sinh ly cao dang

7/31/2019 Sinh Ly Cao Dang

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BI GING

Sinh l hc KHOA NI

IU DNG CAO NG

(LU HNH NI B)

TRNG CAO NG Y T QUNG NAM


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BIN SON

Ths. Nguyn nh Tun Khoa Ni, Trng Cao ng Y t Qung N

Ths. V Th Hng Hnh Khoa Ni, Trng Cao ng Y t Qung N

Bs. V Quc Vit Khoa Ni, Trng Cao ng Y t Qung N

Bs. Hunh Vn Ngh Khoa Ni, Trng Cao ng Y t Qung N

Bs.Trn Qu Phi Phng o to, Trng Cao ng Y t Qu


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LI GII THIU

Gio trnh Sinh l hc dnh cho i tng Cao ng y t v ang

theo hc ti trng Cao ng Y t Qung Nam c cc bc s khoa N bin son da trn chng trnh khung cho gio dc cao ng chuyn nghipnhm ngnh khoa hc sc khe do B Y t ban hnh.

Cc bc s ca khoa Ni tham kho nhiu ti liu vit cc bi gin ph hp vi i tng hc sinh v thi lng cho php ca khung chntrnh. Trong thi gian 3- 5, chng ti s c gng cp nht kin thc mi vng thi trong qu trnh ging dy, cc sai st cng s c khoa ch chnh sa. Chng ti khuyn khch cc em sinh vin tham kho thm nhiunhng gio trnh, sch gio khoa, sch tham kho khc cng ch bsung thm nhng kin thc cn cha trong gio trnh ny.

Mc d c gng nhiu nhng do kin thc v thi gian cn hn ch chc chn gio trnh cn nhiu thiu st. Chng ti mong nhn c s g ca cc ng nghip v cc em sinh vin nhng ln in sau c hochnh hn.

Khoa Ni xin cm n s ng vin, gip nhiu t Ban gim hiu nh

trng, phng o to chng ti c th hon thnh kp tp ti liu na vo ging dy.

Ban bin tp Khoa Ni


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MC LC

MC TIU CHUNG CA CHNG TRNH SINH L HC........................5

I CNG V SINH L HC.........................................................................1 SINH L HC T BO........................................................................................4

SINH L MU ......................................................................................................11

SINH L TUN HON.......................................................................................21

SINH L H TIT NIU....................................................................................32

SINH L H HP................................................................................................42

SINH L TIU HA ...........................................................................................56 SINH L HC CHUYN HA NNG LNG.............................................67

SINH L HC IU HA THN NHIT.......................................................71

SINH L NI TIT.............................................................................................76

SINH L H SINH DC.....................................................................................85

SINH L H THN KINH.................................................................................92

TI LIU THAM KHO..................................................................................114


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SINH L H CAO NG

STT NI DUNG S tit hc

Tng s LT TH1. Sinh l mu 4 42. Sinh l tun hon 4 43. Sinh l h hp 4 44. Sinh l tiu ha 4 45. Sinh l tit niu 4 46. Sinh l ni tit 4 4

7.

Sinh l h thn kinh trung ng 4 4Tng s 28 28


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MC TIU CHUNG CA CHNG TRNH SINH L HC

Sau khi hc xong chng trnh sinh l hc, sinh vin c kh nng:

1. Trnh by y chc nng ca t bo v ca cc c quan trong c th conngi bnh thng.

2. Gii thch c c ch v iu ha hot ng ca cc h c quan trong cth.

3. Phn tch c mi lin h chc nng ca cc h c quan v mi lin hgia c th vi mi trng sng

4. Lm c mt s xt nghim thng thng trong chn on lm sng clin quan n sinh l hc (thc tp sinh l).

5. Xc nh c tm quan trng ca sinh l hc i vi cuc sng v y hc: - Nhn nh c sinh l hc l mn khoa hc c s cho mt s mn y hcc s khc v lm sng. - Vn dng c sinh l hc trong cc lnh vc khc nh k hoch ha gia

nh, sinh l lao ng, th dc th thao, gio dc hc, tm l hc


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I CNG V SINH L HC 1. nh ngha:

Sinh l hc l mn hc v chc nng ca cc c quan, h thng trong cth v ca ton c th nh l mt khi thng nht.

2. Sinh l hc l mn hc c s ca y hc: - Ngi thy thuc phi nm vng khoa hc sinh l v n phn nh nhng hong chc nng ca c th lc bnh thng cng nh khi c bnh. - Mi phng php chn on, iu tr hay phng bnh u phi c t trn s kin thc sinh l hc. 3. i tng v v tr ca sinh l hc trong y hc

Trong y hc, sinh l hc c vai tr quan trng: 1. Hot ng bnh thng ca c th lun c dng lm tiu chun n

gi tnh trng v mc bnh l trong lm sng. 2. Y hc lun t nhng vn nguyn nhn v c ch sinh bnh cho sinh lhc.

3. C th con ngi l mt cu trc hu c c kh nng thch nghi vi honcnh v iu kin sinh sng. Khng c mt c th mu cho nhn loi,khng c ly tiu chun sinh l ca ngi nc ny nh gi hong sinh l ca ngi nc khc.

4. Cc c quan, b phn trong c th u c lin quan mt thit vi nhau vhot ng mt cch hip ng vi nhau. Ton b c th l mt th thng

nht t iu chnh hot ng ca mnh. l c im ca c th sng. 4. Qu trnh hnh thnh mn sinh l hc 4.1. Thi c xa: - Khi khoa hc t nhin cha pht trin, con ngi vn dng thuyt m dng nghnh gii thch cc hot ng sinh l ca c th cng nh s sng ni chungTheo thuyt ny th sc khe l mt hin tng cn bng gia lc m v ldng trong c th. Trong cc tng th phi thuc Kim, gan thuc Mc, thn thuThy, tim thuc Ha v lch thuc Th. - Ren Descartes, nh ton hc v trit gia Php (1596 1650) nghin cu phn x cho rng phn x l mt hotng ca linh kh. - Theo thuyt vt linh (animism) th linh hn chi phi ton b i sng. Linh hn cn hot ng th c th cn sng. - Trc cng nguyn 5 th k, Hippocrate, ngi c


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xem l ng t ca ngh Y c xng thuyt hot kh, cho rng s sng bngun t kh trong phi theo ng h hp trao i sinh lc gia c th vi mtrng.4.2. Giai on khoa hc t nhi n:4.2.1. Quan st- T th k 16: Andr Vesale, mt thy thuc ngi B (1514-1564) tin hnh gii phu c th

ngi thy r cu trc ca c th. Michel Servet, mt thy thuc ngi Ty Ban Nha (1511-1553) thy tun hon

phi trn ngi trong khi m t thi. William Harvey, mt thy thuc ngi Anh (1578-1657) m t thi quan st thy

ton b tun hon mu trong c th. - T th k 17: Marcello Malpighi, mt thy thuc ngi

(1628-1694) dng knh hin vi soi thy tunhon mao mch. 4.2.2. Thc nghim- Th k 18: Antoine Laurent de Lavoisier, mt nh ha

hc ngi Php (1743-1794) chng minh rngh hp l mt qu trnh thiu t c tiu th

oxy. Luigi Galvani, mt thy thuc ngi (1737-1798) pht hin in sinh vt. Francois Magendie, mt thy thuc ngi Php (1783-1855) pht hin xung thn

kinh.- Th k 19: Dubois Reymond, ngi c (1818-1896) sng ch nhiu dng c o c

sinh l hc. Claude Bernard, nh sinh l hc ngi Php (1813-1878) tin

hnh nhiu thc nghim bng phu thut trn ng vt nghincu sinh l hc. - Th k 20:


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Nh sinh l hc ngi Nga Pavlov (1849-1936) nghin cusinh l h thn kinh, lm nhiu th nghim trn ch chngminhhot ng thn kinh cao cp da trn phn x c iu kinva hot ng tm l vo lnh vc thc nghim. - Gia th k 20: Sinh hc phn t ra i vi s pht trin cu trc phn t ca

acid nuclic (Watson, Cricks, Wilkins gii Nobel 1963). Mt m di truyn (Jacob, Monod gii Nobel 1965). Cu trc siu hin vi v chc nng ca t bo. Khng nguyn HLA K thut to khng th n dng Knh ion v nhiu cng trnh nghin cu quan trng khc.

Tm li, sinh l hc, mt khoa hc pht trin hng nghn nm nay vn cnang pht trin. Hin nay, c th ni mi ngy trn th gii u c nhng thng timi v sinh l hc. Ngi sinh vin y khoa c nhim v khng nhng hc sinh lhc cho tt m cn phi ng gp vo khoa hc ny y mnh pht trin sinh hc v nn y hc ni chung. 5. Khi nim v c th sng v nhng c im ca s sng Sng l g? Nm 1878, nh trit hc Engels trong quyn sch Chng Duhring

nh ngha: S sng l mt phng thc tn ti ca cht albumin lun lun thai t l cc thnh phn cu to ca mnh.

Ngy nay chng ta gi albumin l protein hay cht m, gm cc nguyn t C,H, O, N l nhng nguyn t c bn. Ngoi ra cn c nhng nguyn t vi lngnh Fe, Cu, Mg, Na, K, C th ni, cht m thay i t l cc thnh phn cuto ca n to ra s sng.

C th ni u c cht m cha thy phn l c s sng.Nhng c im ca s sng:

Vt sng khc vi vt khng sng 3 c im: 1. Thay c i mi: L lin tc thu nhp vt cht v bin i vt cht theo 2

hng: - ng ha: l bin vt cht thu nhp vo thnh cc thnh phn cu to ca

c th. - D ha: l bin vt cht thu nhp vo thnh nng lng c th hot ng

2. p ng vi kch thch mi trng. 3. Sinh sn ging mnh:l hot ng theo m di truyn duy tr ni ging.


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Tm li, sinh l hc l mn hc c s ca y hc i hi ngi nghin cu sinhl hc phi c kin thc tng hp ca nhiu ngnh khc nhau nh: gii phu, mhc, ha sinh, l sinh, ton hc, x hi hc

Mun phc v tt cho ngi bnh, sinh vin phi hc, hc na, hc mi, hcsut i. Hc vi thy, vi bn, vi ngi bnh. Lm vic theo lng tm nghnghip, l y o v y c.

SINH L HC T BO Mc tiu:

1. Trnh by c nhng c tnh c bn ca t bo c th ngi.

2. Nu c cu trc v 5 chc nng chnh ca mng t bo.3. Trnh by c chc nng ca cc bo quan trong t bo: li ni bo

tng, htRibosom, phc hp Golgi, ti lp th, lysosomv nhn t bo.

Ni dung Mi c th sng u gm nhng n v c bn l t bo. Trong c th n bo, mi qu trnh sng u din ra trong mt t bo. Trong qu trnh tin ha, c th n bo tr thnh c th a bo. Trong c th bo c nhng nhm t bo chuyn chc hp thnh cc c quan, h thng trong cth nh: h tun hon, h hp, tit niu 1. Nhng c tnh c bn ca t bo c th ngi l kh nng bit ha v phn chia. a s t bo trong c th u phn chia

sinh t bo con kt hp li vi nhau thnh t chc hay cn gi l m. Tuy nhin, c mt s t bo pht trin theo mt cch thc ring bit. V d:

- T bo c vn (c chi, c thn) khng phn chia m tng trng theo chiungang v dc.

- T bo thn kinh cng khng phn chia nhng khi tn thng th pht trinnhnh.- Cc t bo mu do ty xng sn xut lu thng trong mu, khng phn chia. T bo c kch thc, hnh dng thay i ty theo v tr v chc nng nh hnh

trn (t bo mu), hnh tr (biu m d dy v rut), hnh vung (t bo tuygip), hnh sao (t bo thn kinh)d hnh dng nh th no, t bo u c mcu to chung bao gm:


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- Mng t bo. - Nhn t bo. - Bo tng (hay cht nguyn sinh) trong c cc bo quan tham gia thc hin

cc chc nng ca t bo.

S t bo (theo Robertson)

2. Mng t bo 2.1. Thnh phn ha hc ca mng t bo

Gm ch yu l: - Glucid.- Protein: gm glycoproteinv lipoprotein.- Lipid: ch yu l phospholipid, chim trn 60% thnh phn ha hc ca mng

v mt t cholesterol. 2.2. Cu trc ca mng t bo

Nhn di knh hin vi in t thy: - Mng t bo dy khong 75 Angstrom ().


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- Hai lp mt trong v mt ngoi bn cht l protein. - Lp gia bn cht l phospholipid.

M hnh mng t bo ca Danielli v Davson

2.3. Chc nng ca mng t bo Mng t bo c 5 chc nng chnh:

2.3.1. Chc nng chia ngn Mi t bo l mt n v bit ha c nhng chc nng ring bit, cha

ng nhng vt cht ring bit. Cc bo quan bn trong cng c nhng chc nng


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ring bit v cng cha nhng vt cht ring bit. T bo cng nh cc bo quacn c chia ngn tin hnh chc nng ring ca mnh. 2.3.2. Chc nng thm q ua

Vt cht c vn chuyn qua li mng t bo theo nhiu phng thkhuch tn n thun, vn chuyn qua trung gian, vn chuyn qua knh ion. 2.3.2.1.Khuch tn n thun

Cc phn t c t hoc khng c nhm phn cc th thm qua mng mtcch d dng, nhanh chng (cc cht du v cht tan trong du). Cc phn t cnhm phn cc (nc v cc cht tan trong nc) th khng thm qua mnh nhcc cht khng phn cc m thm qua cc l lc hoc thm qua cc phn t protein ca mng. 2.3.2.2.Vn chuynqua trung gian

i b phn qu trnh xuyn qua mng trong c qu trnh xuyn qua

mng ca glucose v amino acid l tin hnh theo phng thc ha hc, tc ltheo phn ng ha hc gia cc phn t xuyn mng v cc phn t cu trc cmng. Qu trnhny gi l vn chuyn qua trung gian. 2.3.2.3. Vn chuyn qua knh ion

Mng t bo c nhng m glycoprotein xuyn qua 2 lp phospholipidmng, gi l knh ion c chc nng cho cc ion xuyn qua li mng. Cc ionc vn chuyn qua mng t bo s gy bin i chc nng ca t bo nh hn cc c quan v ton c th.V d: Trong t bo c tim v t bo c trn ca cc ng mch, c nhng knh

Ca++

. Trong trng thi bnh thng, lng Ca++

trong t bo rt thp so vi dch k bn ngoi t bo. Nu ta tim adrenalin vo mch mu, adrenalin s m knh Ca++,lm cho cc ion Ca++ bn ngoi trn vo t bo gy tng huyt p. Thuc Adalate(Nifedipin) ung vo s ng knh Ca++ lm cho Ca++ bn ngoi khng vo ct bo dn n h huyt p. 2.3.3. Chc nng bin hnh v ha mng trong qu trnh thc bo vbi tit Mng t bo l mt cu trc v cng sinh ng v c kh nng to hnh rt caoKh nng ny biu hin r rt trong cc qu trnh thc bo, m bo v bi tit s phm.

Khi t bo tip xc vi mt vt l, mng t bo c th lm vo bao bc vl ri khp ming li thnh mt ti cha vt l, sau ti tch ri mng i vo btng cn mng th khp kn li nh c. Ti cha vt l l bc thc bo. Bthc bo ny khi vo bo tng th s b hp dn n tip xc vi mt bc enzym,gi l lysosom. Hai bc ha mng vi nhau ti im tip xc, pha trn ni dunvi nhau lm thnh mt ti ln l lysosom thc bo.


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2.3.4. Chc nng dn truyn in th mng: hai bn mng t bo, bn trong v bn ngoi u c nhng

ion mang in dng (+) hoc m (-). Cc cht quan trng quyt nh tch in 2bn mng l Na+, K+, v Cl- ; nng ca chng 2 bn mng rt khc nhau:

Ion Nng bn ngoi t bo Nng bn trong t bo Na+ 150 mmol/ lt 15 mmol/ lt

Cl- 125 mmol/ lt 10 mmol/ lt

K+ 5 mmol/ lt 150 mmol/ lt

Tt c cc mng t bo sng u c tnh cht nh mt pin in m cdng quay ra ngoi cn cc m quay vo trong. Khi c kch thch, mng lin thayi tnh thm v c s vn chuyn ion Na+ vo trong, K+ ra ngoi lm cho c trngthi cn bng ion ri tip sau l o ngc ion. S bin i s lng ion g bin i in th, gi l in th ng. Mt khi xut hin in th ng mtim kch thch, xung ng in chy trn mng (thng l mng si thn kinh)Mng t bo lm chc nng dn truyn xung ng in. 2.3.5. Chc nng thng tin Mng t bo cha ng nhng glycoprotein c hiu nh cc khng nguyn

ghp gip cho t bo nhn dng c cc t bo khc. Nu khng nguyn ginnhau th t bo kt li vi nhau thnh t chc, nu khng ging nhau th c hitng tng ghp. Mt trong nhng glycoprotein l mt khng nguyn c

chc nng c bit l nhn dng cc t bo v phn bit t bo quen, t bo lKhng nguyn ny do Jean Dausset pht hin v ng c tng gii Nobel y hcnm 1980, gi l HLA (Human Leucocyte Antigen: khng nguyn bch cungi). Thc ra, HLA khng phi l khng nguyn ca ring bch cu m l ctt c t bo c th. Mng t bo cn cha ng nhng enzym c vai tr nhn v truyn tin ca cc

kch thch t ni tit. Mng t bo cng c kh nng sn xut nhng cht c tc dng kch thch t nh

prostaglandin khi mng tip nhn mt kch thch c hiu qua chui phn ng:


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3. Chc nng ca cc bo quan trong t bo

3.1. Li ni bo tng L h thng ng v ti nh thng vi nhau, thng vi nhn t bo trongv thng t bo vi mi trng ngoi. Li ni bo tng c vai tr quan trngtrong trao i cht trong t bo. 3.2. Ht Ribosom

L nhng bo quan nh cha ARN nm ri rc trong bo tng. Ribosomc vai tr quan trng trong tng hp protein ca t bo. 3.3. Phc hp Golgi

L nhng ti dt c chc nng ch tit cc cht v c bit pht trin nhng t bo c chc nng bi tit nh t bo tuyn gip. 3.4. Ti lp th

L nhng bo quan tng i ln ca t bo, thng c hnh bu dc, rt dng trong bo tng. Ti lp th c vai tr quan trng trong sn xut nng lnca t bo. 3.5. Lysosom

L bo quan c cha nhiu men tiu ha c tc dng tiu ha nhng chthu c l xm nhp vo t bo v gip cho qu trnh thc bo.

3.6. Nhn t bo Thng nm gia t bo, c hnh cu hay hnh bu dc, gm c: mng

nhn v nhn tng. Nhn c 2 chc nng l rp khun DNA v tng hp cc loiRNA.

Phospholipid ca mng Arachidonic acid

Prostaglandin

Phospholipase Cc phn ng trung gian

C tc dng: - Lm h huyt p. - Tng tit cht nhy d dy. - Tng co c t cung. - c ch tc dng caadrenalin


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3.6.1. Mng nhnBao bc quanh nhn c nhng l thng thng vi bo tng to thnh mi

lin h cht ch gia nhn vi bo tng. 3.6.2. Nhn tng

L phn cht lng trong nhn gm c: ht nhn v th nhim sc. Hu htDNA ca t bo u tp trung nhn tng.


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Mu trong ng nghim

SINH L MU

Mc tiu: 1- Trnh by c cc thnh phn chnh ca mu v cc chc nng ca chng. 2- Trnh by c qu trnh cm mu v cc ri lon hay gp. 3- Trnh by c cc nhm mu, ngha trong truyn mu v v c s

truyn mu ca h ABO v Rh. 4- Trnh by c v trnh by ngha cc ch s xt nghim huyt hc thng

thng. 5- Trnh by c tnh cht ca bch huyt.

Ni dung 1. i cng Mu l cht lng phc tp c xem l mt loi m lin kt. Mu l phng tin cc phn khc nhau ca c th lin h vi nhau, v vi mtrng bn ngoi. Ngoi chc nng vn chuyn xy (hng cu), cacbonic, chtdinh dng, cht cn b, mu cn c chc nng bo v (bch cu v khng th) vto nn mi trng cho nhiu phn ng sinh ha ca c th. 2. Cu to chnh

- C khong70 ml mu /kg trng lng - pH = 7,36 - Mu sc: mu nhiu xy (mu ng mch ni chung) cmu ti ,

mu t xy (mu tnh mch ni ring) cmu thm Mu bao gm:

- Huyt tng (plasma) l mt cht dch muvng nht trong sut trong cha nhiu chtha tan chim khong 55% th tch mu.

- Huyt cu (blood cell) l cc t bo mu treo l lng trong huyt tng, chim khong 45% thtch mu.

* Huyt thanh (serum) l huyt tng loi b ccyu t ng mu. 3. Huyt tng Gm nc v cc cht ha tan. 3.1. Cc protein huyt tng

3.1.1. AlbuminL loi protein c t l cao nht trong huyt tng.c to nn gan. Chc nng ca albumin. - Duy trp lc thm thuca mu. p lc thm thu c chc nng gi nctrong lng mch.


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- Vn chuyn cc cht.

3.1.2. Cc globulinMt s globulin c to gan, mt s c to m bch huyt. C 3 loi -globulin; -globulin; v -globulin.

-globulin cn c gi l globullin min dch (Ig: immuno globulin), l cckhng th c nhim v chng li cc khng nguyn. C 5 loi: IgG, IgM, IgA,IgD v IgE.Cc khng th c cc lympho-B tit ra. Vic sn xut khng th sau khi tip xcvi khng nguyn c gi l s p ng min dch. S p ng ny c tnh hiu v nhc li (hc mn Sinh l bnh v min dch).

3.1.3. FibrinogenLoi protein cn cho s ng mu (xem phn Cm mu). 3.2. Cc yu t ng mu

Cc chttham gia qu trnhng mu. (xem phn Cm mu). 3.3. Cc cht in gii Cc cht in gii lin quan n: s cu to cc t bo, s co c (K +), s dntruyn cc xung ng thn kinh, s hnh thnh cc cht tit, p sut thm thu(Na+, Cl-), pH. pH bo m mi trng cho cc phn ng sinh ha. Ch s o c cc nng mui khong gi lin gii .3.4. Cc cht dinh dng

Monosaccharid. (Hnh thnh t s tiu ha glucid) Acid amin. (Hnh thnh t s tiu ha protid) Acid bo, Glycerol. (Hnh thnh t s tiu ha lipid) Cc vitamin.3.5. Cc hormoneXem biSinh l ni tit. 3.6. Cc cht kh O2 v CO2 . xy v Cc b niccvnchuynbnghai cch ho tan trong huytt ng vkt hp vi Hb trn hng cu.Phnln xycvnchuynbngcch kthpviHbPhnln Cac b nic li cvnchuynbngcch ho tan trong huyt t ng(di dng HCO-)4. Cc t bo mu Bch cu, Hng cu, Tiu cu.


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Bch cu ht a baz, trung tnh va acid

Lympho v Mono.

4.1. Bch cu T bo mu ln nht. Chc nng chnh: bo v c th.

4.1.1. Bch cu ht Bch cu ht c cc ht trong nguyn sinh cht. Cn gi l Bch cu a nhn.

C 3 loi, t tn do s bt mu ca cc ht i vi cht nhum: Bch cu ht aaxit, a ba z, v trung tnh.

4.1.1.1. Bch cu ht trung tnh. Chc nng c bn l thc bo cc vt l xm nhp vo c th, c bit l vi khu Chng c cc tnh nng chnh p ng nhim v ny:

- Chuyn ng v bin dng rt linh ng nn c th len li vo cc t chc - Ha ng ng: b thu ht bi cc cht tit ca vi khun. - Thc bo. - Dit khun v tiu ha: lm tiu vi

khun (sau khi chng b bch cuthc bo), cc ht c hiu ca bchcu gii phng men thy phn ph hyhon ton vi khun.

Bch cu ht sau khi tiu ha vi khun th bnthn cng cht i.

4.1.1.2. Bch cu ht a toan v a axit C vai tr trong cc hin tng d ng.

4.1.2. Bch cu n nhn Cn gi lbch cumono .Mt s lu hnh trong mu, mt s di tr trong cc m. Chc nng:

- Thc bo cc vi khun. - Loi b hng cu. - Trnh din khng nguyn. - Ph hy t bo c tnh.

Kh nng thc bo ca bch cu n nhn mnh hn rt nhiu ln so vi bch cht trung tnh.

4.1.3. Bch cu lympho C 3loi: lympho-T, lympho-B v NK (Natural Killer: t bo dit t nhin). Lympho-T: p ng min dch qua trung gian t bo viu ha min dch. Lympho-B: min dch dch th, sn xut cc khng th (ccglobulin).NK : tiu hy trc tip t bo khng qua khng th.


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Si fibrin

Hng cu, ct i.

(Hc k hn mn Sinh l bnh-Min dch) 4.2. Hng cu Hng cu hnh cu, lm gia, khng c nhn, c th bindng nhiu vo cc mao mch rt nh. Hng cu cha hemoglobin l cht kt hp vi xy vnchuyn xy n mi t bo trong c th.

4.2.1. HemoglobinHemoglobin cn c gil huyt sc t .Hemoglobin c trn mng hng cu.Hemoglobin l mt phc hp gm globin (mt loi protein) v mtcht cha st gi l hem. Hemoglobin kt hp vi oxy ti phi v to thnh oxyhemoglobin .Oxyhemoglobin s phng thch xy cho cc t bo. Hemoglobin kt hp vi cacbonic to thnh carbohemoglobin . (Nhng phnln cacbonic trong mu didngho tan trong huytt ng.)GimHemoglobinngngh a vi vicgimkh nng vnchuyn xy (thiu mu)

4.2.2. S pht trin v tui th hng cu Hng cu c to trongty xng . C hai qu trnh:trng thnh hng cu (cn acid folic v vitamin B12) voto hemglobin(cn st). Hng cu pht trinqua nhiu giai on, trong c giai on hng cu li (hng cu non). Txng s gii phng hng cu trng thnh v cmt s t hng cu li vomu. Hng cu li c mt trong mu ngoi vi chng t ty xng cn to m

tt. Khi c th thiu xy s kch thch tng to hng cu thng qua vic sn xuhocmnerythropoietin cthn tit ra. Hng cu th khong 120 ngy. 4.3. Tiu cu L cc t bo nh c nhiu hnh dng, khng c nhn. C vai tr quan trng trongqu trnh cm mu. 5. Cm mu Qu trnh ngn chn vic chy mu khi lng mch khi mch mu b tn thng. L qu trnh phc tp bao gm nhiu yu t v nhiu thnh phn tham gia,kt qucui cng l mt cc mu ng bao gm cc t bo mu b nht trong mt lisi fibrin. Qu trnh hnh thnh cc mu ng gi lqu trnh ng mu.Ban u tiu cu kt dnh vi nhau to thnh nt tiu cu, ng thi tiu cu k pht mt lot phn ng dy chuyn. Phn ng dy chuyn ny c tham gia bi cc yu t ng mu.Cc yu t ng mu c nh s la m (th t theo thi gian c khm ph,khng phi l th t tham gia qu trnh ng mu).


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Cc mu ng

Hng cu

T n thngthnh mch

Tiu cu kt dnhto nt

Tiu cu giiphng

thrombokinase

Prothrombin(II)

Thrombin

Fibrinogen (I)(tan)

Fibrin(khng tan)

Tiu cu

S lc qutrnh cm mu

Sau khi cm mu thnh cng (to cc mung v mu ngng chy) th din ra qutrnh tan cc mu ng v qu trnh linso vt thng mch mu c tin hnh. Vic cm mu s khng hon thin t nht l docc yu t: - S lng tiu cu t, hoc kh nng kt dnhkm (gil cht lng tiu cu km) - Thiu yu t ng mu. V l phnng to cc mu ng l phn ngdy chuyn nn thiu 1 yu t cng giaion 2 b nh hng, v d bnh Hemophilie A (thiu yu tVIII) Hemophilie B (thiu yu t IX).

6. Cc nhm mu v

truyn mu Ngi ta phn bit ccnhm mu bi cc khngnguyn trn mng hng cu. S khc bit v nhmmu l bm sinh v cxc nh v mt di truyn.Khi khng th v khngnguyn tng ng gpnhau s gy ra s ngng

kt hng cu v tan mudo s hiu bit vnhm mu l yu cu c bn trong truyn mu vmt s bnh l v mu.C khong trn 20 hnhm mu c tm

thy nhng c hai h c ngha ln trong truyn mu: h ABO v Rhesus. Nu truyn mu khng ng quy tc th trong c th ngi nhn s xy ra hitng kt hp khng nguyn (hng cu) v khng th (trong huyt tng). C

hng cu (ca ngi cho) b ngng kt, v ra v phng thch cc cht gy c, gyshock tun hon, c bit l tnh trng kt thn cp c th gy t vong. 6.1. H ABO:H nhm mu da trn sc mt (hay khng c mt) khng nguyn c tn l A,

B mng hng cu.


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Gen ABO s quy nh vic c mt cc khng nguyn ny. Kiu gen AA, AO chonhm mu A; kiu gen BB, BO cho nhm mu B, v.v Cha m truyn cho conkiu gen theo nh lut Mendel.

Khng nguyn (trn mng HC) Khng th (trong huyt tng) Thuc nhm mu

A anti-B A

B anti-A B

AB Khng c AB

Khng c anti-A v anti-B O

S truyn mu ABO:

S ny th hin: Quy tc ti a: Ch truyn mu ng nhm (cc mi tn cong) Quy tc ti thiu: Nu truyn khc nhm (cc mi tn thng): Khng khnnguyn ca mu cho gp khng th tng ng trong mu nhn.Quy tc ti thiu c th c thc hin trong trng hp bt kh khng (khng mu ng nhm), l v khng th trong mu ngi cho b ha long trong c thngi nhn, khng s lng gy ngng kt hng cu ca ngi nhn.

S truyn mu ch l mt nim tng qut, trong thc hnh cn bit l: - Cc nhm mu trn c th c phn thnh nhiu nhm ph, c bit l nhm Oc thm nhm O nguy him, l nhm mu O nhng li cha nhiu khng th( , ) hn bnh thng, khng th truyn cho ngi khc nhm c theo s trn.- Phn ln cc trng hp nn truyn mu tng phn, tc l ch truyn thnh phno m bnh nhn cn, v d hng cu ra, truyn tiu cu...


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- Phn ng cho l phn ng bt buc lm trong bt c trng h p no: ngaytrc khi truyn mu trn hng cu (hoc mu) ca ngi cho vi huyt thanh cngi nhn nu phn ng ngng kt xy ra th khng c truyn. 6.2. H Rhesus Khng nguyn quan trng nht c gi l khng nguyn D. Khng nguyn nyc quy nh bi gen D (kiu gen l DD hoc Dd). Ngi c khng nguyn D: Nhm Rh(+) Ngi khng c khng nguyn D: Nhm Rh(_) Nhm chng tc da trng c 85% l Rh(+) trong khi cc chng tc khc (trong c VN) c cha n 0.1%. Khc vi h ABO khng th (khng D) khng t nhin m c trong c th ngm xut hin khi truyn mu hoc do mang thai. Qu trnh to khng th v do s kt hp khng nguyn khng th cng r rt cc ln tip xc sau, ngy cngy ra hu qu nng n. V d: B c Rh(+) th con c th c Rh(+) (kiu gen ca b l DD th 100% con cRh(+), kiu gen Dd th ch c 50% s con c Rh(+)). Nu ngi m c Rh(_) thtrong thi gian mang thai khng nguyn D ca mu con s kch thch c th msn xut ra khng th khng D lm tan huyt thai nhi, c bit l cc ln mang thaisau v vic sn xut khng th tng ln.i vi truyn mu th: Ngi c Rh(+) c th nhn mu Rh(+) hoc Rh(-). Ngi c Rh(-) ch c th nhn mu Rh(-).Trong sn khoa - Xy ra i vi nhng ngi ph n Rh m ly chng Rh dng. Khi c thai, thnhi c th l Rh dng hoc m. Trong ln mang thai Rh dng u tin, m

lng mu Rh dng ca thai nhi s vo tun hon m ch yu l lc sinh v kcthch c th ngi m sn xut khng th khng Rh. a tr sinh ra trong ln nkhng b nh hng g c. Tuy nhin, n ln mang thai tip theo, khng thkhng Rh s vo tun hon thai nhi. Nu l thai Rh dng th khng th khngRh c th lm ngng kt hng cu thai nhi v gy cc tai bin sy thai, thai luhoc a tr sinh ra b hi chng vng da tan mu nng. - Tht ra, trong thi gian mang thai yu t Rh ca bo thai phng thch votrong dch bo thai v c th khuch tn vo mu m. Tuy nhin, trong ln mangthai u tin (ln u tin tip xc khng nguyn Rh) lng khng th to ra cth ngi m khng cao


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Tai bin sn khoa trong bt ng nhm mu Rhesus 7. Cc ch s huyt hc thng thng Ghi ch:1 mm3 = 10-6 dcm3 = 10-6 ltV d: S lnghngcu: 4 x 1012 / lt = 4 x 1012 -6 / mm3 = 4 x 106 /mm3 fl= femto lt = 10-15 lt. pg = picogram = 10-12 g

Loi Ch s bnhthng

ngha

S lng hngcu

RBC: redblood cell

nam: 4,0-5,8 x1012 /ln : 3,9-5,4 x1012 /l

Gim trong thiu mu

Th tch hngcu trung bnhMCV

MeanCorpuscularVolume.

83-92 fl Biuth lntrung bnhhng cu

Hematocrit Hct nam: 0,38-0,50 l/ln : 0,35-0,47 l/l

T l gia hng cu v muton b. Thp l mu long. Cao lmu b c c.

Hng cu li 0,1-0,5% T l s hng cu li/ton b hng cu, tng trongthiu mu (nhng ni lnvic to mu cn tt)

Nng Hbtrong mu

nam: 140-160 g/ln : 125-145 g/l

Thptrong thiumu (chn on xcnhthiumu)

Nng Hbtrung bnh trong

MCH: MeanCorpuscular

27-32 pg Tng c gi l u sc, bnh thng: ng sc,


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Loi Ch s bnhthng

ngha

1 hng cu Hemoglobin. gim: nhc sc. S lng tiucu

Plt: Platelet. 150-400 x 10 /l Gim gy ri lon cm mu

S lng bchcu WBC: whiteblood cell 4-10 x 10 /l Tng trong nhim trng,tng rt nhiu trong ungth mu (bnh bch cu)

T l BC httrung tnh

40-70% T l so vi ton b bchcu. T l tng trong nhimtrng

T l BC ht aaxit

1-5% T l so vi ton b bchcu. Tng trong nhim ksinh vt, d ng

T l BC ht abaz


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Cc loi dch c th

Dch trong c th phn thnh hai loi chnh: dch ni bo, cha trong cc t bo vdch ngoi bo, nm ngoi.Dch ngoi bo bao gm: huyt tng, dch k, dch bch huyt, dch no ty, dc

trong mt, cc dch tiu ha. Dch ngoi bo lu thng trong h mch mu, bchhuyt v c s trao i gia mu v dch ca cc m qua thnh mao mch. H qul tt c mi t bo u sng trong cng mt mi trng l dch ngoi bo, nndch ngoi bo cn c gi l ni mi. 1. Huyt tng Xem trn.2. Dch k L dch nm khong gia cc t bo v nm ngoi h thng mch. Dch k cungcp xy v cc cht dinh dng cho t bo, ng thi thu nhn CO2 v cc sn phm chuyn ha. cc mao mch pha tiu ng mch th dch b y ra khi lng mch, ngc l cc mao mch pha tnh mch th dch k b y vo lng mch, phn dch kcn li s i vo h bch mch. 3. Dch bch huyt L dch k chy vo h thng bch mch. H bch mch s a bch huyt tr tnh mch qua ng ngc v ng bch huyt phi. Trc khi i ti tnh mch dch bch huyt i qua mt s hch bch huyt. Hch bch huyt l ni cha nhiulympho v i thc bo.

Dch bch huyt tng t nh dch k. Ngoi ra n cn cha cc cht kch thcln nh vi khun, t bo b tn thng vng b vim, cht cn b v s b tihy cc hch bch huyt.c bit cc mch bch huyt dn lu bch huyt t rut non cha nhiu cht ddng v c b ngoi nh sa, nn c gi l nh trp. * Lch v tuyn c c xem l nm trong h bch huyt.


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SINH L TUN HON

H tun hon quan trng trong vic duy tr s sng. H tun hon lmnhim v lu thng mu khp c th. Ngng tun hon th tnh mng b e da

nghim trng, ngng qu 4 pht, t bo no tn thng khng hi phc. B my tun hon gm tim v cc mch mu: ng mch, tnh mch v

mao mch. Tim ht mu t tmh mch v v y mu vo ng mch. ng mdn mu t tim n cc m, c quan. Tnh mch dn mu t cc m, c quan vtim. Mao mch l nhng mch mu ni ng mch cui cng v tnh mch cucng, l ni thc hin qu trnh trao i cht gia mu v m, c quan.

S lu thng mu trong c th SINH L TIM

Tim l ng lc chnh ca h tun hon, tim ht mu t tnh mch v vy mu vo ng mch. Trong 24 gi tim co bp khong10.000 ln, y hthng ngn lt mu.

1. c im gii phu v m hc ca tim: 1.1. S lc cu to Tim chia thnh hai na ring bit l tim tri v tim phi. Mi na li chia

thnh hai bung, trn l tm nh, di l tm tht, gia tm nh v tm tht c ccvan:van hai l bn tri, van ba l bn phi, gia tm tht v ng mch c vant chim. Cc van m bo cho mu chy mt chiu t nh xung tht, t tht vng mch.


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1.2. C tim C tim va c cu trc ca c vn va c cu trc ca c trn, nn c tim

c tnh cht ca c c vn v c trn l co bp khe v co bp t ng. 1.3. H thng nt H thng nt l mt cu trc c bit c kh nng pht xung ng. H thng ngm: - Nt xoang nm c tm nh ni tnh mch ch trn vo tm nh phi - Nt nh tht nm c tm nh cnh l xoang tnh mch vnh.- B His i t nt nh tht ti vch lin tht th chia lm hai nhnh phi v trichy di ni tm mc ti hai tm tht, chia thnh nhng nhnh nh tthnh li Purkinje.


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2. Tnh cht sinh l ca tim 2.1. Tnh hng phn

Tnh hng phn ca c tim l kh nng p ng vi kch thch, th hin bng co c. Tnh hng phn ca c tim theo quy lut khng hoc tt ca RanvieC tim hoc l khng p ng vi kch thch hoc l p ng ngay vi mc ta 2.2. Tnh tr c chu k

Trong giai on tm thu, tim ctnh tr tc l khng p ng v i kchthch, giai on ny lp i lp li nn gi l tr c chu k.2.3. Tnh nhp iu

l kh nng pht xung ng nhp nhng ca h thng nt. Nt xoang120 150 ck/pht, nt nh tht: 50 ck/pht, b His: 30 40 ck/pht.2.4. Tnh dn truyn

l kh nng dn truyn xung ng thn kinh ca c tim v h thng n * Nh c tnh nhp iu, tnh dn truyn, tnh hng phn v tnh tr c chu k, timc kh nng co bp nhp nhng, u n.3. Chu k tim

Hot ng ca tim gm nhiu giai on, lp i lp li u n to nn ck tim.3.1. Cc giai on ca chu k tim 3.1.1. Giai on tm nh thu:


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Khi tm nh co bp, p sut tm nh tng ln, lc ny van nh tht ang m,tm nh co bp y lng mu cn li xung tm tht (35 % lng mu t nhxung tht). Thi k tm nh thu ko di 0,1s sau tm nh gin ra sut thi kcn li ca chu k tim.3.1.2. Giai on tm tht thu:

Khi tm nh gin ra th tm tht bt u co bp, p sut tm tht tng lnlm ng van nh tht, ri sau lm m van ng mch, mu phun vo ngmch. Thi k tm tht thu ko di 0,3s.3.1.3. Tm trng ton b:

Tm tht gin ra trong khi tm nh ang gin, tm tht gin lmp sut tmtht gim xung van ng mch ng li. p sut tm tht gim n khi p sutm tht nh hn psut tm nh th van nh tht m ra, mu t nh xung tht.Giai on tm trng ton b ko di 0,4 s.3.2. Vai tr ca h thng nt

Tng khong thi gian nht nh nt xoang pht xung ng, xung ng lanra tm nh lm tm nh co bp tc l tm nh thu. ng thi xung ng lan truynn nt nh tht, b His, cc nhnh ca b His ri theo li Purkinje lan ra tmtht lm tm tht co bp tc l tm tht thu.

Sau khi co bp,tm tht gin ra th ng trong khi tm nh ang th nggin ra tc l giai on tm trng ton b, cho n khi nt xoang pht xung ngmi khi ng chu k tip theo.

Bnh thng ch c nt xoang pht xung ng iu khin hot ng tim, khint xoang tn thng nt nh tht hoc b His pht xung ng thay th.3.3. Lu lng tim

Lu lng tim cn gi l th tch pht, l lng mu tim bm vo ngmch trong mt pht. (Th tch tm thu l lng mu mt ln tim co bp phunvong mch. Bnh thng khong 60ml ngi trng thnh).

Lu lng tim ngi trng thnh trung bnh l:60ml x 75 ln/ pht = 4,5 l/ pht

4. Nhng biu hin bn ngoi chu k tim 4.1. Ting tim

Khi tim co bp ta nghe c hai ting tim:- Ting th nht: trm v di nghe r mm tim. Nguyn nhn do ng van nh tht, ngoi ra cn do mu phun vo ng mch, co c tm tht.

Lu lng tim = Th tch tm thu x tn s tim


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- Ting th hai: cao v ngn, nghe r y tim. Nguyn nhn do ng van tchim.

Ngoi ra thnh thong nghe c ting th ba do mu p vothnh tmtht trong k tm trng. Khi van tim b tn thng, l van ng khng kn hocl van hp, huyt ng ri lon to ra nhng ting bnh l nh ting thi, ti

rung.4.2. Dng in tim

Khi tim hot ng, c tim pht sinh dng in, dng in ny lan ra khpc th. Ngi ta c th o dng in ny bng cch ni hai cc ca my ghi vhai im bt k no ca c th. ng ghi gi l in tm . Trong thc tngi ta quy c ly mt s im ca c th t my ghi, mi cch mc my ghi vo c th l mt o trnh.

Cc loi o trnh: o trnh song cc: Gi l o trnh chun, gm: - o trnh D1: Hai cc ni vi c tay phi v c tay tri.- o trnh D2: Hai cc ni vi c tay phi v c chn tri.- o trnh D3: Hai cc ni vi c tay tri v c chn tri.

o trnh n cc:Gm co trnh n cc chi v o trnh n cc trc tim. Trong

nhng o trnh ny mt cc ni vi mt im chi hoc trc tim gi l cthm d. Cn cc kia ni vi hai im cn li qua mt in tr 50000 Ohmgi lcc trung tnh ( in th cc ny trit tiu).

o trnh n cc chi - aVR cc thm d c tay phi.- aVL cc thm d c tay tri.- aVF cc thm d c chn tri. o trnh n cc trc tim - V1 cc thm d t khong lin sn 4 st b phi xng c.- V2 cc thm d t khong lin sn 4 st b tri xng c.- V3 cc thm d t gia V2 v V4.- V4 cc thm d t mm tim.- V5 cc thm d t ng cch trc tri.- V6 cc thm d t ng nch gia tri. Sau y l hinh nh in tm bnh thn g:


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Chuyn o gm 5 sng: P, Q, R, S, T. Ba sng Q, R, S to thnh phc hp QRS - Sng P l sng kh cc ca tm nh. - Phc hp QRS l sng kh cc ca tm tht - Sng T l sng ti cc ca tm tht - Khong PQ l thi gian dn truyn nh tht 5. iu ha hot ng tim

Hot ng tim thng xuyn c iu ha ph hp vi nhu cu cungcp mu cho c th. l nhng yu t iu ha t bn ngoi v yu t ti tim.


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5.1. iu ha t bn ngo i tim5.1.1. Yu t thn kinh H thn kinh thc vt H thn kinh ph giao cm: Trung tm ph giao cm nm hnh no. Cc si

trc hch theo dyX n hch ph giao cm c tim, cc si sau hch n ntxoang, nt nh tht. Kch thch ph giao cm lm: - Gim lc co bp ca tim. - Gim dn truyn (chm nhp tim).- Gim trng lc c tim. H thn kinh giao cm: Trung tm sng bn cht xm ty on sng c 1 7v tht lng 1 3. Cc si trc hch n hch sao, cc si sau hch n ntxoang, nt nh tht v b His. Kch thch giao cm gy tc dng ngc li vi kchthch h ph giao cm - Tng co bp - Tng dn truyn (tng nhp tim) - Tng trng lc c tim

Nhng si thn kinh thc vt tc dng ln tim khng phi trc tip m qunhng ha cht do u tn cng ca si thn kinh tit ra, i vi h giao cmadrenalin, i vi h ph giao cm l acetylcholin Vai tr ca cc phn x - Phn x gim p: Tng p sut quai ng mnh ch, xoang ng mch cnhgy xung ng truyn v hnh no kch thch dy Xlm tim p chm, huyt pgim. Cc phn x ny c tc dng iu chnh huyt p khi huyt p cao - Phn x tim tim : Khi mu v tim nhiu, gc tnh mch ch vo nh phi bcng pht sinh xung ng v hnh no c ch dyX lm tim p nhanh, lm gim ng mu tm nh - Phn x mt tim: p mnh vo hai nhn cu xung ng v hnh no kch thchdy Xlm tim p chm - Phn x Goltz: nh mnh vo vng thng v xung ng truyn v hnh nokch thch dy Xlm tim ngng p nh hng v no

Trong nhng trng thi hot ng ca v no nh cm xc, s hi, lolng bao gi cng c s thay i hot ng tim

5.1.2. Yu t th dch nh hng ca hormone tuyn ni tit - Hormonety thng thn: Adrenalin lm tim p mnh, nhanh - Hormonetuyn gip Thyroxin lm tim p nhanh nh hng ca nng O 2 v CO2 trong mu Nng CO2 mu tng, O2 mu gim lm tim p nhanh v ngc li


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nh hng ca cc Ion - Ca++ mu tng lm tng trng lc c tim - K+ mu tng lm gim trng lc c tim- pH mu gim lm tim p nhanh 5.2. iu ha ngay ti tim

Tim hot ng theo nh lut Starling: lc co bp ca tim t l vi chiu dica si c tim trc khi co.

SINH L NG MCH

ng mch l nhng mch mu vn chuyn mu t tim n cc m. Tng mch ch, ng mch chia thnh nhng nhnh nh dn, cng xa tim thidin mt ng mch cng nh, thit din tng ng mch cng ln, vn tc c

gim. 1. Tnh cht sinh l ca ng mch 1.1. Tnh n hi - l kh nng tr v trng thi ban u khi b bin dng. Khi mu vo nmch th n gin to ra, khi ra khi ng mch th n co nh tr li - Tnh n hi cao nhng ng mch ln v thnh mch c nhiu si n hi.- Tnh n hi lm cho:

Mu chy lin tc trong mch mu mc d tim co bp phun mu vo ngmch tng t

Lm tng lu lng mu i vi mi ln co bp tim 1.2. Tnh co tht - l kh nng ng mch co nh li lm cho lng mch hp i, gim lng mi qua. Tnh cht ny lm cho ng mch thay i thit din, iu ha lng mn c quan.- Tnh co tht cao nhng ng mch nh, v thnh mch nh cha nhiu si ctrn 2. Huyt p ng mch 2.1. nh ngha:

Tim co bp to nn lc y mu chy trong ng mch. Mu chy trongng mch li chu lc cn ca mch mu. Tun hon mu l kt qu ca hai li lp nhau: lc y mu ca tim v lc cn ca ng mch , trong lc y ctim thng nn mu chy trong ng mch vi mt p sut nht nh l huyp.

Nh vy huyt p l p lc mu chy tc ng ln thnh mch


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2.2. Cc thng s v huyt p - Huyt p ti a: Do lc co bp ca tim to nn, gi l huyt p tm thu. Huytp ti a ph thuc vo lc tm thu v th tch tm thu. Bnh thng huyt p ta t 90 110 mmHg- Huyt p ti thiu: l huyt p trong giai on tm trng cn gi l huyt p

tm trng. Huyt p ti thiu ph thuc vo trng lc mch mu. Bnh thhuyt p ti thiu t 50 70 mmHg- Huyt p hiu s: l mc chnh lch gia huyt p ti a v huyt p tithiu, l iu kin cho tun hon mu. Khi huyt p hiu s b gim hay gi huyt p kp th tun hon mu b tr - Huyt p trung bnh: cn gi l huyt p hu hiu, l trung bnh ca tt c psut mu c o trong mt chu k thi gian, n th hin sc lm vic thc s ctim. Huyt p trung bnh gn vi huyt p tm trng hn huyt p tm thu trongchu k hot ng ca tim.

3. Cc yu t nh hng n huyt p 3.1. Yu t ca tim - Lc co bp: Tim co bp mnh th mu vo ng mch nhiu hn huyt p tng - Nhp tim: Khi tim p chm, mu vo ng mch t, huyt p gim. Khi tim pnhanh mu vo ng mch nhiu huyt p tng, tuy nhin nu tim p qu nhanh(> 140 ln/ pht), giai on tm trng qu ngn, mu v tim t nn lng muvo ng mch cng gim, huyt p gim.

3.2. Yu t ca mch mu - Mch mu co th huyt p tng v ngc li - Mch mu km n hi th sc cn tng , huyt p tng 3.3. Yu t ca mu - qunh tng th huyt p tng v ngc li.- Th tch mu tng th lu lng mu tng do huyt p tng v ngc li.4. iu ha tun hon ng mch .ng mch c mt h thn kinh ni ti c kh nng co gin mch (vn mch). K

nng ny c iu ha bng hai c ch: 4.1. Thn kinh: l cc trung tm co gin mch no v ty sng 4.2. Th dch:- Adrenalin, Noradrenalin c tc dng co mch.- Angiotensin II c tc dng co mch.- Nitroglycerin gin ng mch nh dng iu tr co tht mch vnh.- O2 mu tng, CO2 mu gim lm co mch.

HA trung bnh = HA tm trng +1/3HA hiu s


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SINH L TNH MCH

Tnh mch dn mu t cc m, c quan v tim 1. Nguyn nhn tun hon tnh mch

Mu trong tnh mch chy v tim c l nh nhng yu t sau: 1.1. Sc bm ca tim:

Tim bm mu vo ng mch to nn mt p sut, cng xa tim p sut cng gim dn, ra khi mao mch p sut vn cao hn nh phi nn mu v tim.1.2. Sc ht ca tim :- Giai on tm thu: Khi tm tht co bp, mu phun vo ng mch, van nh thth xung v pha mm tim, bung nh gin lm psut tm nh gim xung, muchy v tim.- Giai on tm trng: Tm tht gin, to sc ht t tm nh xung tm tht, ttnh mch v tm nh 1.3. Sc ht ca lng ngc - Thi k ht vo: Khi ht vo lng ngc gin ra, p sut m trong lng ngc tngthm, tm nh v tnh mch ln gin ra ht mu v tim.- Do tm thu: Khi co bp tim nh li, p sutm trong lng ngc tng thm, tmnh v tnh mch ln gin ra ht mu v tim.1.4. Vn ng ca c

C co ln tnh mch vi s phi hp ca cc van tnh mch y mu d

v tim.1.5. nh hng ca ng mch

Mt ng mch ln thng c hai tnh mch i km nm chung trong m bao x. Khi ng mch p vi s phi hp ca cc van tnh mch, y mu vtim.1.6. nh hng ca trng lc

t th ng, tun hon tnh mch pha trn tim thun li hn tun hotnh mch pha di tim

2. iu ha tun hon tnh mch Tnh mch c kh nng co, gin nhng gin nhiu hn - Lnh lm co, nng lm gin.- Adrenalin, nicotin lm co tnh mch.- Amylnitrit, cafein lm gin tnh mch.


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SINH L MAO MCH

Mao mch dn mu t ng mch sang tnh mch, l ni din ra qu trnhtrao i cht gi mu v dch k.1. Chc nng trao i cht

Khi mu n mao mch, O2 v cc cht dinh dng trong mu vn chuynqua thnh mao mch vo dch k. Ngc li CO2 v cc cht cn b vn chuyn tdch k qua thnh mch vo mu.

Qu trnh trao i cht mao mch chu nh hng ca nhng yu t:1.1. p sut thy tnh ca mu (huyt p) : C tc dng y nc v cccht ha tan t mu sang dch k.1.2. p sut keo ca protein huyt tng: C tc dng gi nc v cccht ha tan li trong mao mch.Ty theo psut no ln hn th qu trnh trao

i cht theo chiu ca p sut . Nh vy trao i cht mao mch theo c chkhuch tn do chnh lch v p sut. Qu trnh trao i cht c th nh sau:1.3. phn mao ng mch: Huytp l 35mmHg, p sutkeo l 25mmHg,chiu trao i cht l chiu t mao mch sang dch k. Mu v cc cht ha tan tmu vn chuyn sang dch k.1.4. phn mao tnh mch: Huyt p l 15mmHg, trong khi p sutkeovn l 25 mmHg, chiu trao i cht t dch k sang mao mch. Mu v cc cht dch k vo mao mch.

2. iu ha tun hon mao mch 2.1. Thn kinh: - Kch thch giao cm lm co mch.- Kch thch ph giao cm lm gin mch.2.2. Th dch:- Lnh lm co, nng lm gin mao mch.- Adrenalin, vasopressin lm co mch.- O2 lm co, CO2 lm gin mch.


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SINH L H TIT NIU

MC TIU:

Sau khi hc xong bi ny sinh vin c kh nng: 1. Trnh by c cu to v chc nng ca nephron. 2. Trnh by c qu trnh lc ca cu thn. 3. Trnh by c qu trnh hp thu v bi tit mt s cht ng thn. 4. Trnh by c chc nng ni tit ca thn.

NI DUNG

1. Nhc li gii phu sinh l ca thn - n v gii phu v chc nng ca thn l nephron. Mi nephron u c chnng to nc tiu. Do khi m t chc nng ca mt nephron cng l m tchc nng ca thn. Mi thn cha khong t 1- 1,3 triu nephron.

- Nephron gm cu thn v ng thn.

- Mu i vo cu thn qua tiu ng mch n v ri khi cu thn bng tiu mch i. Cu thn l mt bi mao mch gm trn 50 nhnh mao mch song songCc mao mch ni thng nhau v c bao bc trong bao Bowman. ng thn gmng ln gn, quai Henle, ng ln xa v ng gp.

- Cu thn v ng ln gn nm vng v thn. Quai Henle nm su trong khthn. Mt s quai Henle i vo tn y ca vng ty thn. Quai Henle gmhai


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nhnh, nhnh xung v nhnh ln. Thnh ca nhnh di v phn di ca nhnhln rt mng gi l on mng ca quai. Khi nhnh ln ca quai Henle quay tr lvng v thn th nhnh ng tr nn dy nh phn khc ca ng, l on dca quai. ng ln xa cng nm trong vng v thn.Ti y c khong tm n

ln xa hp li thnh ng gp vng v. Ri ng gp ri vng v i su vo vngty thn tr thnh ng gp vng ty. Sau cc ng gp hp li thnh nhnng gp ln hn i sut qua vng ty song song cc quai Henle. Cc ng gp ln vo ty b thn. Mi ng ny nhn nc tiu ca 4000 nephron.

2. Chc nng ca nephron: - Chc nng c bn ca nephron l lc sch nhng cht c hi hoc v ch ra khihuyt tng khi mu chy qua thn. l nhng sn phm cui cng ca chuynha nh ur, creatinine, acid uric... Nephron cng lc lng ion tha ra khi huytng.


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- Khi mu qua cu thn, khong5

1lng huyt tng c lc qua cu thn.

Trong h thng ng, nhng sn phm c hi, khng nhng khng c hp thu mcn c bi tit t huyt tng ra t bo biu m ri vo dch ng. Ngc lnc v cc cht in gii, cc cht chuyn ha c ti hp thu vo cc mamch quanh ng.

3. Lu lng mu v p sut tun hon trong tun hon thn 3.1. Lu lng mu qua thn: - ngi nng 70kg, lu lng mu qua c hai thn khong 1200ml/pht, llng tim 5600ml/ pht, nn phn s lc ca cu thn bnh thng khong21%.

3.2. p sut trong tun hon thn: p sut trong cc ng mch nh v tiu ng mch n vo khong

100mmHg gim xung cn 60mmHg trong mao mch cu thn, khi n mao mcquanh ng thn, p sut ch cn 13mmHg.

4. Qu trnh lc ca cu thn 4.1. Mng cu thn v tnh thm ca mng:

Mng cu thn c cu to gm ba lp: + Lp t bo ni m mao mch.

+ Mng y.

+ Lp t bo biu m ph trn mt ngoi ca mao mch.

- Tuy c nhiu lp nh vy, nhng tnh thm ca mng cu thn ln hn mamch ni khc t 100- 500 ln, do cu trc c bit ca n nh sau:

Cu to mng lc cu thn


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- Lp t bo ni m c hng ngn l nh gi l ccca s.

- Mng y l mt mng li ca cc si collagen v proteoglycan, li nay cngc nhng khoang rng cho php dch lc qua ddng.

- Lp t bo biu m khng lin tc v c hng ngn, hng triu ch li ra hnhngn tay ph trn mt y. Nhngngn tay ny to ra nhng khe h dch lcqua.

4.2. Thnh phn ca dch lc: Dch lc c thnh phn tng t nh ca huyt tng, nhng c rt

protein (vo khong 0,03% protein, nghal bng24

1 protein trong huyt tng).

Do nng protein mang in tch m rt thp nn nng nhng anion khng phi protein nh Cl , 3 HCO trong dch lc cao hn trong huyt tng khong5%.4.3. Lu lng lc ca cu thn:

Lu lng lc cu thn l lng dch c to ra trong mt pht ca to b nephron ca c hai thn. ngi bnh thng, lu lng ny khon125ml/pht. Nh vy ton b dch lc ca cu thn mi ngy vo khong 180lt,gp hn hai ln trng lng ca c th.

5. Qu trnh ti hp thu v bi tit ng thn

5.1. Tihp thu v bi tit cc cht ng ln gn 5.1.1. Tihp thu ion Na +: Na+ c hp thu khong 65% ng ln gn theo c ch nh sau:

b bn v b y ca t bo, Na+ c vn chuyn theo c chtch cc nguynpht vo dch knh Na+-K+-ATPase, iu ny dn n 2 hin t ng:

Nng Na+ trong tbo gim xung so v i dch trong lngng thn

Do nng Na+ trong t bo gim xung nn in th trong t bo cng gim

xung thp hn in th dch trong lng ng. 5.1.2. Ti hp thu glucose Glucose c ti hp thu hon phn u ca ng ln gn theo c ch vchuyn tch cc th cp cng protein mang vi Na+ nhsau:


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- Khi Na+ c vn chuyn theo c ch khuch tn d dng xui chiu bc thain ha t lng ng thn vo trong t bo, protein mang gn vi Na+ nhng nthi n cng gn vi glucose v vn chuyn ng thi c 2 cht i qua b bn chvo bn trong t bo. Nng lng vn chuyn glucose sinh ra t c ch vn

chuyn xui theo chiu bc thang nng ca Na+. Nh , glucose c vchuyn ngc bc thang nng vo trong t bo.

- Khi nng glucose thp hn 180 mg/100 ml huyt tng (180 mg%), ng lgn s ti hp thu ht glucose trong dch lc. V vy, glucose khng xut hitrong nc tiu. Nhng khi nng glucose tng cao hn 180 mg%, ng ln gkhng th hp thu ht glucose v glucose bt u xut hin trong nc tiu. Vvy, nng glucose 180 mg% c gi l ngng ng ca thn.

5.1.3. Ti hp thu protein v acid amin Acid amin c ti hp thu theo c ch vn chuyn tch cc th cp cng vi Natng t nh ti hp thu glucose.

Ring protein c hp thu theo c ch m bo nh sau: protein trong dch lctip xc vi t bo biu m ti b bn chi, mng t bo lm vo v a phn t protein vo bn trong t bo. Ti , protein c phn gii thnh cc acid aminri i vo dch k qua mng y theo c ch khuch tn d dng. Qu trnh vnchuyn ny cng cn nng lng nn y cng l mt hnh thc vn chuyn tc

cc. 5.1.4. Ti hp thu nc ng ln gn c tnh thm i vi nc rt cao. Khi Na+ v glucose c t bng ln gn ti hp thu, nc cng c ti hp thu th ng theo c ch ththu. Khong 65% nc c ti hp thu y, tng ng 117 lt/24 gi.

Cn li khong 63 lt tip tc i vo quai Henle, do nc c hp thu tng nvi Na+ nn dch i vo quai Henle l dch ng trng.

5.1.5. Ti hp thu Cl- v urKhi nc c ti hp thu th ng theo Na+ v glucose, nng Cl- v ure trongdch lng ng tng ln. V th, 2 cht ny s c ti hp thu th ng theo c chkhuch tn n thun. Tuy nhin, do t bo biu m ng ln gn km thm vure nnch khong 50% ure trong dch lc c ti hp thu. Cn Cl-, ngoi chnhlch nng cn c s chnh lch in th do Na+ ti hp thu lm dch lng n


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tch in (-) nn c ti hp thu th ng kh mnh. Ngoi ra, phn sau cang ln gn, Cl- cn c ti hp thu theo c ch tch cc th cp cng vi Na+.

Khong 65% Cl- c ti hp thu ng ln gn.

5.1.6. Ti hp thu 3 HCO v bi tit H+

Khi protein mang vn chuyn Na+ t lng ng vo t bo xui theo chiu bthang inha, n cng vn chuyn ngc chiu H+ t trong t bo i ra lng ng(vn chuyn ngc chiu).

Khi H+ i ra lng ng, n s kt hp vi 3 HCO to ra H2CO3 v gip hp thu

3 HCO .

C 1 H+ bi tit th ng ln gn ti hp thu 13 HCO . Qu trnh ny xy ra mnh

khi c th b nhim acid v gp phn quan trng vo c ch iu ha thng bnacid - base ca c th.

5.1.7. Ti hp thu K+

Khong 65% K+ trong dch lc c ti hp thu tch cc ti ng ln gn.

5.2. S ti hp thu v bi tit ng gp, ng ln xa v quai Henle Qu trnh ti hp thu nc v cc ion quai Henle din ra nh sau:

- nhnh ln, ion Natri c vn chuyn tch cc t lng ng vo dch k, cng

thm s ng vn chuyn cc ion Cl, K+ v mt s ion khc vo dch k lm chonng cc ion tng dn trong dch k vng ty ngoi.- nhnh xung, do s chnh lch ca p sut thm thu gia lng ng v dch kv cng c tnh thm cao on ny i vi nc, nc s khuch tn vo dch klm cho nng cc ion tng dn v tng cao nht chp quai, to iu kinthun li cho s vn chuyn tch cc ca cc ion nhnh ln.

- Khong 27% cc ion Na+, K+, Cl trong dch lc cu thn c ti hp thu

on dy nhnh ln ca quai Henle trong khi ch c 15% nc c ti hp thunn dch ng i vo ng ln xa l dch nhc trng. 5.3. S ti hp thu v bi tit ca ng ln xa


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5.3.1. S ti hp thu on pha long on pha long l na u ca ng ln xa v c c tnh nh on d

ca nhnh ln quai Henle. Ti y ion c ti hp thu nhng mng ng khngthm nc v ur, do on ny cng gp phn pha long dch ng.

5.3.2. S ti hp thu v bi tit on cui ng ln xa v ng gpvng v: - S ti hp thu ion Na+ :

Tc ti hp thu ca ion Na+ c kim sot bi aldosteron trong mu. Nu nng aldosteron rt cao, natri s ti hp thu ht v khng c Na+ trongnc tiu. Ngc li nu khng c aldosteron, hu ht Na+ i vo on cui cang ln xa s khng c ti hp thu v i vo nc tiu. Nh vy s bi xuNa+ c th thay i t rt t n rt nhiu ty theo nng ca aldostetron tronmu.

- S bi tit K + :

on cui ca ng ln xa v ng gp vng v c nhng t bo gi l tbo chnh, chim khong 90% t bo biu m hai on ny. Cc t bo chnh ckh nng bi tit mt lng ln ion K + vo lng ng khi nng K + trongdchngoi bo cao hn bnh th ng.

mng y- bn ca t bo chnh, bm Na+, K+ - ATPase hot ng bmNa+ t t bo vo dch k, ng thi b m K+ vo bn trong t bo. Mng ng cat bo chnh rt thm K +. Do khi nng K + tng cao trong t bo th K + snhanh chng khuch tn vo trong lng ng.

Nh vy s bi tit K + ph thuc ch yu vo bm Na+-K+ mng y bnv chu iu ha cahormone aldosteron v aldosteron hot ha bm Na+, K+-ATPase.

- S bi tit ion H + :

on ng ln xa v ng gp cng c mt loi t bo c bit gi l t bo xen k. Cc t bo ny c kh nng bi tit ion H+ theo c ch vn chuyn tchcc nguyn pht.

C ch vn chuyn tch cc nguyn pht ca ion H+ xy ra mng ng cat bo biu m nh mt protein mang c hiu gi l Protein mang H+ -ATPase.


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- S hp thu nc:

Khong 10% nc ca dch lc cu thn c ti hp thu ng ln xa.

5.4. Ti hp thu v bi tit ng gp ng gp, s ti hp thu nc cng ph thuc vo nng ADH huy

tng. Khi nng ADH ca huyt tng cao, nc c ti hp thu vo dch kvng ty lm cho th tch nc tiu gim v lm c c hu ht cc cht c hatan trong nc tiu. C khong 9% nc ca dch lc cu thn c ti hp thung gp.

Mt phn nh ca ur cng c ti hp thu ng gp.

6. Chc nng ni tit ca thn Thn c chc nng bi tit v tham gia vo qu trnh hnh thnh mt shormonetrong c th:

Bi tit Renin

Bi tit Erythropoietin

Tham gia qu trnh to vitamin D (cng l 1 loihormone)

6.1.Thn bi tit renin iu ho huyt p

Thn tham gia iu ha huyt p thng qua h thng R -A-A (Renin - Angiotensin

- Aldosteron) theoc ch nh sau: Khi lu lng mu n thn gim hoc Na+ mu gim, n c tc dng kch thct chc cnh cu thn bi tit ra mthormonel renin. Di tc dng ca renin,mt loi protein trong mu l angiotensinogen bin i thnh angiotensin I.Angiotensin I n phi, do tc dng ca men chuyn (converting enzyme), bini thnh angiotensin II.

Angiotensin II c tc dng lm tng huyt p mnh theo c ch nh sau:

- Co mch Angiotensin II gy co mch lm huyt p tng (co mch mnh nht cc ting mch). Tc dng co mch mnh ngi bnh thng. Tc dng co mgim ngi c Na+ gim, bnh nhn x gan, suy tim v thn nhim m v nhng bnh nhn ny, cc receptor ca Angiotensin II c trn mch mu bgim.


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- Gy cm gic kht

AngiotensinII kch thch trung tm kht vng di i gy cm gic kht bsung nc cho c th .

- Tng tit ADH

Angiotensin II kch thch nhn trn th tng bi tit ADH tng ti hp thu nc ng ln xa v ng gp.

- Tng tit aldosteron

Angiotensin IIkch thch v thng thn bi tit aldosteron tng ti hp thu Na+ v nc ng ln xa v ng gp.

Nh vy, angiotensin II gy co mch v tng th tch mu nn lm tng huyt p

Huyt p tng nh hng tr li lm thn gim tit renin. C ch iu ha huyca thn theo nguyn l: nguyn nhn gy hu qu, hu qu to nguyn nhn.

6.2. Thn bi tit erythropoietin tng to hng cu

Thn tham gia iu ha sn sinh hng cu nh hormone erythropoietin.

Khi b mt mu, thiu mu hoc thiu O2, thn s sn xut rahormoneerythropoietin. Erythropoietin c tc dng kch thch t bo u dng sinh hngcu (erythroid stem cell) chuyn thnh tin nguyn hng cu (proerythroblast) v

lm tng sinh hng cu. V vy, erythropoietin c dng iu tr bnh thimu.

6.3. Thn tham gia to dng hot tnh ca vitamin D

Theo quan im mi, vitamin D c xem l mthormone. Trong qu trnh hnhthnh dng hot tnh ca vitamin D, c s tham gia ca thn theo c ch nhsau:

C 2 cht 25-Hydroxycholecalciferol v 1,25-Dihydroxycholecalciferol u chot tnh sinh hc nhng 1,25-Dihydroxycholecalciferol mnh hn 25-

Hydroxycholecalciferol 100 ln. Chng c tc dng sau:

Ti xng: tng t bo to xng, tng hot ng to xng, tng nhp v hng Calci v Phospho xng

Ti rut: tng hp thu Calci v Phospho


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Ti thn: tng ti hp thu Calci ng thn.


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SINH LH HP

MC TIU: Sau khi hc xong bi ny sinh vin c kh nng:

1. Trnh by c chc nng ca b my h hp. 2. Trnh by c qu trnh h hp. 3. Trnh by c qu trnh trao i v vn chuyn kh.

NI DUNG 1. Nhc li gii phu sinh l ca b my h hp:

B my h hp c nhng chc nng sau:

- Chc nng h hp.

- Chc nng iu ha nhit.

- Chc nng thng bng kim toan.

- Chc nng ni tit v mt s chc nng khc...

Trong chc nng chnh v quan trng nht l chc nng h hp. Chc nng hhp l chc nng a oxy t mi trng ngoi vo c th cung cp cho cc t

bo hot ng ng thi o thi kh CO2 t trong c th ra ngoi. nghin cu chc nng ny chng ta s ln lt nghin cu ba qu trnh

sau:

+ Qu trnh thng kh.

+ Qu trnh trao i v vn chuyn kh.

+ Qu trnh iu ha h hp.

1.1. Lng ngc - Lng ngc c vai tr rt quan trng trong qu trnh thng kh. N c cu tonh mt khoang kn.

+ Pha trn l c, gm cc b mch thn kinh ln, thc qun, kh qun, ccc v m lin kt vng c.


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+ Pha di l c honh l mt c h hp rt quan trng ngn cch vi bng.

+ Xung quanh l ct sng, xng sn,xng c, xng n v cc c bm vo, trong quan trng l cc c h hp (c ngc ln, c ngc b, c lin

sn..). - Khi cc c h hp gin, xng sn s chuyn ng theo kch thc ca lnngc thay i v phi s co gin theo, nh m ta th c.

1.2. Cc ng dn kh:

ng dn kh l mt h thng ng, i t ngoi vo trong gm: mi, huthanh qun, kh qun v cc tiu ph qun.

Ngoi chc nng dn kh, ng dn kh cn c nhng chc nng khc.

+ iu ha lng khng kh i vo phi.

+ Lm tng tc trao i kh phi. + Bo v phi.

S d nh vy l nh ng dn kh c nhng c im cu to sau:


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+ Nimmc c h thng mao mch phong ph si m cho khng kh ivo, ng thi c nhiu tuyn tit nc bo ha hi nc chokhng kh.Khng kh c si m v bo ha th tc trao i kh phi tng ln.

+ Nimmc mi c h thng lng cn tr ht bi ln, nim mc pha

trong c nhng tuyn tit cht nhy, gi li cc ht bi nh. Mt khc, ngdn kh cng vo trong cng hp, gp khc nn bi d b gi li hn. Ngoi ra cct bo kh qun cn c mt h thng lng rung ng phe phy theo chiu ttrongra ngoi c tc dng y bi v cc cht dch ng trong ng h hp ra ngoHot ng ca h thng lng rung gim ngi ht thuc l nhiu.

+ Kh qun v ph qun c cu to bi nhng vng sn, nh ndn kh lun c gin rng lm cho khng kh lu thng d dng. cc ph qunh cn c mt h thng c trn, chng t ng co gin lm thay i khu knng dn kh iu ha lng khng kh i vo phi.

1.3. Phi:Phi l mt t chc rt n hi, c cu to bi cc ph nang. y l n

ch yu xy ra qu trnh trao i kh. Tng din tch mt bn trong ca ph nanchng khong 50- 100m2 ngi trng thnh.

Xung quanh cc ph nang c c bao bc bi mt mng mch mu r phong ph. Thnh ph nang v thnh mch mu bao quanh to nn cu trc bit ng vai tr quan trng trong vic khuch tn kh gia mu v ph nang gi lmng h hp. Mng ny rt mng, trung bnh 0,5 m, ni nh nht khong 0,2m.


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Nh vy: Cu to ca phi c nhng c im ph hp vi chc nng ca ndin trao i ln, mch mu phn b phong ph, mng h hp rt mng.

Mt khc bn trong lng ph nang c lt bi mt cht c bit c bcht l lipoprotein gi l cht hot din (surfactant). Cht ny c chc nng rt

quan trng thng qua ba c ch: - Ngn cn cc cht dch t mch mu trn vo lng ph nang, nu khng c chsurfactant, cc ph nang s b trn dch dn n suy h hp v c kh nng cht.

- Lm gim sc cng mt ngoi ca cc ph nang, gip cho cc ph nang gin rad dng trong h hp.

-n nh p sut bn trong lng ph nang trnh hin tng xp v lm v phnang.

Cht surfactant ny gim nhng ngi ht thuc l, nhng bnh nhn btc mch mu phi, c bit l nhng tr em b non, phi khng c surfacta,cc ph nang s b xp, v, trn dch gy suy h hp nng dn n t vong.

1.4. Mng phi v p sut m mng phi:

C ch hnh thnh p sut m trong khoang mng phi

Mng phi gm hai l: l thnh dnh st vo lng ngc v l tng dnh st vo phi. Hai l khng dnh vo nhau to nn mt khoang o kn gi l khoang mng phi, trong khoang ch c cha t dch nhn lm cho hai l c th trt ln nhaumt cch ddng.


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Bng th nghim ngi ta thy p sut trong khoang mng phi thp hn psut ca kh quyn v gi l p sut m (nu quy c p sut kh quyn bngkhng).

S d khoang mng phi c p sut m l do hai c ch:

+ Do tnh cht n hi ca nhu m phi.

+ Do s thay i kch thc ca lng ngc trong qu trnh h hp.

p sut m ca khoang mng phi c ngha v mt sinh l rt quantrng:

+ Nh c p sut m ny, trong lng ngc lun c p sut ln hn ccvngkhc v vy mu t cc ni tr v tim mt cch d dng.

+ p sut m lm cho tun hon phi c p sut rt thp to thun li chtim phi bm mu ln phi, c bit l lc ht vo p sut cng m hn mu ln phi nhiu hn cng lc oxy i vo phi cng nhiu hn, s trao i kh din rti a.

+ Nh c p sut m nn khi kch thc ca lng ngc thay i, phi s cogin theo thc hin mt ng tc h hp. Khi p sut m ny mt i, phi skhng co gin theo lng ngc na dn n ri lon h hp.

2. Qu trnh thng kh Qutrnh thng kh c thc hin thng qua cc ng tc h hp.

2.1. ng tc ht vo: Ht vo l ng tc ch ng, tn nng lng do co cc c ht vo lm tng

th tch lng ngc theo ba chiu: chiu thng ng, chiu trc sau v chiungang.

Khi bt u ht vo, c honh co lm h thp vm honh, tng ng knhthng ng ca lng ngc. ng thi cc c lin sn ngoi co lm xng snnng ln, tng ng knh ngang ca lng ngc. Khi xng c cng nng lnv nhra pha trc lm tng kch thc chiu trc sau ca lng ngc.

Khi lng ngc tng th tch lm phi t ng n theo, phi n, ph nangn, lm gim p sut ca ph nang xung tr s m, c tc dng ht khng kh tngoi tri vo ng h hp n ph nang.


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2.2. ng tc th ra. Th ra l mt ng tc th ng thng l v thc v khng dng nng

lng, cc c h hp khng co na m gim mm ra, lc co n hi ca phi vlng ngc lm cho lng ngc tr v v tr ban u. Cc c xng sn h thp

thu vo trong, xng c h thp v lui v, c honh li nh ln cao v pha ng Ngc thu nh li lm phi thu nh li, p sut ph nang tng ln y khng kh ngoi.

C ng h hp ca lng ngc v c honh

3. Khong cht v thng kh ph nang: - Khi ta ht mt lng khng kh vo, khng phi ton b khng kh ny u thamgia trao i vi mu m ch c phn khng kh bnh thng mi thc hin thamgia trao i, phn cn li nm trong ng dn kh hoc trong cc ph nang bthng th khng tham gia trao i.Th tch khng kh khng tham gia trao i

ny gi l khong cht . C hai loi khong cht: + Khong cht gii phu: L th tch khng kh cha trong ng dn kh,

bnh thng khong 150ml.

+ Khong cht sinh l: Bng khong cht gii phu cng vi th tch khngkh cha cc ph nang bt thng mt kh nng trao i kh nh b x hathuyn tc mao mch quanh ph nang.


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4. Cc th tch v cc dung tch ca h hp.

Cc th tch v dung tch tnh ca phi 4.1. Cc th tch ca t hng kh:

Mt th tch (V) l mt lng kh tnh bng lt c huy ng trong mtng tc th c bn c cc th tch v dung tch nh sau:

Th tch lu thng (TV: Tidal Volume): L s lt kh ra vo phi trong mtln th bnh thng. Bnh thng khong 500ml, namln hn n.

Th tch d tr ht vo (IRV: Inspiratory Reserved Volume): L th tchkhng kh ta c th c gng ht vo c thm na sau khi ht vo bnh th ng,cn c gi l th tch b sung. Bnh thng khong 1500ml- 2000ml.

Th tch d tr th ra (ERV: Expiratory Reserved Volume): L th tchkhng kh ta c th c gng th ra thm na sau khi th ra bnh thng, cn gl th tch d tr ca phi. Bnh thng khong 1100ml- 1500ml.

Th tch cn ( RV: Residual Volume): L th tch khng kh cn li trong phi sau khi th ra ht sc. Bnh thng khong 1000ml- 1200ml.

Th tch th ra ti a trong giy u tin ( FEV 1: Fored ExpiratoryVolume): y l th tch h hp quan trng thng c dng nh gi chcnng thng kh.

4.2. Cc dung tch ca h hp: Theo qui c, mt th tch khng kh c gi l dung tch h hp khi n

gm tng ca hai hay nhiu th tch h hp.


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Dung tch sng (VC): L mt ch s thng dng nh gi th lc, ngm ba th tch:

- Th tch lu thng.

- Th tch d trht vo.

- Th tch d tr th ra.

Dung tch ton phi (TV): L tng s lt kh ti a c c trong phi bao gm:

- Th tch lu thng

- Th tch d tr th ra

- Th tch d tr ht vo

- Th tch cn

Dung tch cn chc nng (FRC): L tng hai th tch, bao gm:

- Th tch d tr th ra

- Th tch cn.

5. Qu trnh trao i v vn chuyn kh - Nh qu trnh thng kh,khng kh trong ph nang s c phn p O2 cao, CO2

thp so vi mu tnh mch, s chnh lch phn p l ng lc chnh cho s trai O2 v CO2 phi. Sau khi trao i mu tnh mch tr thnh mu ng mchc phn p O2 cao, CO2 thp so vi cc t chc, l ng lc cho s trao i kh cc t chc.

- Trong qu trnh trao i v vn chuyn kh, mu ng vai tr quan trng, bncnh lng kh ha tan, mu cn cha cc cht cn thit cho s vn chuyn kHemoglobin, protein, mui, kim...

- Cng vi mu, h tun hon cng ng vai tr quyt nh i vi qu trnh vnchuyn kh. Khi chc nng tun hon b ri lon dn n ri lon chc nng hhp.

5.1. Qu trnh trao i v vn chuyn O 2:Cc dng oxy c vn chuyn:


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5.1.1. Dng ha tan: Chim khong 0,3ml/100ml mu trong mu ng mch, to nn mt phn

p ca O2 khong 95mmHg, lng oxy ha tan tuy nh nhng ng vai tr rtquan trng, v n to nn phn p O2 ca mu, v y l dng trc tip trao i vi

t chc. 5.1.2. Dng Hemoglobin vn chuyn:

y l dng vn chuyn ch yu ca oxy trong mu. Hemoglobin vnchuyn Oxy bng cch gnOxy vo Fe2+ ca nhn Hem, to nn Oxy-Hemglobin(HbO2).

Cc yu t nh hng n s kt hp v phn ly HbO2

- Phn p Oxy

- Phn p CO2

- Ccyu t khc nh nhit , pH...

Khi mu tnh mch n phi, do c s chnh lch phn p ca oxy (100mmHg/ 40mmHg), Oxyt ph nang s khuch tn qua mng h hp i vohuyt tng di dng ha tan lm phn p O2 tng ln khong 95mmHg. O2 stip tc khuch tn vo mng hng cu kt hp vi Hb to thnh HbO2 Khi dung tch ca Oxy tng ln, tr thnh mu ng mch ri phi n t chc.


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Khi mu ng mch n t chc, do chnh lch phn p O2, Oxy ha tan

trong huyt tng s khuch tn qua mng mao mch i vo t chc lm cho php oxy trong huyt tng gim xung ch cn 40mmHg, khi HbO2 s phn lyv Oxy s i ra huyt tng ri i vo t chc.

5. 2. Qu trnh trao i v vn chuyn kh CO2:CO2 c vn chuyn trong mu di ba dng:

5.2.1. Dng ha tan: Dng ny ch chim mt lng nh3ml/100mlmu, to nn mt phn p

trong mu tnh mch khong chng 46mmHg, dng ha tan quan trng v n tonn phn p CO2 trong mu v s l dng trc tip trao i phi.


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5.2.2. Dng Hemoglobin vn chuyn (dng carbamin) 5.2.3. Dng Bicarbonat.

Khi mu t ng mch n t chc do s chnh lch phn p caCO2 ,CO2 t t chc s khuch tn qua mao mch i vo huyt tng di dng ha talm phn p CO2 trong huyt tng tng ln t gi tr khong 46mmHg v CO2 s i vo hng cu. khong 20% CO2 s kt hp vi Hb to thnh HbCO2,cn khong 75% kt hp vi nc di tc dng ca enzym carbonic anhydras

to thnh H2CO3, H2CO3 s phn ly to thnh 3 HCO ri hng cu i ra huyt

tng, 3 HCO s kt hp vi cc ion Na+ v K+ to nn dng vn chuyn chyu Bicarbonat. Dung tch ca CO2 tng ln, cha khong 51ml/100ml mu. Tr thnh mu tnh mch ri t chc n phi.

Mu nh CO 2 phi:


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Khi mu tnh mch n phi, do chnh lch phn p CO2 , CO2 ha tantrong huyt tng s khuch tn qua mng h hp i vo phnang lm phn pCO2 trong huyt tng gim xung, lc HbCO2 s phn ly v CO2 i ra huyttng ri n ph nang, ng thi trong huyt tng c Bicarbonat s phn ly v

3 HCO i vo hng cu. 3 HCO kt hp viH+ to nn H2CO3, H2CO3 b

kh nc v CO2 i ra huyt tng vo ph nang.

6. Qu trnh iu ha h hp: Ni chung, h hp l mt qu trnh t ng do mt trung tm thn kinh c

bit iu khin, l trung tm h hp.

Tuy nhin hot ng ca h hp nhu cu v oxy ca c th trongnhng trng thi khc nhau, hot ng ca trung tm h hp cn phi c i

chnh.Qutrnh iu chnh hot ng ca trung tm h hp h hp ph hp vtng hon cnh gi l qu trnh iu ha h hp.

iu ha h hp c thc hin theo hai c ch l: c ch th dch vc ch thn kinh.

6.1. Trung tm h hp

Trung tm h hp l nhng nhm t bo thn kinh i xng hai bn v nm ri rc hnh no v cu no. Mi bn c 3 nhm iu khin h hp ca na lng ngc

cng bn.

Cu to trung tm h hp


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6.2. iu ha h hp theo c ch th dch

Yu t tham gia iu ha h hp bng th dch quan trng nht l CO2, k n lion H+, cn oxy khng c tc ng trc tip ln trung tm h hp m gin tip quacc cm th ho ngoi vi.

- iu ho h hp do nng CO 2 mu:

Nng CO2 mu ng vai tr rt quan trng. Khi nng CO2 mu tng s tcdng kch thch h hp theo 2 c ch:

- CO2 kch thch trc tip ln cc receptor ha hc ngoi vi, t y c lungxung ng i ln kch thch vng ht vo lm tng h hp.

- CO2 thch thch gin tip ln receptor ho hc hnh no thng qua H+ : CO2 iqua hng ro mu no vo trong dch k. , CO2 hp vi nc to thnhH2CO3, H2CO3 s phn ly v H+ s kch thch ln trung tm nhn cm ha hcnm hnh no, t y c lung xung ng i n kch thch vng ht vo lmtng thng kh. V CO2 i qua hng ro mu no rt d dng nn c ch gin tipny ng vai tr quan trng.

Nng CO2 bnh thng trong mu c tc dng duy tr hot ng ca trungtm h hp.

Khi nng CO2 gim thp di mc bnh thng s c ch vng ht vo gygim thng kh v c th ngng th. iu ho h hp caCO2 thng qua H+Khi nhim toan, nng CO2 mu tng s kch thch gy tng cng h hp, mcch tng thi CO2. Khi nhim kim, nng CO2 mu gim s c ch lmgim h hp, mc ch gi CO2 li.

- iu ho h hp do nng H+ mu

Khi H+ tng ln s kch thch lm tng h hp theo 2 c ch :

- Kch thch trc tip ln cc receptor ha hc ngoi vi.

- Kch thch trc tip ln receptor ha hc hnh no, tuy nhin, tc dng ny caH+ yu hn so vi CO2 v ion H+ kh i qua hng ro mu dch no tu.

Tc dng ca H+ cng gip cho b my h hp c chc nng iu ha thng bntoan kim cho c th.

- iu ho h hp do nng O 2 mu


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Bnh thng, nng O2 mu khng c tc dng iu ha h hp, ch tc ngn h hp khi phn p trong mu gim rt thp (< 60 mm Hg ) trong mt s ikin bnh l hoc vn c mnh, khi , n s tc ng vo cc receptor ha hcngoi vi lm tng thng kh.

6. 3. iu ha h hp theo c ch thn kinh 6.3.1. Xung ng thn kinh t cm th quan ngoi bin

Khi kch thch ngoi da nh v nc lnh, gy au c th lm tng thng kh. Ccreceptor nhn cm bn th khp, gn, c cng vi nhng kch thch t v no kch thch trung tm h hp lm tng thng kh rt sm v mnh.

6.3.2. Xung ng t cc trung tm cao hn

6.3.2.1. Trung tm nut hnh no

Khi trung tm nut hng phn s pht xung ng n c ch vng ht vo. V vy,khi nut chng ta khng th, mc ch thc n khng i lc vo ng h hp

6.3.2.2. Vng di i

Khi thn nhit tng ln s kch thch vo vng di i, t y s pht sinh lunxung ng i n kch thch vng ht vo lm tng thng kh, gip thi nhit.

6.3.2.3. V no

V no c th iu khin c trung tm h hp, v vy ta c th h hp ch iu ny c ngha quan trng trong luyn tp. Khi v no b c ch (ng, gym...), hot ng h hp gim xung. Xc cm, s hi cng lm thay i h hc khi gy ngng th.

6.3.3. Dy thn kinh X

Phn x th ra do cc cm th cng gin nm thnh tiu ph qun v ph qutruyn v qua dy X ch xy ra khi th tch kh lu thng trn 1,5 lt do yl

mt phn x bo v ph nang khi b cng phng hn l c ch iu ho nhp bthng.


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SINH L TIU HA

MC TIU:

Sau khi hc xong bi , sinh vin c kh nng: 1. Trnh by c chc nng sinh l ca b my tiu ha. 2. Trnh by c qu trnh tiu ha ca b my tiu ha. 3. Trnh by c qu trnh hp thu ca b my tiu ha. 4. Trnh by chc nng sinh l hc ca gan.

NI DUNG: 1. Nhc li gii phu sinh l ca b my tiu ha


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- B my tiu ha gm ng tiu ha v cc tuyn tiu ha. ng tiu ha bt u tming ri n thc qun, d dy, rut non, rut gi, v kt thc l hu mn. Ctuyn tiu ha gm tuyn nc bt, tuyn ty ngoi tit v gan bi tit mt.

- B my tiu ha cung cp lin tc cho c th cc cht dinh dng, vitamin, ch

in gii v nc thng qua cc chc nng sau y: Chc nng c hc: vn chuyn, nghin nt v nho trn thc n vi cc

dch tiu ha.

Chc nng ha hc: Cc tuyn tiu ha bi tit cc dch tiu ha thcn thnh cc dng n gin.

Chc nng hp thu: a thc n c tiu ha t ng tiu ha vo mutun hon.

- Tt c chc nng trn c iu ha theo c ch thn kinh vhormone. Trongtng on ng tiu ha, ba chc nng trn cng phi hp hot ng vnchuyn, tiu ha v hp thu thc n.

2. Qu trnh tiu ha2.1. Tiu ha ming v thc qun

Ming v thc qun l hai on u ca ng tiu ha, chng c chc nngtiu ha sau:

- Tip nhn v nghin x thc n thnh nhiu mnh nh. - a thc n xung on cui ca thc qun st ngay pha trn tm v ca

d dy. - Phn gii tinh btchn.

thc hin cc chc nng , ming v thc qun c cc hot ng chc nnsau:

- Nhai- Bi tit nc bt - Nut

Bi tit nc bt: - Nc bt l dch tiu ha ca ming c ngun gc t ba cp tuyn n

bt ln l tuyn mang tai, tuyn di hm, tuyn di li v mt s tuyn nhkhc nh tuyn m v tuyn li.


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- Nc bt l dch tit tng hp ca cc tuyn trn, s lng khong800ml-1000ml/ 24h.

- Thnh phn v tc dng ca nc bt: Nc bt l cht lng qunh cnhiu bt, pH trung tnh, gm c cc thnh phn chnh sau:

+ Amylase nc bt : L mentiu ha glucid, hot ng trong mi trngtrung tnh, c tc dng phn gii tinh bt chn thnh ng i maltose. + Cht nhy: C tc dng lm cho cc mng thc n dnh vo nhau, trnv

d nut ng thi bo v nim mc ming chng li cc tc nhn c hi trong thcn.

+ Cc ion Na+, K+, Ca2+, Cl ... trong Cl c tc dng tiu ha thng quac ch lm tng hot tnh ca men amylase ca nc bt.

+ Ngoi ra cn c mt vi thnh phn c bit c trong nc bt, bch cukhng th ...

- C ch bi tit nc bt thng qua c ch thn kinh.

2.2. Tiu ha d dy:

D dy l on gia ca ng tiu ha, pha trn thng vi thc qun qua tm v pha di thng vi rut non thng qua mn v, c chia lm ba phn: y, thnv hangv.

D dy c hai chc nng: cha ng thc n, tip tc tiu ha s b thcn. 2.2.1. Chc nng cha ng thc n ca d dy:


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- Do d dy l on phnh to nht ca ng tiu ha v c ca n rt n hi, nn ddy c kh nng cha ng rt ln nvi lt.- n cui ba n, thc n c cha vng thnd dy mt cch c th t.Thc n vo trc nm xung quanh v tip xc vi nim mc ca d dy, thc n

vo sau nm chnh gia. - Do cch sp xp thc n nh vy nn giai on u sau khi n, trong d dy c hai qu trnh tiu ha thc n:

+ Thc n nm xung quanh ngm dich v v c dch v tiu ha.+ Thc n gia cha ngm dch v, pH cn trung tnh nn amylase nc

bt cn tip tc phn gii tinh bt chn thm mt thi gian na cho n khi thn phn thc n gia cng ngm dch v th amylase nc bt mi ngng hong.

2.2.2. Hot ng c hc ca d dy: - Nhu ng d dy: Khi thc n vo d dy th nhu ng bt u xut hin, lnhng ln sng co bp lan t vng thn n vng hang v, khong 15-20 giy cmt ln, cng n vng hang nhu ng cng mnh. Nhu ng ca d dy c haitc dng:

+ Nghin nh thc n thm na v trn u thc n vi dch v to thnhnh trp.

+ y nh trp nm xung quanh xung hang v v p vo khi nh trpny mt p sut ln m mn v, y nh trp xung t trng.

2.2.3. Bi tit dch v:

Cu to tuyn ca d dy


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- Dch v l dch tiu ha ca d dy do cc tuyn nim mc ca d dy bi tit,ty thnh phn dch tit c th chia tuyn nythnh hai nhm:

+ Tuyn vng tm v v mn v bi tit cht nhy.e+ Tuyn vng thn l tuyn tiu ha chnh ca d dy gm ba loi t bo

sau: T bo chnh bi tit pepsinogen v lipase. T bo vin bi tit HCl v yu t ni. T bo c tuyn bi tit cht nhy.

2.2.4. Thnh phn v tc dng ca dch v: - Pepsin : L men tiu ha protid c bi tit di dng cha hot ha lpepsinogen.- Lipase dch v:L men tiu ha lipidhot ng trong mi trng acid, c tcdng thy phn triglycerid c nh tng ha sn trong thc n thnhglycerol v acid bo.- Chymosin (Prezure): L men tiu ha sa, c vai tr quan trng nhng trem b m. - HCl : Khng phi lmen tiu ha nhng ng vai tr rt quan trng trong qutrnh tiu ha v n c cc tc dng sau y:

+ Lm tng hot tnh ca men pepsin.+ Thy phn cellulose carau non.+ St khun, tiu dit cc vi khun t ngoi vo theo thc n trnh

nhim trng ng tiu ha. + Ngoi ra cn gp phn vo c ch ng m tm v v mn v.

- Cc yu t ni : Do t bo vin bi tit, l mt cht cn thit cho s hp thuVitamin B12 trong rut non.

- 3 HCO : Do t bonimmc d dy bi tit, c tc dng bo vnimmc d dy thng qua hai c ch:

+ Trung ha mt phn HCl trong dch v khi c tnh trng tng tit acid.+ Lin kt vi cht nhy to thnh hng ro bo vnimmc d dy.

- Cht nhy: C bn cht l glycoprotein c tit ra t cc tuyn mn v, tm v,t bo c tuyn ca cc tuyn vng thn v t ton b t bo nim mc d d

Cht nhy lin kt vi 3 HCO nhm bo vnimmc d dy.


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2.2.5. iu ha bi tit dch v: Dch v c bi tit do hai c ch iu ha: thn kinh v th dch

- C ch thn kinh: C hai h thng iu ha tit dch v: + Thn kinh ni ti:L ccsi thn kinh ca m ri Meissner nm ngay

dinim mc d dy, m ri ny lm bi tit dch v di tc dng kchthchca thc n vo d dy hoc t nhng kch thch ca thn kinh trung ng. + Thn kinh trung ng: L dy thn kinh X, lm bi tit dch v di tc

dng kch thch ca hai loi phn x, phn x khng iu kin v phn x c kin. - C ch th d ch: Thng qua mt s chtsau:

C nhiu yu t iu ha bi tit dch v qua c ch th dch: + Gastrin: L mt hormon do t bo G vng hang d dy bi tit di tc dng

kch thch ca dy X hoc ca cc sn phm tiu ha protid trong d dy (peptonproteose). Ngoi ra, khi sc cng ca thnh d dy tng ln cng kch thch bi titgastrin.

Sau khi bi tit, gastrin theo mu n vng thn d dy, kch thch cctuyn bi tit acid HCl v pepsinogen. Khi thc n trong vng hang qu acid s cch bi titgastrin [feed back (-)]

Trong iu tr ngoi khoa bnh lot d dy, ngi ta thng ct km thmvng hang (ni tit gastrin), lm gim bi tit acid HCl.

+ Gastrin-like: L mt hormon do nim mc t trng v ty ni tit bi tit, tcdng tng t gastrin. Khi bnh nhn b u ty, cc t bo khi u tng cng btit gastrin-like dn n tng bi tit acid HCl v pepsin gy ra lot d dy t trng nhiu ch (hi chng Zollinger -Ellison). iu tr, phi ct b khi u. + Histamin: L mt sn phm chuyn ha t histidin ca t bo nim mc d dyHistamin kch thch cc th th H2 ca t bo vin (H2-receptor) lm tng tit acidHCl.

V vy, trong iu tr lot d dy, ngi ta s dng cc loi thuc c chH2-receptor lm gim tc dng tit acid HCl ca histamin (v d: cimetidin,ranitidin, famotidin...).+ Glucocorticoid:L hormoneca v thng thn c tc dng kch thch bi titacid HCl v pepsin ng thi c ch bi tit cht nhy.

V vy, nhng ngi c tnh trng cng thng thn kinhko di (stresstm l) do c tnh trng tng tit glucocorticoid nn thng b lot d dy.


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Trong iu tr, chng ch nh dng cc thuc thuc nhm glucocorticoid(Dexamethason, Prednisolon...) cho nhng bnh nhn b lot d dy hoc c tins lot d dy.+ Prostaglandin E2: L mt hormon ca t bo nim mc d dy c tc dng c

ch bi tit acid HCl v pepsin ng thi kch thch bi tit cht nhy, n xem l mt yu t bo v nim mc d dy.V vy, trong iu tr lot d dngi ta s dng cc loi thuc dn xut t prostaglandin (v d: cytotec) hoc cthuc c tc dng lm tng bi tit prostaglandin E2 ca d dy (v d: colloidabismuth subcitrate).

Ngc li, cc tc nhn c ch bi tit prostaglandin s gy ra lot d dy l cc thuc gim au, chng vim nh: aspirin, voltaren, piroxicam,ibuprofen... Cc thuc ny chng vim mnh thng qua c ch gim tng hp

prostaglandin l mt tc nhn gy vim ti vim nhng cng lm gim tit prostalandin E2 ti d dy gy ra lot d dy. Cc thuc ny phi chng ch nh nhng bnh nhn lot d dy.

2.2.6. Kt qu tiu ha d dy: Nh hot ng c hc v ha hc ca d dy, thc n c nghin v tr

ln vi dch v thnh mt cht bn lng gi l v trp trong c phn nh pr oteinc tiu ha d dang thnhproteose (chui di)v pepton(chui ngn), mt phn tinh bt chn c tiu ha thnh maltose, m hu nh cha b phn gii. 2.3. Tiu ha rut non:

Rut non c chc nng hon tt vic tiu ha thc n, v vy ng vai trquan trng nht.

c im cu to ca rut non rt thun li cho qu trnh tiu ha: L on di nht ca ng tiu ha. C nhiu dch tiu ha vo. H thngmenrt phong ph c kh nng

phn gii tt c thc n thnh dng c th hp thu c.

hon tt qu trnh tiu ha, rut non c cc hot ng chc nng sau: 2.3.1. Hot ng c hc ca rut non: Rut non c 4 hnh thc hot ng c hc.

- Hot ng co tht:C tc dng chia nh trp ra thnh nhiu mnh nh dngm dch tiu ha.


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- C ng qu lc:Ctc dng trn u nh trp vi dch rut tng tc tiuha.- Nhu ng:L nhng ln sng co bp lan t on u n on cui ca rutnon, c tc dng y thc n di chuyn trong rut.

- Phn nhu ng rut: L nhng ln sng co bp ngc chiu vi nhu ngnhng xut hin tha v yu hn nhu ng. Phn nhu ng c tc dng phi hvi nhu ng y nh trp di chuyn vi tc chm qu trnh tiu ha v hpthu trit hn. 2.3.2. Hot ng bi tit dch rut non:

Dch tiu ha rut non rt phong ph v c tit ra t ba ni: ty, mt vrut non.

Bi tit dch ty: Dch ty l sn phm ca ty ngoi tit. Sau khi bi tit, dch

ty theo ng ty vo t trng, s lng khong 1lt - 1,5lt/ 24h.Trong dch ty c nhngnhm men tiu ha protid, lipid, glucid.+ Nhm men tiu ha protid: chymotrypsin, carboxypeptidase, trypsin+ Nhm men tiu halipid: lipase dch ty, phospholipase + Nhm mentiu ha glucid: amylase dch ty, maltase.

Bi tit mui mt: L mui kali hoc natri ca acid mt glycocholic vtaurocholic c ngun gc t cholesterol.Mui mt l thnh phn duy nht trongdch mt c tc dng tiu ha:

+ Nh tng ha triglycerid lipase trong rut non c th phn gii tt ccc triglycerid trong thc n.

+ Gi p hp thu cc sn phm ca lipid nh acid bo,monoglycerid, qua cng gip hp thu cc vitamin tan trong lipid nh vitamin A, D, E, K. Thiu muimt s hp thu ca cc cht ny gim r rt.

+ Ngoi ra mui mt cn gip cho cholesterol tan d trong dch mt chnghnh thnhsi mt.

Bi tit ca dch rut: Do cc t bo nim mc rut v cc tuyn nm ngay trnthnh rut bi tit:

+ Tuyn Brunner: Bi tit cht nhy v3 HCO .+ Tuyn Liberkuhn: Bi tit nc.+ T bonimmc: Bi titmen tiu ha.


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Nh vy cc t bo nim mc rut ng vai tr rt quan trng trong vic btit dch rut, cn cc tuyn rut ch bi tit cc cht ph. S lng dch rut c bi tit khong2-3lt/ 24h bao gm:

+ Nhm men tiu ha protid g m: aminopeptidase, dipeptidase,

tripeptidase.+ Nhm men tiu ha glucid gm: amylase dch rut, maltase, sucrase,lactase.2.4. Tiu ha rut gi:

Qu trnh tiu ha rut gi khng quan trng, bi khi xung n rut ginh trp hu nh ch cn li nhng cht cn b ca thc n.3. Qu trnh hp thu: 3.1. Hp thu ming:

Ming khng hp thu thc n nhng c th hp thu thuc, c bit l cloi thuc gin mch vnh chng cn au tht ngc nh: Nitroglycerin,Nifedipin...3.2. Hp thu d dy:

D dy c th hp thu ng, st, ru v nc. 3.3. Hp thu rut non:

Qu trnh tiu ha rut non c vai tr rt quan trngtrong tiu ha.Huht cc cht cn thit cho c th u c a vo lng ng tiu ha vo mu q

rut non. S d nh vy l nhdorut non c nhng c im cu to rt thun licho s hp thu:

+ Rut non rt di khong 3m,nim mc c nhiu np gp, nhiu nhungmao v vi nhungmao to nn dim bn chi c din tch tip xc ln khong300m2, bn trong nhungmao c h thng mch mu, bch huyt v thn kinh rtthun li cho s hp thu.

+ T bonimmc rut non cha nhiu yu t cn thit cho s hp thu vtcht qua mng nhmen, cht ti v nng lng.

+ Tt c cc thc n i xung n rut non u c phn gii thnh nhngcht d hp thu c. Cc cht c hp thu rut non bao gm: glucid, protid, lipid, cc vitamin, ccion vnc.


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3.4. Hp thu rut gi: Qutrnh hp thu rut gi khng quan trng, bi khi xung n rut gi

cc cht cn thit cho c th c hp thu gn ht rut non, trong rut gi hnh ch cn li cht cn b ca thc n.

Mt s cht c hp thu y nh: cc ion, nc, cc amine,amonic, mts thuc c th c hp thu ti y.

4. Sinh l hc gan: 4.1. Nhc li gii phu sinh l ca gan:

Gan l mt c quan c nhiu chc nng quan trng: - Chc nng chuyn ha - Chc nng to mt - Chc nng chng c - Chc nng ni tit v mt s chc nng khc

Nhng chc nng ny c lin quan mt thit mt cch chc ch vi im gii phu v t chc hc ca gan.

Gan l tng ln nht trong c th, nng khong 2,4kg. T bo gan c nhity lp th v mt h thngmen rt hon chnh. V vy, chng hot ng chuynha rt mnh. 4.2. Chc nng ca gan: 4.2.1. Chc nng chuyn ha: - Chuyn h a glucid: Glucidtheo tnh mch ca v gan ch yu l glucose, cnfructose, galactose s c gan chuyn ha thnh glucose trc khi s dng. - Chuyn ha lipid:Gan tng hp acid bo t glucid, protid v cc sn phm thoiha ca lipid.

- Chuyn ha pro tid: Gan va l c quan chuyn ha cng nh d trprotid.Chuyn ha protid ca gan din ra rt mnh m bao gm hai qu trnh: chuyn haxt aminv tng hp protein.

4.2.2. Chc nng d tr :Gan d tr cho c th nhiu cht quan trng nh: mu, glucid, st v mt

s vitaminA, D, B12, trong quan trng nht l vitaminB12.


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4.2.3. Chc nng to mt: Mt l sn phm bi tit ca t bo gan. Sau khi bi tit, mt theo ng m

vi ti vo ng mt ca khong ch. T y mt theo ng gan phi v ng gtri vo ng mt chung ri theo ng ti mt i n cha ti mt. Ti y m

c c c li v di tc dng ca mt s kch thch, ti mt s co bp a mtvo t trng qua c vng Oddi. Trc khi vo t trng, mt c trn ln vi dchty trong ng ty chnh. 4.2.4. Chc nng chng c :

Gan c xem nh l hng ro bo v c th chng li cc sn phm cxm nhp qua ng tiu ha, ng thi lm gim c tnh v thi tr mt s chc to ra trong qu trnh chuyn ha ca c th. C ch chng c ca gan doc t bo Kupffer v t bo gan m nhim.

4.2.5. Chc nng ni tit: - Bi tithormone erythroprotein.- Tham gia vo qu trnh to dng hot tnh ca Vitamine D.


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SINH L HC CHUYN HA NNG LNG

1. Nng lng vo c th Nng lng vo c th di dng thc n. Ni chung tt c cc loi thc n cha 6 cht dinh dng: protit, lipit, gluxit, vitamin, mui khong, nc; trong ch c 3 cht cung cp nng lng cho c th: protit, lipit, v gluxit gi l nhngcht sinh nng lng. Gi tr nng lng ca thc n ph thuc vo hm lng cacht dinh dng sinh nng lng.

Gi tr nng lng ca mt s thc n thng thng: - Du m: 900 kcalo/ 100g - Ng cc: 350 kcalo/ 100g - Tht, c: 100 250 kcalo/100g- Rau qu: < 100 kcalo/ 100g

2. Chuyn ha nng lng trong c th C th khng c mt c quan chuyn ha nng lng ring m cc cht

c vn chuyn t mu n t bo, t bo cc cht tham gia vo cc phn chuyn ha chuyn ha thnh nng lng cn thit cho c th.

Chuyn ha nng lng i km vi chuyn ha cht din ra theo 3 bc 3khuvc ca t bo:

2.1. bo tng: Cc cht bin i thnh cc cht chuyn ha trung gian.Phn ln nng lng ca cc cht dng nng lng ca cc cht trung gian, m phn thnh hp cht giu nng lng ATP.

2.2. ti lp th: Cc cht trung gian phn gii thnh CO2 v H2O, v nnglng ATP.

2.3. cc bo quan khc: ATP tham gia vo:

- Cung cp nng lng cho vn chuyn vt cht qua mng. - Cung cp nng lng cho co rt s i c, vn ng c quan, c th.

- Cung cp nng lng cho phn ng tng hp cht, d tr, bi tit.


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3. Tiu hao nng lng ca c th 3.1. Tiu hao nng lng cho duy tr c th .

y l nng lng cn cho c th tn ti bnh thng, khng thay i thtrng, khng sinh sn.

3.1.1. Chuyn ha c s :Chuyn ha c s l chuyn ha c th trong iu kin c s: khng ti

ha, khng vn c, khng iu nhit. Chuyn ha c s l nguyn nhn tiu haonhiu nng lng. Nng lng cho chuyn ha c s 1 ngi/ 1 ngy khong 1400kcalo trong tng s tiu hao nng lng ca c thl 2200kcalo.

Chuyn ha c s thay i theo:- Tui: Tui cng cao chuyn ha c s cng gim.

- Gii: cng mt tui chuyn ha c s n thp hn nam.- Nhp ngy m: Chuyn ha c s cao nhtlc 13 14 gi, thp nhtlc 1 - 4gi, khi ng chuyn ha c s gim.- Bnh l: Khi st, u nng tuyn gip chuyn ha c s tng, suy dinh dngchuyn ha c s gim.3.1.2. Vn c:

Trong nng lng tiu haodo vn c, khong 25% chuyn thnh cng coc, 75% ta ra di dng nhit.

3.1.3. iu nhit iu nhit l hot ng thn nhit khng thay i theo mi trng bn

ngoi, cn thit cho c th tn ti v hot ng.Trong mi trng lnh, tiu hao nng lng b cho lng nhit khuch tn

ra mitrng xung quanh. Trong mi trng nng, tiu hao nng lng cng tngln cho iu nhit nhng sau gim i do gim chuyn ha trong mi trngnng.3.1.4. Tiu ha

Tiu hathc n cung cp nng lng cho c th, nhng bn thn victiu ha thc n cng cn nng lng. Tiu hao nng lng chotiu ha ty theotng cht dinh dng: - Protit lm tiu haonng lng thm 30%.- Lipit lm tiu haonng lng thm 14%.- Gluxit lm tiu haonng lng thm 6%.


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- Ch n hn hp ca ngi 10%3.2. Tiu hao nng lmg cho pht trin c th

pht trin c th, tng chiu cao v tng trng lng u cn tng kchthc, s lng t bo. C th phi tng hp cc cht, phi tng tiu hao nn

lng.3.3. Tiu hao nng lng cho sinh sn 3.3.1. Thi k mang thai

Thi k mang thai, m cn nng lng cho to thai, thai pht trin, to cc phn nui thai, tng khi lng tun hon, pht trin tuyn v, pht trin khunchu Tng nng lng khong60000 kcalo.3.3.2. Thi k nui con

Thi k nui con, m bi tit sa mi ngy khong 500 600ml sa. Nng

lng tiu hao cho bi tit sa mi ngy khong 450kcalo.4. iu ha chuyn ha nng lng 4.1. iu ha chuyn ha nng lng mc t bo

mc t bo, chuyn ha nng lng c iu ha bng c ch iha ngc. Yu t iu ha l ADP. Khi hm lng ADP trong t bo tng th phn ng sinh nng lng tng , khi ADP gim th phn ng sinh nng lng gii. Kt qu l trong iu kin bnh thng, hm lng ADP trong t bo mc nht nh m bo cho t bo hot ng bnh thng.

4.2. iu ha chuyn ha nng lng mc c th Trong c th nhu cu v nng lng thay i theo tng c quan, ph thu

vo iu kin bn trong v bn ngoi c th. V vy chuyn ha nng lngthng xuyn c iu ha.4.2.1. iu ha chuyn ha nng lng bng c ch thn kinh :- Thn kinh giao cm: Kch thch h giao cm lm tng chuyn ha nng lng.- Vng di i: L trung tm cao cp ca h thn kinh thc vt nn nh hngn chuyn ha nng lng.

4.2.2. iu ha chuyn ha nng lng bng c ch th dch: Nhiuhormonetham gia vo chuyn ha nng lng

- Hormone tuyn gip: Tng chuyn ha t bo bng thc y oxy ha ti lp thlm tng chuyn ha nng lng.- Hormone ty thng thn: Adrenalin thc y phn gii glycogen thnh glucose,thiu tglucoselm tng chuyn ha nng lng.


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- Hormone v thng thn: Hormonev thng thn thc y bin i axt aminthnh gluxit.- Hormone GH tuyn yn: GH lm gim gluxit, huy ng m d tr.- Hormone sinh dc: Hormonesinh dc nam lm tng ng ha protit, estr ogen

cng lm tng ng ha protit nhng yu hn, progesteron tng chuyn ha nnglng.


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SINH L HC IU HA THN NHIT

iu ha thn nhit gi tt l iu nhit l mt hot ng c tc dng gicho thn nhit hng nh trong khi nhit ca mi trng sng thay i. N m

bo cho cc phn ng chuyn ha din ratrong c th tng i hng nh,lmcho qu trnh sng tng i hng nh trong mi trng lun thay i.

Hot ng iu nhit c thc hin trn c s mt trung tm iu hanhit nm vng di i. Mt tn thng ca trung tm ny cng nh m bin i qu ln hoc qu nhanh ca mi trng u dn ti ri lon thn nhit.1. Thn nhit

Thn nhit l nhit ca c th. Thn nhit c chia thnh hai loi lthn nhit ngoi vi v thn nhit trung tm.1.1. Thn nhit trung tm : L nhit nhng vng nm su bn trong c th, c nh hng trc tip ti phn ng chuyn ha trong c th, t thay i thnhit ca mi trng.

Ngi ta o thn nhit trung tm : - Trc trng : Hng nh nht.- ming : Thp hn trc trng 0,2 0,5oC.- nch: Thp hn trc trng 0,5 1oC, dao ng nhiu hn nhng tin nht dng theo di thn nhit bnh thng.1.2. Thn nhit ngoi vi: o da, chu nh hng ca mi trng nhiu hn, trn 33,5oC, lng bn tay 32oC, mu bn chn 28oC.2. Cc yu t nh hng n thn nhit: - Tui: Tui cng cao thn nhit cng gim.- Nhp ngy m: Thn nhit cao nht thng vo lc14 17 gi, thp nhtlc 3 6 gi .- Kinh nguyt v mang thai: Ph n sau chu

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