1. Sa u g a y m e noi kh i q u a n : dat m o vit, c a n b o m t h u d c tu c u n g .
C h o c 3 t r o c ar t n h u c a c c u o c noi soi k ha c. Ne u c an t h a o tac de c o the c h o c t h e m tuy turng t r u d n g h o p cu the.
2. N h i n t o a n bo o b u n g x ac d inh vi trf tu c u n g , hai p h a n p hu, q u a n sat t a n g tren 6 b u n g t im bat t h u d n g d v u n g gan, mat... T h u d n g bdt g a p c a c dai x o tren 6 b u n g t im bat t h u d n g d v u n g gan, mat... T h u d n g bdt g a p c a c dai x o m o n g dfnh t u ga n len t h a nh b u n g (dau hieu c u a v ie m do c h l a m y d i a , hoi c h u n g Fitz - H u g h Curtis ) ( x e m h in h 29 va 3 0 d phu ban).
3. S a u khi q u a n sat o b u n g n h i n t o a n c a n h tieu k h u n g
a) Co dich trong c u n g do k h d n g : ma u sac, so luong
h) T u cu n g : the tfch, ma u sac mat nhan, go ghe cd nhan xo, co hinh d a n g bat th ud ng n h u tu cu ng 2 sung - 2 tu cung... , co cac ton t huong dac hieu k h o ng ? (viem lao cd cac not trang nam rai rac).
- T u c u n g c o bi dfnh va o c a c to c h u c x u n g q u a n h k h d n g : c d t he g a p m a n g m o n g c h e m a t t ru d c tu c u n g h oa c co n h i e u dai x o m o n g d i n h t u t u c u n g ra t h a n h c h a u va 2 p h a n phu ( dau hieu c u a v i e m do c h l a m y d i a )
- C ac khoi u a tir c u n g ?
c) H a i b u o n g trting: the’ tich, mau sac, nhan, go ghc, co na ng trufng d a n g phat trien khong? Co the gap cac tru dn g hop sau:
- B uo ng trufng to h a n b in h t h u d n g , ma t n h a n b o n g , t rdng n g a -> t r u d n g h a p n a y phai nghT d e n b u o n g trufng d a n a ng . Ket h o p vai lam s a n g va dinh l u g n g noi tiet, c o t he cdt g o c 2 b u o n g trufng.
- Buon g trting to n ho , n h a n n h e o m a u v a ng nha t -> ket h g p vai d i n h l u g n g noi tiet, ta n g h i den b u o n g trting thoai h o a (suy b u o n g trting)
- Cac bat thuang khac cua buong trting, khoi u buong trting, nang nuoc buong trting, buong trting chi la mot dai trdng, can xet n g hi e m n h i i m sdc do.
- Co m a n g dfnh ba o b g c lay b u o n g trting k h o n g ?
d) Ila i vdi trting: co bi dfnh, bi gap kh dn g? , mo m mai hay cting, loa vdi binh t hudng nhin ro cac tua, loa thanh tui bit, ti nude,... cd the gap b u d n g trting va vdi trting cuon lai thanh mot khoi hoac bi che lap kho ng nhin ro tung phan cua buong trting va voi trting.
4. C hi so d a n h gia t on t h u o n g d o a n xa vdi t r u n g va c h i so d a n h gi a mure
d o d in h (t he o Bru ha t va M a g e , n a m 1976)
a. C h i so danh gid Ion thuong doan xa vdi trdng (bang 1): dua vao 3 yeu to:
- N i e m m a c voi trting - T h a n h vdi trting - D o t h o n g voi trting
B ang 1: D a n h gia t h u o n g ton do an xa voi t r un g
Chi so 0 2 5 10
Vo i trting ( q u a soi) D i n h d loa, tui bit ti n u d e N i e m m a c voi trting ( c h u p X q u a n g ) Binh t h u d n g N e p ga p g ia m K h o n g c o n n e p g a p h o a c teo T h a n h vdi trting ( q u a soi) Binh t h u d n g M o n g D a y , x a c ti ng
Giai doan 1: tu 2 dc'n 5diem; giai doan 2: tir 6 den 10 diem Giai doan 3: tCr 11 den 15 diem; giai doan 4: tren 15 diem
b. C h i so dan h gid m tic do d in h : d ua vao mtic do dinh q u a n h vdi trting va bu dn g trting (b an g 2)
- Dinh nhe: tu 1 de n 6 die m - Di nh vira: tir 7 den 15 die m - Di nh nang: tren 15 die m
Hang 2: D anh gia dinh tieu k h u ng
C a q u a n dinh D ie n tich ca q u a n bi dfnh 1/3 2/3 toa n bo Buong trung: m a n g da y 1 2 4 m a n g m o n g 4 8 16 V T d o an gan: m a n g d a y 1 2 4 m a n g m o n g 2 5 10 V T d o a n xa: m a n g da y 1 1 4 m a n g m o n g 5 10 10
5. Sa u khi da n h a n d in h ro r a n g: b o m x a n h m e t h y l e n tir tir c u n g len
( hinh 31 d p hu b an )
So s a n h vdi p h i m c h u p tir c u n g - voi trung, tuy m u c do n g a m x a n h m e t h y l e n vao 2 voi tr un g, ta se q u y e t dinh p h u o n g p h a p p h i u t huat tiep theo.
a) X a n h m e t h y l e n q u a 2 voi t r u ng vao o b u n g -> 2 voi trufng t h o n g va 2 b u o n g trurng b in h t h ud ng : k h o n g c an lam thu t huat gi t h e m . N e u c o ft m a n g m o n g dfnh vao tu c u n g va 2 ph an phu g d dfnh b i n g q u e g i y h o a c dot va cat.
b) X a n h me t hy le n k ho n g nga m vao 2 voi trung, chi thay tu c u n g phinh to len, trudng hop nay c h i n doa n la t i c voi trung d doan ke. Neu 2 b u o n g trurng b mh th u dn g k ho n g lam gi them. Neu 2 bu on g trung hoac bi m a n g m o n g bao boc, lai g d dfnh 2 buo ng trdng tu do giup c ho viec didu tri tiep theo de da ng (choc hut n a n g noan qu a sieu am lam thu tinh trong ong nghiem).
c) X a n h m e t h y l e n vao, voi t r un g p h i n h to len, t h u d c k h o n g ra o b u n g d o loa vdi t h a n h tui bit lam c a c thu t huat tiep theo.
+ G d dfnh giai p h o n g b u o n g t ru n g va voi t ru n g tu do. + M d tui bit: tuy td n g t h u a n g tdn ta q u y e t dinh:
- N e u d o a n p h i n h to n g a n , m o n g : m d chur t h a p b i n g d a o m o t c u c ( h o a c d a o l aser) ( hi nh 32 va 33).
- Ne u d o a n p h m h to dai, m d d oc theo tha n voi trurng tCr c h o tui bit n g u a c len k h o a n g 2 c m b i n g da o 1 c u c h oa c keo, sau do dot c a m m a u b i n g d a o hai cuc.
Ilin h 32: m d rong loa vdi Irdng I l i n h 33: m d h in h chu: Ihdp d chd dinh vdi Irdng
Neu d o a n tui bit p h i n h to d a y cting, cat d o a n sau do ra ch d o c len t ren tao loa voi trting m6i
d) X a n h m e t h y l e n vao 2 voi trting ra o b u n g ft, k h o k h a n do b a n t i c a l oa m o r o n g loa voi b i n g t ach r o ng c h o dfnh
e) X a n h m e t h y l e n vao o b u n g tot q u a 1 voi trting ( t h o n g 1 b en) , n e u be n kia dfnh phtic tap h oa c tac ke k h o n g lam gi th e m
f) K h o k h a n t h u a n g g a p t ro n g m o vo sinh la g o dfnh l am s ao bo c lo d u g c tu c u n g , b u o n g trting va voi trting tu do.
- C a c c h o dfnh m o n g c o the g o b a n g q u e g£y h o a c k eo, c a c c h o d a y c a n dot b a n g k e p l u o n g c u c sau do cat b a n g keo.
- T r a n h g a y ton t h u a n g h o a c dot di en n hi eu a voi trting lam c h o voi trting n g a n lai, d a y len
- T r o n g khi lam thu t huat neu c h a y m a u vua, dot di en c a m m a u va r u a c h o s ach se de de k i e m tra, t ra n h d i n h lai sau nay.
T o m lai: phoi h g p g i u a chi so t6n t h u a n g voi trting va do d i n h , c h u n g ta se c o p h u o n g h u a n g p h a u t huat t hich hgp.
* Giai d o a n 1: d m h nhe h o a c vua = > g o dfnh
* Giai d o a n 2: dfnh nhe h oa c vua = > g o dinh va tao hinh loa voi trting
* Giai d o a n 3: + dfnh nhe va v ua => g o dfnh va tao hinh loa voi trting
+ dfnh n a ng , he p hai d o a n e o = > thu tinh t rong o n g n g h i e m ( I VF )
* Giai d o a n 4 => thu tinh t r ong o n g n g h i e m ( I VF )
- Sau khi lam x o n g c a c thu thuat, b o m r ua b a n g x a nh m e t h y l e n de k i e m tra ket q u a do t h o n g c u a hai voi trung.
- R u a 6 b u n g va k i e m tra toan bo x e m c o c o n c h a y m a u k h o n g ?
Ne u t r u o n g h o p phai g o dinh va m o t h o n g hai voi t r ung nen de lai t r ong b u n g 2 0 0 - 3 0 0 ml d u n g dich lactat r inge r, k h d n g sinh g e n t a m y c i n va a c h y m o t r y p s i n .
- Rut tr oc a rt va k h a u lai t h a n h b u n g