vng da ny l bilirubin t do tng cao trong mu nhng v
khng tan trong nc nn khng o thi ra nc tiu. Do c nhiu bilirubin t do cho
nn gan lm vic ti a, tng sn xut bilirubin kt hp lm cho phn thm mu,

Stercobilinogen v Urobilinogen u tng.

- Vng da do tn thng ti gan:
Khi gan b tn thng s dn n nhng ri lon v sc t mt nh sau:
+ Ri lon vn chuyn bilirubin t do qua mng t bo, lm tr bilirubin t do.
+ Ri lon kt hp bilirubin t do c th do thiu men glucuronyl-transferaza nn
bilirubin t do tng trong mu gy nhim c thn kinh hoc tng hot ng ca men
nn trong mu v trong nc tiu tng bilirubin kt hp.
+ T bo gan mt kh nng lc mt t mu vo trong ng mt hoc gan b sng,
154
vim ng mt nh lm tc ng dn mt . V vy, bilirubin t do v bilirubin kt hp
u tng trong mu, bilirubin kt hp ra phn t lm phn c mu nht.
Nguyn nhn ch yu ca hin tng ny l do nhim vi rt vim gan, nhim
trng huyt, ng c phospho, benzol, iodofoc.
- Vng da do tc mt (nhng nguyn nhn sau gan): mt khng xung rut c
vo mu gy vng da, phn trng, nc tiu vng. Cc thnh phn khc ca mt nh
cholesterol, axit mt tng do mt.
Nguyn nhn c hc nh si ng mt, giun chui ng mt, u u tu, hch to chn
p ng dn mt..., vim so, dy chng, ri lon thn kinh thc vt gy co bp c
ng dn mt.
c im: vng da m, phn trng, nc tiu vng, cholesterol, axit mt v
bilirubin kt hp tng. Nu tnh trng tc mt din bin lu ngy, nhu m gan ngy
cng b h hi th kh nng lin kt ca t bo nhu m gan chuyn bilirubin t do
thnh bilirubin kt hp s km dn. Do bilirubin t do tng ch khng phi
bilirubin kt hp tng nh giai on u ca vng da, khi cha c tn thng t bo
nhu m gan. Si mt thng do cc thnh phn trong mt ng li gy tc ng dn mt
bao gm cc cht c th kt tinh c cholesterol, can xi, sc t mt...Nguyn nhn do
vim ti mt hoc ng dn mt, cc t bo nim mc ng dn mt, ti mt long kt hp
vi cc cht nhy lm cho cc cht khc d kt dnh. Mt khc khi thay i tnh cht
ca mt lm thay i dung mi ho tan nn cc cht ho tan trong mt d sa lng kt
ta.
5.3.4. Ri lon tun hon v chc nng to mu ti gan
5.3.4.1. c im tun hon ti gan
Mu khi ti gan do hai ngun cung cp:
- Do ng mch gan: trong 1 pht ng mch chuyn vo gan 300 mi mu, mt
ngy khong 400-500 lt mu.
- Do tnh mch ca: sau khi hp thu cc cht dinh dng rut vo gan trn
ln gia mu ng mch v mu tnh mch ca to cc xoang mu k cc t bo
trc khi n dn vo tnh mch gan v tnh mch trn gan ri vo tnh mch ch.
5.3.4.2. Ri lon tun hon gan
- Gim lu lng tun hon: thy r nht trong sc, trong phn ng phn v dn
ti co tht ng mch gan v c vng tnh mch ca cho nn mu khng vo gan c
gy tnh trng thiu mu gan. Khi gan thiu mu s tit ra cht VDM (Va so dilatotor
material) lm gin mch, h huyt p.
- mu ti gan (ch yu do sung huyt tnh mch gan) c th do suy tim phi,
vim ngoi tm mc, vim phi, tc tnh mch ch di dn n gan to cha y mu
155
ko di lm cho gan thiu oxy ko di dn ti hoi t t no nhu m gan quanh tnh

mch trung tm tiu thu, t chc x pht trin dn n hnh thnh bnh l gan ht
cau. C nh vy ko di gan s b thoi ha m, x ha, to rn v b sc.
Tng huyt p tnh mch ca: do huyt p tnh mch ton thn tng, do tc h
thng tnh mch ca, do x gan, do u chn p
Hu qu:
T chc x pht trin v gan thiu oxy v dinh dng
Tun hon ngoi gan pht trin
- Bng nc l kt qu ca phi hp nhiu ri lon:
+ Do tng p lc thu tnh ca h thng tnh mch ca
+ Do tng tnh thm thnh mch v tnh trng thiu oxy v nhim c mn tnh
+ Do gim p lc keo huyt tng
156
+ Do gan khng phn hu mt s hormon gi mui nh aldosteron v gi nc
nh ADH.
Bng nc trong x gan l bng nc nhiu nc, mu chanh v hi snh. Bng
nc c th gy chn p cc tng trong bng, nh hng n hot ng ca c honh
gy kh th. Nc bng l dch thm xut, rivalta m, m protein trong dch c
th ln ti 1000 mg/l.
5.3.4.3. Ri lon chc nng to mu
Bnh thng gan l ni tng hp thot cn thit cho vic to hng cu v thot
huyt tng.
- Gan l ni d tr st.
- Gan l ni cha vitamin B12.
- Gan l ni d tr vitamin K.
Khi b tn thng gan, vim gan, x gan dn ti ri lon chuyn ha nghim
trng. Gan l c quan chuyn ha cc cht. Khi ri lon, tng hp protein, Fe, Bi2, K...
u b gim. Ni chung cc nguyn liu m gan cung cp cho tu xng l khng c
dn ti hin tng thiu mu v km theo l xut huyt, biu hin vng da nht nht,
ngi gy, bng bng v khng c kh nng lao ng.
5.3.5. Thiu nng gan (suy gan)
L tnh trng bnh l trong gan khng lm trn nhng chc phn m bnh
thng n m nhim trong c th. Ngoi nhng ri lon chc phn ca bn thn gan,
nhng ri lon cn nh hng rt su sc n hot ng ca cc c quan chc nng
khc gy nn hnh nh bnh l chung ca suy gan, ngi th teo c, gy cm, da bt,
gim sc khng, nu suy gan cp d b t vong.
6. SINH L BNH CHC NNG THN
6.1. i cng v chc nng thn
Thn c chc nng o thi khi c th nhiu cht nng ca chng khi
tng ln trong huyt tng (chc nng ngoi tit), ng thi thn cn sn xut mt s
cht a vo mu (chc nng ni tit) duy tr s lng hng cu v huyt p.
Chc nng ni tit gm:
- Tit renin: c vai tr duy tr n nh huyt p
- Tit erythropoietin: c vai tr duy tr s lng hng cu
Thn thc hin chc nng trn l nh c im cu trc v sinh l ca n.
Chc nng ngoi tit thc hin bng:
- Lc cu thn, o thi khi huyt tng:
157

+ Cc sn phm cui cng ca cc qu trnh chuyn ha cht trong c th (ur,

axit c, creatinin...)
+ Cc cht c ni sinh (bilirubin kt hp, cc axit gy nhim toan) v mt s
cht c ngoi sinh (vo bng ng tiu ha, ng mu)...
+ Cc sn phm tha (so vi nhu cu): natri, nc, mui v c...
- Bi tit v ti hp thu: thc hin ng thn;
+ Bi tit mt s cht ngoi s lng c o thi bng lc cn c bi tit gp
5 ln ng thn; v d ng thn bi tit H+, NH4
+, K+...
+ Ti hp thu thu hi v tr v huyt tng nhiu cht cn thit cho c th
trc b thot ra t cu thn do ln vo cc cht o thi. Nhng cht c hp thu
ton b v ti a nh axit quan, glucoza,... Nhng cht c hp thu mt phn nh
Na+, nc; trong phn c bn c ti hp thu ng ln gn; sau ng ln
xa v ng gp c s ti hp thu b sung, di s iu khin ca hon non ADH v
aldosteron.
c im chc nng quan trng nht ca thn l s bi tit nc tiu. Vic bi tit
nc tiu c tin hnh thng xuyn ch ng duy tr hng nh ca ni mi,
bao gm: qu trnh lc cu thn, qu trnh bi tit v ti hp thu ca ng thn.
6.1.1. Qu trnh lc cu thn
Nc tiu c hnh thnh do hin tng lc xy ra cu thn ph thuc vo p
lc biu din bng cng thc sau:
P1 = Pc - (Pk + Pn)
Trong :
P1 l p lc lc
Pc l p lc thu tnh mao mch cu thn, khong 60 mmHg
Pk l p lc keo mao mch cu thn, khong 32 mmHg
Ph l p lc nc v keo trong xoang Bowmann, khong 18 mmHg
Do vy, p lc lc tnh ra khong xp x 10 mmHg
Nh vy:
(1) Gip qu trnh lc gm ba lc :
- p lc thu tinh (Pc) trong mao mch cu thn: phn nh tng quan gia huyt
p v sc cn ca tiu ng mch n v tiu ng mch i ca cu thn. Nu sc cn
c duy tr khng i th khi thay i huyt p s dn n thay i mc lc cu thn;
ngc li nu huyt p ng n l khng i th khi tiu ng mch co li lm gim
lc cn nu gin s tng. i vi tiu ng mch i th ngc li.
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- p lc keo ca Bowmann: vai tr khng ng k, v bnh thng dch lc trong
nang hu nh khng c protein (ch bng 0,2-0,5% ca huyt tng)
- Lu lng mu qua thn: mao mch cu thn b mt dch sang nang Bowmann
c xu hng c c dn, lm tng nng protein, ngha l s cn tr qu trnh lc;
nu c thay th bng huyt tng mi khc phc xu hng trn th lc lc vn
duy tr tt. l c ch lng dch lc ph thuc vo lu lng mu qua cu thn.
(2) Cn tr qu trnh lc gm:
p lc thu tnh ca nang Bowmann v p lc keo trong mao mch cu thn: bnh
thng khong > 18 mmHg.
Nu tng chng (nh khi c tc nghn ng thn v ng tit niu, hoc khi mu
b c c- a n tng protein mu) s lm gim p lc lc.

Tr s bnh thng ca p lc lc P lc = Pc - (Pk + Pn) = 60 - (32+18) = 10 mmHg.

H s lc (Kf) l t s lu lng lc v p lc lc, bnh thng l Kf= 125/10 =1,25
ml/pht/mmHg. Qu trnh lc ch c thc hin nu P1 >0
Ngoi cc yu t trn, mc lc cu thn cn ph thuc bn thn cu trc vch mao
mch cu thn, c th l tnh thm v din tch m mng lc.
Nh vy, gim lc cu thn c th do:
+ Gim Pc trong mao mch cu thn (nh khi sc, mt mu, tt huyt p...)
+ Tng Pn nang Bowmann (nh khi tc ng thn hoc ng tit niu)
+ Tng Pk cu thn nh khi c c mu, mt nc, tng thot huyt tng, bnh
cu thn (Pk cu thn khong 32 mmHg, cn huyt tng chng l 28 mmHg)
(3) iu kin lc ca cu thn
Thn c c ch t iu ho dng mu ti thn vi iu kin huyt p trung bnh t
80- 1 80 mmHg; nu vt ra khi gii hn ny th mc lc ph thuc vo huyt p v
nu < 70 mmHg th qu trnh lc b ngng. Qu trnh t iu ho th pht sau khi thay
i ng knh ca tiu ng mch thn (tiu ng mch n): nu tng p s dn ti
co mch v nu gim p s gy gin mch. Ngoi ra mt s yu t khc cng tham gia
vo nh h thng thn kinh giao cm, mt s hormon v cc cht vn mch
(angiotensin II, arginin vasopressin, prostaglandin).
a) Cu to cu thn
Mi cu thn l s kt hp cht ch b mao mch gn lin vo trong biu b ca
u ng thn. Cho nn mng c bn ca biu b ng thn gn lin vi mng c bn ca
ni b mch qun.
cu thn t bo biu b ng thn c chn xen k vi nhau, ngc li ni b mao
mch bn trong li hnh thnh mng r c nhiu l khong 100 Ao, iu ni ln
159
qu trnh lc cu thn l s khuch tn qua mng c bn.
Cu to siu vi th mng lc ca cu thn: T bo c chn xen k nhau, lp xi
mng ca biu b, mng c bn chung, lp xi mng ni b v lp ni b hnh thnh
mng r.
Qu trnh lc l s khuch tn qua mng, lp t bo ny bnh thng n cho qua
mi thnh phn ca huyt tng tr thot c trng lng ln trn 70.000, ch khi no
thn b tn thng th thot mi qua c.
- Ti m ri mao qun c mt nhm t bo rt nhy cm vi huyt p. Khi huyt
p h th t bo ny tit ra Re nin lm tng huyt p.
cc loi gia sc s lng n v thn khc nhau: b l 8 triu, ln l 1,4 triu,
cu: 1 triu n v, mo 2-3 triu n v (mt n v thn bao gm cu thn, ng ln
gn, quai Henle, ng ln xa v ng gp.)
Tt c cc n v thn ny khng hot ng cng mt lc m n thay phin nhau
hot ng v vy ngi ta thy thn c kh nng b tr rt mnh.
b) Thnh phn ca nc tiu trong nang Bowmann
Gn nh l thnh phn huyt tng ca mu, cho nn nu thn lc m khng c s
ti hp thu th c th s suy kit mt nc v mt cc cht dinh dng.
6.1.2. Chc nng ti hp th v bi tit ca ng thn
* Qu trnh ti hp thu
Phn ln cc cht nh ng, mui, nc c hp thu gn ht trong ng thn.
ng ti hp thu hon ton (tr khi ng huyt p cao qu ngng hp th ca
thn).

C mt s cht ch hp thu mt phn nh: quan, phosphat, sulfat, ur, axit

ascorbic...
S ti hp thu nc, Na+, K+ qua hai giai on khc nhau:
- Giai on u ti ng ln gn hp thu 80% nc v Na+, ton K+ c hp thu
gn 100% S hp thu giai on ny khng chu nh hng ca cacbon.
- Giai on sau di ng thn, quai hen le, ng ln xa v ng gp: nc v con
Na+ c hp thu theo yu cu ca c th di s iu ho ca hormon nh:
Hormon ADH ca thu sau tuyn yn lm tng hp thu nc ca quai Henle v
ng gp; hormon thng thn aldosteron tng ti hp thu Na+ ng ln xa, ng gp
v nhnh bn ca quai Henle, ng thi cn trao i K+ ng ln xa.
Vic hp thu Na+ l mt c ch thch nghi ca c th trong qu trnh iu ho axit
baz.
160
* Qu trnh bi tit:
Trong nc tiu nng mt s cht cao hn trong mu, cc axit hu c c mi
thm, axit hipuric, penicilin, B, PSP (phenolsulphatlein).
6.2. Ri lon b my tit niu
6.2.1. nh hng ca thn kinh v thn kinh th dch
- V no: Theo Cau non v Vemey khi gy mt cm xc mnh trn con vt s lm
gim tit niu do co tht mch v thn lm cho mu dn ti t.
Cc tc gi Lin X (c) cng c th gy phn x c iu kin lm tng tit
niu.
- Phn di v: C nh hng r rt ti s tit niu cng c chng minh
bng thc nghim. Hin tng u no gia gy tng tit niu, dng kali kch thch vo
no tht IV hoc vng di i th (h khu no) s gy tng lng nc tiu r rt.
Theo Vemey vng di i th c cc trung khu cm th thm thu v th tch (p
sut thm thu v p sut thu tnh) khi lng nc t ti vng di i (p sut thu
tnh h hoc huyt p h mu ti t) cc c quan cm th ny b kch thch t n
kch thch ln thu sau tuyn yn gy tit ADH lm gim bi tit. iu cng cho
php gii thch s tng nc tiu khi no c hin tng sung huyt nh trong vim
no, u no v s gim nc tiu trong trng hp gim mu qua no nh trong sc
mt mu, mt nc (ngoi sc do thn kinh cn sc do gin mch mu ngoi vi dn ti
huyt p h lm cho mu n thn t v nc tiu gim.
- Thn kinh thc vt (h giao cm v h ph giao cm)
Khi kch thch thn kinh giao cm thy gim tit niu do thiu mu ti v thn v
c co mch; khi kch thch thn kinh bng (thn kinh giao cm) cng gy gim tit
niu v khi ct t chng th gy tng tit niu.
- Ni tit:
+ H no-tuyn yn-v thng thn (tt c stress u lm thay i trc h no khi
cc yu t tc ng) c nh hng trn tit niu.
Di nh hng ca hormon tuyn yn (ACTH) v c tuyn tng tit (GTH), v
thng thn tit cortisol v aldosteron, khi nhng cht ny tng trong mu s gi mui
ko theo nc li lm gim bi tit nc tiu.
Cht re nin do t bo cn cu thn tit ra khi thiu mu cng gy tng tit
aldosteron lm gim tit niu.
6.2.2. nh hng ca mu
Tt c nhng trng hp bnh l lm thay i thnh phn v trng thi l ha ca

mu u gy nn nhng bin i v cht lng v s lng nc tiu.

161
V d: Lng ng huyt cao dn n ng niu v km theo a niu (lng
ng trong nc tiu cao lm tng p lc thm thu, nc khng ti hp thu c ti
ng thn nn theo ng ra ngoi).
Khi nhim c axit dn ti axit trong nc tiu cng cao, thot huyt thp dn ti
a niu, hemoglobin trong mu tng dn ti H niu.
6.2.3. nh hng ca huyt ng hc
Chc nng lc ca thn chu nh hng ca huyt p, c th l lu lng mu qua
thn trong mt pht.
Khi lu lng mu gim th nc tiu gim v khi huyt p h di 40 mmHg th
khng c nc tiu.
Khi ri lon tun hon ni chung dn ti ri lon tun hon ti thn (lm thay i
nc tiu) gy thiu mu v thn nh do hot ng ca h mch tt (shunt) vng
ranh gii gia v thn v li thn s a n thiu niu hoc v niu. Hin tng ri
lon tun hon ti thn cn dn ti suy dinh dng ti thn, tn thng nhu m thn
dn n nh hng chc nng ca thn.
6.3. Mt s bnh thn
6.3.1. Bnh vim ng thn cp
6.3.1.1. Nguyn nhn
Ch yu do nhim c cc cht c c th l do nhng ha cht t ngoi a vo
nh thu ngn, ch, a sen, xyanua, sulfamid... hoc c th do c t trong c th nh
c t ca t bo hu hoi, s truyn mu nhm loi, bng nng, b chn thng dp
nt nhiu... hoc cn c th nhim khun nh nhim bacillus perfringens.
6.3.1.2. C ch
Cc cht c vo thn c ch h thng men chuyn ha ti t bo thn lm cho
men mt hot tnh a n nhng tn thng ti thn.
Theo Peters (1929-1932) dng hp cht c a sen gy vim thn thc nghim v
chng minh c rng a sen c i tnh rt mnh vi men c nhm SH thn lm
cho men b phong to khng hot ng c. ng biu din cng thc nh sau:
Sau ng li tm cch gii phng men ny ra v khi gii phng c th thn li
hi phc c.
ng dng cht BAL (British anh Lewiste tc cht chng hi c Lewiste ca Anh
162
tm ra sau i chin th gii th 2) v biu din bng cng thc sau:
6.3.2. Bnh vim cu thn cp
6.3.2.1. Nguyn nhn
Ch yu do vim nhim khun nhng v c ch c l l do ri lon min dch,
bnh pht sinh thng lin quan ti s vim nhim cc ni khc nh vim hng,
da, rng, mi, phi.
6.3.2.2. C ch
Trong thc nghim ngi ta cng chng minh thnh cng vic gy vim cu
thn theo c ch min dch:
- Masugi: dng khng huyt thanh vt chng thn th dn n gy vim thn th.
- Cavelti: dng thn th trn vi c t lin cu khun tiu huyt nhm B ri em
tim cho th lnh cng gy c vim cu thn.
- Dixn (1961) tim huyt thanh d loi nhc i nhc li nhiu ln cng gy c

nhng lng ng khng nguyn - khng th bn ngoi mng c bn cu thn th.

- Heymann dng thn th nghin cng t cht Freund tim vo trong bng th
gy vim cu thn ngoi mng do ng khng nguyn quanh ng ln gn.
Kt hp vi nhng hin tng lm sng nh vim thn th pht xut hin sau 1015 ngy, sau khi cc vim nhim khun trn pht ni khc cng c th xc nh
c c ch vim cu thn l do c ch min dch: do phc hp khng nguyn khng
th lng ng thn nhiu v do vi khun c cu trc tng t nh thn.
Cho n nay ngi ta gii thch nh sau:
+ Do phc hp khng nguyn-khng th t nhim trng tin pht lng ng
thn c s tham gia ca b th gy ra mt lot cc phn ng: hot ha h thng ng
mu, hot ha h thng khn huyt tng t gy tn thng ti ch.
+ Phc hp khng nguyn-khng th cng nh bn thn khng nguyn c kh
nng lin kt vi cu trc ca cu thn to thnh phc hp mi c c tnh nh khng
nguyn dn n kt qu l to ra mt qu trnh t min dch i vi c th mnh.
+ Mt khc s lng ng ca cc phc hp min dch trn ni mc cu thn gy
nn phn ng thm nhim nhiu t bo bch cu gy tn thng tng sinh t bo ni
mc cu thn.
163
6.3.2.3. Biu hin v hu qu
Din bin cp: Thiu niu hoc v niu, nc tiu c t trng cao, c, c cha
protein, hng cu, bch cu, tr ht... Trong mu c ng cc sn phm chuyn ha
chp cht no phi protein v cc axit, cc mui v c: natri, phospho...) a n tnh
trng gi l hi chng "tng m huyt" c th gy hn m. Tng p lc thm thu (ch
yu do Nai a n ph.
Tt c th hin bnh l cu thn: suy gim chc nng cp din v nng n, cn
chc nng ng thn t b nh hng hn (vn cn kh nng c c), th hin t trng
nc tiu rt cao.
Hu qu: Lm thay i cu thn, mt mt lm gim kh nng lc cu thn, mt
khc lm thay i chc nng hp thu ca ng thn dn n thiu niu hoc v niu,
mt na lm tn thng t bo c bit l t bo nang thn lm cho tnh thm thu ca
n tng dn ti xut hin protein niu.
6.3.3. Thn h nhim m
Gi l thn h nhim m v chc nng gi protein ca cu thn suy gim ng
thi t bo ng thn c hin tng nhim m
Nguyn nhn: Do nhim c ton thn th pht t vim cu thn, nghn tc mch
qun, t mt s bnh khc nh i ng.
Biu hin: Ch yu bi nhng thay i dch th nh protein niu rt cao, lm gim
protein huyt vi tng alpH v be ta globulin v nht l tng lipit v cholesterol
trong mu. Bnh cnh lm sng l mt tnh trng gi nc quan trng vi ph n gn
nh ton thn, c th c thu thng ph mc, bng nhng thng c huyt p cao v
thiu nng thn bi tit.
Thc cht, thn h nhim m l vim cu thn siu vi th, trn lan, ch thy c
tn thng bnh l di kinh hin vi in t. Tn thng sm nht l s gin rng ca
cc l lc cu thn khin protein d dng thot ra, khin huyt tng mt protein, c
th n mc lm nng cht ny trong huyt tng gim xung m ch n v s
164
sn xut ca gan khng b p c. Lng protein trong nc tiu ni ln phm vi

tn thng cu thn. Lng dch lc t cu sang ng bnh thng, do vy khng c

ng cht o thi trong c th v khng ph do tng p lc thm thu, m ph l do
gim p lc keo trong mu. Chc nng ng thn bnh thng.
Cc ri lon khc cng bt ngun t mt protein huyt tng: lipit huyt cao, ph,
suy dinh dng, thiu mu... nhng khng nhim axit v khng c hi chng m
huyt. Chnh do lipit huyt tng ln, nng lipit trong dch lc cu thn tng theo, s
ti lc vt kh nng ti hp thu ca ng thn: biu hin bng m tch ng trong bo
tng ng thn, di ci tn "nhim m".
Tnh trng thoi ha m ca t bo ng thn c gii thch
- Do cu thn b h hi lt qua cc thnh phn m, thot v nc tiu u, m
t bo ng thn li phi hp thu qu nhiu, n ng trong cc tng bo ng thn,
m cc men chuyn ha ng thn gim v vy m ng khng thot ra c gy
thoi ha m.
Gn y c gi thuyt cho rng h thn cng c min dch nh trong vim cu
thn, ngi ta cng thc nghim tim protein l lin tip nhiu ln hay trn t chc
thn vi dc t Freund thy mt s con vt thc nghim cng b h thn.
6.3.4. Vim k thn
Ch yu do nhim khun m thng qua ng niu vo b thn ri ti nhu m
thn. Vim k thn thng vim mn tnh ch yu y l tng sinh cc t chc lin
kt dn n hin tng x thn. Vim k thn cng c khi dn ti thiu niu do teo
niu, nhim c c th.
Trong hnh nh bnh l cc ng thn v cu thn gin ra, t chc x tng sinh rt
nhiu, li lm... Ct vi th ra thy t chc x chn p nhu m thn.
6.4. Nhng biu hin lm sng ca bnh thn
6.4.1. Nhng biu hin trong nc tiu
6.4.1.1. Thay i v cht lng nc tiu
Bnh thng nc tiu ca gia sc c mu vng nht, mi khai v trong sut nh:
tru b mu vng rm, nga mu thm hn, ch c mi khai nh ti. Bnh thng
nc tiu khng c cn tr nc tiu nga c mui cacbonat can xi phosphat khng
ho tan nn c, cn cc loi gia sc nu c s vn c l c s ri lon chc nng
thn.
Trong nc tiu c mt s cht chnh nh: clorua, phosphat, sulfat, m, axit c,
creatinin... v mt s t bo long ca ng tit niu bng quang (lin bo).
Nc tiu ca ng vt n c kim tnh, ng vt n tp thng toan tnh, ring
ln c th kim tnh hoc toan tnh.
165
Bng 10. Mt s ch tiu v nc tiu ca gia sc kho
Tn gia sc S lng nc tiu 1 ngy (lt) T trng pH
Nga
i gia sc
Cu
Ln
Ch
Mo
Th
3-6
6-12

0,5-1
2-4
0,2-1
0,05-0,2
0,05-0,5
1,025-1,055
1,025-1,050
1,015-1,050
1,018-1,020
1,016-1,060
1,020-1,040
1,010-1,015
7,2-8,7
7,7-8,7
8,0-8,5
6,5- 7,8
5,0-7,0
5,0-7,0
8,0
Khi ri lon hot ng ca thn th khng nhng thnh phn, t trng v t l cc
cht trn thay i m cn xut hin nhng cht bt thng trong nc tiu:
- Protein niu: l do mng cu thn b tn thng lt qua protein c phn t
lng ln hoc do ng thn b tn thng khng ti hp thu c hoc c 2 trng
hp. Thng th Albumin qua c trc tin v trng lng phn t nh (69.00072.000) sau n globulin...
Hin tng ny ph thuc vo mc tn thng ca thn. Ngi ta c th nh
gi mc tn thng ca cu thn qua t s A/G. Khi t s A/G trong nc tiu cng
nh th bnh cng nng.
- Huyt niu: Nc tiu bnh thng hu nh khng c hng cu, khi xut hin
hng cu c th do hai nguyn nhn:
+ Do v mch mu ng tit niu thng thy nc tiu c mu ti
+ Do tn thng thnh mch cu thn nh vim, nhim c, d ng hng cu
lt ra c, thng rt t, kh thy, cn nu khi mch qun tn thng nng th mu
sc thay i r rt c khi mu en thm, nu...
- Tr nim: Tr niu l nhng khun ca ng thn do cc cht nh thot, lipit, t
bo long ra ng li vi nhau trong lng ng thn. Khi i theo nc tiu ra ngoi tng
on. Tu theo thnh phn ca tr niu c:
+ Tr t bo do kt t ca cc t bo hng cu, bch cu, lin bo ng thn, c th
c xc vi khun.
+ Tr khng t bo: Cu to do cc cht thot, lipit.
- ng niu: Do qu trnh ti hp thu ca thn hng ch yu l do ri lon
chuyn ha ng nh bnh cm ch, vim no tu, trng c CO2, Hg, As, clorofoc.
- Axit niu: Trong mu nng axit tng ln lm cho axit c tng ln.
6.4.1.2. Thay i v s lng nc tiu
166
C th l tng, gim hoc hon ton khng c:
- a niu: C th thi tit mt khi lng nc tiu ln hn bnh thng do tng

cng qu trnh lc nc tiu v qu trnh ti hp thu trong cc ng thn c th do:

+ Do ung nhiu nc, n mn, n nhiu rau qu cha nhiu nc.
+ Do trong trng hp bnh i tho ng.
+ Do qu trnh ti hp thu ti ng thn km: do teo, tn thng.
+ Tng huyt p, tng tun hon.
- Thiu niu: l lng nc tiu gim xung di mc bnh thng, c th do:
+ Tn thng thc th t chc thn vim cu thn hay ng thn, ri lon chc
nng lc v ti hp thu, cng c th thiu niu khng phi do thn nh:
+ Khi mt nc gim th tch mu qua thn: a chy, ra m hi nhiu, nn ma.
+ Mt mu.
+ Khi suy tim tr tun hon.
+ Khi sc gim huyt p chung.
+ Khi tit niu b cn tr.
+ Khi ph, thu thng, tch nc t chc, xoang.
- V nim l khi hon ton khng c nc tiu bi tit, thng gp trong vim ng
thn cp do:
+ Do h hi ng thn lm tc ng thn, nc tiu u khng ra ngoi c.
+ Do h hi t bo ng thn lm hng s ngn cch gia ng thn v mao qun
lm nc tiu b hp thu hon ton vo mu gy nhim c nng.
+ Do ri lon tun hon ti v thn gy thiu mu vng v thn lm gim chc
nng lc ca thn.
+ Do phn x bi cc kch thch au n ti vng tit niu hay mt s b phn
ca ni tng gy phn x co mch lm thiu mu thn.
6.4.2. Nhng thay i trong mu khi tn thng thn
6.4.2.1. Ur huyt cao
Cc sn phm phn hu protein tch li v to nn hi chng m huyt cao. Trong
mu m nh phi thot tng nh: ur, NH3, creatinin, quan trng nht l m,
thng biu hin chn n, mt mi, co git.
6.4.2.2. Nhim c toan
Nng axit cao dn n nhim c axit do khng thi c axit hoc do khng
hp thu c ton Na+ trung ho.
167
6.4.2.3. Thiu mu
Thiu cc hormon sinh hng cu (erythropoietin); thiu nguyn liu mu long v
gi mui v nc, tc dng ca cc cht c khng c o thi li c ch tu
xng to hng cu.
6.4.2.4. Ri lon chuyn ha natri
Khi natri huyt tng lm cho con Na+ t chc tng dn n ph. c ba nguyn
nhn gy gi natri:
- Tn thng cu thn lm lng natri lc qua t i m ti hp thu ng thn vn
bnh thng.
- Trong thn h th do mt nhiu protein huyt tng m sinh ph v tip c
tng aldosteron th pht lm gi natri.
- Do suy tim th pht vi bnh thn thng l v cao huyt p do thn.
6.4.3. Biu hin ton thn
Khi gia sc mc bnh thn biu hin ton thn l ph. Ph do vim cu thn, m
vim cu thn do gi nhi trong t chc v gim protein trong mu; do thn h lm

gim p lc keo tc gim thot mnh v do thiu mu biu hin da xanh, mi mt nht
nht.
6.5. Bin chng ca ri lon chc nng thn
Cc bnh ca thn u dn n suy thn hay cn gi l thiu nng thn:
- Suy thn: tc l hin tng thn khng cn kh nng lc v bi tit nc tiu.
+ Suy thn cp: xy ra nhanh kh hi phc m biu hin l v niu. Triu chng
ch yu ca v niu l huyt p cao, m huyt cao c th dn ti hn m v cht do
nhim c
+ Suy thn mn tnh: xy ra t t, bnh tin trin tng t, gim chc nng bi
tit, nhim c ngy cng tng, thng khng hi phc c.
Triu chng: thiu niu, nc tiu c thot, c hng cu, bch cu, tr niu, m
huyt, axit huyt tng, c ph thng, huyt p cao.
- Hn m: l giai on cui cng v nng n nht do qu trnh nhim c nng.
Cc cht c t ng rut vo nh indol, scatol, phenol, cc axit c nh: axit c,
axit xc, axit oxalic, cc gc sulfat khng c o thi gy nhim c chung cho c
th.
7. SINH L BNH TUYN NI TIT
7.1. i cng
H thng ni tit l mt h thng cc tuyn ni tit, tit ra cc cht c hot tnh
168
sinh l iu khin cc hot ng sng trong c th gi l hormon.
Hormon trc tip vo mu hoc gin tip qua lm ba vo mu. Tc dng ca
hormon gm nhiu mt bao gm:
(1) Tc ng vo qu trnh trao i cht.
(2) Tc ng vo qu trnh sinh trng, pht trin v qu trnh hnh thnh cc c
quan t chc bit ha trong c th v bin i v hnh thi.
(3) Tc ng vo ng lc khi ng: cc hormon gin mch, co mch, tim p
nhanh, h hp nhanh.
(4) iu khin cc chc nng ca ton b c th hoc chc nng ca cc c quan
trong c th.
ng vt cp thp hormon c tc dng iu ho hot ng v cc quyt nh i
vi s iu ho hot ng sinh l ca cc b phn trong c th.
ng vt bc cao: Cc hom lon tc ng cng vi h thn kinh iu ho ton
b hot ng ca c th l s iu ho ca thn kinh v th dch.
Tc dng ca ni tit ni chung thng qua h thn kinh thc vt v v no, cn v
no thng qua trung tm di v iu ho ni tit.
Tc dng ca hormon i vi cc m v c quan ph thuc vo bn cht ha hc
ca hormon v c tnh ca m. Do trng thi v chc nng ca cc c th khc nhau
th tc dng ca cng loi hormon cng c th khc nhau. Ni tit m ri lon c th
c nhng yu t bn ngoi v nhng yu t bn trong. V d: tuyn thng thn, tuyn
sinh dc b lao hay b tn thng (do b thng, do chn p) hoc b ng c, u c
tnh... dn n mt chc nng.
Hot ng ca ni tit cn nh hng bi phng thc chn nui v d: v ma h
cu th rng khng c b sung thc n th t l ng dc gim, ngc li b sung
thc n tt th t l ng dc cao.
Trong trng hp ring bit ni tit cng c nh hng n s di truyn v ging
v sn lng sn phm.

7.2. iu ho ni tit
m ca hormon trong ni mi tng i hng nh do s cn bng gia bi
tit hormon v phn hu hormon. m ca hormon quyt nh hot ng ca tuyn
ni tit, v d: kch dc t t tuyn yn vo mu s quyt nh hot ng ca tuyn
sinh dc. Mt khc trng thi l ha ca dch th ni mi cng tc ng ln tuyn ni
tit nh: glucoza huyt vi tuyn tu, can xi huyt i vi tuyn cn gip trng. Khi c
ri lon s lm mt s cn bng gia sinh v hu hormon sinh ra cc ri lon ni tit.
Ngoi ra thn kinh c nh hng trc tip ln ni tit: thn kinh s X ln tuyn
tu, thn kinh giao cm vi li thng thn, c bit l vng h khu no tc ng ln
169
vng thn kinh ca tuyn yn t tc ng ln thu trc v sau ca tuyn yn.
7.3. Ri lon cn bng ni tit
Ri lon chc nng ni tit biu hin di ba dng bnh l:
- u nng: lng hormon dng hot ng c nng vt gii hn nhu cu sinh
l Nhiu trng hp tng lng hormon trong mu rt thp m vn biu hin u nng,
do a s dng hot ng.
- Nhc nng (suy): gim hoc khng c hormon dng hot ng. Nhiu trng
hp nng hormon rt cao trong mu nhng vn biu hin lm sng bng cc triu
chng nhc nng, l do hormon tn ti dng kt hp (b bt hot).
- Ri lon chc nng: do sai st enzym tham gia sn xut hom lon. Chng hn,
trong hi chng sinh dc-thng thn bm sinh, do ri lon enzym nn c gim sn
xut cortisol nhng li tng sn xut androgen.
Hot tnh ca hormon trong mu c ngha ln ti c ch bnh sinh ca bnh ni
tit S thay i hot tnh ca hormon theo nhng con ng sau:
(1) Ri lon quan h gia hormon v thot ca huyt tng (corticosteron,
tyroxin, insulin) gn vi thot ton b hay tng phn lm gim hot tnh ca honon.
(2) Ri lon c ch hom lon trong cc m m ch yu trong gan (gan b x, gan b
vim).
(3) Trong c th to ra khng th l nhng thot, polypeptit lnh phong b hom
lon, v d: Bnh tiu ng do khng th phong b insulin hoc do men insulinaza ph
hu insulin.
(4) Ri lon s kt hp hormon vi cc c quan cm th trong t bo hoc cc tiu
phn cm th tng ng vi cc men. Tc l cc yu t lm bin i hot lc ca men,
v d: Oestrogen, tyroxin vi men glutamat-dehydro-genaza.
7.3.1. u nng tuyn ni tit
l nhng biu hin s hot ng tng cng ca tuyn ni tit.
7.3.1.1. Nguyn nhn
- Tuyn b ph i v nhu m, pht trin nhu m lm tng tit hormon.
- B kch thch t bn ngoi qu nhiu. V d: hi chng Cushing ngi, trong
v thng thn b ph i v tuyn yn tit qu nhiu ACTH hoc trong trng hp
iu tr tim mt liu cao ACTH.
Bnh Basedow do u nng tuyn gip do c th sn xut ra mt cht m cht ny
kch thch tuyn gip tng cng hot ng l cht LATS (Long acting thyroid
stimulation) cht ny do qu trnh mn cm sinh ra (trc y ngi ta cho rng bnh
Basedow l do tuyn yn tit ra TSH).
170
bnh Basedow, ngi ta cn thy vai tr ca thn kinh v bnh nhn thng l

nhng ngi hay lo lng, d xc cm. Trong thc nghim ngi ta thy kch thch vo
tuyn no thi gian lu th tuyn u nng.
7.3.1.2. Hu qu
- Bn thn tuyn khi u nng th ph i gy nn u bu do tng cng chuyn
ha ti ch. V d: Tuyn gip trng khi tim tt nh du bng phng x ng v vo
th cht ny nhanh chng tp trung vo tuyn gn vo hormon ri phng thch ra
ngoi. i vi c quan cm th: khi tng cc hormon lm tng hot ng ca cc c
quan cm th.
V d: Tng insulin dn n tng chuyn ha glucoza lm cho glucoza gim.
- i vi cc tuyn ni tit khc s c nh hng khi c lin quan, v d: trong
tuyn yn m u nng th n c ch kch dc t dn ti lm teo tuyn sinh dc.
Hi chng Cushing do u lnh ca v thng thn m v thng thn tng tit
cortisol lm c ch ACTH, do ACTH khng tc ng ln phn khc ca thng
thn dn ti teo mt bn kia.
7.3.1.3. u nng gi
L trng hp tuy c nhng triu chng lm sng u nng nhng khi o trong
mu th nng hon non vn bnh thng (khng cao, m c khi cn thp). C ch
a n cc triu chng lm sng u nng gi l:
- Do c quan cm th tng mn cm vi hormon v d: chuyn ha c bn tng
ln nhng khng c u nng tuyn gip gp trong bnh to cc b tng b phn (tc l
ch mt ch chn tay hay xng hm) c th do c quan nhn cm ca vng tng
nhy cm vi STH.
- Hormon khng b phn hu hoc gim tc phn hu li trong mu.
V d: Suy gan do khng phn hu c ADH, eostrogen cho nn gy ph,
nc, rng lng, da mn.
- Gim tng hp cht vn chuyn hormon, khin lng hon non dng t do
(dng hot ng) chim t l cao.
7.3.2. Thiu nng ni tit
7.3.2.1. Nguyn nhn
- Ri lon tun hon ti cc tuyn, tc mch, huyt khi lm cho mu khng cung
cp cho tuyn c.
- T chc tuyn b tn thng do chn thng, do vim nhim khun, nhim c,
nhim phng x.
Ri lon v dinh dng: nh thiu rt vng cao (ngi v gia sc) lm cho
171
tuyn gip trng thiu nng, suy dinh dng lm ri lon sinh dc.
- Ri lon chung gia cc tuyn c nh hng ln nhau.
V d: Tn thng tuyn yn do nh hng n tuyn gip, thng thn, tuyn
sinh dc.
Hoc do c th phn hi v d: iu tr bng cc hormon tng hp nh
hyrocactanxyt hoc cc loi steroit lm cho m ca n trong mu tng ln s c
ch tuyn yn tit ACrH dn ti gim hot ng ca v thng thn.
7.3.2.2. Hu qu
- Tuyn khng hot ng v b teo i, t chc x pht trin.
- C quan nhn cm s ri lon tng ng. V d: Gim tit kch dc t th tuyn
dinh dc thiu nng, cc b phn sinh dc km pht trin.
7.3.2.3. Thiu nng gi

Khi tuyn sn xut mt lng hormon khng gim, c khi cn tng nhng vn c
nhng du hiu lm sng ni ln thiu nng tuyn. C ch l:
- Tc hu hay bt hot hormon qu nhanh.
- C quan ch gim nhy cm vi hormon.
V d: T chc km nhy cm vi insulin gy bnh tiu ng (bnh tiu ng
25% l do t chc km nhy cm vi insulin).
- Nhu cu hormon tng cao nhng chc nng tuyn ch tng t...
172
TI LIU THAM KHO
1. V Triu An. 1978. i cng sinh l bnh hc. Nh xut bn Y hc, H Ni.
2. V Triu An, Jean Claude Homberg. 1998. Min dch hc. Nh xut bn Y
hc, H Ni.
3. Coles, Embert H. 1980. Vetennary Clinical PHthology, 3rd Edition. W.B.
Saunders CompHny, Philadelphia, USA.
4. Cotran, Ramzi S., Kumar Vi nay, Robbins Stanley L. 1994. Robbins Pathologic
Basis of Disease, 5th Edition. W.B. Saunders CompHny, Philadelphia, USA.
5. V Cng Ho, Vi Hu Trc, Nguyn Vn Phi, Nguyn Vng, Trnh Vn
Quang, L nh Ho v Phan ng. 1986. Bi ging gii phu bnh. Nh xut bn Y
hc, H Ni.
6. Hunh Vn Khng. 1993. Bnh ngoi Khoa gia sc. Nh xut bn nng
nghip, H ni.
7. Nguyn Ngc Lanh, Vn nh Hoa, Phan Th Thu Anh v Trn Th Chnh.
2002. Sinh l bnh hc. Nh xut bn Y hc, H Ni.
8. Cao Xun Ngc. 1997. Gii phu bnh i cng th y. Nh xut bn Nng
nghip, H Ni.
9. Nguyn Vnh Phc. 1978. Gio trnh bnh truyn nhim gia sc. Nh xut
bn Nng nghip, H Ni.
10. Smith, H. A., Jones, T. C., and Hm, R. D. 1972. Veterinary PHthology, 4th
Edition. Leo & Febiger, Philadelphia, USA.
11.Nguyn Nh Thanh. 1996. Min dch hc. Nh xut bn Nng nghip, H Ni.
12. Thom son, R. G. 1984. General Veterinary PHthology, 2nd Edition. W.B.
Saunders CompHny, Philadelphia, USA.
13. Nguyn Xun Tnh, Tit Hng Ngn, Nguyn B Mi v L Mng Loan.
1996. Sinh l gia sc. Nh xut bn Nng nghip, H Ni.
14. Tizard, lan R. 1977. An Introduction to Veterinary Immunology. W. B.
Saunders CompHny, Philadelphia, USA.
15. T Th Vnh. 1991. Gio trnh sinh l bnh th y. Xng in Trng i hc
Nng nghip I, H Ni.
16. William W. Carlton and M. Donald McGavin. 1995. Special Veterinary
PHthology, 2nd Edition. Mosby-year Book, lc., USA.
173

MC LC
LI NI U................................................................................................................2
Bi m u: NI DUNG V PHNG PHP NGHIN CU MN SINH L
BNH TH Y ................................................................................................................3
1. nh ngha mn hc..............................................................................................3

2. Ni dung mc hc...................................................................................................3
3. Phng php nghin cu mn sinh l bnh th y ..............................................4
3.1. Phng php thc nghim cp tnh (cp din) ....................................................4
3.2. Phng php thc nghim mn tnh (trng din)..............................................4
Chng 1: CC KHI NIM V QUY LUT CHUNG V BNH......................6
1. Khi nim v bnh .................................................................................................6
1.1. Mt s khi nim trong lch s ............................................................................6
1.2. Quan nim v bnh hin nay..............................................................................11
2. i cng v bnh nguyn hc ...........................................................................12
2.1. nh ngha..........................................................................................................12
2.2. Mt s quan nim sai lm v bnh nguyn hc .................................................13
2.3. Quan nim khoa hc v bnh nguyn hc .........................................................14
2.4. Phn loi cc yu t bnh nguyn......................................................................16
3. i sng v bnh sinh hc.................................................................................18
3.1. nh ngha..........................................................................................................18
3.2. nh hng ca bnh nguyn ti qu trnh bnh sinh ........................................19
3.3. Quan h gia cc b v ton thn trong qu trnh bnh sinh.............................20
3.4. Vng bnh l ......................................................................................................21
3.5. Cc hin tng bnh l ......................................................................................22
3.6. Cc giai on pht trin ca bnh ......................................................................23
3.7. C ch phc hi sc kho ..................................................................................26
4. Tnh phn ng ca c th v bnh l ca qu trnh min dch.......................27
4.1. Tnh phn ng ca c th...................................................................................27
4.2. Bnh l ca qu trnh min dch ........................................................................30
Chng 2: SINH L BNH CC QU TRNH BNH L CHUNG ..................48
1. Ri lon tun hon cc b......................................................................................48
1.1. Sung huyt cc b (local Hypercmia)................................................................48
1.2. huyt (Stasis)..................................................................................................51
1 3. Thiu mu cc b (Ischemia).............................................................................52
1.4. Nhi huyt (Infarction) ......................................................................................53
1.5. Xut huyt (Hemorrhage) ..................................................................................53
1.6. Huyt khi (Thrombosis) ...................................................................................55
1.7. Lp qun (Embolism).........................................................................................56
2. Ri lon chuyn ha cc cht..............................................................................57
2.1. Ri lon chuyn ha gluxit ................................................................................57
2.2. Ri lon chuyn ha lipit ...................................................................................63
2.3. Ri lon chuyn ha thot..................................................................................67
2.4. Ri lon chuyn ha nc v in gii..............................................................73
2.5. Ri lon cn bng axit- baz..............................................................................79
3. Sinh l bnh qu trnh vim................................................................................85
3.1. Khi nim v vim.............................................................................................85
174
3.2. Nguyn nhn gy vim.......................................................................................85
3.3. Biu hin ca vim.............................................................................................86
3.4. Nhng bin i ch yu trong vim................................................................87
3.5. Quan h gia phn ng vim v c th..............................................................96
3.6. Phn loi vim....................................................................................................97

3.7. ngha ca vim ...............................................................................................98

4. Sinh l bnh iu ha thn nhit - st................................................................98
4.1. i cng v cn bng thn nhit......................................................................98
4.2. Ri lon thn nhit ...........................................................................................101
4.3. St (Fever hay pyrexia)....................................................................................102
Chng 3: SINH L BNH CC C QUAN H THNG.................................108
1. Sinh l bnh h thng mu................................................................................108
1.1. i cng.........................................................................................................108
1.2. Ri lon ca mu..............................................................................................108
2. Sinh l bnh tun hon......................................................................................118
2.1. i cng.........................................................................................................118
2.2. Ri lon tun hon ph thuc vo tim v mch...............................................118
3. Sinh l bnh h hp ...........................................................................................126
3.1. i cng.........................................................................................................126
3.2. Ri lon h hp ................................................................................................127
3.3. Hu qu ca ri lon h hp.............................................................................134
3.4. Hot ng thch nghi ca c th khi thiu oxy ................................................136
4. Sinh l bnh tiu ha .........................................................................................137
4.1. i cng.........................................................................................................137
4.2. Ri lon cm gic n ung...............................................................................137
4.3. Ri lon tiu ha xoang ming .....................................................................138
4.4. Ri lon chc nng ca thc qun ...................................................................139
4.5. Ri lon tiu ha d dy................................................................................139
4.6. Ri lon tiu ha rut....................................................................................144
5. Sinh l bnh chc nng gan ..............................................................................148
5.1. i cng.........................................................................................................148
5.2. Nguyn nhn gy ri lon chc nng gan........................................................149
5.3. Ri lon chc nng gan....................................................................................150
6. Sinh l bnh chc nng thn.............................................................................156
6.1. i cng v chc nng thn...........................................................................156
6.2. Ri lon b my tit niu .................................................................................160
6.3. Mt s bnh thn...........................................................................................161
6.4. Nhng biu hin lm sng ca bnh thn ........................................................164
6.5. Bin chng ca ri lon chc nng thn..........................................................167
7. Sinh l bnh tuyn ni tit.................................................................................167
7.1. i cng.........................................................................................................167
7.2. iu ho ni tit ...............................................................................................168
7.3. Ri lon cn bng ni tit ................................................................................169
TI LIU THAM KHO.........................................................................................172