1

TRNG I HC BCH KHOA H NI VIN IN T VIN THNG

B MN IN T Y SINH

TIU LUN: NG DNG CA CC LOI DAO M TRONG PHU THUT

GVHD:Th. Phm Mnh Hng SVTH: Vn Tn SHSV20092332

H Ni Ngy 29/03/2013

NG DNG CA CC LOI DAO M TRONG PHU THUT Dao m l mt phng tin phu thut khng th thiu trong hu ht cc loi phu thut ni chung cng nh phu thut ni soi ni ring. 5 nguyn tc gip cho kt qu lnh vt m c tt nht l: 1. Cm mu tht tt 2. Gim thiu cc tn thng m 2. Duy tr cung cp mu thch hp 3. Gim thiu nhi m trng 4. Gim thiu cng m S dng dao m c th nh hng ti 3 nguyn tc u: cm mu, tn thng m & cung cp mu. Cc loi dao m hot ng khc nhau, dn n hiu ng trn m khc nhau. Phu thut vin chn loi dao m c kh nng cm mu tht tt & hn ch tn thng m xung quanh. Tn thng m nhiu c th lm tng tnh trng vim cp tnh & ko di tin trnh lnh vt m. V vy vic la chn loi dao m tt & ph h p l mt trong nhng yu t gp phn vo s thnh cng ca cuc phu thut. I. CC LOI DAO M THNG S DNG HIN NAY: 1. Dao m dng nng lng in t: Dao m in n cc Dao m in lng cc Dao m Laser 2. Dao m dng nng lng c hc: Dao m siu m Trong , dao m in n cc & lng cc l 2 loi dao m ph bin nht trong cc bnh vin v gn y c s xut hin ca dao m siu m.

II. MT S NHNG HIU BIT CN THIT: 1. Hai lai dng i n: Dng in 1 chiu (Direct Current - DC): Dng in chy theo mt chiu nht nh. Dng in xoay chiu (Alternating Current- AC): Dng in chy theo 2 chiu,

v lin tc o chiu. V d: in nh, in dng trong dao m n cc, lng cc. S ln dng in o chiu trong 1 giy th tng ng vi Tn s v c o bng n v Hertz (Hz) 2. Ti sao bnh nhn khng b in git khi phu thut vin dng dao m in? in nh c tn s khong 60 Hertz, khi chng ta chm vo s b in git do b kch thch thn kinh c. Vo thp nin 1920, Dr. William Bovie khm ph ra rng: ti tn s 100,000 vng trong 1 giy (100kHz), khng gy ra kch thch thn kinh c trn c th sng. Cc my t in hin nay u vn hnh an ton tn s 200kHz hoc cao hn (nn cng c gi l my ct t cao tn). 3. Nguyn l ca dng in: Dng in s i theo con ng c t tr khng nht. c th ngi, iu ny t l vi lng nc cha trong m (mu, thn kinh, c, m, xng). Lng nc cng nhiu, tr khng cng t. Khi m b sy kh, tr khng gia tng, dng in i tm con ng khc i. Con ng ny khng bao gi c nh & kh c th on trc c.

4. S lan ta nhit sang bn: S lan ta nhit gy ra bi dng in i & nhit. Khi dng in qua m dn, m b sy kh dng in i theo con ng c t tr khng nht, s lan ta sang 2 bn ca in cc gy ra lan ta nhit lm tn thng m 2 bn. Khi nhit c truyn qua m cng gy ra hin tng lan ta nhit sang bn.

S lan ta nhit sang bn nhiu s gy tn thng m khng mong mun, nh hng n qu trnh lnh vt m & c bit l lm tn thng cc m, c quan quan trng xung quanh. V vy cc nh sn xut c gng tm ti & sng ch to ra loi dao m c kh nng hn ch s lan ta nhit sang bn ny.

Mt vi loi dao m lng cc tin tin hin nay c kh nng pht hin tr khng v t ng ngt dng ngn nga s lan ta nhit sang bn. C loi dao m lng cc k thut cao mi c h s nhit dng (Positive Temperature Coefficient- PTC) c kh nng duy tr nhit m khong 100, gim thiu lan ta nhit. III. CC C IM CA 1 LOI DAO T CM MU L TNG: Nhiu tc dng a chc nng Khng c dng in qua ngi bnh nhn Hiu qu kinh t D s dng An ton cho bnh nhn An ton cho phu thut vin Ct nh 1 con dao Cm mu ng tin cy Gim thiu tn thng m Gim thiu m chy thnh than Khng khi Mt loi dao m l tng phi c tc dng ct cm mu cng mt lc. IV. DAO M N CC 1. Cc my t in n cc u tin c gi l h thng my t tip t: Dng in i t u in cc, xuyn qua c th bnh nhn, n in cc thu hi v tr v t qua dy tip t, hon tt mch in. Cc my pht in tip t c th gy ra nhng tn thng ti ch k tip nhau thng nhng vng nh tay hoc chn. Nguyn nhn l do dng in lun tm kim con ng tr v t, nn bt c vt kim loi no tip xc ngu nhin vi bnh nhn, nh l ci gi kim loi treo dch truyn hoc ng monitor theo di bnnh nhn, bn m c th xem nh l 1 in cc hp dn dng in v lm trch hng tr v ca dng in. Dng in ny s tp trung v lm bng bnh nhn ti ch ni m dng in tip xc vi vt kim loi c gng thot ra khi c th. Do , xy ra hin tng phu thut vin ang dng dao m

in vng bng m bnh nhn b chy bng in tay hoc chn.

V nguy c ny, ngy nay hu ht cc nh sn xut khng cn mun sn xut loi my ny na, nhng mt s my c vn cn c s dng cc bnh vin tuyn huyn, tnh Vit Nam. 2. My t in cch ly: gii quyt cc nguy c vn c ca h thng my tip t nh trn, my t in cch ly c pht trin & gii thiu vo nm 1975.

Vi h thng cch ly, my pht tr thnh ngun nng lng ca chnh n. Dng in tr v my pht qua ngi bnh nhn n in cc thu hi trn ngi bnh nhn hon tt mch in, v khng cn phi tip t na. 3. Cc nguy c khi s dng dao m n cc: Phu thut ni soi dng dao m n cc c th lm tng thm cc nguy c. a. Tip xc trc tip:

Xy ra khi u dao in ang hot ng gn st vi 1 dng c dn in hay 1 vt bng kim loi khc, dng c th hai ny b nhim in. Dng in s tm con ng c t tr khng nht n in cc tr v trn bnh nhn hon tt mch in. iu ny c th dn n tn thng nghim trng trn bnh nhn m khng lng trc c.

Phu thut vin c to tip xc trc tip: chm u dao in ang hot ng vo dng c khc c m mch mu nh hay ch ang chy mu. i khi phu thut vin v chm u dao in ang hot ng vo dng c khc ngoi phu trng trn mn hnh, thng gp trong phu thut ni soi, cng hay gp trong phu thut ni soi mt vt m. b. Tip xc in dung: Xy ra khi 2 vt dn in c tch ring bi 1 lp cch in. 1 dng in to ra 1 trng tnh in gia 2 vt dn in. Kt qu l, 1 dng in trong 1 vt dn in c th to ra 1 dng in trong vt dn in th 2. Phu thut vin c th to ra tip xc in dung khi s dng trocar kim loi bao xung quanh 1 dao m n cc ang hot ng: 2 vt dn in l trocar kim loi & u dao in, cch nhau bi vt cch in l lp cch in ca dao m (dng c mc t ni soi). c. Lp cch in trn dng c ni soi b trc: Ch b trc lp cch in cng nh, dng in tp trung cng cao, gy ra tn thng cng nghim trng. d. Chy n trong phng m: L 1 trong nhng nguy c nghim trng nht trong phu thut

Dao m n cc hot ng c th xt tia la in d bt la trong mi trng phng m c nhiu nguyn liu d chy, kh oxy. e. Chy bng ti ch: khi s dng h thng my pht tip t.

f. in cc thu hi tip xc khng tt vi c th bnh nhn: Nu in cc thu hi khng tip xc khng tt vi da bnh nhn, chy bng c th xy ra ti ch in cc thu hi. Cc my hin nay u c h thng theo di bo m s tip xc ca in cc thu hi vi bnh nhn. V. DAO M LNG CC Dao m lng cc s dng dng in xoay chiu. Dng in ch i gia 2 in cc (l 2 u ca dao m: 1 u l in cc dng & u kia l in cc m) v qua m c kp bi 2 u dao m. Khng cn s dng tm m trn ngi Bnh nhn na. M c kp hon tt mch in.

Dao m lng cc hn ch cc nguy c ca dao m n cc nh: tip xc trc tip v tip xc in dung, cc tn thng ti ch & cc tn thng do li ca in cc thu hi. Khi m b sy kh, tr khng gia tng, dng in tm con ng c t khng tr nht l qua 2 bn ca dao m do s gy tn thng nhit lan ta 2 bn hm kp ca dao. 1. Dao m lng cc truyn thng: My khng c c ch phn hi xc nh in tr hoc c ch kim sot nhit nn c th gy ra tn thng nhit lan ta ra 2 bn rt nhiu. hn ch iu ny, phu thut vin khi s dng dao m phi quan st tht k bng mt ki m sot mc chy lan ca m. Lc p m ca 2 u dao m km nn hiu qu cm mu khng cao. Nh hnh nh minh ha, 2 thnh ca mch mu khng p st c vo nhau. Nhc im ca dao m lng cc l ch c hiu ng t cm mu m khng c kh nng ct m. Do vy dao m lng cc thng ch c dng cm mu. Cn khi s dng phu tch th sau khi cm mu an ton, phu thut vin phi dng ko ct m.

2. Dao m lng cc hin i: Dao m lng cc hin i ci thin & khc phc hu ht nhng hn ch ca dao lng cc truyn thng: Lc p c hc ca dao m lm tng hiu qu hn mch mu, c th hn mch mu n 7mm

My pht o c in tr ca m & kim sot c vic chuyn giao nng lng in gim thiu tn thng lan ta sang bn. My pht c kh nng to cng ngh xung: iu tit hiu qu t bng s dng cng ngh in t. C c ch ct c hc 1 con dao sc ct m i km trong dng c t lng cc. Phu thut vin c th ct & cm mu vi cng 1 dng c. 3. Dao m lng cc hin i th h mi nht: Loi dao ny c 1 s sng ch & ci tin m i, c kim sot nhit <100oC, lm tng hiu qu cm mu & gim thiu tn thng nhit sang 2 bn (< 1mm): Cu hnh in cc thng minh : nhiu in cc m xung quanh 1 in cc dng gip tp trung v cha s di chuyn ca dng in qua m ch trong hm ca dng c, khng lan ra 2 bn, lm gim thiu tn thng nhit ra 2 bn (<1mm), cho php ct v cm mu vi chnh xc cao, c bit cn thit gn cc cu trc v c quan quan trng.

H s nhit dng (Positive Temperature Coefficient): Hp cht Polymer bn trong hm kp ca dng c dao iu chnh dng nng lng trong sut chu trnh hot ng duy tr nhit m khong 100oC, trnh cho hm kp khi t nhit cao qu mc v gim thiu hin tng dnh, ha than hoc to khi. Dao hnh ch I to lc p m ng nht: Dao trong dng c c thit k vi cu trc hnh hc dng ch I chc khe, cung cp lc p m ng nht trn ton b din tch hm kp ca dao, lm gia tng kh nng cm mu. Cm mch mu ln 7mm, vi p lc hn mch gp 7 ln p lc tm thu.

10

VI. DAO M SIU M Trong loi dao m dng nng lng siu m ny, c 2 vic ct & cm mu u da trn s truyn c hc ca sng m t 1 ngun nng lng qua 1 cht trung gian n u li dao hot ng. C 3 di sng c hc: Sng c tn s di mc tai nghe ca con ngi < 20 vng/ giy (Hertz) Sng mc tai nghe ca con ngi, c tn s 20 20,000 vng/ giy Sng siu m c tn s trn mc tai nghe ca con ngi > 20.000 vng/ giy Dao m siu m hot ng tn s 55.500 vng/giy

1. Nguyn l hot ng & Hiu ng trn m ca Dao m siu m: Nng lng in t my pht s c chuyn thnh sng c hc ti tay cm ca dy dao do y c cc a s piezo-electric chuyn nng lng in thnh chuyn ng c hc dc theo chiu di ca dao & t tn s 55.500 ln/ giy.

Cc a s Piezo-electric Khi dao siu m kp m hot ng, n s to ra s ma st ni bo trong m, lm ph v mi lin kt hydro bin tnh protein v thnh lp khi ng dnh. Ct & cm mu cng lc, c th cm mch mu n 5mm. Nhit c to ra l th pht do s ma st m bn trong l kt qu ca s chuyn ng m vi tn s cao, nn nhit thp < 100oC. Hiu ng bc tch: s chuyn ng ca li dao to ra 1 vng c p sut thp, lm cho dch ni bo bc hi nhit thp. S bc hi nc phng ra, lm tch cc lp m bn di li dao, tng cng kh nng bc tch khi dao hot ng. 2. u im ca Dao siu m : Hon ton khng c dng in qua ngi bnh nhn Dng c dao a chc nng: ngoi chc nng ct & cm mu, dng c dao cn c th dng bc tch, kp gi, ct ngc nhng m v mch (back-scoring), c l to l thng, s dng hiu ng bc tc.

11

- Gim thiu tn thng nhit lan ta sang 2 bn (<1mm) cho php ct v c m mu vi chnh xc cao, c bit cn thit gn cc cu trc v c quan quan trng. t khi, t dnh Ct & cm mu cng lc, cm c mch mu ti 5mm i ci cc loi dao dng ko, v mch mu 2mm vi cc dao dng li cong hoc u mc. VII. DAO M TH H MI NHT HIN NAY TRN TH GII L s kt hp gia dao m lng cc hin i & dao m siu m trong mt my pht. VIII. TIU CHUN QUAN TRNG NHT CHN LOI DAO M : 1. An ton 2. S lan ta nhit ti thiu 3. Kh nng cm mu hiu qu 4. Tc & hiu qu 5. a chc nng 6. Chi ph chp nhp c. Phu thut ni soi ngy cng c ng dng nhiu v trin khai nhiu loi phu thut khc nhau, t n gin n phc tp. Vic chn la phng tin cm mu hu hiu l v cng quan trng, gip cho phu thut vin ct, t cm mu an ton, cuc phu thut thnh cng vi nhng thao tc ngy cng n gin, t mt mu, phu trng sch, r rng, cc m xung quanh t b tn thng, gim thiu sang chn m. Cc nh ch to dng c khng ngng sng to ra cc thit b mi nhm p ng mong mi ca cc phu thut vin, s tin b ca k thut, s an ton ca ngi bnh. Ngi lm cng tc qun l v ngi dng cn kp thi nm bt v s dng hiu qu nht cc phng tin mi p dng, pht trin phng php iu tr xm nhp ti thiu (phu thut ni soi) to ra s an ton cho c thy thuc ln bnh nhn. IX. NGUYN L PHU THUT IN Mi vt cht tn ti xung quanh ta u cu to bi cc nguyn t. Mi nguyn t gm mt nhn tch in dng v cc in t tch in m quay xung quanh n theo cc qu o nht nh. Bnh thng in tch ca ht nhn v tng in tch ca cc in t quay quanh n bng nhau v tr s v tri du tc n trung ha v in. Khi nguyn t thu nhn thm in t n s tch in m gi l ion m, cn khi nguyn t mt bt in t n s thnh ion dng. Qu trnh bin thnh ion gi l s ion ha. nh ngha dng in : Dng in l dng chuyn ng c hng ca cc in t trong mi trng dn in. C 2 dng dng in chnh l dng in xoay chiu v dng in mt chiu. Dng in xoay chiu (AC) : cn gi l dng in hnh sin, l dng in t c hng lun phin thay i, theo hm s sin. Tn s dng in l s ln thay i hng ca dng in trong mt giy, tnh bng Hertz, 1 Hertz l mt chu k mi giy. Mt s tn s AC tiu biu : 50 Hz 60 Hz tn s in nh 100 Hz 5 kHz ting ni bnh thng

12

100 kHz thn kinh c khng p ng kch thch 200 kHz 3,3MHz tn s my phu thut in 550 kHz 1,6 MHz tn s sng radio AM 88 MHz 108 MHz tn s sng radio FM 54 MHz 880 MHz tn s Tivi Dng in mt chiu (DC) : l dng in c hng ch di chuyn theo mt hng, dng in ca pin hoc acquy l dng in mt chiu. Tr khng : l s cn tr vic di chuyn dng in t ca vt dn in, ngi ta ni impedance l ni tr khng dng in xoay chiu cn resistance l tr khng dng 1 chiu. Trong phu thut in, tr khng l bnh nhn. Tr khng o bng ohm. Hiu in th ( in p ): l lc y in t di chuyn trong chu trnh, o bng Volt, 1 vol l lc y 1 amp dng in qua 1 ohms tr khng. Cng dng in : S lng in t chuyn ng qua mt n v din tch trong mt giy gi l cng dng in tnh bng Ampe ( A ). d hiu chng ta ly hnh tng mu trong mch mu minh ha dng in : trong Lc co bp ca tim tng ng vi hiu in th, dng mu, cung lng tim tng ng vi dng in t gi l dng in c o bng ampe, nhng ch hp (tng ng vi in tr tng) tim tip tc bm vi lc nh nhau lm p lc trn mch mu tng lm tng huyt p, tng t trong in, khi dng in n nh i gp phi tr khng ( v d nh m ngi ) th lc dng in v in th tng ln, sc khng tng cng lm tng nhit , dng in dn dng Vit nam c tn s l 50Hz. Khi chy qua ngi n c th gy ngng tim, tuy nhin khi tn s dng in tng ln th tc ng ln m cng thay i, ti tn s 100.000 Hz dng in ngng kch thch thn kinh c, iu ny c gii thch l do tn s thay i hng ca dng in qu nhanh nn thn kinh c khng kp p ng. Phu thut in ty ni c nhng tn gi khc nhau Chu u gi l nhit phu thut cn M gi l my t in 1. Lch s phu thut in : Cch nay 5000 nm con ngi bit dng nhit ca la cm mu, mt trong nhng ng dng u tin l lm nng bn i bng la sau p vo vt thng cm mu. Tng t nm 1875 ngi ta dng dng in chy qua dy dn lm nng chng ln ri p vo m. Phu thut in tht s c gii thiu u tin bi Harvey Cushing mt nh phu thut thn kinh ni ting M v William Bovie mt nh vt l Harvard t nm 1924. T , vi nhng u im ca mnh, n ngy cng c chp nhn rng ri. Cho n nay c khong 80% cc cc ca phu thut c s dng phu thut in, iu ny lm gim thi gian phu thut v thi gian hi phc ca bnh nhn. My phu thut in u tin ca Bovie l mt my nh la h quang, gm 2 mnh kim loi cch nhau bi mt khong h khng kh, n hot ng ging buri trong xe m t, khi in p cao th s xy ra hin tng phng h quang. Mt chu trnh in phi bao gm ba yu t : my to dao ng dng in, in cc hot ng v in cc phn tn, cng vi bnh nhn to mt vng khp kn. Mt dng phu thut dng in khc l cautery in. Ngi ta s dng dng in 1 chiu i qua in tr lm chng nng ln t m, 2. Nguyn l hot ng :

13

Phu thut in l qu trnh s dng dng in xoay chiu tn s cao (200,000 Hz 3,300,000 Hz) ct m v ng m. dng in ny chy qua ton b phn c th nm gia u in cc hot ng v in cc phn tn, di tc ng ca in trng, Ion trong m gn vi in cc di chuyn Chng lin tc va chm vi nhng nguyn t v phn t khc v truyn ng nng ca chng cho nhau. iu ny gy tng vn ng ngu nhin ca cc phn t trong m v s tp hp ny lm tng nng lng bn trong to ra nhit. Nhit lm nc gian bo si, lm tng p lc ni bo gy v mng t bo Trong phu thut in ngi ta phi s dng dng in tn s cao gim thiu kch thch khng mong mun n c th, khi tn s cao do tn s thay i dng in qu nhanh lm t bo khng kp phn ng. Bnh thng thn kinh c s ngng p ng vi dng in ti tn s 100.000 Hz tr ln. My t in hot ng tn s t 200KHz 3,3 MHz, tn s ny cao hn gii hn ti thn kinh c b kch thch kh nhiu (<100.000 Hz), nn vic s dng my phu thut in kh an ton. Mt dng phu thut dng in khc l cautery in, trong dng in i qua mt in tr (di dng mt in cc) lm tng nhit in tr n mt mc mong mun sau ngi ta p in tr vo m ct hoc t. Nh vy khng c dng in chy qua ngi bnh nhn v nh vy khng cn in cc phn tn. 3. Cc dng phu thut in : Phng tin phu thut in hin i to ra sng in t c tn s rt cao, gia 200kHz 3,3MHz, sng dng trong phu thut in c tnh cht v tn s ging nh tn s sng radio dng trong pht thanh v truyn thanh, v vy sng phu thut in cn gi l sng tn s Radio. My phu thut in c th to ra nhiu dng sng khc nhau, khi thay i dng sng th tc dng vo m cng thay i tng ng. Dng in ct l dng in c dng sng lin tc, n to nhit rt nhanh v gy bc hi m (Nhit lm nc gian bo si, lm tng p lc ni bo gy v mng t bo. iu ny gi l s bay hi t bo), cn dng in ng m c dng sng gin on, n sinh nhit t hn v chm hn nn thay v bc hi m chng ch lm kh ng li, gia 2 kiu ny cn c cckiu pha trn c tc dng gia ct v t. Ngoi ra cn c kiu t phun cm mu lan ta trn din rng. Vi tt c cc my t in hin i cc tc dng thng c to bi sng trn, vic iu chnh tc dng t v ct hon ton c lp nhau hay ni khc hn th cng t cm mu trong qu trnh ct th khng b nh hng bi vic iu chnh cng ct. My t c bn ca Bovie vi dng in ct v t ring bit c dng rng ri M trong khong thi gian 1930-1960, vi mt s ci tin nh, nm 1970 my t c nhng tin b ln, mch in cho php to ra nhng dng sng phc hp, t n cho php phu thut vin c th thc hin c nhng phu thut tinh vi v an ton hn. 1, Kiu ct : Dng in c dng sng lin tc, dng in c vol thp c pht ra lin tc c tc dng to nhit nhanh. t c hiu qu ct nn u in cc nh trn m ch. 2, Kiu t : Dng in c dng sng gin on, n to nhit t v chm nn ch c tc dng t. 3, Kiu pha trn :

14

Kiu pha trn trn my pht in l dng sng ct nhng in th cao hn mt ct thng thng, c tc dng t bn cnh tc dng ct. (Tucker, 1998).. c mt s dng sng pha trn c th thay i t s ct v t. 4, Kiu t phun : t c khi my pht in ch t, kiu t to dng sng gin on 4. Cc hnh thc phu thut in : K thut phu thut in chia thnh 2 nhm chnh : n v 2 cc Mch in phu thut th tng t trong c ng dng n cc v hai cc. Dng in t cun giao ng theo in cc hot ng qua m ngi ri tr v in cc phn tn. Trong kiu hai cc c in cc hot ng v phn tn cng nm trn tay cm nn th tch m gia 2 in cc rt nh (Malis 1996). iu ny cho php p dng dng in n m chnh xc hn . Trong kiu n cc, th tch m gia 2 in cc kh ln. a. H thng phu thut n cc : Phu thut in n cc l dng phu thut in ph bin nht. Trong kiu n cc, my pht in to dng in chy t cc hot ng qua c th bnh nhn v cc phn tn v tr v my pht in to vng khp kn. Trong kiu ct n cc, dng sng in hnh c dng hnh sine 3 3,3 MHz, nng lng tp trung ti u t vi in th rt cao ( trn 2500 vol) c mt dng in s lan ta theo hnh nn t in cc hot ng xung in cc phn tn. Ngi ta thy c s d dng in ng k t chu trnh ny n m k cn, iu ny c ngha c dng in i qua cc t chc m khc nm gia chng nh mch mu, thn kinh, co xng, vv. Thc t ngi ta thy c mt s lng ng k in v nhit khong cch 1-2 cm xung quanh t mt im nh tip xc vi in cc hot ng. V l do ny vic dng t n cc b hn ch. Chng khng hot ng c trong mi trng t hoc mu, v thm ch khng c chm vo xng, rng hay kim loi. b. H thng phu thut hai cc (bipolar) H thng dng sng 1 MHz ct, Nhng nghin cu phu thut khng nh rng tn s ti u cho ct m l 1 MHz, v nu tn s thp hn s to ra nhng kch thch khng mong mun cn tn s cao hn s to nhit v lan ta dng in mt cch ng k. Nng lng ti u in cc hon ton ring bit. Dng in khng chy qua ngi m ch chy qua vng m nh nm gia 2 in cc, khng cn ming pad t, nn loi b s lan ta ca dng in v nhit n cc m k cn. in th my hai cc thng ch khong 140 vol so vi h thng n cc l khong 2500 vol. in th thp v tr khng cc thp lm gim thiu nhng tc dng ph do nhit v d in gy ra. Song cng do in th thp nn bipolar khng hiu qu trong trng hp chy mu nhiu ( Mitchell, 1978). Cc h thng bipolar hin i (v d h thng Bident) dng hai dng sng khc nhau c chng trnh v vi tnh ha to hiu qu ti u. Khng ging nh my t n cc, h thng bipolar c th dng tt cho c mi trng t hay kh. H thng c th dng ct hoc t trong tt c cc m an ton, k c trc tip trn xng, rng m khng s hoi t m. Nhng u im khi dng bipolar so vi n cc C th hot ng c trn nhng bnh nhn t my to nhp hay my ph rung. Ct v t trong mi trng t hay kh u c

15

Khng cn pad t, khng c dng in qua ngi bnh nhn Kim sot nng lng chnh xc Khng c s co m hay ha than Hot ng ct v t tiu th t in nng hn lng in nu dng my t n cc. Gim thiu hin tng nhit v dng in lan ta Nguyn l phu thut coblation Bc x tn s radio l g? Bc x in t tn s radio l s truyn nng lng bng sng radio ( c rng tn s t 3 kilohertz (kHz) to 300 gigahertz (GHz). Ngun pht sng tn s radio Bc x in t tn s radio c to bi c ngun t nhin v nhn to Ngun t nhin nh mt tri, tri t, tng in ly, chng pht ra trng RF mc thp. Ngun nhn to ch yu dng trong lnh vc vin thng, radio, tivi, in thoi di ng, my nhn tin, in thoi khng dy, v tinh, l vi ba, radar, thit b nhit cng nghip, Tc dng ca sng tn s radio ln m sinh hc C 3 tc dng chnh : Tc dng faradic : khng thng gp nhng my t hin i c tn s trn 300kHz Tc dng in ly : gy ra do s phn cc ca ion trong m khi dng in xoay chiu t vo m m gm ch yu l nc v cht in gii, do dng in tn s cao nn nhng ht ion trong m s rung hoc di chuyn nh lm tng ng nng, a n tng nhit m Tc dng nhit : c mt vi yu t nh hng n kiu dn truyn nhit qua m. Nc l mi trng ti ho duy tr cn bng nhit trong m do n c nhit si hng nh. Yu t quan trng khc l mch mu ca m, v tun hon gip gii nhit. Tc dng nhit ln m sinh hc ty thuc vo nhit cui cng t c ti m v khong thi gian duy tr nhit cao ti . Khi nhit tng chm, m s kh v c s ng protein cu thnh, tri li khi nhit tng nhanh n 100oC lm si nc ni bo gy tng p lc lm v mng t bo. Khi nhit tng qu nhanh nc khng kp bc hi cng nh m cha kp gii nhit i nn nc si ln nhanh chng. Mt s yu t khc l nc lm nh hng n tr khng ca m, tr khng m kh cao hn m t. Hot ng ct phu thut : t c khi nhit trong m tng cao nhanh chng n 100C trong vng micro giy.