Ngoại khoa thực hành Lê Đình Sáng (th)

Ngoại khoa thực hành Lê Đình Sáng (th) Ngoại khoa thực hành Lê Đình Sáng (th) Ngoại khoa thực hành Lê Đình Sáng (th) Ngoại khoa thực hành Lê Đình Sáng (th) Ngoại khoa thực hành Lê Đình Sáng (th) Ngoại khoa thực hành Lê Đình Sáng (th) Ngoại khoa thực hành Lê Đình Sáng (th) Ngoại khoa thực hành Lê Đình Sáng (th) Ngoại khoa thực hành Lê Đình Sáng (th)

NGO ѴI KHOA TH ҞC HÀNH

TÀI LI҇h^ҙhdѷM ʹ TҎNG HҖP ʹ D҉CH

GiӀi thiҵu Information MӅc lӅc

Biên soҢn ebook : >ġŞŶŚ^ĄŶŐ

ѴI HҊC Y KHOA HÀ NҐI

Trang web : www.ykhoaviet.tk

Email : Lesangmd@gmail.com, bachkhoayhoc@gmail.com

ŝҵn thoҢi : 0973.910.357

THÔNG TIN

THÔNG BÁO V҄ VI҇C XUѶT BѵN BÁCH KHOA Y HҊC 2010 :

Theo yêu cҥu và nguyҵn vҸng cӆa nhiҲu bҢŶĜҸc, khác vӀi Bách Khoa Y HҸc các phiên bңŶƚƌӇӀc, bên cҢnh viҵc cҨp nhҨt các bài viұt mӀi và các chuyên khoa mӀŝ͕ĐƹŶŐŶŚӇƚŚĂLJĜҼi cách thӈc trình bày, Bách Khoa Y HҸĐϮϬϭϬĜӇӄc chia ra làm nhiҲu cuҺn nhҹ, mҽi cuҺn bao gһm mҾt chӆ ĜҲ cӆa Y

HҸĐ͕ŶŚӇƚŚұ sҰ giúp bҢŶĜҸc tiұt kiҵŵĜӇӄc thӁi gian tra cӈu thông tin khi cҥn Tác giң xin chân ƚŚăŶŚĐĄŵҿŶƚҤt cң nhӋng ý kiұŶĜſŶŐŐſƉƉŚġďŞŶŚĐӆĂƋƵljĜҾc giң trong thӁi gian qua TҤt cң các cuҺn sách cӆa bҾ sách Bách Khoa Y HҸc 2010 bҢŶĜҸc có thҳ tìm thҤy và tңi vҲ tӉ trang web

ǁǁǁ͘LJŬŚŽĂǀŝĞƚ͘ƚŬĜӇӄĐ>ġŞŶŚ^ĄŶŐdžąLJĚӌng và phát triҳn

ҘNG HҐ :

Tác giң džŝŶĐŚąŶƚŚăŶŚĐĄŵҿŶŵҸi sӌ ӆng hҾ vҲ mҭƚƚăŝĐŚşŶŚĜҳ giúp cho Bách Khoa Y HҸĐĜӇӄc phát triҳn tҺƚŚҿŶǀăŶŐăLJĐăŶŐŚӋƵşĐŚŚҿŶ͘

MҸi tҤm lòng ӆng hҾ cho viҵc xây dӌng mҾt website dành cho viҵc phҼ biұn tài liҵu hҸc tҨp và giңng

dҢy Y Khoa cӆa các cá nhân và Doanh nghiҵp xin gӊi vҲ :

dġŶŶŐąŶŚăŶŐ͗E'E,E'ѷhdҙsW,ddZ/҅N VI҇T NAM

Tên tài khoңŶŶŐąŶŚăŶŐ͗>ġŞŶŚ^ĄŶŐ

thұ mҸi thông tin trong cuҺŶƐĄĐŚŶăLJĜҲu chҶ mang tính chҤƚƚӇҿŶŐĜҺi CuҺn sách năLJĜӇӄc phân phát miҴn phí vӀi mӅĐĜşĐŚƐӊ dӅŶŐƉŚŝƚŚӇҿŶŐŵҢi, bҤt cӈ ŚăŶŚǀŝŶăŽůŝġŶƋƵĂŶĜұn viҵc mua bán, ƚƌĂŽĜҼi, chҶnh sӊa, in Ҥn cuҺn sách này vào bҤt cӈ thӁŝĜŝҳŵŶăŽĜҲu là bҤt hӄp lҵ NҾi dung cuҺn ebook này có thҳ ĜӇӄĐƚŚĂLJĜҼi và bҼ sung bҤt cӈ lúc nào mà không cҥŶƚŚƀŶŐ漏ƚƌӇӀc

BҾƐĄĐŚŶăLJĜӇӄĐ>ġ^ĄŶŐƐӇƵƚҥm , biên dҷch và tҼng hӄp vӀi mӅĐĜşĐŚĐƵŶŐĐҤp mҾt nguһn tài liҵu tham khңo hӋu ích cho các bҢn sinh viên y khoa, và tҤt cң nhӋng ai có nhu cҥu tìm hiҳu, nghiên cӈu, tra cӈu , tham khңo thông tin y hҸc

sӀŝƚŝġƵĐŚşůăďҾ sách mӂ͕ĜӇӄĐdžąLJĚӌng dӌa trên nguһn tài liҵu cӆa cҾŶŐĜһng , không mang mӅc ĜşĐŚǀӅ lӄi, không gҩn vӀi mӅĐĜşĐŚƚŚӇҿŶŐŵҢŝŚſĂĚӇӀi bҤt kLj hình thӈĐŶăŽ͕ŶġŶƚƌӇӀc khi sӊ

dӅng bҾ sách này bҢn phңŝĜһng ý vӀi nhӋŶŐĜŝҲu kiҵn sau NұƵŬŚƀŶŐĜһng ý , bҢn không nên tiұp tӅc sӊ dӅng sách :

BҾƐĄĐŚŶăLJĜӇӄĐĐƵŶŐĐҤƉĜұn tay bҢn , hoàn toàn dӌa trên tinh thҥn tӌ nguyҵn cӆa bҢn Không có

bҤt kLj sӌƚŚӇҿŶŐůӇӄŶŐ͕ŵƵĂĐŚƵҾc, mӁi gҸi hay liên kұt nào giӋa bҢn và tác giң bҾ sách này

MӅĐĜşĐŚĐӆa bҾ ƐĄĐŚĜҳ phӅc vӅ công tác hҸc tҨp cho các bҢn sinh viên Y khoa là chính, ngoài ra

nұu bҢn là nhӋŶŐĜҺi tӇӄŶŐĜĂŶŐůăŵǀŝҵĐƚƌŽŶŐŶŐŚăŶŚzĐƹŶŐĐſƚŚҳ sӊ dӅng bҾ ƐĄĐŚŶŚӇůăƚăŝ

liҵu tham khңo thêm

MҸi thông tin trong bҾ ƐĄĐŚĜҲu chҶ ĐſƚşŶŚĐŚşŶŚdžĄĐƚӇҿŶŐĜҺŝ͕ƚŚƀŶŐƚŝŶĐŚӇĂĜӇӄĐŬŝҳm chӈng

bӀi bҤt cӈ ĐҿƋƵĂŶWŚĄƉůƵҨt, Nhà xuҤt bңn hay bҤt cӈ ĐҿƋƵĂŶĐſƚƌĄĐŚŶŚŝҵm liên quan nào Vì vҨy, hãy luôn cҦn trҸŶŐƚƌӇӀc khi bҢn chҤp nhҨn mҾƚƚŚƀŶŐƚŝŶŶăŽĜſĜӇӄc cung cҤp trong bҾ sách này

TҤt cң các thông tin trong bҾƐĄĐŚŶăLJĜӇӄĐƐӇƵƚҥm, tuyҳn chҸn, phiên dҷch và sҩp xұp theo trình

tӌ nhҤƚĜҷnh Mҽi bài viұt dù ngҩn hay dài, dù hay dù dӂ ĐƹŶŐĜҲu là công sӈc cӆa chính tác giң bài

viұƚĜſ͘>ġŞŶŚ^ĄŶŐ chҶ ůăŶŐӇӁŝƐӇƵƚҥm và phiên dҷch, nói mҾƚĐĄĐŚŬŚĄĐ͕ŶŐӇӁi giúp chuyҳn tңi

nhӋng thông tin mà các tác giң bài viұƚĜĆĐƵŶŐĐҤƉ͕Ĝұn tay các bҢn

BҾ sách này là tài liҵƵƐӇƵƚҥm và dҷch bӂi mҾt sinh viên Y khoa chӈ không phңi là mҾƚŐŝĄŽƐӇʹ tiұn Ɛšhay mҾt chuyên gia Y hҸc dày dҢn kinh nghiҵŵ͕ĚŽĜſĐſƚŚҳ có rҤt nhiҲu lҽi và khiұm khuyұt ŬŚƀŶŐůӇӁŶŐƚƌӇӀc , chӆ quan hay khách quan, các tài liҵu bҺ trí có thҳ ĐŚӇĂŚӄp lý , nên bên cҢnh

viҵc thҨn trҸŶŐƚƌӇӀc khi thu nhҨn thông tin , bҢŶĐƹŶŐĐҥŶĜҸc kӎ phҥn mӅc lӅc bҾ sách và phҥn ŚӇӀng dҧn sӊ dӅng bҾ ƐĄĐŚĜҳ sӊ dӅng bҾ sách này mҾt cách thuҨn tiҵn nhҤt

Tác giң bҾ ƐĄĐŚĜŝҵn tӊ này không chҷu bҤt cӈ trách nhiҵŵŶăŽůŝġŶƋƵĂŶĜұn viҵc sӊ dӅng sai mӅc ĜşĐŚ͕ŐąLJŚҨu quң không tҺt vҲ sӈc khҹe, vҨt chҤt, uy ƚşŶ͙Đӆa bҢn và bҵnh nhân cӆa bҢn

Không có chuyên môn , không phңi là nhân viên y tұ , bҢŶŬŚƀŶŐĜӇӄĐƉŚĠƉƚӌ sӊ dӅng nhӋng thông tin có trong bҾ ƐĄĐŚŶăLJĜҳ chҦŶĜŽĄŶǀăĜŝҲu trҷ TӉ ƚƌӇӀc tӀi này, các thҥy thuҺĐ/҄U TR҉

B҇NH NHÂN chӈ không phңi là /҄U TR҉ B҇NH MҽŝŶŐӇӁi bҵnh là mҾt thӌc thҳ ĜҾc lҨp hoàn toàn ŬŚĄĐŶŚĂƵ͕ĚŽĜſǀŝҵc bê nguyên xi tҤt cң mҸi thông tin trong bҾ sách này vào thӌc tiҴn sҰ là mҾt sai lҥm lӀn Tác giң sҰ không chҷu bҤt cӈ trách nhiҵm gì do sӌ bҤt cҦn này gây ra

Vì là bҾ sách cҾŶŐĜһng, tҢo ra vì mӅĐĜşĐŚĐҾŶŐĜһng, do cҾŶŐĜһng , bҾ sách này có phát triҳŶĜӇӄĐŚĂLJŬŚƀŶŐŵҾt phҥn rҤt lӀn, không chҶ dӌa vào sӈc lӌc, sӌ kiên trì cӆĂŶŐӇӁi tҢo ra bҾ sách này , thì nhӋŶŐĜſŶŐŐſƉ͕džąLJĚӌng, góp ý, bҼ sung, hiҵu chҶnh cӆĂŶŐӇӁi ĜҸĐĐŚşŶŚůăĜҾng lӌc to

lӀŶĜҳ bҾƐĄĐŚŶăLJĜӇӄĐƉŚĄƚƚƌŝҳn Vì mҾt mӅc tiêu trӂ thành mҾt bҾ sách tham khңo y khoa tҼng

hӄp phù hӄp vӀi nhu cҥu và tình hình thӌc tiҴŶƚƌŽŶŐůšŶŚǀӌc y tұ nói riêng và trong cuҾc sҺng nói chung Tác giң bҾ sách mong mҹi ӂ bҢŶĜҸc nhӋng lӁŝĜſŶŐŐſƉĐŚąŶƚŚăŶŚŵĂŶŐƚşŶŚdžąLJĚӌng, nhӋng tài liҵu quý mà bҢn muҺn san sү cho cҾŶŐĜһng , vì mҾƚƚӇҿŶŐůĂŝƚҺƚĜҮƉŚҿŶ͘ſůăƚҤt cң

niҲm mong mҹi mà khi bҩƚĜҥu xây dӌng bҾ sách này , tôi vҧŶŬŝġŶƚƌŞƚŚĞŽĜƵҼi

NҾi dung bҾ sách này, có thҳ chҶ ĜƷŶŐƚƌŽŶŐŵҾt thӁŝĜŝҳm nhҤƚĜҷnh trong quá khӈ và hiҵn tҢi hoҭc ƚƌŽŶŐƚӇҿŶŐůĂŝŐҥn Trong thӁŝĜҢi cách mҢng khoa hҸc công nghҵ tiұŶŶŚĂŶŚŶŚӇǀƹďĆŽŶŚӇŚŝҵn nay, không ai biұƚƚƌӇӀĐĜӇӄĐůŝҵu nhӋng kiұn thӈc mà bҢŶĐſĜӇӄĐĐſƚŚҳ áp dӅŶŐǀăŽƚӇҿŶŐůĂŝŚĂLJŬŚƀŶŐ͘ҳ trң lӁi câu hҹi này, chҶ có chính bңn thân bҢn , phңi luôn luôn không ngӉng-TҞ MÌNH-cҨp nhҨt thông tin mӀi nhҤt trong mҸŝůšŶŚǀӌc cӆĂĜӁi sҺŶŐ͕ƚƌŽŶŐĜſĐſůšŶŚǀӌc y khoa Không ai có thҳ, tҤt nhiên bҾ sách này không thҳ, ůăŵĜŝҲƵĜſƚŚĂLJďҢn

Nghiêm c Ҥm sӊ dӅng bҾ ƐĄĐŚŶăLJĚӇӀi bҤt kLj mӅĐĜşĐŚdžҤu nào, ŬŚƀŶŐĜӇӄĐƉŚĠƉƚŚӇҿŶŐŵҢi hóa

sңn phҦŵŶăLJĚӇӀi bҤt cӈ ĚĂŶŚŶŐŚšĂŶăŽ͘dĄĐŐŝң bҾ sách này không phңi là tác giң bài viұt cӆa bҾ ƐĄĐŚ͕ŶŚӇŶŐĜĆŵҤt rҤt nhiҲu công sӈc, thӁi gian, và tiҲn bҢĐĜҳ tҢo ra nó, vì lӄi ích chung cӆa cҾng Ĝһng BҢn phңi chҷu hoàn toàn trách nhiҵm vӀi bҤt kLj viҵc sӊ dӅng sai mӅĐĜşĐŚǀăŬŚƀŶŐƚƵąŶƚŚӆ

nҾi dung bҾ sách này nêu ra

MҸi lý thuyұƚĜҲu chҶ là màu xám, mҾt cuҺn sách hay vҢn cuҺŶƐĄĐŚĐƹng chҶ là lý thuyұt, chҶ có

thӌc tұ cuҾc sҺng mӀi là cuҺn sách hoàn hңo nhҤt, ӂ ĜſďҢn không phңŝůăĜҾc giң mà là diҴn viên chính Và Bách Khoa Y HҸĐĐƹŶŐĐŚҶ là mҾt hҢt thóc nhҹ, viҵc sӊ dӅŶŐŶſĜҳ xào nҤu hay nhân giҺng

là hoàn toàn tùy thuҾc vào bҢŶĜҸĐ͘săŶŐӇӁi tҢo ra hҢt thóc này sҰ vui mӉŶŐǀăĜӇӄc truyҲn thêm ĜҾng lӌĐĜҳ tiұp tӅc cҺ gҩng nұu biұt rҪng chính nhӁ bҢn mà biұƚďĂŽŶŐӇӁi không còn phңi xұp ŚăŶŐĜҳ chӁ cӈu trӄ

MҸŝĜſŶŐŐſƉůŝġŶƋƵĂŶĜұn bҾ sách xin gӊi vҲ cho tác giң ƚŚĞŽĜҷa chҶ trên RҤt mong nhҨŶĜӇӄĐ

phңn hһi tӉ các bҢŶĜҾc giң Ĝҳ các phiên bңŶƐĂƵĜӇӄĐƚҺƚŚҿŶ͘

Kính chúc bҢŶĜҸc, gia quyұn và toàn thҳ ŶŐӇӁi ViҵƚEĂŵůƵƀŶĜӇӄc sҺng trong khҹe mҢnh, cuҾc sҺng ngày càng Ҥm no hҢnh phúc

ƀ>ӇҿŶŐ͕EŐŚҵ An Tháng 8/2010

ABOUT

ebook editor: Le Dinh Sang

Hanoi Medical University

Website: www.ykhoaviet.tk

Email: Lesangmd@gmail.com, bachkhoayhoc@gmail.com

Tel: 0973.910.357

NOTICE OF MEDICAL ENCYCLOPEDIA PUBLICATION 2010:

As the request and desire of many readers, in addition to updating the new articles and new

specialties, as well as changes in presentation, Medical Encyclopedia 2010 is divided into many small ebooks, each ebook includes a subject of medicine, as this may help readers save time looking up informations as needed The author would like to thank all the critical comments of you all in the recent past All the books of the Medical Encyclopedia 2010 can be found and downloaded from the site www.ykhoaviet.tk ,by Le Dinh Sang construction and development

Bank name: BANK FOR INVESTMENT AND DEVELOPMENT OF VIETNAM

Bank Account Name: Le Dinh Sang

Account Number: 5111-00000-84877

DISCLAMER :

The information provided on My ebooks is intended for your general knowledge only It is not a substitute for professional medical advice or treatment for specific medical conditions You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health professional Please contact your health care provider with any questions or

concerns you may have regarding your condition

Medical Encyclopedia 2010 ĂŶĚĂŶLJƐƵƉƉŽƌƚĨƌŽŵ>ġŞŶŚ^ĄŶŐĂƌĞƉƌŽǀŝĚĞĚΖ^/^ΖĂŶĚǁŝƚŚŽƵƚwarranty, express or implied Lê Sáng specifically disclaims any implied warranties of

merchantability and fitness for a particular purpose In no event will be liable for any damages,

including but not limited to any lost or any damages, whether resulting from impaired or lost

money, health or honnour or any other cause, or for any other claim by the reader Use it at Your risks !

FOR NON-COMMERCIAL USER ONLY

YOU ARE RESTRICTED TO adapt, reproduce, modify, translate, publish, create derivative works from,

distribute, and display such materials throughout the world in any media now known or hereafter ĚĞǀĞůŽƉĞĚǁŝƚŚŽƌǁŝƚŚŽƵƚĂĐŬŶŽǁůĞĚŐŵĞŶƚƚŽLJŽƵŝŶƵƚŚŽƌ͛ƐĞŬƐ͘

FOREWORD

These ebooks ĂƌĞ>ĞŝŶŚ^ĂŶŐ͛ƐĐŽůůĞĐƚŝŽŶ͕ĐŽŵƉŝůĂƚŝŽŶĂŶĚƐLJŶƚŚĞƐŝƐǁŝƚŚƚŚĞĂŝŵŽĨƉƌŽǀŝĚŝŶŐĂuseful source of reference-material to medical students, and all who wish to learn, research,

investigate to medical information

Just a set of open-knowledge, based on community resources, non-profit purposes, not associated with commercial purposes under any kind, so before you use this books you must agree to the following conditions If you disagree, you should not continue to use the book:

This book is to provide to you, completely based on your volunteer spirit Without any negotiation, bribery, invite or link between you and the author of this book

The main purpose of these books are support for studying for medical students, in addition to others if you are working in health sector can also use the book as a reference

All information in the book are only relative accuracy, the information is not verified by any law agency, publisher or any other agency concerned So always be careful before you accept a certain information be provided in these books

All information in this book are collected, selected, translated and arranged in a certain order Each artical whether short or long, or whether or unfinished work are also the author of that article Lê

ŞŶŚ^ĄŶŐǁĂƐŽŶly a collectors in other words, a person to help convey the information that the authors have provided, to your hand Remember the author of the articles, if as in this book is clearly the release of this information you must specify the author of articles or units that publish articles

This book is the material collected and translated by a medical student rather than a professor ʹ Doctor experienced, so there may be many errors and defects unpredictable, subjective or not offices, documents can be arranged not reasonable, so besides carefull before reading information, you should also read carefully the contents of the material and the policy, manual for use of this book

The author of this e-book does not bear any responsibility regarding the use of improper purposes, get bad results in health, wealth, prestige of you and your patients

7 Not a professional, not a health worker, you are not allowed to use the information contained in this book for diagnosis and treatment Ever, the physician treating patients rather than treatment Each person is an independent entity and completely different, so applying all information in this book into practice will be a big mistake The author will not bear any responsibility to this

negligence caused

8 As is the community material, these books could be developed or not are not only based on their strength and perseverance of the author of this book , the contribution, suggestions, additional adjustment of the reader is great motivation for this book keep developed Because a goal of

becoming a medical reference books in accordance with general requirements and the practical situation in the health sector in particular and life

9 The contents of this book, may only correct in a certain time in the past and the present or in the near future In this era of scientific and technological revolution as sweeping as fast now, no one knew before is whether the knowledge that you have obtained can be applied in future or not To answer this question, only yourself, have to always update-YOURSELF-for latest information in all areas of life, including the medical field No one can, of course this book can not, do it for you

10 Strictly forbidden to use this book in any bad purpose, not be allowed to commercialize this pƌŽĚƵĐƚƵŶĚĞƌĂŶLJŵĞĂŶĂŶĚĂŶLJƚŝŵĞďLJĂŶLJŵĞĚŝĂ͘dŚĞĂƵƚŚŽƌŽĨƚŚŝƐŬŝƐŶŽƚƚŚĞ͞ŝŶǀĞŶƚŽƌ͟

of the book-articles, but has made a lot of effort, time, and money to create it, for the advanced of the community You must take full responsibility for any misuse purposes and does not comply with the contents of this book yet

11 All theories are just gray, a thousand books or a book are only theory, the only facts of life are

the most perfect book, in which you are not an audience but are the main actor This Book just a small grain, using it to cook or fry breeding is completely depend on you And the person who created this grain will begin more excited and motivated to keep trying if you know that thanks that

so many people no longer have to queue to wait for relief

12 All comments related to the books should be sent to the me at the address above We hope to receive feedbacks from you to make the later version better

13 We wish you, your family and Vietnamese people has always been healthy, happy and have a prosperous life.

,ҙґE'ϭ͘</҃N THҚґѵN

1 VÔ KHUѸN NGOѴI KHOA

2 VÔ TRÙNG TRONG NGOѴI KHOA

8 QUÁ TRÌNH LI҄N V҃dd,ҙґE'

9 KIM VÀ KÌM KҀP KIM KHÂU PHѹU THUѺT

10 CÁC LOѴI ҌNG THÔNG VÀ ҌNG DѹE>ҙh

11 CÁC THAO TÁC PHѹU THUѺT

12 CÂN BѼE'EҙҒ͕/҇N GIѵI

13 CѶP CҚU NGқNG TIM PHҎI

20 1-KҠ EE's</҃N THҚEѵN TRONG PHÒNG MҎ:

21 2-KҠ EE's</҃N THҚEѵN TRONG PHѹU THUѺT:

22 3-CÁC KҠ EE'W,ѹU THUѺT NÂNG CAO:

,ҙґE'ϯ͘W,ѹU THUѺT

23 PHѹU THUѺT CѻT GAN TRÁI

24 KҠ THUѺT TÌM VÀ XҜ LÝ TÚI THOÁT V҉ BҀN

25 PHѹU THUѺT MILES

26 PHѹU THUѺT HELLER QUA NҐI SOI

27 KҠ THUѺT LÀM HѺU MÔN NHÂN TѴO

28 PHѹU THUѺT CѻdhҙғNG MѺT RҌN GAN

29 PHѹU THUѺT CѻT KHҌI TÁ TUҟ BѵO TҍN MÔN V҉

30 PHѹU THUѺT CѻT TÚI MѺT NҐI SOI

31 PHѹU THUѺT CѻT TOÀN BҐ DѴ DÀY

32 PHѹU THUѺT CѻT THѷN KINH X

33 PHѹU THUѺT CѻT RUҐT THқA NҐI SOI

34 PHѹU THUѺT CѻT RUҐT THқA

35 PHѹU THUѺT CѻT GAN PHѵI

36 PHѹU THUѺT CѻdѴI TRÀNG XÍCH-MA NҐI SOI

37 PHѹU THUѺT CѻdѴI TRÀNG PHѵI NҐI SOI

38 PHѹU THUѺdKѴEE,ldZ/҇dEѵI BIÊN

39 PHѹU THUѺdW,0E,ҐNG MѴCH CHҘ BҗNG

40 DѹE>ҙh<1E<,KE'DE'W,ҎI

41 PHѹU THUѺT TUY҃N GIÁP

42 PHѹU THUѺT CѻT THU{ GIÁP

43 PHѹU THUѺT CѻT THҞC QUѵN KHÔNG MҔ NGҞC

44 PHѹU THUѺT IVOR LEWIS

,ҙґE'ϰ҇͘NH LÝ NGOѴI Ҏ BҗNG

86 PHѹU THUѺT TÁI TѴO DÂY CHѼNG CHÉO SAU

,ҙґE'ϳ͘ҋNG NGOѴI KHOA

87 Ѵ/ҙґE's҄ BҋNG

88 DI҇N TÍCH - Ґ SÂU TҎEd,ҙґE'ҋNG

89 LÂM SÀNG SҌC BҋNG

90 /҄U TR҉ SҌC BҋNG

113 hW,0ѴI LÀNH TÍNH TI҄N LI҇T TUY҃N

114 CѺN LÂM SÀNG CHѸEKEd,ѺN TI҃T NI҇U

119 ^ґ>ҙҖC V҄ GÂY MÊ HҍI SҚC

120 Ѵ/ҙґE's҄ CÁC THUҌC MÊ

132 'zdDZҌI THѷN KINH CÁNH TAY

133 GÂY TÊ THѷN KINH GIҝA

134 GÂY TÊ THѷN KINH TRҗ

135 GÂY TÊ THѷN KINH TRҗ

136 GÂY TÊ THѷE</E,,/ҙҒI

137 HѴN CH҃ TRUY҄N MÁU TRONG NGOѴI KHOA

138 GÂY TÊ TҘY SҌNG Ҕ TRҁ EM

139 PHҌI HҖP THUҌC TÊ VҒI CÁC THUҌC Hҏ TRҖ TRONG GÂY TÊ CҗC BҐ

140 CHUѸN B҉ dZҙҒC MҎ s,D^M҇NH NHÂN SAU MҎ

141 QUѵN LÝ B҇NH NHÂN CHѶEd,ҙґE'^Ҋ NÃO Ҕ TUY҃Eґ^Ҕ

142 KW>Ҟd3E,DѴCH TRUNG TÂM

143 YhzdZ0E,,D^M҇E,E,EMѿT ҌNG NҐI KHÍ QUѵN

,ҙґE'ϭϬ͘E'KѴI KHOA THғI CHI҃N

149 NHI҆M KHUѸN V҃dd,ҙґE',/҃N TRANH

150 HÔ HѶP NHÂN TѴO

160 XҚ dZ1ҙҒѷU CHѶEd,ҙґE'^Ҋ NÃO

161 TҎEd,ҙґE'DѴCH MÁU NGOѴI VI

168 /҄U TR҉ V҃dd,ҙґE's҃T BҋNG BѼNG THUҌC NAM

TÀI LI ҇U TRA CҚU

-* -* -

,ҙґE'ϭ͘</҃N THҚґѵN

1 sN<,hѸEE'KѴ/<,K

sƀŬŚƵҦŶůăŵҾƚŶŐƵLJġŶƚҩĐ͕ŵҾƚĐŚұĜҾŚăŶŐĜҥƵĐӆĂŶŐăŶŚzƚұŶſŝĐŚƵŶŐǀă ĐӆĂŶŐăŶŚŶŐŽҢŝŬŚŽĂŶſŝƌŝġŶŐ͕ŶſĐſljŶŐŚšĂƚŚăŶŚďҢŝƚƌŽŶŐĐƀŶŐƚĄĐŶŐŽҢŝ khoa

sƀŬŚƵҦŶƚƌŽŶŐŶŐŽҢŝŬŚŽĂĜӇӄĐĜҭƚƌĂƐĂƵŬŚŝŶŐӇӁŝƚĂƚŞŵƌĂǀŝŬŚƵҦŶǀă ŶŚҨŶƚŚҤLJǀĂŝƚƌžŐąLJďҵŶŚĐӆĂĐŚƷŶŐĜҺŝǀӀŝĐҿƚŚҳƐĂƵŬŚŝĐŚƷŶŐdžąŵŶŚҨƉ ĜӇӄĐƋƵĂǀұƚƚŚӇҿŶŐ͕ǀұƚŵҼ͘

dŚƵҨƚŶŐӋǀƀŬŚƵҦŶďĂŽŚăŵŚĂŝůšŶŚǀӌĐ͗

- dŝҵƚƚƌƶŶŐ;ƐƚĞǀŝůŝƐĂƚŝŽͿůă ĐĄĐďŝҵŶƉŚĄƉƚŝġƵĚŝҵƚŵҸŝŚŞŶŚƚŚĄŝĐӆĂǀŝŬŚƵҦŶ ďĂŽŐһŵĐңŶŚĂďăŽ͘

- <ŚӊƚƌƶŶŐ;ĚĞƐŝŶĨĞĐƚŝŽͿůăĐŚҶƚŝġƵĚŝҵƚǀŝŬŚƵҦŶӂĚҢŶŐƚŚӌĐǀҨƚ͘

<ŚӊƚƌƶŶŐ͕ƚŝҵƚƚƌƶŶŐůăƚҢŽŶġŶŵҾƚŵƀŝƚƌӇӁŶŐǀƀŬŚƵҦŶ͕ŶŐĉŶŶŐӉĂŬŚƀŶŐ ĐŚŽǀŝŬŚƵҦŶdžąŵŶŚҨƉǀăŽĐҿƚŚҳůăŵĐŚŽĐĄĐƚҼĐŚӈĐĐӆĂĐҿƚŚҳŬŚƀŶŐďҷ ŶŚŝҴŵŬŚƵҦŶ͘EġŶŶŚӀƌҪŶŐ͗ŶŐĂLJďăŶƚĂLJĐӆĂƉŚҧƵƚŚƵҨƚǀŝġŶ͕ĚĂĐӆĂŶŐӇӁŝ ďҵŶŚƐĂƵŬŚŝĜĆƐĄƚƚƌƶŶŐĜҳŵҼĐƹŶŐŬŚƀŶŐƉŚңŝůăǀƀŬŚƵҦŶ͘ҳŬŚҩĐƉŚӅĐ ŶŚӋŶŐǀҤŶĜҲŶăLJƉŚҧƵƚŚƵҨƚǀŝġŶƉŚңŝĜĞŽŐĉŶŐŵҼǀăƚҢŝǀƶŶŐŵҼĐӆĂďҵŶŚ

nh ąŶŶŐӇӁŝƚĂƚƌңŝƐĉŶŐǀăĚĄŶŽĨƐŝƚĞ͘sӀŝĐĄĐƉŚӇҿŶŐƚŝҵŶƐӊĚӅŶŐƚƌŽŶŐƉŚҧƵ ƚŚƵҨƚĜҳĜңŵďңŽǀƀƚƌƶŶŐƚƵLJҵƚĜҺŝŶŐӇӁŝƚĂƉŚңŝӈŶŐĚӅŶŐĐĄĐƉŚӇҿŶŐƉŚĄƉ ůlj͕ŚŽĄĜҳƚŝҵƚƚƌƶŶŐ͘

ϭ͘ĄĐƚĄĐŶŚąŶĜӇӄĐƐӊĚӅŶŐĜҳƚŝҵƚƚƌƶŶŐ͕ŬŚӊƚƌƶŶŐ͘

ϭ͘ϭ͘ĄĐĚƵŶŐĚҷĐŚŚŽĄĐŚҤƚ͗

,ŽĄĐŚҤƚĜҳƚŝҵƚŬŚƵҦŶşƚĐſŚŝҵƵƋƵңǀŞŬŚƀŶŐĐſŚŽĄĐŚҤƚŶăŽĐſƚŚҳĐƶŶŐ ŵҾƚůƷĐĚŝҵƚƚҤƚĐңĐĄĐǀŝƐŝŶŚǀҨƚ͘EſĐſƚŚҳĚŝҵƚǀăŝůŽăŝǀŝƐŝŶŚǀҨƚŶăLJŶŚӇŶŐ ůҢŝŬŚƀŶŐƚŚҳĚŝҵƚĜӇӄĐĐĄĐůŽҢŝǀŝƐŝŶŚǀҨƚŬŚĄĐ͘dşŶŚŚӋƵŚŝҵƵĐӆĂŚŽĄĐŚҤƚ ƉŚӅƚŚƵҾĐǀăŽŶһŶŐĜҾ͕ďҲŵҭƚĐӆĂĚӅŶŐĐӅĐҥŶĜӇӄĐƐĄƚŬŚƵҦŶĐſƐҢĐŚŚĂLJ ŬŚƀŶŐ͕ƚŚӁŝŐŝĂŶƚŝұƉdžƷĐǀӀŝĚӅŶŐĐӅĐſĜӆŚĂLJŬŚƀŶŐ͘ĄĐŚŽĄĐŚҤƚƚŚӇӁŶŐ ĜӇӄĐƐӊĚӅŶŐĜҳŬŚӊŬŚƵҦŶƚƌŽŶŐŶŐŽҢŝŬŚŽĂŐһŵ͗

- һŶ;ĂůĐŽůͿ͗ ĐſƚĄĐĚӅŶŐĚƵLJƚƌŞƐӌŬŚӊŬŚƵҦŶĐӆĂŵҾƚǀҨƚƐĂƵŬŚŝǀҨƚĜſĜĆ

ĜӇӄĐŬŚӊŬŚƵҦŶďҪŶŐƉŚӇҿŶŐƉŚĄƉŬŚĄĐ͕ŶſĐžŶĜӇӄĐĚƶŶŐĜҳƐĄƚŬŚƵҦŶƚƌġŶ ĚĂǀŞşƚŐąLJŚҢŝӂĚĂ͘dŚӁŝŐŝĂŶŬŚӊŬŚƵҦŶĐҥŶƚŚŝұƚĐӆĂĐһŶůăϮϬƉŚƷƚ͕ŶһŶŐĜҾ ƐӊĚӅŶŐƐĄƚŬŚƵҦŶůăϳϬ0͘ҤƚůӄŝĐӆĂĐһŶůă͗ŬŚƀŶŐĚŝҵƚĜӇӄĐďăŽƚӊ͕ůăŵŬŚƀ ĚĂ͕ŬŚƀŶŐůăŵŵҤƚƚĄĐĚӅŶŐĐӆĂĜҾĐƚҺ͕ůăŵŚҹŶŐĚӅŶŐĐӅďҪŶŐĐŚҤƚĚүŽ͕ůăŵ ŚĂŶŐҶĚӅŶŐĐӅƐҩƚ͕ŬŚƀŶŐƚҦLJĜӇӄĐĚҥƵŵӃ͕ƚĄĐĚӅŶŐĐӆĂĐһŶŐŝңŵĜŝŬŚŝďҷ

ďҺĐŚҿŝŚŽҭĐƉŚĂůŽĆŶŐ͘

- ƵŶŐĚҷĐŚŝҺƚ;ŝŽĚͿ͗EŐӇӁŝƚĂƉŚĂĚƵŶŐĚҷĐŚĐһŶŝŽĚĚƶŶŐĜҳƐĄƚŬŚƵҦŶůăϮй ŝŽĚƚƌŽŶŐĐһŶϳϬ0͘sӀŝůŽҢŝĐһŶŝŽĚŶăLJƐҰďҷŬŚƀĐŚҨŵůҢŝǀăŬŚƀŶŐůăŵĐŚĄLJ ĚĂ͘dŚӁŝŐŝĂŶŬŚӊŬŚƵҦŶůăϭϱ- ϮϬƉŚƷƚ͘Ҥƚůӄŝ͗ŶſĐſƚŚҳŐąLJŬşĐŚӈŶŐĚĂ͕ŶұƵ

ĜҨŵĜҾĜҭĐĐſƚŚҳŐąLJĐŚĄLJĚĂ͖ĐſƚŚҳůăŵŵҤƚŵăƵǀăĉŶŵžŶŬŝŵůŽҢŝ͘

- ƵŶŐĚҷĐŚŽdžLJŐŝă;ĞĂƵŽdžLJŐĞŶĞͿ͗ ĐſƚĄĐĚӅŶŐƚҺƚ ǀӀŝĐĄĐǀŝŬŚƵҦŶLJұŵŬŚş͕

ĜӇӄĐƐӊĚӅŶŐĜҳƌӊĂĐĄĐǀұƚƚŚӇҿŶŐŶŚŝҴŵďҦŶŬŚŝŐҭƉĐĄĐǀұƚďҦŶ͕ŵĄƵ͕ŵӆ ĚƵŶŐĚҷĐŚƐҰƐӆŝďҸƚ͕ŶſĐžŶĐſƚĄĐĚӅŶŐĐҥŵŵĄƵǀŞůăŵĐŽĜҥƵĐĄĐŵĂŽŵҢĐŚ

ŶŚҹ͘<ŚƀŶŐĜӇӄĐĚƶŶŐĚƵŶŐŽdžLJŐŝă ĐŚŽĐĄĐǀұƚƚŚӇҿŶŐĜĂŶŐůġŶƚҼĐŚӈĐŚҢƚ͘

- C ĄĐŚӄƉĐŚҤƚĂŵŽŶŝ- NH4 :

ĄĐŚӄƉĐŚҤƚĂŵŽŶŝE,4 ĚƶŶŐĜҳŬŚӊŬŚƵҦŶĐĄĐĚӅŶŐĐӅŬŝŵůŽҢŝŶŚҸŶƐҩĐ͕ ĚӅŶŐĐӅďҪŶŐĐŚҤƚĚүŽ͘ҤƚůӄŝĐӆĂĚƵŶŐĚҷĐŚŶăLJůăŬŚƀŶŐĚŝҵƚĜӇӄĐŶŚĂďăŽ͕ ŬŚƀŶŐĐſƚĄĐĚӅŶŐŬŚŝĚӅŶŐĐӅĐžŶĚşŶŚdžăƉŚžŶŐ͕ĚҥƵŵӃ͘

- ƵŶŐĚҷĐŚtĞƐĐŽĚLJŶĞ͗ůă ĚƵŶŐĚҷĐŚŚӋƵŚŝҵƵĜҳƚŝҵƚŬŚƵҦŶǀŞŶſĐſƚŚҳĚŝҵƚ ĜӇӄĐĐңŶŚĂďăŽ͘ƵŶŐĚҷĐŚŶăLJĐžŶĜӇӄĐƐӊĚӅŶŐĜҳŬŚӊŬŚƵҦŶƐăŶǀăƚӇӁŶŐ

ƉŚžŶŐŵҼ͘

- ƵŶŐĚҷĐŚŝĚĞdž͗ĐſŵăƵǀăŶŐ͕ĜӇӄĐƐӊĚӅŶŐĜҳŬŚӊƚƌƶŶŐĚӅŶŐĐӅŵҼ͕ĜҭĐ ďŝҵƚůăĐĄĐĚӅŶŐĐӅŵҼŶҾŝƐŽŝ͘

- ĄĐŚӄƉĐŚҤƚ có clo:

ƵŶŐĚҷĐŚƐŽĚŝƵŵŚLJƉŽĐŚůŽƌŝƚĞůăĚƵŶŐĚҷĐŚŶӇӀĐǀƀŝƚƌŽŶŐĐſĐůŽĚƶŶŐĜҳƚҦLJ ƵұĐŚҤƚƚŚңŝĐſŶŚŝҴŵŬŚƵҦŶ͘

Ϯ͘dŝҵƚƚƌƶŶŐďҪŶŐŶŚŝҵƚĜҾĐĂŽ͘

dŝҵƚƚƌƶŶŐďҪŶŐŶŚŝҵƚĜҾĐĂŽĐſϮĐĄĐŚůăŚҿŝŶſŶŐŬŚƀǀăŶſŶŐҦŵ͘

- ,ҿŝŶſŶŐŬŚƀ͗

- ҺƚĚӅŶŐĐӅƐҩƚďҪŶŐĐһŶ͗ƉŚӇҿŶŐƉŚĄƉŶăLJşƚĜӇӄĐƐӊĚӅŶŐǀŞƐҰůăŵŚҹŶŐ ĚӅŶŐĐӅŶŚӇŶŐŶſĐſӇƵĜŝҳŵůăƚŝҵƚƚƌƶŶŐŚŽăŶŚңŽǀăŶŚĂŶŚĐŚſŶŐ͘

- dӆƐҤLJŬŚƀ͗ĜſůăŵҾƚĐĄŝƚӆďҪŶŐƚŚĠƉĐſŚŞŶŚŬŚҺŝŚҾƉĐŚӋŶŚҨƚ͕ǀҹĚăLJĐſ ůӀƉĐĄĐŚŶŚŝҵƚǀăĐŚҷƵĜӇӄĐĄƉůӌĐ͘,ҵƚŚҺŶŐĐĄŶŚƚӆĐſůӀƉŐŝŽĉŶŐĐĂŽƐƵĐŚҷƵ ŶŚŝҵƚ͕ƉŚşĂƚƌġŶƚӆĐſŶŚŝҵƚŬұ͕ĐſƌҿůĞŶŚŝҵƚ͕ĜһŶŐŚһĜŽƚŚӁŝŐŝĂŶǀăĐƀŶŐƚҩĐ ĜŝҵŶ͘dƌŽŶŐůžŶŐƚӆĐſĐĄĐŶŐĉŶĜҳdžұƉĚӅŶŐĐӅ͕ƉŚşĂĜĄLJƚӆůăŚҵƚŚҺŶŐďұƉ ĜŝҵŶǀăƋƵҢƚŐŝſ͘

<ŚŝďҨƚĐƀŶŐƚҩĐĜŝҵŶ͕ĐĄĐďұƉĜŝҵŶŚŽҢƚĜҾŶŐ͕ŚҵƚŚҺŶŐƋƵҢƚĜӇĂŚҿŝŶſŶŐ ǀăŽůžŶŐƚӆ͘<ŚŝƐӈĐŶſŶŐƚƌŽŶŐůžŶŐƚӆĜҢƚĜӇӄĐŵӈĐƋƵLJĜҷŶŚ;ϭϲϬ- 1800C) ƚŚŞƌҿůĞŶŚŝҵƚƚӌĜҾŶŐŶŐҩƚďұƉĜŝҵŶ͘<ŚŝŶŚŝҵƚĜҾŚҢĚӇӀŝŵӈĐƋƵLJĜҷŶŚƚŚŞ ƌҿůĞƚӌĜҾŶŐĜſŶŐǀăďұƉĜŝҵŶůҢŝŚŽҢƚĜҾŶŐ͘<ŚŝĜӆƚŚӁŝŐŝĂŶĚƵLJƚƌŞƚŚŞƚӆ ĜӇӄĐƚҩƚ͘

- ,ҿŝŶſŶŐҦŵ͗

- WŚӇҿŶŐƉŚĄƉĜƵŶƐƀŝ͗ƉŚӇҿŶŐƉŚĄƉŶăLJĚŽŶŚŝҵƚĜҾŬŚƀŶŐĐĂŽ;ϭϬϬ0C) nên ŵҾƚƐҺŶŚĂďăŽŬŚƀŶŐďҷĚŝҵƚ͕ŶġŶŬŚƀŶŐƚŚҳƚŝҵƚƚƌƶŶŐŵҾƚĐĄĐŚƚƵLJҵƚĜҺŝ ĜӇӄĐ͕ĚŽĜſƚƌӇӀĐŬŚŝůƵҾĐĚӅŶŐĐӅŵҼƉŚңŝƌӊĂƐҢĐŚƌһŝŶŐąŵǀăŽĚƵŶŐĚҷĐŚ ŚŽĄĐŚҤƚşƚŶŚҤƚϭϱ- 20 ƉŚƷƚƌһŝŵӀŝĜĞŵůƵҾĐ͘EſŝĐŚƵŶŐĜąLJĐŚҶůăŵҾƚŐŝңŝ

ƉŚĄƉƚŞŶŚƚŚұƚƌŽŶŐĜŝҲƵŬŝҵŶƚŚŝұƵƚŚҺŶǀҲƉŚӇҿŶŐƚŝҵŶƉŚҧƵƚŚƵҨƚŚĂLJƚƌŽŶŐ ŶŐŽҢŝŬŚŽĂĚĆĐŚŝұŶ͘

- WŚӇҿŶŐƉŚĄƉĐŚƁƐƀŝ͗ĜſůăŶŐƵLJġŶůljŚŽҢƚĜҾŶŐĐӆĂĐĄĐŶһŝŚҤƉĚĆĐŚŝұŶ ĜӇӄĐƋƵąŶĜҾŝĐĄĐŶӇӀĐĄƉĚӅŶŐƚƌŽŶŐĜŝҲƵŬŝҵŶĐŚŝұŶƚƌĂŶŚ͘ҤƵƚҢŽĐӆĂŶһŝ ŚҤƉĚĆĐŚŝұŶŶŚӇŵҾƚĐŚƁƐƀŝ͗ŶŐĉŶĚӇӀŝĜҼŶӇӀĐ͕ŶŐĉŶƚƌġŶdžұƉĚӅŶŐĐӅ͘ dŚăŶŚŶһŝŚҤƉůăŶŚƀŵŚĂLJƚŚĠƉĚăLJ͕ĐŚҷƵĜӇӄĐůӌĐ͕ǀƵŶŐĐſҺĐǀҭŶĐŚҭƚǀ㎠ƚŚăŶŚŶһŝ͕ƚƌġŶǀƵŶŐĐſǀĂŶdžңŚҿŝ͕ĜƵŶďҪŶŐĐӆŝ͘ҙƵĜŝҳŵĐӆĂůŽҢŝŶăLJůăĐſ ƚŚҳĜӇĂĜӇӄĐŶŚŝҵƚĜҾůġŶĐĂŽƚƌġŶϭϬϬ0͕ĐſƚŚҳĚŝҵƚĜӇӄĐĐңŶŚĂďăŽ͘EŚӇӄĐ ĜŝҳŵůăŬŚſŬŚҺŶŐĐŚұĜӇӄĐŶŚŝҵƚĜҾ͕ŚҤƉĜӇӄĐşƚĚӅŶŐĐӅ͕ƀŶŚŝҴŵŵƀŝ

ƚƌӇӁŶŐ͘

- EһŝŚҤƉҦŵŚŝҵŶĜҢŝĂƵƚŽĐůĂǀĞ;ĂƵƚŽĐůĂƌŝŶŐĐŽůĚͿ͗

EŐƵLJġŶůljŚŽҢƚĜҾŶŐ͗ĚӌĂƚƌġŶŶŐƵLJġŶůljďŝұŶĜŝҵŶŶĉŶŐƚŚăŶŚŶŚŝҵƚŶĉŶŐǀă ŶŚŝҵƚŶĉŶŐƚŚăŶŚĐƀŶŐŶĉŶŐĜҳůăŵƚĉŶŐĄƉƐƵҤƚŶҿŝŶӇӀĐŶŚҪŵĜӇĂŶŚŝҵƚĜҾ ůġŶĐĂŽƚŚĞŽljŵƵҺŶĜҳŬŚӊƚƌƶŶŐĚӅŶŐĐӅƉŚҧƵƚŚƵҨƚ͘sҲĐҤƵƚҢŽŶһŝŚҤƉҦŵ ĂŶƚŽĐůĂǀĞůăŵҾƚŶһŝŚŞŶŚƚƌӅ͕ƚŚăŶŚĐſϮůӀƉĐĄĐŚďŝҵƚǀăĐŚҷƵĜӇӄĐĄƉƐƵҤƚ ůӀŶ͘ӇӀŝĜĄLJŶһŝůăŚҵƚŚҺŶŐďұƉĜŝҵŶ͕ƉŚşĂƚƌġŶůăŵҾƚŬŚŽĂŶŐĐŚӈĂŶӇӀĐ͕ ŬŚŽĂŶŐŶăLJĐſŵҾƚƉŚҴƵĜҳĜҼŶӇӀĐǀăŽ͘WŚҴƵŶăLJĐſŵҾƚǀĂŶ͕ŬŚŝĜҼĜҥLJ ŶӇӀĐƚӀŝŵӈĐƋƵLJĜҷŶŚƉŚңŝǀҭŶĐŚҭƚǀĂŶůҢŝ͘<ŚŽĂŶŐĐŚӈĂĚӅŶŐĐӅĐſŵҾƚǀĂŶ ĜҳdžңŚҿŝŶӇӀĐŶſŶŐǀăŽ͘ EҩƉŶһŝĐſŵҾƚĜһŶŐŚһĜŽĄƉůӌĐ͕ŵҾƚƌҿůĞŶŚŝҵƚǀă ĐſĐĄĐŶƷŵǀҭŶŐŝӋĐŚҭƚŶҩƉŶһŝǀӀŝƚŚăŶŚŶһŝ͘<ŚŝĜƵŶƐƀŝŶӇӀĐ͕ŶӇӀĐďҺĐŚҿŝ ŶŚӇŶŐŬŚƀŶŐƚŚŽĄƚƌĂĜӇӄĐŶġŶĄƉƐƵҤƚĐӈƚĉŶŐĚҥŶǀăŶŚŝҵƚĜҾĐƹŶŐǀŞƚŚұ ƚĉŶŐƚŚĞŽ͕ƚĂĐſ͗

1 kg/cm2 (1 atmotphe) = 1200C

2 kg/cm2 (2 atmotphe) = 1340C

3 kg/cm2 (3 atmotphe) = 1450C

<ŚŝŚҤƉƚĂƚŚӇӁŶŐĜҳƌҿůĞĄƉůӌĐӂŵӈĐƚҺŝƚŚŝҳƵůăϭŬŐͬĐŵ2ǀăƚҺŝĜĂӂŵӈĐ 1,5 - 2 kg/cm2͘^ĂƵŬŚŝĜһŶŐŚһĄƉůӌĐĜҢƚƚӀŝϭŬŐͬĐŵ2ƚĂŵӂǀĂŶdžңĜҳŚҿŝ ŶſŶŐƚƌăŶǀăŽŬŚŽĂŶŐĚӅŶŐĐӅ͕ůƷĐĜſĄƉůӌĐƐҰƐӅƚŐŝңŵŶŚӇŶŐĚŽƚĂǀҧŶƚŝұƉ ƚӅĐĚƵLJƚƌŞďұƉĜŝҵŶŶġŶĄƉůӌĐƚƌŽŶŐďƵһŶŐĚӅŶŐĐӅůҢŝƚĉŶŐĚҥŶ͘<ŚŝƚĉŶŐƚӀŝ ĐŽŶƐҺϭ͕ϱ- 2 kg/cm2ƚŚŞŶһŝůҢŝƚӌĜҾŶŐŶŐҩƚĜŝҵŶ͘ӈŶŚӇǀҨLJƚĂĚƵLJƚƌŞϰϬ- 60 ƉŚƷƚůăĜӇӄĐ͘^ĂƵŬŚŝŚҤƉdžŽŶŐƉŚңŝƚŚĄŽǀĂŶdžңĜҳŚҿŝŶӇӀĐƚƌŽŶŐďƵһŶŐ ĚӅŶŐĐӅdžŞƌĂŚұƚŵӀŝĜӇӄĐŵӂŶһŝŶұƵŬŚƀŶŐƐҰƌҤƚŶŐƵLJŚŝҳŵĜһŶŐƚŚӁŝĜңŵ ďңŽĚӅŶŐĐӅĜӇӄĐŬŚƀ͘

- WŚӇҿŶŐƉŚĄƉdLJŶĚĂůů͗

>ăƉŚӇҿŶŐƉŚĄƉĜƵŶĐĄĐŚƚŚӆLJӂϱϬ- 550ŵҽŝŶŐăLJϭŐŝӁŚŽҭĐ 60 - 800 trong ϯϬƉŚƷƚƚƌŽŶŐϯŶŐăLJůŝġŶƚŝұƉƐҰĚŝҵƚĜӇӄĐĐңǀŝŬŚƵҦŶǀăŶŚĂďăŽ͘WŚӇҿŶŐ ƉŚĄƉŶăLJĚƶŶŐĜҳƚŝҵƚŬŚƵҦŶĐĄĐĚƵŶŐĚҷĐŚĐſĐŚӈĂĂůďƵŵŝŶ͕ĐĄĐĚӅŶŐĐӅĐŚҤƚ ĚүŽǀăŵҾƚƐҺĚƵŶŐĚҷĐŚĜҭĐďŝҵƚĜҳĐҤLJŬŚƵҦŶ͘ҙƵĜŝҳŵĐӆĂƉŚӇҿŶŐƉŚĄƉ ŶſŶŐҦŵ͗ƚŝġƵĚŝҵƚ ĜӇӄĐĐĄĐǀŝŬŚƵҦŶǀăŶŚĂďăŽƚƌŽŶŐŵҾƚƚŚӁŝŐŝĂŶŶŐҩŶ͖ƚŝҵƚ ŬŚƵҦŶĜӇӄĐŶŚŝҲƵĚӅŶŐĐӅǀăǀҨƚĚӅŶŐŬŚĄĐŶŚĂƵ͖ĚҴŬŝҳŵƐŽĄƚĜӇӄĐŶŚŝҵƚ ĜҾ͘

EŚӇӄĐĜŝҳŵ͗ŶұƵƐӊĚӅŶŐŬŚƀŶŐĜƷŶŐ͕ŬŚƀŶŐƚŚăŶŚƚŚҢŽĚҴŐąLJƚĂŝŶҢŶŶŐƵLJ Śŝҳŵ͘

ϯ͘<ŝҳŵƚƌĂǀŝҵĐƚŝҵƚƚƌƶŶŐ͘

ſƚŚҳŬŝҳŵ ƚƌĂǀŝҵĐƚŝҵƚƚƌƶŶŐďҪŶŐĐŚӈŶŐŶŐŚŝҵŵŚŽĄŚҸĐǀăĐŚӈŶŐŶŐŚŝҵŵǀŝ ŬŚƵҦŶ͘dŚƀŶŐƋƵĂĜſƐҰŬŝҳŵƚƌĂĜӇӄĐĐŚҤƚůӇӄŶŐŵĄLJŵſĐ͕ŬŝҳŵƚƌĂĜӇӄĐĜҾ ĐŚşŶŚdžĄĐĐӆĂĄƉŬұǀăŶŚŝҵƚŬұ͕ŬŝҳŵƚƌĂĜӇӄĐŚŝҵƵƋƵңƚŝҵƚƚƌƶŶŐĚӅŶŐĐӅ͘

- ŚӈŶŐŶŐŚŝҵŵŚŽĄŚҸĐ͗

- ,ҽŶŚӄƉĂdžŝƚďĞŶnjŽŝĐǀӀŝŵҾƚůӇӄŶŐďҪŶŐŚĂŝŚҢƚŶŐƀǀăƐƵůĨĂƚŬҰŵǀӀŝŵҾƚ ůӇӄŶŐďҪŶŐŚҢƚƚҤŵ͕ƚƌҾŶĜҲƵĐŚŽǀăŽҺŶŐƚŚӆLJƚŝŶŚ͕ŶƷƚŬşŶĜҳǀăŽďƵһŶŐ ŚҤƉ͘,ҽŶŚӄƉŶăLJƐҰŶſŶŐĐŚңLJӂŶŚŝҵƚĜҾϭϮϭ0C

- ,ҽŶŚӄƉƚĞĐƉŝŶϭϬϬŐǀăƚşŵŵĞƚLJůϭŐĂŵĐƹŶŐƚƌҾŶůҧŶĐŚŽǀăŽҺŶŐŶŐŚŝҵŵ͘

ŚƷŶŐƐҰŶſŶŐĐŚңLJӂŶŚŝҵƚĜҾϭϭϳ0C

- ƶŶŐůŽҢŝŵӌĐŚŽĄŚҸĐǀŝұƚůġŶŵңŶŚŐŝҤLJŵҾƚŬljŚŝҵƵŶăŽĜҤLJĜӇĂǀăŽƚƌŽŶŐ ҺŶŐŶŐŚŝҵŵƌһŝĜҳǀăŽďƵһŶŐŚҤƉ͘

ϰ͘<ŚӊƚƌƶŶŐ- ƚŝҵƚƚƌƶŶŐ͘

ϰ͘ϭ͘<ŚӊƚƌƶŶŐ͕ƚҦLJƵұ :

dŚƀŶŐƚŚӇӁŶŐĜҳŬŚӊƚƌƶŶŐ͕ƚҦLJƵұŶŐӇӁŝƚĂƐӊĚӅŶŐĐĄĐĚƵŶŐĚҷĐŚŚŽĄĐŚҤƚ͘

ӅŶŐĐӅƚƌӇӀĐŬŚŝŬŚӊƚƌƶŶŐƉŚңŝĜӇӄĐƌӊĂƐҢĐŚ͕ĐŚҸŶůŽҢŝŚŽĄĐŚҤƚƚŚşĐŚŚӄƉ ǀӀŝĐŚҤƚůŝҵƵĚӅŶŐĐӅǀăůŽҢŝǀŝŬŚƵҦŶĐҥŶƉŚңŝŬŚӊ͘WŚңŝĐŚƷljƚӀŝƚŚӁŝŐŝĂŶĐҥŶ ƚŚŝұƚĜҳŬŚӊŬŚƵҦŶ͘

ӅŶŐĐӅĐĂŽƐƵ͕ĐŚҤƚĚүŽŚĂLJĚƶŶŐŚҿŝĨŽƌŵŽů͘ӅŶŐĐӅƚŚӆLJƚŝŶŚƚŚŞůƵҾĐ͘͘͘͘ sӀŝĐĄĐŵĄLJŚƷƚ͕ŵĄLJŐąLJŵġĐſƚŚҳĚƶŶŐŚҿŝĨŽƌŵŽů͕ ĚƵŶŐĚҷĐŚƐŝĚĞdž͘͘͘sӀŝ ŵƀŝƚƌӇӁŶŐƉŚžŶŐŵҼĚƶŶŐĜğŶĐӌĐƚşŵ͕ŚҿŝĨŽƌŵŽů͕ŶұƵĐſĜŝҲƵŬŝҵŶƚŚŞĚƶŶŐ ĨŝůůҸĐǀŝŬŚƵҦŶĜҳƚŚƀŶŐŬŚşƉŚžŶŐŵҼ͘

ϰ͘Ϯ͘dŝҵƚƚƌƶŶŐ͗

ҳƚŝҵƚƚƌƶŶŐƚŚƀŶŐƚŚӇӁŶŐĚƶŶŐŚҿŝŶſŶŐŬŚƀǀăҦŵ͘

- ӅŶŐĐӅŬŝŵůŽҢŝ͗ĐſƚŚҳĚƶŶŐŚҿŝŶſŶŐŬŚƀϭϲ0 - 1800C trong vòng 40 - 60 ƉŚƷƚ͕ĐſƚŚҳĚƶŶŐŚҿŝŶſŶŐҦŵƚƌŽŶŐǀžŶŐϯϬƉŚƷƚ͘

- һǀңŝ͗ĐŚҶƐӊĚӅŶŐŚҿŝŶſŶŐҦŵ͘

ϭ͘ϭ͘WŚžŶŐŵҼ͗

- WŚžŶŐŵҼƉŚңŝĐſŬşĐŚƚŚӇӀĐƚҺŝƚŚŝҳƵůăϲŵDzϲŵĜҳĐſĜӆŬŚŽңŶŐŬŚƀŶŐ ŐŝĂŶĐŚŽŚŽҢƚĜҾŶŐĐӆĂŬşƉŵҼ͘WŚңŝĐſƚŚƀŶŐŬŚşƚҺƚ͕ůӇӄŶŐŬŚşƚƌŽŶŐƉŚžŶŐ ƉŚңŝĜӇӄĐƚŚĂLJĜҼŝϮϬ-ϮϱůҥŶŵҽŝŐŝӁ͕ĚžŶŐŬŚşƉŚңŝĜŝƋƵĂďҾƉŚҨŶůҸĐĜҳŐŝӋ ůҢŝĐĄĐǀŝŬŚƵҦŶǀăŶҤŵ͘dҤƚĐңĐӊĂĐӆĂƉŚžŶŐŵҼŶġŶĜӇӄĐĜſŶŐŬşŶƚƌӉŬŚŝ ƉŚңŝŵӂĜҳĚŝĐŚƵLJҳŶƉŚӇҿŶŐƚŝҵŶ͕ŬşƉŵҼǀăďҵŶŚŶŚąŶ͘ĄƉůӌĐŬŚƀŶŐŬŚş ƚƌŽŶŐƉŚžŶŐŵҼĐҥŶŚҿŝĐĂŽŚҿŶďġŶŶŐŽăŝĜҳƚƌĄŶŚďӅŝǀăǀŝŬŚƵҦŶƚӉŶŐŽăŝ tràn vào

- WŚӇҿŶŐƚŝҵŶĚӅŶŐĐӅƚƌŽŶŐƉŚžŶŐŵҼ͗

- dҤƚĐңĐĄĐĜӇӁŶŐĐĄƉ͕ĚąLJĚҧŶǀăҺŶŐĐӆĂŵҸŝƉŚӇҿŶŐƚŝҵŶƉŚžŶŐŵҼƉŚңŝ ĜӇӄĐŐŝӋǀƀƚƌƶŶŐďҪŶŐĐĄĐŬҮƉƉŚƶŚӄƉ͘ĄĐĚӅŶŐĐӅŬŚƀŶŐǀƀƚƌƶŶŐŬŚŝĐҥŶ ŵĂŶŐǀăŽƚƌӇӁŶŐŵҼƚŚŞƉŚңŝĜӇӄĐďҸĐƚƌŽŶŐďĂŽǀƀƚƌƶŶŐ͘

- dҤƚĐңĐĄĐĚӅŶŐĐӅǀăƉŚӇҿŶŐƚŝҵŶĚƶŶŐӂƉŚžŶŐŵҼƉŚңŝĜӇӄĐŬŚӊ trùng dƶLJǀăŽĜҭĐĜŝҳŵĐҤƵƚҢŽĐӆĂǀҨƚůŝҵƵĐŚұƚҢŽĚӅŶŐĐӅĜſŵăĐŚҸŶƉŚӇҿŶŐ ƉŚĄƉŬŚӊƚƌƶŶŐƚŚşĐŚŚӄƉ͘

ϭ͘Ϯ͘ҵŶŚŶŚąŶ͗

ҵŶŚŶŚąŶůăŶŐƵһŶƀŶŚŝҴŵƋƵĂŶƚƌҸŶŐŶŚҤƚƚƌŽŶŐƉŚžŶŐŵҼ͘WŚąŶůŽҢŝƉŚҧƵ ƚŚƵҨƚǀƀƚƌƶŶŐŚĂLJŚӋƵƚƌƶŶŐůăĚӌĂǀăŽƚŞŶŚƚƌҢŶŐƀŶŚŝҴŵǀŝŬŚƵҦŶƐҬŶĐſƚҢŝ ƚƌӇӁŶŐŵҼƚƌġŶĐҿƚŚҳďҵŶŚŶŚąŶ͘

ŚƵҦŶďҷĚĂӂǀƶŶŐŵҼĐӆĂďҵŶŚŶŚąŶ͗ůăŵҾƚƚƌŽŶŐŶŚӋŶŐďŝҵŶƉŚĄƉƋƵĂŶ ƚƌҸŶŐďҨĐŶŚҤƚĜҳůăŵŐŝңŵŶŚŝҴŵƚƌƶŶŐǀұƚŵҼ͘

- EġŶĐŚŽďҵŶŚŶŚąŶƚҩŵǀӀŝĐŚҤƚdžăƉŚžŶŐŬŚĄŶŐŬŚƵҦŶǀăŽĜġŵƚƌӇӀĐŶŐăLJ ŵҼ͘ſƚŚҳĜҭƚŵҾƚŵŝұŶŐŐҢĐǀƀƚƌƶŶŐůġŶǀƶŶŐĚĂĜҷŶŚŵҼǀăďĉŶŐůҢŝ͕ŵŝұŶŐ

ŐҢĐŶăLJƐҰĜӇӄĐďҹƌĂŬŚŝďҵŶŚŶŚąŶĜĆŶҪŵƚƌġŶďăŶŵҼ͘WŚңŝĐҢŽůƀŶŐӂ ǀƶŶŐĚĂĜҷŶŚŵҼŶŚӇŶŐŶġŶƚŚӌĐŚŝҵŶƚҢŝƉŚžŶŐŵҼŶŐĂLJƚƌӇӀĐŬŚŝƚŝұŶŚăŶŚ ƚŚӆƚŚƵҨƚ͕ŶġŶĚƶŶŐŬĞŵƚҦLJůƀŶŐŚŽҭĐĚĂŽĐҢŽ ĜŝҵŶĜҳƚƌĄŶŚůăŵdžąLJdžĄƚĚĂ͘

- ^ĄƚƚƌƶŶŐĚĂďҵŶŚŶŚąŶƚƌӇӀĐŬŚŝƌҢĐŚĚĂ͗ƐĄƚƚƌƶŶŐĚĂƚŚĞŽĜӇӁŶŐǀžŶŐƚƌžŶ ĜŝƌҾŶŐĚҥŶƚӉǀƶŶŐĜҷŶŚƌҢĐŚĚĂƌĂŶŐŽăŝ͕ŬŚƀŶŐďĂŽŐŝӁĜӇĂŵŝұŶŐŐҢĐƐĄƚ ƚƌƶŶŐƚӉǀƶŶŐŶŐŽҢŝǀŝƚƌӂůҢŝĐŚҽǀұƚĜҷŶŚƌҢĐŚĚĂ͘DŝұŶŐŐҢĐĚƶŶŐƌһŝƉŚңŝďҹ Ĝŝ͕ŬŚƀŶŐĜӇӄĐĐŚҤŵƚƌӂůҢŝĚƵŶŐĚҷĐŚƐĄƚƚƌƶŶŐ͘

<ŚңŶĉŶŐĜҲŬŚĄŶŐĐӆĂďңŶƚŚąŶďҵŶŚŶŚąŶĜҺŝǀӀŝĐĄĐǀŝŬŚƵҦŶĐƹŶŐĜſŶŐǀĂŝ ƚƌžƌҤƚƋƵĂŶƚƌҸŶŐ͘ĄĐLJұƵƚҺŶŚӇƚƵҼŝ͕ďĠŽƉŚŞ͕ĜĄŝĜӇӁŶŐ͕džҿŐĂŶ͕ƚĉŶŐƵƌġ ŵĄƵ͕ĐĄĐƌҺŝůŽҢŶĐӆĂƚҼĐŚӈĐůŝġŶŬұƚ͕LJұƵƚҺĚŝƚƌƵLJҲŶ͕ƚŞŶŚƚƌҢŶŐƐƵLJŐŝңŵ ŵŝҴŶĚҷĐŚĐҿƚŚҳ͘͘͘ĜҲƵңŶŚŚӇӂŶŐĜұŶƚҶůҵŶŚŝҴŵƚƌƶŶŐǀұƚŵҼ͘

ϭ͘ϯ͘<şƉŵҼ͗

^ӌĐŚƵҦŶďҷǀăƚƌŝҳŶŬŚĂŝĐӆĂŬşƉŵҼĜſŶŐǀĂŝƚƌžĐӌĐŬLjƋƵĂŶƚƌҸŶŐƚƌŽŶŐǀŝҵĐ ĜңŵďңŽǀƀƚƌƶŶŐƉŚҧƵƚŚƵҨƚ͘

- ZӊĂƚĂLJƚƌӇӀĐŵҼ͗ƚŽăŶďҾƚŚăŶŚǀŝġŶŬşƉŵҼƉŚңŝƌӊĂƚĂLJŶŐĂLJƚƌӇӀĐŬŚŝŵҼ ƚӉŶŐſŶĜұŶŬŚƵӏƵďҪŶŐĚƵŶŐĚҷĐŚƐĄƚƚƌƶŶŐ͘ĄĐĐŚҤƚŶŚӇŝŽĚŽƉŚŽƌƐ

và ĐŚůŽƌŚĞdžŝĚŝŶĞŬұƚŚӄƉǀӀŝŵҾƚĐŚҤƚƚҦLJĐſƚĄĐĚӅŶŐƌҤƚƚҺƚĐŚŽŵӅĐĜşĐŚ này

- ĞŽŬŚҦƵƚƌĂŶŐ͗ƚƌŽŶŐŬŚŝŵҼŵҸŝŶŚąŶǀŝġŶƉŚңŝŵĂŶŐŬŚҦƵƚƌĂŶŐ, bao trùm ĐңŵŝҵŶŐǀăŵƹŝĜӆĜҳŶŐĉŶĜӇӄĐĐĄĐĐŚҤƚďҩŶƌĂƚӉŚҿŝƚŚӂǀăŵŝҵŶŐŬŚŝŶſŝ͘

- ŝŐĉŶŐƚĂLJ͗ŐĉŶŐƚĂLJƉŚҧƵƚŚƵҨƚƚŚӇӁŶŐĜӇӄĐůăŵƚӉĐĂŽƐƵǀăĚƶŶŐŵҾƚůҥŶ͘ EſĐſƚĄĐĚӅŶŐŬĠƉ͗ďңŽǀҵďҵŶŚŶŚąŶďҷŶŚŝҴŵƚƌƶŶŐƚӉƚĂLJƉŚҧƵƚŚƵҨƚǀŝġŶ ǀăŶŐӇӄĐůҢŝďңŽǀҵƉŚҧƵƚŚƵҨƚǀŝġŶŬŚƀŶŐďҷůąLJŶŚŝҴŵĐĄĐďҵŶŚĐӆĂďҵŶŚ ŶŚąŶƋƵĂĜӇӁŶŐŵĄƵ͘<ŚŝŐĉŶŐƚĂLJďҷƚŚӆŶŐƚŚŞĜĂƐҺ;ϱϬ- 70%) trong vòng 20 ƉŚƷƚĐſƚӀŝϰϬϬϬϬǀŝŬŚƵҦŶĜŝƋƵĂůҽƚŚӆŶŐĜſ͘^ĂƵŶŚӋŶŐĐĂŵҼŬĠŽĚăŝƚƌġŶϮ ŐŝӁƚŚŞŚҥƵŚұƚ;ϵϬ͕ϲйͿĜҲƵƚŚҤLJĐſǀұƚƚŚӆŶŐƚƌġŶŐĉŶŐƚĂLJ͘EŐſŶƚƌҹƚĂLJƚƌĄŝ ůăǀҷƚƌşŚĂLJďҷƚŚӆŶŐŐĉŶŐŶŚҤƚ;ϰϰйͿ͘sŝҵĐƚŚĂLJŐĉŶŐƚĂLJĚӇӀŝϮŐŝӁŵҾƚůҥŶǀă ĜĞŽŐĉŶŐĜƷƉӂŶŐſŶƚƌҹďăŶƚĂLJƚƌĄŝƐҰŐŝƷƉďңŽǀҵƚҺƚŚҿŶĐңďҵŶŚŶŚąŶůҧŶ ƉŚҧƵƚŚƵҨƚǀŝġŶ͘

- DҭĐĄŽŵҼ͗ďҾƋƵҥŶĄŽŵҼĐӆĂƉŚҧƵƚŚƵҨƚǀŝġŶĐſƚĄĐĚӅŶŐĚӌƉŚžŶŐǀŝ ŬŚƵҦŶƚӉĚĂƉŚҧƵƚŚƵҨƚǀŝġŶƚƌƵLJҲŶǀăŽďҵŶŚŶŚąŶ͘sңŝĐӆĂŶſƉŚңŝůăůŽҢŝ ŬŚƀŶŐƚŚҤŵŶӇӀĐĜҳƚƌĄŶŚǀŝŬŚƵҦŶĐſƚŚҳƚƌƵLJҲŶƚӉŵҭƚŶăLJƐĂŶŐŵҭƚŬŝĂĐӆĂ ĄŽ͘ҺŝǀӀŝĐĄĐƉŚҧƵƚŚƵҨƚşƚŵҤƚŵĄƵ;ĚӇӀŝϭϬϬŵůͿǀăŶŚĂŶŚ;ĚӇӀŝϮŐŝӁͿƚŚŞ ĐſƚŚҳĚƶŶŐĄŽŵҼŵҾƚůӀƉ͘ҺŝǀӀŝĐĄĐƉŚҧƵƚŚƵҨƚůąƵϮ- ϰŐŝӁŚŽҭĐŵҤƚŵĄƵ ŶŚŝҲƵϭϬϬ- ϱϬϬŵů͕ŚŽҭĐĐĄĐƉŚҧƵƚŚƵҨƚӂҼďӅŶŐŚĂLJůһŶŐŶŐӌĐƚŚŞĐҥŶƉŚңŝ ŵҭĐĄŽŵҼŚĂŝůӀƉ͘ҺŝǀӀŝĐĄĐƉŚҧƵƚŚƵҨƚůąƵŚҿŶϰŐŝӁŚŽҭĐŵҤƚŶŚŝҲƵŚҿŶ ϱϬϬŵůŵĄƵƚŚŞƉŚңŝĚƶŶŐĐĄĐĄŽŵҼďҪŶŐĐŚҤƚĚүŽŚĂŝůӀƉŚŽăŶƚŽăŶŬŚƀŶŐ ƚŚҤŵŶӇӀĐ͘

- dƌңŝŬŚĉŶŵҼ͗ĐŚӈĐŶĉŶŐĐŚşŶŚĐӆĂŬŚĉŶƚƌңŝǀұƚŵҼůăĜҳŬŚƵƚƌƷǀăďңŽǀҵ ŬŚƵǀӌĐǀƀƚƌƶŶŐǀƶŶŐŵҼ͘sңŝĐӆĂŶſƉŚңŝůăůŽҢŝŶŐĂLJĐңŬŚŝďҷӇӀƚǀŝŬŚƵҦŶ

ĐƹŶŐŬŚƀŶŐĜŝƋƵĂĜӇӄĐ͘<ŚŝƚƌңŝŬŚĉŶŵҼ͕ƉŚңŝŐŝӋŬŚĉŶĐĂŽƚƌġŶŵӈĐƚŚҩƚ ůӇŶŐǀăƚƌңŝŬŚĉŶƚӉǀƶŶŐŵҼƌĂǀƶŶŐŶŐŽҢŝǀŝ͘>ƷĐƚƌңŝŬŚĉŶŵҼ͕ĐŚƷljĜҳƚĂLJ ŬŚƀŶŐďҷĐŚҢŵǀăŽĚĂďҵŶŚŶŚąŶ͘^ĂƵŬŚŝĜĆƚƌңŝŬŚĉŶƌһŝƚŚŞŬŚƀŶŐĜӇӄĐĚŝ ĐŚƵLJҳŶŚŽҭĐŶŚҤĐŶſůġŶ͘

- ŝĐŚƵLJҳŶƚƌŽŶŐƉŚžŶŐŵҼ͗ĐĄĐƚŚăŶŚǀŝġŶŬşƉ ŵҼĐŚҶĜӇӄĐƉŚĠƉĚŝĐŚƵLJҳŶ ƚӉǀƶŶŐǀƀƚƌƶŶŐƚӀŝǀƶŶŐǀƀƚƌƶŶŐ͘EұƵĐҥŶƉŚңŝƚŚĂLJĜҼŝǀҷƚƌşƚŚŞƉŚңŝƚŚĞŽ ŶŐƵLJġŶƚҩĐůӇŶŐƋƵĂLJǀăŽůӇŶŐǀăŵҭƚƋƵĂLJǀăŽŵҭƚ͕ĜһŶŐƚŚӁŝǀҧŶƉŚңŝŐŝӋ ĜӇӄĐŵҾƚŬŚŽңŶŐĐĄĐŚĂŶƚŽăŶǀӀŝŶŚĂƵ͘

- ӇĂĚӅŶŐĐӅ͗ĐҥŶƉŚңŝƌҤƚƚŝŶŚƚұ ĜҳĐŚƷŶŐĜұŶĜӇӄĐƚĂLJĐӆĂƉŚҧƵƚŚƵҨƚǀŝġŶ ŵҾƚĐĄĐŚĂŶƚŽăŶǀăӂƚӇƚŚұŚŽҢƚĜҾŶŐĜӇӄĐŶŐĂLJ͘<ŚŝĚƶŶŐdžŽŶŐ͕ƉŚңŝĜҭƚ ĚӅŶŐĐӅĜſӂǀҷƚƌşƉŚƶŚӄƉĜҳƐҬŶƐăŶŐƐӊĚӅŶŐůҥŶƚŝұƉƐĂƵ͘

ϭ͘ҢŝĐӇҿŶŐ͘

sҨŶĐŚƵLJҳŶŶŐӇӁŝďҷƚŚӇҿŶŐ;ŐҸŝƚҩƚůăĐŚƵLJҳŶƚŚӇҿŶŐͿŶŚҪŵĜңŵďңŽĜӇĂ ŶŐӇӁŝďҷƚŚӇҿŶŐƚӉŶҿŝďҷƚŚӇҿŶŐǀҲƚӀŝĜӇӄĐĐҿƐӂLJƚұǀăƋƵąŶLJĐſŬŚңŶĉŶŐ ĐӈƵĐŚӋĂƚҺƚŶŚҤƚ͘dƌġŶďҨĐƚŚĂŶŐĜŝҲƵƚƌҷ͕ǀŝҵĐĐŚƵLJҳŶƚŚӇҿŶŐƚŚӌĐŚŝҵŶƚŚĞŽ ƚƵLJұŶ͘<ŚŝĐſĐĄĐĜŝҲƵŬŝҵŶĐŚŽƉŚĠƉǀăƚŚĞŽĐĄĐĐŚҶĚҧŶĜĆƋƵLJ ĜҷŶŚƚƌŽŶŐĐĄĐ ƋƵLJĜҷŶŚĐŚƵLJġŶŵƀŶ͕ĐſƚŚҳƚҼĐŚӈĐĐŚƵLJҳŶƚŚӇҿŶŐǀӇӄƚƚƵLJұŶǀҲĐĄĐĐҿƐӂ ĜŝҲƵƚƌҷĐſŬŚңŶĉŶŐdžӊƚƌşƚŚşĐŚŚӄƉŶŚҤƚ͕ƚŚĞŽƚşŶŚĐŚҤƚĐŚƵLJġŶŬŚŽĂĐӆĂǀұƚ ƚŚӇҿŶŐ͘

sҨŶĐŚƵLJҳŶŶŐӇӁŝďҷƚŚӇҿŶŐůăŵҾƚŶҾŝĚƵŶŐĐƀŶŐƚĄĐƌҤƚƋƵĂŶƚƌҸŶŐ͕ĐſңŶŚ ŚӇӂŶŐƚƌӌĐƚŝұƉĜұŶƚşŶŚŵҢŶŐŶҢŶŶŚąŶǀăĜұŶŬұƚƋƵңĜŝҲƵƚƌҷ͘

Ϯ͘EŐƵLJġŶƚҩĐ

Ϯ͘ϭ͘ӈƵĐŚӋĂůŝġŶƚӅĐ͗

sӀŝĐĄĐŶҢŶŶŚąŶ͕ŶŚҤƚůăĜҺŝǀӀŝĐĄĐŶҢŶŶŚąŶŶҭŶŐ͕ĜӇӄĐĐŚƵLJҳŶƚӀŝƚƵLJұŶ ĜŝҲƵƚƌҷĐſĐŚҤƚůӇӄŶŐƚŚŞƚҢŝŵҽŝƚƵLJұŶ͕ƉŚңŝƚŝұŶŚăŶŚĐĄĐďŝҵŶƉŚĄƉŬŚҦŶĐҤƉ ĐҥŶƚŚŝұƚ͕ĜҳĐſƚŚҳƚŝұƉƚӅĐǀҨŶĐŚƵLJҳŶŶҢŶŶŚąŶŶҭŶŐǀҲƚӀŝƚƵLJұŶĜŝҲƵƚƌҷĐſ ĐŚҤƚůӇӄŶŐ͕ŵăƚŞŶŚƚƌҢŶŐƚŽăŶƚŚąŶĐӆĂŶҢŶŶŚąŶŬŚƀŶŐďҷdžҤƵĜŝ͕ĜĄƉӈŶŐŚĂŝ LJġƵĐҥƵ͗ŶŚĂŶŚĐŚſŶŐǀăĂŶƚŽăŶ͘

dƌĂŶŚƚŚӆǀҨŶĐŚƵLJҳŶƐӀŵĜӇӄĐĐĄĐŶҢŶŶŚąŶŶҭŶŐĜұŶĐĄĐĐҿƐӂĜŝҲƵƚƌҷ ƚŚşĐŚŚӄƉƐҰĐſŚŝҵƵƋƵңƚҺƚǀҲŵҭƚĜŝҲƵƚƌҷǀăƚŝġŶůӇӄŶŐ͘dƌġŶĜӇӁŶŐǀҨŶ ĐŚƵLJҳŶĐҥŶƚŝұŶŚăŶŚĐĄĐďŝҵŶƉŚĄƉďңŽĜңŵĂŶƚŽăŶǀăƐĉŶƐſĐĐŚƵĜĄŽ͘ĄĐ ĐĄŶďҾLJƚұ͕ůăŵĐƀŶŐƚĄĐŚҾƚҺŶŐ͕ĐĄĐŶŚąŶǀŝġŶůăŵĐƀŶŐƚĄĐĐŚƵLJҳŶƚŚӇҿŶŐ͕ ƉŚңŝӈŶŐĚӅŶŐĐĄĐďŝҵŶƉŚĄƉĐҤƉĐӈƵǀăďңŽǀҵƐŝŶŚŵҢŶŐĐӆĂŶҢŶŶŚąŶƚƌġŶ ĜӇӁŶŐǀҨŶĐŚƵLJҳŶ͘

Ϯ͘Ϯ͘ƀŶŐƚĄĐĐŚƵLJҳŶƚŚӇҿŶŐƉŚңŝŬұƚŚӄƉĐŚҭƚĐŚҰǀӀŝĐƀŶŐƚĄĐĐŚҸŶůҸĐ͕ƉŚąŶ ůŽҢŝŶҢŶŶŚąŶ͗

WŚңŝӇƵƚŝġŶǀҨŶĐŚƵLJҳŶĐĄĐŶҢŶŶŚąŶĐſĐŚңLJŵĄƵƚƌŽŶŐ͕ĐſŐĂƌƀӂĐĄĐĐŚŝ͕ ǀұƚƚŚӇҿŶŐƚŚҤƵďӅŶŐ͕ƚƌăŶŬŚşŵăŶŐƉŚҼŝŵӂŚŽҭĐŬŝҳƵǀĂŶ͕ǀұƚƚŚӇҿŶŐǀƶŶŐ ĜҥƵ͕ĐҼ͕ĐſƌҺŝůŽҢŶŚƀŚҤƉ͕ƐҺĐŶҭŶŐ͕ǀұƚƚŚӇҿŶŐďҷŶŚŝҴŵĐŚҤƚĜҾĐŚŽĄŚҸĐ͕ ĐŚҤƚƉŚſŶŐdžҢ͘

<ŚƀŶŐǀҨŶĐŚƵLJҳŶĐĄĐŶҢŶŶŚąŶĜĂŶŐŚҤƉŚҺŝ͕ĐĄĐŶҢŶŶŚąŶŶăLJƉŚңŝĜӇӄĐĐҤƉ ĐӈƵǀădžӊƚƌşĐŚŽҼŶĜҷŶŚƌһŝŵӀŝ ĐŚƵLJҳŶǀҲƚƵLJұŶƐĂƵ͘WŚңŝůӌĂĐŚҸŶŶŚӋŶŐ ƉŚӇҿŶŐƚŝҵŶĐŚƵLJҳŶƚŚӇҿŶŐƚŚşĐŚŚӄƉǀӀŝƚŞŶŚƚƌҢŶŐďҵŶŚůljĐĄĐƚҼŶƚŚӇҿŶŐ͘ sӀŝĐĄĐŶҢŶŶŚąŶŶŚҮĐſƚŚҳŬŚҹŝĜӇӄĐƐĂƵĐӈƵĐŚӋĂƚƌŽŶŐŵҾƚƚŚӁŝŐŝĂŶŶŐҩŶ ƚŚŞĜӇĂǀҲĐĄĐƚƌҢŵdžĄĜҷĂƉŚӇҿŶŐ͕ĐĄĐĜҿŶǀҷƋƵąŶLJŚŽҭĐĜŝҲƵƚƌҷŶŐŽҢŝƚƌƷ͘ ϯ͘ŚƵLJҳŶŶŐӇӁŝďҷƚŚӇҿŶŐďҪŶŐƚĂLJŬŚƀŶŐ͘

ӇӄĐƚŝұŶŚăŶŚӂŶŐŽăŝƚƌҨŶĜҷĂŚŽҭĐӂŶҿŝdžңLJƌĂƚĂŝŶҢŶĜҳĜӇĂŶŐӇӁŝďҷ ƚŚӇҿŶŐƌĂŶŐŽăŝŬŚƵǀӌĐŶŐƵLJŚŝҳŵĜұŶŵҾƚŶҿŝƚӇҿŶŐĜҺŝĂŶƚŽăŶƚƌŽŶŐŬŚŝ ĐŚӁĜӄŝĐŚƵLJҳŶǀҲƉŚşĂƐĂƵ͘

sҨŶĐŚƵLJҳŶŶŐӇӁŝďҷƚŚӇҿŶŐďҪŶŐƚĂLJŬŚƀŶŐƚŚӇӁŶŐĚŽŵҾƚŶŐӇӁŝůăŵ͕ǀŞǀҨLJ ƚŚӇӁŶŐŬŚƀŶŐƚŚҳĐŚƵLJҳŶĜӇӄĐĜŝdžĂ͘

ϯ͘ϭ͘ҭƚŶŐӇӁŝďҷƚŚӇҿŶŐůġŶĜƶŝǀăůġŶŐŚŝġŶŐ;ŚŞŶŚϭͿ͗

- ҭƚŶŐӇӁŝďҷƚŚӇҿŶŐŶҪŵŶŐŚŝġŶŐǀҲďġŶŬŚƀŶŐďҷƚŚӇҿŶŐ͘

- zƚĄŶҪŵŶŐŚŝġŶŐƐĂƵůӇŶŐŶŐӇӁŝďҷƚŚӇҿŶŐ͕ ŵҩƚŶŚŞŶǀҲĐƶŶŐŵҾƚŚӇӀŶŐǀӀŝ ŶŐӇӁŝďҷƚŚӇҿŶŐ͕ĐŚąŶĚӇӀŝĐŽ͕ĐŚąŶƚƌġŶĚƵҽŝƚŚҫŶŐ͘

Hình 1

- ҭƚŶŐӇӁŝďҷƚŚӇҿŶŐŶҪŵƚƌġŶĐŚąŶĐŽĐӆĂLJƚĄ͕ŵăŽĐŚҨƵĐӆĂŶŐӇӁŝďҷ

ƚŚӇҿŶŐĜҭƚƐĄƚǀăŽŵҭƚƚƌŽŶŐĜƶŝĐӆĂLJƚĄ͕ƚĂLJƚƌġŶĐӆĂLJƚĄƀŵŶŐĂŶŐŶĄĐŚ ŶŐӇӁŝďҷƚŚӇҿŶŐ͕ŬĠŽƐĄƚǀăŽŶŐӇӁŝŵŞŶŚ͘

- >ġŶŐŚŝġŶŐůұƚĜӇĂŶŐӇӁŝďҷƚŚӇҿŶŐǀҲƉŚşĂƐĂƵ͘<ŚŝůġŶŐŚŝġŶŐ͕ĐŚąŶĐŽĜӃ ŶŐӇӁŝďҷƚŚӇҿŶŐŬŚƀŶŐĐӊĜҾŶŐŵăƉŚңŝŶŚҤĐƚŚĞŽƚӉŶŐďӇӀĐĐӆĂƚĂLJĚӇӀŝǀă ĜҢƉĐӆĂĐŚąŶƚƌġŶĜҳĚŝĐŚƵLJҳŶ͘

ϯ͘Ϯ͘žĐƁŶŐŶŐӇӁŝďҷƚŚӇҿŶŐƚƌġŶůӇŶŐ(hình2):

- ҭƚŶŐӇӁŝďҷƚŚӇҿŶŐŶҪŵŶŐŚŝġŶŐǀҲŵҾƚďġŶ͘

- zƚĄďžƚŝұƉ ĐҨŶŶŐӇӁŝďҷƚŚӇҿŶŐ͕ĄƉƐĄƚůӇŶŐŵŞŶŚǀăŽŶŐӌĐŶŐӇӁŝďҷ

ƚŚӇҿŶŐ͘

- ŚŽŶŐӇӁŝďҷƚŚӇҿŶŐƀŵǀăŽĐҼLJƚĄ͕LJƚĄĚƶŶŐŚĂŝĐŚąŶƋƵҭƉǀăŽĐŚąŶŶŐӇӁŝ ďҷƚŚӇҿŶŐ͘

- zƚĄĐŚƵLJҳŶƚӉƚӇƚŚұŶҪŵŶŐŚŝġŶŐƐĂŶŐŶҪŵƐҤƉ͕ŬŚŝĐŚƵLJҳŶĚƶŶŐƚĂLJƚƷŵ ǀăŽƋƵҥŶŶŐӇӁŝďҷƚŚӇҿŶŐǀăĚƶŶŐϮĐŚąŶĜҳŬĠŽϮĐŚąŶŶŐӇӁŝďҷƚŚӇҿŶŐůġŶ͕ ƌһŝďžƚŚĞŽƚӇƚŚұďžƚŚҤƉ͘<ŚŝďžĐŚҶĚƶŶŐŵҾƚĐŚąŶĜҢƉĜҤƚĜҳĐŚŽŶŐӇӁŝďҷ ƚŚӇҿŶŐŬŚҹŝďҷůҩĐůӇŚŽҭĐůұƚĜҥƵϮďăŶĐŚąŶǀăϮƚĂLJ͘

ϰ͘ŚƵLJҳŶŶŐӇӁŝďҷƚŚӇҿŶŐďҪŶŐĐĄŶŐ͘

ąLJůăĐĄĐŚǀҨŶĐŚƵLJҳŶƉŚҼďŝұŶŶŚҤƚӂŚŽңƚƵLJұŶĐƹŶŐŶŚӇӂŶҿŝdžңLJƌĂƚĂŝ ŶҢŶƚӉƚƌӇӀĐĜұŶŶĂLJ͘

- ĄŶŐŶŐӇӁŝďҷƚŚӇҿŶŐ͗

DҽŝƚңŝƚŚӇҿŶŐĐſŵҾƚĐŚŝұĐŐҨLJĐŚҺŶŐĐĂŽ ŬŚŽңŶŐϭ͕ϰϬŵ- ϭ͕ϱϬŵ͕ĐſĐŚҢĐӂ ĜҥƵƚƌġŶĜҳĜӃĜžŶĐĄŶŐŬŚŝĐҥŶŶŐŚҶŚŽҭĐĜҼŝǀĂŝ͘

- <ŚŝĐĄŶŐƚƌġŶĜӇӁŶŐďҪŶŐ͗ϮƚңŝƚŚӇҿŶŐĐҥŶƚƌĄŶŚĜŝĜҲƵďӇӀĐĜҳĐĄŶŐŬŚҹŝ ůҩĐůӇ͘

- <ŚŝĐĄŶŐůġŶĜӇӁŶŐĚҺĐ͗ŐŝӋĐŚŽĜžŶĐĄŶŐƚŚĉŶŐďҪŶŐŚŽҭĐĜҥƵŶŐӇӁŝďҷ ƚŚӇҿŶŐŚҿŝĐĂŽŚҿŶĐŚąŶ͘

ƚƌӇӁŶŐŚӄƉŵҼŶŚҹ͕ŵҼŶƀŶŐ͕ĐŚşĐŚƌҢĐŚĄƉdžĞ͘͘͘

- 'ąLJůҢŶŚ͗

- WŚƵŶĐĄĐůŽҢŝƚŚƵҺĐŵġďҺĐŚҿŝŶŚĂŶŚůġŶŵҭƚĚĂ;ŬġůĞŶͿ͗ĚƶŶŐƚƌŽŶŐĐŚşĐŚ ƚŚĄŽŵӆĄƉdžĞ͕ŵӅŶ͕ŶŚҸƚ͘͘͘

- >ăŵůҢŶŚďҪŶŐŶӇӀĐĜĄ͗ůăƉŚӇҿŶŐƉŚĄƉĐҼĜŝҳŶ͕ƐӊĚӅŶŐƚƌŽŶŐĐĄĐƚƌӇӁŶŐ ŚӄƉĐҩƚĜŽҢŶĐŚŝӂďҵŶŚŶŚąŶĐſƚŚҳƚƌҢŶŐƌҤƚŬĠŵ͕ŬŚƀŶŐƐӊĚӅŶŐĜӇӄĐĐĄĐ ƉŚӇҿŶŐƉŚĄƉǀƀĐңŵŬŚĄĐ͘

ĄĐŚƚŚӌĐŚŝҵŶ͗ĜҭƚŵҾƚŐĂƌƀŬŚŽңŶŐϭϬĐŵƉŚşĂƚƌġŶǀҷƚƌşƐҰŵҼƐĂƵŬŚŝĜĆ ĐŚӇӁŵĜĄǀƶŶŐĜſƌһŝŶŐąŵĐŚŝƚƌŽŶŐďҳŶӇӀĐĜĄ͗

Chi trên 90 phút

͘ŚŝĚӇӀŝϭϱϬƉŚƷƚ͘

2.2 Gây tê vùng (regional anesthesia):

'ąLJƚġǀƶŶŐůăƉŚӇҿŶŐƉŚĄƉĚƶŶŐƚŚƵҺĐƚġƚĄĐĚӅŶŐƚƌӌĐƚŝұƉůġŶĐĄĐĜӇӁŶŐ ĚҧŶƚƌƵLJҲŶƚŚҥŶŬŝŶŚ;ƚŚąŶ͕ĜĄŵƌҺŝ͕ƌҴƚŚҥŶŬŝŶŚͿƋƵĂĜſůăŵŵҤƚĐңŵŐŝĄĐӂ ŵҾƚǀƶŶŐƚӇҿŶŐӈŶŐĚŽƚŚҥŶŬŝŶŚĜſĐŚŝƉŚҺŝ͘

- ^ӄŝƚŚӌĐǀҨƚ͘

- ^ӄŝĐңŵŐŝĄĐ;ŶſŶŐ͕ůҢŶŚ͕ĜĂƵ͕džƷĐŐŝĄĐͿ͘

- ^ӌŚһŝƉŚӅĐĐӆĂĐĄĐƐӄŝƐҰƚŚĞŽĐŚŝҲƵŶŐӇӄĐůҢŝ͘

- ĄĐƚŚƵҺĐƚġĐŚӆLJұƵďҷƉŚąŶŚӆLJӂŐĂŶ͕ŵҾƚƉŚҥŶӂƚҼĐŚӈĐďӂŝĐĄĐŵĞŶĜҭĐ ŚŝҵƵĐŚŽƚӉŶŐůŽҢŝƚŚƵҺĐ͘^ңŶƉŚҦŵƉŚąŶŚӆLJĐӆĂƚŚƵҺĐĜăŽƚŚңŝƋƵĂƚŚҨŶ͕ ƉŚҼŝ͕ĐŚҶŵҾƚƚӏůҵƌҤƚŶŚҹƚŚңŝŶŐƵLJġŶĐŚҤƚ;ŬŚŽңŶŐϱйͿ͘

ϰ͘ĄĐƚŚƵҺĐƚġ͘

4.1 Phân ůŽҢŝ͗

ĄĐƚŚƵҺĐĐŽŵҢĐŚƉŚҺŝŚӄƉǀӀŝƚŚƵҺĐƚġĐſƚĄĐĚӅŶŐĐŽŵҢĐŚůăŵŐŝңŵƚҺĐĜҾ ŬŚƵұĐŚƚĄŶ͕ƋƵĂĜſůăŵƚĉŶŐƚŚӁŝŐŝĂŶƚĄĐĚӅŶŐĐӆĂƚŚƵҺĐ͘EŐŽăŝƌĂ͕ŬŚŝƐӊ ĚӅŶŐĜҳŐąLJƚġƚҢŝĐŚҽŶſĐžŶĐſƚĄĐĚӅŶŐŚҢŶĐŚұĐŚңLJŵĄƵǀăƚĂŝďŝұŶŶŐҾ ĜҾĐ͘

- EŽǀŽĐĂŝŶŬŚƀŶŐĐſƚĄĐĚӅŶŐŐąLJƚġďҲŵҭƚ͘

- ,ŝҵŶƚҢŝŶŽǀŽĐĂŝŶĐŚҶĜӇӄĐĚƶŶŐĜҳŐąLJƚġƚҢŝĐŚҽĐŚŽŶŚӋŶŐĐĂŵҼŶŚҹ͕ƚŚӁŝ ŐŝĂŶŶŐҩŶ͘EһŶŐĜҾƐӊĚӅŶŐƚƌŽŶŐŐąLJƚġƚҢŝĐŚҽϬ͕ϱ- 1%

4.2.3 Chloroprocain (nescain):

- ҤƵƚƌƷĐŚŽĄŚҸĐƚӇҿŶŐƚӌŶŽǀŽĐĂŝŶ͘

- dŚӁŝŐŝĂŶƚŝҲŵƚăŶŐŶŐҩŶ͕ƚŚӁŝŐŝĂŶƚĄĐĚӅŶŐŶŐҩŶ;ϯϬ- ϰϱƉŚƷƚŬŚŝĚƶŶŐĜҿŶ ƚŚƵҥŶ͖ϲϬ- 75 phút khi ƉŚĂǀӀŝƚŚƵҺĐĐŽŵҢĐŚͿ͘

- dŚƵҺĐĐſĜҾĐƚşŶŚƌҤƚƚŚҤƉĐŚҶďҪŶŐŵҾƚŶӊĂŶŽǀŽĐĂŝŶ͘EһŶŐĜҾƐӊĚӅŶŐϭ- 3%

- >ŝҲƵƚҺŝĜĂϲϬϬ- ϴϬϬŵŐ;ƉŚĂĐŽŵҢĐŚͿ͘

4.2.4 Tetracain (pontocain):

- dĞƚƌĂĐĂŝŶĐſƚĄĐĚӅŶŐŐąLJƚġŵҢŶŚŚҿŶůŝĚŽĐĂŝŶϰůҥŶ͘

- ſƚŚҳƐӊĚӅŶŐĜҳƚġƚҢŝĐŚҽ;ĐӅĐďҾƚġƚŚҤŵͿ͕ƚġƚŚąŶƚŚҥŶŬŝŶŚ͕ƚġED͕ ŬŚŽĂŶŐĐƶŶŐ͕ƚġƚӆLJƐҺŶŐ͘dŚӁŝŐŝĂŶƚŝҲŵƚăŶŐŶŐҩŶ͕ĐŚҤƚůӇӄŶŐŐŝңŵĜĂƵƚҺƚ͕ ӈĐĐŚұǀҨŶĜҾŶŐƚҺƚ͘dŚӁŝŐŝĂŶƚĄĐĚӅŶŐϮ- ϯŐŝӁ;ŶұƵĚƶŶŐĜҿŶƚŚƵҥŶͿ͕ϰ- 6 ŐŝӁ;ŶұƵƉŚĂƚŚƵҺĐĐŽŵҢĐŚͿ͘

- >ŝҲƵƚҺŝĜĂϭϬϬŵŐ;ĜҿŶƚŚƵҥŶͿ͕ϭϱϬŵŐ;ƉŚĂǀӀŝƚŚƵҺĐĐŽŵҢĐŚͿ͘

4.2.5 Lidocain (xylocain, lignocain):

- >ăƚŚƵҺĐƚġŶŚſŵĂŵŝĚĜҥƵƚŝġŶĜӇӄĐƐӊĚӅŶŐƚƌŽŶŐůąŵƐăŶŐ;ϭϵϰϴͿ͘

- >ăƚŚƵҺĐƚġĜӇӄĐӇĂĐŚƵҾŶŐǀŞƚŚӁŝŐŝĂŶƚŝҲŵƚăŶŐŶŐҩŶ͕ƚŚӁŝŐŝĂŶƚĄĐĚӅŶŐ trung bình (60 - 90 phút khi ĚƶŶŐĜҿŶƚŚƵҥŶ͖ϵϬ- ϭϮϬƉŚƷƚŬŚŝƉŚĂǀӀŝƚŚƵҺĐ ĐŽŵҢĐŚͿ͕ĜҾĐƚşŶŚŬŚƀŶŐĐĂŽ;ŐҤƉĜƀŝŶŽǀŽĐĂŝŶͿ͘ſƚŚҳƐӊĚӅŶŐĜҳŐąLJƚġƚҢŝ ĐŚҽ;ďҲŵҭƚ͕ƚġƚŚҤŵͿŐąLJƚġƚŚąŶƚŚҥŶŬŝŶŚ͕ŐąLJƚġĜĄŵƌҺŝĐĄŶŚƚĂLJ͕ŐąLJƚġ ŶŐŽăŝŵăŶŐĐӈŶŐ͕ŐąLJƚġƚӆLJƐҺŶŐ͕ŐąLJƚġƚšŶŚŵҢĐŚ͘

- >ŝҲƵƚҺŝĜĂĜҿŶƚŚƵҥŶ͗ϰŵŐͬŬŐ͘

4.2.6 Mepivacain (carbocais):

- dŝҲŵůӌĐŐąLJƚġǀăĜҾĐƚşŶŚŶŚӇůŝĚŽĐĂŝŶ͘

- dŚӁŝŐŝĂŶƚŝҲŵƚăŶŐŶŐҩŶ͕ƚŚӁŝŐŝĂŶƚĄĐĚӅŶŐƚƌƵŶŐďŞŶŚ͕ŬŚƀŶŐĐſƚşŶŚĐŚҤƚƚġ ďҲŵҭƚ͘

- ^ӊĚӅŶŐĜҳŐąLJƚġƚҢŝĐŚҽ͕ƚġƚšŶŚŵҢĐŚ͕ƚġƚŚąŶƚŚҥŶŬŝŶŚ͕ƚġĜĄŵƌҺŝƚŚҥŶ ŬŝŶŚĐĄŶŚƚĂLJ͕ƚġŶŐŽăŝŵăŶŐĐӈŶŐ͕ƚġƚӆLJƐҺŶŐ͘

4.2.7 Prilocain (citanest):

- şƚĜҾĐŚҿŶůŝĚŽĐĂŝŶ͕ƚĄĐĚӅŶŐƚӇҿŶŐƚӌůŝĚŽĐĂŝŶ͘

- ^ŽǀӀŝůŝĚŽĐĂŝŶ͕ƉƌŝůŽĐĂŝŶşƚŐąLJŐŝĆŶŵҢĐŚ͘dŚӁŝŐŝĂŶƚĄĐĚӅŶŐĐӆĂƉƌŝůŽĐĂŝŶ ŬŚƀŶŐĐſĂĚƌĞŶĂůŝŶƚӇҿŶŐƚӌƚŚӁŝŐŝĂŶƚĄĐĚӅŶŐĐӆĂůŝĚŽĐĂŝŶĐſƉŚĂĂĚƌĞŶĂůŝŶ͘ sŞƚŚұŶŚӋŶŐďҵŶŚŶŚąŶĐſĐŚҺŶŐĐŚҶĜҷŶŚĚƶŶŐĂĚƌĞŶĂůŝŶƚŚŞĚƶŶŐƉƌŝůŽĐĂŝŶ͘

- WƌŝůŽĐĂŝŶůăƚŚƵҺĐƚġşƚĜҾĐŶŚҤƚƚƌŽŶŐŶŚſŵĂŵŝĚŶġŶĜӇӄĐӇĂĐŚƵҾŶŐƚƌŽŶŐ

ŐąLJƚġƚšŶŚŵҢĐŚ͘>ŝҲƵĐĂŽĐſƚŚҳŐąLJŵĞƚŚĞŵŽŐůŽďŝŶ ŵĄƵĚŽĜſŬŚƀŶŐŶġŶ ĚƶŶŐƚƌŽŶŐǀƀĐңŵŵҼůҤLJƚŚĂŝ͘

- ſƚŚҳƐӊĚӅŶŐĜҳŐąLJƚġƚҢŝĐŚҽ͕ƚġƚŚąŶƚŚҥŶŬŝŶŚ͕ƚġĜĄŵƌҺŝƚŚҥŶŬŝŶŚĐĄŶŚ ƚĂLJ͕ƚġED͕ƚġƚӆLJƐҺŶŐ͘

- >ŝҲƵƚҺŝĜĂ͗Ϯ- ϯŵŐͬŬŐ;ƌŝġŶŐƚġƚӆLJƐҺŶŐ͗Ϭ͕Ϯ- 0,3mg/kg)

4.2.9 Etidocain (duranest):

- dŚӁŝŐŝĂŶƚŝҲŵƚăŶŐŶŐҩŶ͕ƚŚӁŝŐŝĂŶƚĄĐĚӅŶŐƚӇҿŶŐƚӌŵĂƌĐĂŝŶ͕ӈĐĐŚұĐңŵ ŐŝĄĐ͕ǀҨŶĜҾŶŐƚҺƚ͘

- ҵŶŚŶŚąŶŬŚƀŶŐĜһŶŐljŐąLJƚġ͘

- WŚңŶӈŶŐǀӀŝƚŚƵҺĐƚġ͘

- EŚŝҴŵƚƌƶŶŐǀƶŶŐŐąLJƚġ͘

- ҵŶŚŶŚąŶďҷďҵŶŚƚąŵ- ƚŚҥŶŬŝŶŚ͘

ƋƵңŶ͘͘͘Ϳ͘

- dƌŝҵƵĐŚӈŶŐŶŚŝҴŵĜҾĐďŝҳƵŚŝҵŶƌƁƚƌġŶŚҵƚŚҥŶŬŝŶŚƚƌƵŶŐӇҿŶŐǀăƚŝŵ ŵҢĐŚ͗

- dŚҥŶŬŝŶŚ͗ďҵŶŚŶŚąŶĚĆLJĚӅĂ͕ƌҺŝůŽҢŶƚąŵƚŚҥŶ͕ůŽƐӄ͕ďƵһŶŶƀŶ͕ŶƀŶ, co ŐŝҨƚ͘͘͘͘ĚҥŶĚҥŶĚҧŶĜұŶŚƀŶŵġ͘

- dƵҥŶŚŽăŶ͗ĚĂƚĄŝŶŚӄƚ͕ŵҢĐŚŶŚĂŶŚ͕ŚƵLJұƚĄƉƚĉŶŐ͕ƐĂƵŵҾƚƚŚӁŝŐŝĂŶŶŐҩŶ ŵҢĐŚĐŚҨŵ͕ŚƵLJұƚĄƉŐŝңŵĚҧŶƚӀŝƚƌӅLJŵҢĐŚǀăŶŐӉŶŐƚŝŵ͘

- ,ƀŚҤƉ͗ďҵŶŚŶŚąŶĐſĐңŵŐŝĄĐŬŚſƚŚӂ͕ƚŚӂŶŚĂŶŚŶƀŶŐǀăĐſƚŚҳŶŐӉŶŐƚŚӂ hoàn toàn

- yӊƚƌşĐҤƉĐӈƵ͗

- EŐӉŶŐƚŝġŵƚŚƵҺĐ͘

- ŚŽƚŚӂŽdžLJ͕ƚƵLjŵӈĐĜҾĐſƚŚҳŚƀŚҤƉǀŝҵŶƚƌӄƋƵĂŵҭƚŶҢŚŽҭĐŚƀŚҤƉĜŝҲƵ ŬŚŝҳŶƋƵĂҺŶŐŶҾŝŬŚşƋƵңŶ͘

- ŚƵҦŶďҷďҵŶŚŶŚąŶ͗ďҵŶŚŶŚąŶŶŚҷŶĉŶƚƌӇӀĐϲŐŝӁ͘

T ŝġŵƚŚƵҺĐƚŝҲŶŵġ͗ůăŵĐŚŽďҵŶŚŶŚąŶƚƌҤŶƚšŶŚĜӃůŽƐӄ͘

- ҵŶŚŶŚąŶŶҪŵƚƌŽŶŐůƷĐŐąLJƚġ͘

- ƵŶŐĚҷĐŚĜҨŵĜҭĐƚŚӇӁŶŐĜҾĐŚҿŶĚƵŶŐĚҷĐŚůŽĆŶŐ͕ƚҺĐĜҾƚŝġŵĐăŶŐŶŚĂŶŚ ĐăŶŐĚҴŐąLJĜҾĐ͘EŚӋŶŐƚĂŝďŝұŶĜƀŝŬŚŝĚҧŶƚӀŝƚӊǀŽŶŐůăŵҾƚůӇӄŶŐůӀŶƚŚƵҺĐ

tê vào nhan ŚƚƌŽŶŐŵĄƵ͘ӂŝǀҨLJƉŚңŝƌҤƚƚŚҨŶƚƌҸŶŐŬŚŝŐąLJƚġĜӇӁŶŐƚŝұƚ ŶŝҵƵ͕ŵƹŝ͕ŚҸŶŐ͘

- sŝġŵƚҤLJ͗ƐҮŽdžҿĐӈŶŐ͕ŶŐĉŶĐңŶƚŚƵҺĐƚġŬŚƵұĐŚƚĄŶ͕ĚŽĜſƚĄĐĚӅŶŐĐӆĂ ƚŚƵҺĐƚġďҷŚҢŶĐŚұ͘

- dƌӇӀĐŬŚŝƚŝұŶŚăŶŚƉŚҧƵƚŚƵҨƚ͗ƉŚңŝŬŝҳŵƚƌĂŚŝҵƵůӌĐĐӆĂƚŚƵҺĐƚġ͕ƉŚңŝĜӄŝ

m ҾƚƚŚӁŝŐŝĂŶƚӉϱ- ϭϱƉŚƷƚƚġŵӀŝĐſŚŝҵƵůӌĐ͘

- ŚƵҦŶďҷƐҬŶƐăŶŐĐĄĐƉŚӇҿŶŐƚŝҵŶĐҤƉĐӈƵ͗ƀdžLJ͕ŵĄLJŚƀŚҤƉŶŚąŶƚҢŽ͕ҺŶŐ ŶҾŝŬŚşƋƵңŶ͘

dŝұŶŚăŶŚĐĄĐƚŚӊŶŐŚŝҵŵ;ƚĞƐƚͿďңŽĜңŵĂŶƚŽăŶ;ŚƷƚŬŝҳŵƚƌĂdžĞŵĐſŵĄƵ ŬŚƀŶŐ͘͘͘ͿǀăĜңŵďңŽǀƀŬŚƵҦŶƚƵLJҵƚĜҺŝ͘

5 GÂY MÊ

ϭ͘ҷŶŚŶŐŚšĂ͘

'ąLJŵġůăƉŚӇҿŶŐƉŚĄƉǀƀĐңŵŶŚҪŵŵӅĐĜşĐŚůăŵŵҤƚƚҢŵƚŚӁŝljƚŚӈĐĐңŵ ŐŝĄĐ͕ĐĄĐƉŚңŶdžҢ͕ďҪŶŐĐĄĐƚŚƵҺĐŵġƚĄĐĜҾŶŐƚƌġŶƚŚҥŶŬŝŶŚƚƌƵŶŐӇҿŶŐ͘ ,ŽҭĐŶſŝŵҾƚĐĄĐŚŬŚĄĐůă͗

'ąLJŵġůăŵҾƚƐӌŶŚŝҴŵĜҾĐĐſĜҷŶŚůӇӄŶŐ͕ĐſŬŝҳŵƐŽĄƚ͕ŵҾƚƐӌŶŚŝҴŵĜҾĐ ĚҥŶĚҥŶƚŚƵҺĐŵġĚҧŶĜұŶŵҤƚĐңŵŐŝĄĐƚҢŵƚŚӁŝ͕ŵҤƚljƚŚӈĐǀăŐŝĆŶĐҿ͕Śһŝ ƉŚӅĐĜӇӄĐǀăŬŚƀŶŐĜҳůҢŝĚŝĐŚӈŶŐ͘

Ϯ͘ҿĐŚұ͘

ҿĐŚұŵҾƚŐŝҤĐŶŐӆ;ŐŝҤĐŵġͿŬŚƀŶŐĜҿŶŐŝңŶ͘ZҤƚŶŚŝҲƵƚŚƵLJұƚ͕ƌҤƚŶŚŝҲƵ ƉŚӇҿŶŐĄŶĜӇĂƌĂĜҳŐŝңŝƚŚşĐŚĐŚŽǀҤŶĜҲŶăLJŶŚӇŶŐĐŚӇĂĐſĐĄĐŚŐŝңŝƚŚşĐŚ Ŷ㎌ŽăŶƚŽăŶƚŚŽңĜĄŶŐ͘DҭƚŬŚĄĐ͕ďңŶĐŚҤƚĐӆĂŐŝҤĐŶŐӆĐſůҰĐƹŶŐƚŚĂLJĜҼŝ şƚŶŚŝҲƵƚƶLJƚŚĞŽĐŚӈĐŶĉŶŐĐӆĂĐĄĐƚŚƵҺĐŐąLJŶŐӆ͘dŚӌĐƐӌŶұƵŚŝҳƵĜӇӄĐĐҿ ĐŚұŐŝҤĐŶŐӆƚŚŞŶŐӇӁŝƚĂƐҰŐŝңŝƚŚşĐŚĜӇӄĐŶŚӋŶŐƚĄĐĚӅŶŐŬŚĄĐŶŚĂƵĐӆĂĐĄĐ

th ƵҺĐŐąLJŶŐӆӂĐĄĐŵӈĐĜҾ͗

- dŽăŶďҾĐҿƚŚҳ͘

- ,ҵƚŚҺŶŐƚŚҥŶŬŝŶŚ͕ŬŚŝĐŽŝŚҵƚŚҺŶŐŶăLJŚŽҢƚĜҾŶŐŶŚӇŵҾƚƚŚӌĐƚŚҳdžĄĐ ĜҷŶŚ͘

- ^ĂƵĐƶŶŐӂŵӈĐĜҾŶŚҹŶŚҤƚůăƚұďăŽ͕ƚŚҨŵĐŚşӂĐңĐĄĐƚŚăŶŚƉŚҥŶĐҤƵƚҢŽ ĐӆĂƚұďăŽ͘

Ϯ͘ϭ͘ӂŵӈĐƚұďăŽ͗

Ϯ͘ϭ͘ϭ͘^ӌƚŚĂLJĜҼŝǀҲůlj - ŚŽĄŚҸĐ͗

ůĂƵĚĞĞƌŶŽƌĚĜĆŶŚҨŶƚŚҤLJӂƚҤƚĐңĐĄĐƚұďăŽƚŚӌĐǀҨƚĐƹŶŐŶŚӇĜҾŶŐǀҨƚ ĜҲƵĐſƐӌƚŚĂLJĜҼŝǀҲŚŞŶŚĚĄŶŐĐӆĂĜҢŝƚŚӌĐďăŽŶŐĂLJŬŚŝĐŚƷŶŐĐŚҷƵƚĄĐĚӅŶŐ ĐӆĂƚŚƵҺĐŐąLJŵġ͘ŝҲƵŶăLJĚҧŶĜұŶƐӌŚҢŶĐŚұƚŽăŶďҾŚŽҢƚĜҾŶŐĐӆĂŶŐƵLJġŶ ƐŝŶŚĐŚҤƚĚŝҴŶƌĂƚŚĞŽďңŶĐŚҤƚǀ㌪ŶŚƚŚӈĐƚŚҳŚŝҵŶĐӆĂŶſ͘

ӇӀŝŬşŶŚŚŝҳŶǀŝ͕ŶŐӇӁŝƚĂĐſƚŚҳŶŚŞŶƚŚҤLJďҪŶŐŵҩƚƚŚӇӁŶŐƐӌďŝұŶĜҼŝĐŚҤƚ ŶăLJƚӇҿŶŐĜӇҿŶŐǀӀŝƐӌƚŚĂLJĜҼŝĚҢŶŐŬĞŽƚƌŽŶŐůžŶŐƚұďăŽ͘

^ӌĜƀŶŐǀſŶƚŚăŶŚƉŚҥŶůŝƉŝĚĐӆĂŶŐƵLJġŶƐŝŶŚĐŚҤƚƚұďăŽŶŚӇӁŶŐĐŚҽĐŚŽ Ɛӌ ĜƀŶŐǀſŶĐӆĂƚŚăŶŚƉŚҥŶƉƌŽƚŝĚĚӇӀŝƚĄĐĚӅŶŐĐӆĂƚŚƵҺĐŐąLJŵġǀăĜŝҲƵŶăLJ ĚŝҴŶƌĂŵҾƚĐĄĐŚŬŚĄƉŚҼďŝұŶ͘dƵLJŶŚŝġŶƐӌĜƀŶŐǀſŶƚŚăŶŚƉŚҥŶƉƌŽƚŝĚŶăLJ ůҢŝƚƌӂǀҲƚƌҢŶŐƚŚĄŝďĂŶĜҥƵƚƌӇӀĐĐĄĐƚŚăŶŚƉŚҥŶůŝƉŝĚ͘

dƌŽŶŐƚŚӌĐƚұ͕ƐӌƚŚĂLJĜҼŝŶăLJĚҧŶĜұŶŚŝҵŶƚӇӄŶŐƚĉŶŐƚŚăŶŚƉŚҥŶůŝƉŝĚŵă ŚҨƵƋƵңůăůăŵƚĉŶŐĜҾŶŚӀƚĐӆĂŚƵLJұƚƚӇҿŶŐ͘ƵҺŝĐƶŶŐŚŝҵŶƚӇӄŶŐŶăLJůăŵ ĐңŶƚƌӂŚŽҢƚĜҾŶŐĐӆĂĐĄĐŝŽŶƚƌŽŶŐƚұďăŽ͕ĜŝҲƵŶăLJŐŝңŝƚŚşĐŚƐӌƚŚĂLJĜҼŝŚŽҢƚ ĜҾŶŐĐӆĂƚұďăŽ͕ďҤƚŬҳĐŚӈĐŶĉŶŐĐӆĂƚұďăŽĜſůăŶŚӇƚŚұŶăŽ͘

2.1.2 ^ӌƚŚĂLJĜҼŝǀҲŚŽĄŚҸĐ͗

ġŶĐҢŶŚŶŚӋŶŐƐӌ ƚŚĂLJĜҼŝǀҲůlj- ŚŽĄŚҸĐ͕ĐžŶĐſŶŚӋŶŐƚŚĂLJĜҼŝƚŚƵҥŶƚƵlj ǀҲŵҭƚŚŽĄŚҸĐ͘EŚӋŶŐƐӌƚŚĂLJĜҼŝŶăLJŐŝңŝƚŚşĐŚŵҾƚƉŚҥŶŚŝҵŶƚӇӄŶŐŐŝңŵ ŚŽҢƚĜҾŶŐĐӆĂƚұďăŽ͕ƚƌŽŶŐĜſĐĄĐŚŝҵŶƚӇӄŶŐĐҢŶŚƚƌĂŶŚǀăĜҺŝŬŚĄŶŐŚŽĄ ŚҸĐůăůljĚŽĐӆĂǀŝҵĐŐŝңŵŚŽҭĐĐңŶƚƌӂŚŽҢƚĜҾŶŐĐӆĂŵҾƚǀăŝŚҵƚŚҺŶŐŵĞŶĐҿ ďңŶ͘

DҾƚǀşĚӅĜŝҳŶŚŞŶŚůăŚŝҵŶƚӇӄŶŐӈĐĐŚұĐĄĐŵĞŶŚĞdžŽŬŝŶĂnjĂĚŽŶŚӋŶŐƚŚƵҺĐ ŚҸďĂĐďŝƚƵƌŝĐ͕ƚӉĜſĚҧŶĜұŶǀŝҵĐŐůƵdžŝƚĐŚƵLJҳŶŚŽĄƚŚăŶŚƚƌŝŽƐĞĐŚӈŬŚƀŶŐ ƉŚңŝůăŚĞdžŽƐĞŶŚӇŬŚŝŬŚƀŶŐĚƶŶŐƚŚƵҺĐ͘

Ϯ͘ϭ͘ϯ͘^ӌӈĐĐŚұ͗

DҭĐĚƶĐſŶŚŝҲƵĐҿĐŚұƚҢŽƌĂƐӌӈĐĐŚұŶŚӇŶŐŬұƚƋƵңĜҲƵůăǀŝҵĐůăŵŐŝңŵ ƐӌƚŝġƵƚŚӅŽdžLJƚұďăŽ͘dƌŽŶŐŵҾƚƐҺƚƌӇӁŶŐŚӄƉ͕ĜŝҲƵŶăLJůăƚĄĐĚӅŶŐƉŚӅdžңLJ ƌĂƚƌŽŶŐŐąLJŵġ͕ŶŚӇŶŐƚƌŽŶŐŵҾƚƐҺƚƌӇӁŶŐŚӄƉŬŚĄĐ͕ĜąLJůҢŝůăƚĄĐĚӅŶŐƚӈĐ ƚŚŞĐӆĂƚŚƵҺĐŐąLJŵġ͘

dƵLJŶŚŝġŶ͕ƌƁƌăŶŐůăŚŝҵŶƚӇӄŶŐƚŚŝұƵŽdžLJƚұďăŽǀӀŝƚӇĐĄĐŚůăŶŐƵLJġŶŶŚąŶ ŚĂLJŚҨƵƋƵңĐӆĂŐąLJŵġĜĆůăŵƚŚĂLJĜҼŝŐŝӀŝŚҢŶƐŝŶŚůljĐӆĂĜӁŝƐҺŶŐƚұďăŽ͘

ҺŝǀӀŝďĄĐƐӎĐŚƵLJġŶŬŚŽĂ͕ŐąLJŵġĐſŶŐŚšĂůăůăŵŐŝңŵĜұŶŵӈĐƚŚҤƉŶŚҤƚ ůӇӄŶŐƚŝġƵƚŚӅŽdžLJŵăƚұďăŽĜӇӄĐĐƵŶŐĐҤƉ͘

Ϯ͘Ϯ͘DӈĐƚŽăŶďҾĐҿƚŚҳ͗

ҥŶƉŚңŝdžĄĐĜҷŶŚǀҷƚƌşƚĄĐĚӅŶŐĐŚҸŶůҸĐĐӆĂŶŚӋŶŐƚŚƵҺĐŐąLJŵġƚҢŝǀƶŶŐƚŚҳ ůӇӀŝĐӆĂƚŚąŶŶĆŽ͘

ĄĐƚŚşŶŐŚŝҵŵĜĆĐŚӈŶŐŵŝŶŚ͗ƐӌƚĄĐĜҾŶŐƋƵĂůҢŝŐŝӋĂŚăŶŚŶĆŽǀăĜһŝŶĆŽ ĜŝҲƵŚŽăƚŞŶŚƚƌҢŶŐƚŚӈĐǀăŶŐӆ͘ӇӀŝƚĄĐĚӅŶŐĐӆĂƚŚƵҺĐŐąLJŵġ͕ŚŝҵƵĜŝҵŶ ƚŚұĐŚҸŶůҸĐƚҢŝǀƶŶŐŶăLJĐƹŶŐƚŚĂLJĜҼŝƐŽǀӀŝďĂŶĜҥƵ͕ŵҭĐĚƶƚƌӇӀĐĜſŬŚƀŶŐ ĐſƐӌƚŚĂLJĜҼŝĜŝҵŶŶĆŽĜһƚҢŝǀƶŶŐǀҹŶĆŽ͘

<ұƚƋƵңůăŶŐӇӁŝƚĂĐſƚŚҳůăŵŐŝңŵŶŚӋŶŐŚŝҵŶƚӇӄŶŐďĂŶĜҥƵdžĄĐĜҷŶŚӂ ŚŽҢƚĜҾŶŐĐӆĂƚŚąŶŶĆŽǀăŚăŶŚŶĆŽƋƵĂƋƵĄƚƌŞŶŚƐŝŶŚŚŽĄǀ㌎ĄŚҸĐĜĆ ĜӇӄĐŶſŝƚӀŝӂƉŚҥŶƚƌӇӀĐ͕ĜŝҲƵŶăLJĚŝҴŶƌĂƚƌӇӀĐƚҤƚĐңĐĄĐƚĄĐĚӅŶŐĐӆĂ

ƚŚƵҺĐŐąLJŵġ͘

ϯ͘ĄĐŐŝĂŝĜŽҢŶĐӆĂŐąLJŵġ(theo Guedel)

ϯ͘ϭ͘EŐŚŝġŶĐӈƵůąŵƐăŶŐ͗

ĆƚӉůąƵ͕ŐąLJŵġĜһŶŐŶŐŚšĂǀӀŝǀŝҵĐƚҢŽƌĂŐŝҤĐŶŐӆŵŽŶŐŵƵҺŶ͕ĐăŶŐŐŝҺŶŐ ŐŝҤĐŶŐӆďŞŶŚƚŚӇӁŶŐĐăŶŐƚҺƚ͘

- dƌġŶůąŵƐăŶŐŶŐŚŝġŶĐӈƵƚƌġŶŵҾƚŶŐӇӁŝƚƌӇӂŶŐƚŚăŶŚŬŚŽүŵҢŶŚǀăŐąLJ ŵġĜҿŶƚŚƵҥŶďҪŶŐĞƚŚĞƌǀăĜӇӄĐƚŚĞŽĚƁŝĚӌĂƚƌġŶĐĄĐLJұƵƚҺƐĂƵ͗

- WŚңŶdžҢ͗

EŚӋŶŐŶŐŚŝġŶĐӈƵǀҲƉŚңŶdžҢƚƌŽŶŐĐƵҾĐŐąLJŵġůăŶҲŶƚңŶŐĜҳĐſƚŚҳŚŝҳƵ ďŝұƚƐąƵŚҿŶǀҲŐąLJŵġ͘

dŝұŶƚƌŞŶŚĐӆĂŶŚӋŶŐƉŚңŶdžҢŶăLJůăƚĉŶŐĚҥŶ͕ ĐŚƷŶŐďŝұŶŵҤƚƚŚĞŽŵҾƚƚŚӈƚӌ ŶŚҤƚĜҷŶŚǀăůҢŝdžƵҤƚŚŝҵŶƚŚĞŽƚŚӈƚӌŶŐӇӄĐůҢŝŬŚŝĐƵҾĐŐąLJŵġŬұƚƚŚƷĐ͘

- ĄĐƉŚңŶdžҢŶƵҺƚ͕ŶƀŶďŝұŶŵҤƚĚҥŶĚҥŶӂĐƵҺŝŐŝĂŝĜŽҢŶƚŚӈ//;ŚŽҭĐŐŝĂŝ ĜŽҢŶŬşĐŚƚŚşĐŚͿ͘

- WŚңŶdžҢƚŚĂŶŚƋƵңŶǀăĜſŶŐŶҩƉƚŚĂŶŚŵƀŶŵҤƚĜŝŵƵҾŶŚҿŶ͕ǀăŽŐŝӋĂŐŝĂŝ ĜŽҢŶ///;ŐŝĂŝĜŽҢŶŵġƉŚҧƵƚŚƵҨƚͿ͘ŝҲƵŶăLJĚҧŶĜұŶŐŝңŵǀăƐĂƵĜſůăŵҤƚ ƉŚңŶdžҢŚŽĐӆĂƉŚұƋƵңŶ͘

ĄĐƉŚңŶdžҢƉŚұƋƵңŶǀăƚŚĂŶŚƋƵңŶůăƌҤƚƋƵĂŶƚƌҸŶŐ͕ĐŚƷŶŐƋƵLJұƚĜҷŶŚĜұŶ ƐҺůӇӄŶŐĐĄĐƚĂŝďŝұŶǀăƚĂŝŶҢŶŬŚŝŐąLJŵġŶƀŶŐ͘'ŝĂŝĜŽҢŶĂŶ ƚŽăŶĐӆĂŐąLJŵġ ƉŚҧƵƚŚƵҨƚůăƐĂƵŬŚŝĐĄĐƉŚңŶdžҢŶăLJďŝұŶŵҤƚ͘

- ĄĐƉŚңŶdžҢƚŝұƚĚҷĐŚĐŚŝƉŚҺŝŚŽҢƚĜҾŶŐĐӆĂĐĄĐƚƵLJұŶŶӇӀĐŵҩƚ͕ŵһŚƀŝ͕ ŶӇӀĐďҸƚǀăƉŚұƋƵңŶƐҰŵҤƚĜŝӂĜҥƵŐŝĂŝĜŽҢŶ///͘

- ĄĐƉŚңŶdžҢŵҩƚůăĚҴƚŚĞŽĚƁŝŶŚҤƚ͗ƉŚңŶdžҢŵŝŵҩƚŵҤƚĜŝŵƵҾŶŚҿŶ;ӂ ŵӈĐĜҾϮĐӆĂŐŝĂŝĜŽҢŶ///Ϳ͘

sŝҵĐŐŝңŝƚŚşĐŚǀҲƐӌďŝұŶŵҤƚĐӆĂĐĄĐƉŚңŶdžҢŵҩƚƚŚӇӁŶŐůăŬŚſŬŚŝƐӊĚӅŶŐ ƉŚҺŝŚӄƉƚŚƵҺĐ͕ĚŽŚŝҵŶƚӇӄŶŐŐŝĂŽƚŚŽĂƚĄĐĚӅŶŐĐӆĂĐŚƷŶŐƚƌġŶŚҵƚŚҥŶŬŝŶŚ ŐŝĂŽĐңŵǀăƉŚſŐŝĂŽĐңŵ͘

- ĄĐďŝҳƵŚŝҵŶŚƀŚҤƉ͗

ĄĐďŝҳƵŚŝҵŶŶăLJĜӇӄĐĜĄŶŚŐŝĄƚŚƀŶŐƋƵĂŶŚҷƉǀăďŝġŶĜҾĐӆĂĐӊĜҾŶŐĐҿ ƚŚҳ͘^ӌĜҲƵĜҭŶĐӆĂƚŚӂƌĂǀ㌺ƚǀăŽ͕ŬŚƀŶŐĐſƐӌŶŐҩƚƋƵĆŶŐŐŝӋĂϮƚŚŞŶăLJůă ďŝҳƵŚŝҵŶĐӆĂŐŝĂŝĜŽҢŶŵġƉŚҧƵƚŚƵҨƚ͘'ŝĂŝĜŽҢŶƚŚӂŚҽŶůŽҢŶǀӀŝŶŚҷƉƚŝŵǀă ďŝġŶĜҾŬŚƀŶŐĜҲƵdžƵҤƚŚŝҵŶƚƌӇӀĐŐŝĂŝĜŽҢŶŶăLJ͘,ŝҵŶƚӇӄŶŐƐƵLJƚŚӂ͕ĜҭĐďŝҵƚ ů㌺ƚǀăŽƌҤƚŶŐҩŶƐĂƵŵҾƚŐŝĂŝĜŽҢŶŶŐӉŶŐƚŚӂ͕ƚŚҳŚŝҵŶƐӌďҩƚĜҥƵĐӆĂŐŝĂŝ ĜŽҢŶŶŚŝҴŵĜҾĐ͘

- ŝҳƵŚŝҵŶǀҲƚƵҥŶŚŽăŶ͗

ҥƵƚŝġŶ͕ďŝҳƵŚŝҵŶĐӆĂŚҵƚƵҥŶŚŽăŶůăŶŚҷƉƚŝŵŶŚĂŶŚŬŚƀŶŐĜҲƵ͕ƐĂƵĜſĜҲƵ ŶŚӇŶŐǀҧŶĐžŶŬŚĄŶŚĂŶŚ͕ŚƵLJұƚĄƉĜҾŶŐŵҢĐŚƚƌӂǀҲďŞŶŚƚŚӇӁŶŐƐĂƵŬŚŝ ƚĉŶŐŶŚҮ͘ӂŐŝĂŝĜŽҢŶŶŚŝҴŵĜҾĐdžƵҤƚŚŝҵŶŚŝҵŶƚӇӄŶŐƐƵLJƚƵҥŶŚŽăŶǀӀŝŵҢĐŚ ŶŚĂŶŚ͕LJұƵǀăŬŚƀŶŐĜҲƵ͕ƚŚҳŚŝҵŶŵҾƚƐӌƚƌӅLJŵҢĐŚŶŐŽҢŝďŝġŶ͘DҾƚŐŝĂŝ ĜŽҢŶƚĉŶŐŚƵLJұƚĄƉŶŐҩŶdžƵҤƚŚŝҵŶ;ĐſůҰĚŽŚŝҵŶƚӇӄŶŐӈĜҸŶŐK2ͿƐĂƵĜſĚĂ ƚƌӂŶġŶŶŚӄƚŶŚҢƚ͕ůҢŶŚ͕ƚşŵƚĄŝ͕ƚƵLJǀҧŶĐžŶŶŚŞŶƚŚҤLJƚƵҥŶŚŽăŶŵĂŽŵҢĐŚ͘

- ŝҳƵŚŝҵŶŶŐŽăŝĚĂ͗

<ŚŝŐąLJŵġ͕ĚĂŚһŶŐ͕ŬŚƀǀăҤŵ͕ŶŚӇŶŐƚƌŽŶŐŐŝĂŝĜŽҢŶŶŚŝҴŵĜҾĐĚĂŶŚӄƚ ŶŚҢƚ͕ƚşŵƚĄŝŶŚҮǀăůҢŶŚ͕ŶŚҤƚůăӂĜҥƵĐŚŝ͘

ӌĂƚƌġŶŶŚӋŶŐďŝҳƵ ŚŝҵŶŶăLJ͕'ƵĞĚĞůĜĆdžĄĐĜҷŶŚϰŐŝĂŝĜŽҢŶĐӆĂŐąLJŵġ͘ ϯ͘Ϯ͘ҺŶŐŝĂŝĜŽҢŶĐӆĂŐąLJŵġ;ƚŚĞŽ'ƵĞĚĞůͿ͗

- dŚƵҺĐƚŝҲŶŵġůăƌҤƚĐҥŶƚŚŝұƚĜҳŚҢŶĐŚұŚŝҵŶƚӇӄŶŐŶăLJ͘

- ŝҳƵŚŝҵŶĚĂǀҧŶďŞŶŚƚŚӇӁŶŐ͕ĐĄĐďŝҳƵŚŝҵŶǀҲƚŝŵŵҢĐŚǀăŚƀŚҤƉĐƹŶŐŶŚӇ

ŐŝĂŝĜŽҢŶƚƌӇӀĐ͕ƚŚӂŶŚĂŶŚǀăŶŚҷƉƚŝŵŶŚĂŶŚŬŚƀŶŐĜҲƵ͘

- DҤƚljƚŚӈĐǀăĐңŵŐŝĄĐ͕ƚĉŶŐǀҨŶĜҾŶŐ͕ƚŚҳŚŝҵŶƌҪŶŐĐĄĐƚƌƵŶŐƚąŵƚӆLJďҷ ŬşĐŚƚŚşĐŚŬŚƀŶŐĜһŶŐďҾǀӀŝĐĄĐƚƌƵŶŐƚąŵӂǀҹŶĆŽ͘

- һŶŐƚӊŐŝĆŶŶŚҮ͘

- WŚңŶdžҢŐŝĄĐŵҢĐ ŵҤƚ͕ŵҢĐŚƚĉŶŐŶŚĂŶŚ͕ŚƵLJұƚĄƉĜҾŶŐŵҢĐŚŐŝңŵ͘

- DӈĐĜҾ///4 :

- ,ƀŚҤƉŶƀŶŐŬŚƀŶŐĜҲƵ;ĐĄĐĐҿůŝġŶƐӇӁŶůŝҵƚŚŽăŶƚŽăŶ͕ŚŽҢƚĜҾŶŐĐҿŚŽăŶŚ ŐŝңŵĚҥŶͿ͘

- һŶŐƚӊŐŝĆŶƚŽ͘

- DҤƚƉŚңŶdžҢǀӀŝĄŶŚƐĄŶŐ͘

- DҢĐŚƚĉŶŐŶŚĂŶŚ͕ŚƵLJұƚĄƉĜҾŶŐŵҢĐŚŐŝңŵŚҿŶ͘

dŚҤLJŶŚӋŶŐĚҤƵŚŝҵƵӂŵӈĐĜҾ///4͕ĜžŝŚҹŝƉŚңŝŶŐӉŶŐƐӊĚӅŶŐĞƚŚĞƌŶŐĂLJůҨƉ ƚӈĐ͘

ϯ͘Ϯ͘ϰ͘'ŝĂŝĜŽҢŶ/s ;'ŝĂŝĜŽҢŶŶŚŝҴŵĜҾĐƚŚƵҺĐŵġͿ͗

,ŽҢƚĜҾŶŐĐӆĂĐĄĐĐҿŚƀŚҤƉӂůһŶŐŶŐӌĐŐŝңŵǀăĚӉŶŐůҢŝ͕ĐŚҶĐžŶĐҿŚŽăŶŚ ŚŽҢƚĜҾŶŐLJұƵǀӀŝŶŚӋŶŐŬŚŽңŶŐŶŐŚҶŬŚŝŚşƚǀăŽ͕ŬĠŽĚăŝ ĚҥŶƌĂǀăŶŐҩƚƋƵĆŶŐ ƚӉŶŐŚһŝ͘

һŶŐƚӊŐŝĆŶŚұƚĐӃ͕ŵҢĐŚŶŚҹŬŚſďҩƚ͕ŬŚƀŶŐĜҲƵ͕ŚƵLJұƚĄƉĜҾŶŐŵҢĐŚŐŝңŵ ŶŚŝҲƵǀăŬҮƚ͘

dƵҥŶŚŽăŶŵĂŽŵҢĐŚŐŝңŵ͕ĚĂƚӉŵăƵŚһŶŐƐĂŶŐŶŚӄƚŶŚҢƚ͕ƚşŵƚĄŝ͕ƐĂƵĜſ ĜҾƚŶŐҾƚŶŐӉŶŐŚƀŚҤƉ͕ŶŐӉŶŐƚƵҥŶŚŽăŶ͕ďŝҳƵŚŝҵŶĚĂƚşŵƚĄŝ͕ŬŚông còn ŵҢĐŚďҮŶ͕ŵҢĐŚĐңŶŚ͕ŬŚƀŶŐŶŐŚĞĜӇӄĐŶŚҷƉƚŝŵ͕ŬŚƀŶŐĐžŶĐŚңLJŵĄƵƚҢŝ ǀƶŶŐƉŚҧƵƚŚƵҨƚ͕ĜһŶŐƚӊŐŝĆŶƚҺŝĜĂ͕ŐŝĆŶĐĄĐĐҿƚŚҩƚ͘

n

dŝұƚ Ěҷ

ch

Mi ŵҩ

t

Gâ

n gó

t

EƵҺ

t, nôn

và ƚĉŶŐ

ĚҥŶ

dĉŶŐ

khi hít vào

Nhan

h

Bình ƚŚӇӁ

ng

Bình ƚŚӇӁŶŐ

Bình ƚŚӇӁ

và ƚĉŶŐ ĚҥŶ

ng

Bình ƚŚӇӁŶŐ

ng

Bình ƚŚӇӁŶŐ

và Őŝңŵ

EŚӇ

trên

Bình ƚŚӇӁ

ng

Bình ƚŚӇӁŶŐ

Giãn

III4

m ĚҥŶ

'ŝңŵ

khôn ŐĜҲƵ

ŶŚҤƚ

là khi hít vào

zұƵ͕

nhan

h, khôn

g ĜҲƵ

sau khi hít vào

và ŶŐӉŶ

g ŚҫŶ

EŚӋŶŐĚҤƵŚŝҵƵƚƌġŶĐſƚŚҳĚҴĚăŶŐƚŚҤLJӂďҵŶŚŶŚąŶŐąLJŵġďҪŶŐĞƚŚĞƌĜҿŶ ƚŚƵҥŶǀăŬŚƀŶŐĐſƚŝҲŶŵġ͘

- WŚӇҿŶŐƉŚĄƉŶӊĂŚӂ;ϭͬϮŚӂͿ͗

ҵŶŚŶŚąŶŚşƚůҢŝŵҾƚƉŚҥŶƌҤƚŶŚҹŬŚşƚŚӂƌĂ͕ŐҭƉƚƌŽŶŐŵĄLJŐąLJŵġĚĆĐŚŝұŶ ǀăŵĄLJŐąLJŵġǀžŶŐŬşŶĜҳӂŚҵƚŚҺŶŐϭͬϮŚӂ͘

- WŚӇҿŶŐƉŚĄƉŬşŶ͗

ҵŶŚŶŚąŶŚşƚůҢŝƚŽăŶďҾŬŚşƚŚӂƌĂ͕ŐҭƉƚƌŽŶŐŵĄLJŐąLJŵġǀžŶŐŬşŶĜҳӂŚҵ ƚŚҺŶŐŬşŶ͘WŚӇҿŶŐƉŚĄƉŶăLJĐҥŶĐſǀƀŝƐŽĚĂĜҳŬŚӊŬŚşK2

- WŚӇҿŶŐƉŚĄƉŶӊĂŬşŶ;ϭͬϮŬşŶͿ͗

ҵŶŚŶŚąŶŚşƚůҢŝŵҾƚƉŚҥŶŬŚşƚŚӂƌĂ͕ĚŽĜſĐƹŶŐĐҥŶĐſƐŽĚĂĜҳŬŚӊK2͕ŐҭƉ ƚƌŽŶŐŐąLJŵġďҪŶŐŵĄLJŐąLJŵġǀžŶŐŬşŶŬŚŝĜŝҲƵĐŚҶŶŚǀĂŶӂŚҵƚŚҺŶŐϭͬϮŬşŶ͘ Máy gây m ġǀžŶŐŬşŶ;ŚҵƚŚҺŶŐǀžŶŐŚĂLJŚҵƚŚҺŶŐůҸĐͿ͗

DĄLJĜӇӄĐďҺƚƌşϮǀĂŶ͕ϭǀĂŶŚşƚǀăŽǀăϭǀĂŶƚŚӂƌĂ͘ҵŶŚŶŚąŶŚşƚǀăŽƋƵĂ ŵҾƚĜӇӁŶŐǀăƚŚӂƌĂŵҾƚĜӇӁŶŐŬŚĄĐ͘EŚӇǀҨLJŽdžLJǀăŚҿŝƚŚƵҺĐŵġĐŚҶĜŝ ƚŚĞŽŵҾƚĐŚŝҲƵĚƵLJŶŚҤƚ͘

DĄLJŐһŵĐſϭďſŶŐĐĂŽƐƵ͕ϭdžƵƉĄƉƚŚӂƌĂ͕ϭďŞŶŚǀƀŝƐŽĚĂ͕ĐĄĐůҸŚŽҭĐďŞŶŚ ĜӌŶŐƚŚƵҺĐǀăďҺĐŚҿŝ͘

ϰ͘ϯ͘'ąLJŵġƉŚҺŝŚӄƉ͗

- ƶŶŐĐĄĐƚŚƵҺĐŵġŬŚĄĐŶŚĂƵƋƵĂϭĜӇӁŶŐŚŽҭĐŶŚŝҲƵĜӇӁŶŐŬŚĄĐŶŚĂƵǀ㎠ĐҿƚŚҳďҵŶŚŶŚąŶĜҳŐąLJŵġ͘sşĚӅ͗ĚƶŶŐƚŚŝŽƉĞŶƚĂůĜҳŬŚӂŝŵġƋƵĂĜӇӁŶŐ ƚšŶŚŵҢĐŚ͕ƐĂƵĜſĚƵLJƚƌŞŵġďҪŶŐƚŚƵҺĐŵġĜӇӁŶŐŚƀŚҤƉŶŚӇĞƚŚĞƌ͕

halothane

'ąLJŵġƉŚҺŝŚӄƉďĂŽŐһŵĐңŶŚӋŶŐƉŚӇҿŶŐƉŚĄƉĚƶŶŐƚŚƵҺĐŵġƉŚҺŝŚӄƉ ǀӀŝĐĄĐƚŚƵҺĐŐŝңŵĜĂƵ͕ƚŚƵҺĐŐŝĆŶĐҿ͕ƚŚƵҺĐĐſƚĄĐĚӅŶŐĜҭĐďŝҵƚĜҺŝǀӀŝĐŚӈĐ ƉŚҨŶĐӆĂĐĄĐĐҿƋƵĂŶŬŚĄĐŶŚĂƵĐӆĂĐҿƚŚҳŶŚӇĐĄĐƚŚƵҺĐůŝҵƚŚҢĐŚ͕ӈĐĐŚұ ƚŚҥŶŬŝŶŚ͕ŐŝңŵĜĂƵ͕ŐŝңŵĜĂƵƚƌƵŶŐӇҿŶŐ͕ĂŶƚŚҥŶƚƌҤŶƚšŶŚ͘͘͘

ſŶŚŝҲƵůŽҢŝƚŚƵҺĐŶŐӆŬŚĄĐŶŚĂƵĚŽŵҾƚƐҺƚĄĐŐŝңĜҲƌĂ͕ƚƶLJƚŚĞŽŬӎƚŚƵҨƚ ŵăƐӊĚӅŶŐĐŚŽŚӄƉůljǀӀŝŵӅĐĜşĐŚƉŚžŶŐŶŐӉĂĐĄĐƉŚңŶdžҢĐſŚҢŝ͘ңŵƚŚӅ ĜĂƵӂŵҾƚƐҺĐҿƚŚҳĐŚҷƵĜӌŶŐŵҾƚƐҺĐƀŶŐŬşĐŚŚŽҭĐŐŝңŵůŝҲƵůӇӄŶŐƚŚƵҺĐ ŵġ͕ƚƌĄŶŚŶŚӋŶŐƚĄĐĚӅŶŐƉŚӅǀăŶŐҾĜҾĐƚŚƵҺĐŵġ͘

- EŐŽăŝƌĂĐžŶĐſŶŚӋŶŐŬӎƚŚƵҨƚŐąLJŵġŬŚĄĐŶŚӇ͗

>ăŵĐŚŽƚŚąŶŶŚŝҵƚŚҢdžƵҺŶŐϮϴ- 300͕ŐąLJůҢŶŚďҪŶŐŶӇӀĐĜĄǀăĚƶŶŐƚŚƵҺĐ ůŝҵƚƚŚҥŶŬŝŶŚĜҳůŽҢŝƚƌӉƉŚңŶӈŶŐƚҢŝĐŚҽǀăƚŽăŶƚŚąŶ͕ŐŝңŵĐŚңLJŵĄƵ͘^ĂƵ ƉŚҧƵƚŚƵҨƚƉŚңŝĜӇĂŶŚŝҵƚĜҾĐҿƚŚҳǀҲŵӈĐďŞŶŚƚŚӇӁŶŐƚƌӇӀĐŬŚŝŬŝҳŵƚƌĂŬӎ ƚŚƵҨƚƉŚҧƵƚŚƵҨƚŬӎůӇӃŶŐ͘

- Gây mê - ŬӎƚŚƵҨƚŚҢŚƵLJұƚĄƉĐſŬŝҳŵƐŽĄƚ͗

ƶŶŐĐĄĐƚŚƵҺĐůŝҵƚŚҢĐŚ;ƉĞŶƚŽŶŝƵŵ͕ŚĞdžĂŶŝƵŵ͕ĂƌĨŽŵĂƚ͕ůŽdžĞŶ͘͘͘ͿƉŚҺŝŚӄƉ

ǀӀŝĐĄĐŚĜҭƚŬŚƵǀӌĐĐҥŶŵҼӂǀҷƚƌşĐĂŽŚҿŶƐŽǀӀŝŬŚƵǀӌĐŬŚĄĐĐӆĂĐҿƚŚҳ͘

ŝҲƵŬŚŝҳŶŚƵLJұƚĄƉŐŝңŵdžƵҺŶŐ͕ŵӈĐ ĜҾŐŝңŵƚƶLJƚŚƵҾĐƚŚĞŽƚӉŶŐƚƌӇӁŶŐ ŚӄƉŶŚӇŶŐƚŚҤƉŶŚҤƚŬŚƀŶŐĜӇӄĐĚӇӀŝϲϬ- ϳϬŵŵ,Ő͕ŶŚӇǀҨLJƚҢŝĐŚҽŵҼƐҰşƚ ĐŚңLJŵĄƵ͘^ĂƵƉŚҧƵƚŚƵҨƚƉŚңŝĜӇĂŚƵLJұƚĄƉƚƌӂůҢŝďŞŶŚƚŚӇӁŶŐƚƌӇӀĐŬŚŝ ŬŝҳŵƚƌĂŬӎůӇӃŶŐƉŚҧƵƚŚƵҨƚŬӎĐăŶŐ͘

WŚӇҿŶŐƉŚĄƉŬӎƚŚƵҨƚŶăLJĜӇӄĐĐŚҶĜҷŶŚĐŚŽĐĄĐƉŚҧƵƚŚƵҨƚĚҴŐąLJĐŚңLJŵĄƵ ŶŚŝҲƵŶŚӇ͗ƉŚҧƵƚŚƵҨƚƚŚҥŶŬŝŶŚƐҸŶĆŽ͕ŵҼƚŝŵ͕ƉŚҼŝ͕ƵŵĄƵ͕ĐҩƚƚŚƶLJŐĂŶ͘͘͘

- 'ąLJŵġƉŚҺŝŚӄƉǀӀŝŐąLJƚġǀƶŶŐ͕ĐŚąŵƚġĐƹŶŐůăŵҾƚƉŚӇҿŶŐƉŚĄƉǀƀĐңŵ ĐſӈŶŐĚӅŶŐƚҺƚƚƌŽŶŐůąŵƐăŶŐ͘

- 'ąLJŵġĐҿƐӂ͗

Là gây mê nông tr ŽŶŐŵҾƚƚŚӁŝŐŝĂŶŶŐҩŶ͕ŶŐŚšĂůăůăŵĐŚŽďҵŶŚŶŚąŶŵҤƚlj ƚŚӈĐ͕ŵҤƚĐңŵŐŝĄĐ͕ŬŚƀŶŐƉŚңŶӈŶŐǀӀŝĐĄĐƚĄĐŶŚąŶŬşĐŚƚŚşĐŚŶŚҮ͕ƚŚӇӁŶŐ ĐŚҶĜҷŶŚƚƌŽŶŐƐӊĂĐŚӋĂƚƌӇӁŶŐŚӄƉŵҼŬŚƀŶŐůӀŶ͕ƚŚӌĐŚŝҵŶŐąLJŵġĐҿƐӂ ďҪŶŐĐĄĐŚĚƶŶŐĐĄĐƚŚƵҺĐƚŝҲŶŵġƉŚҺŝŚӄƉǀӀŝĐĄĐƚŚƵҺĐŐąLJŶŐӆŶŚӇ

ƚŚŝŽƉĞŶƚĂů͕ŬĞƚĂŵŝŶƚŝġŵǀăŽďҩƉƚŚҷƚŚŽҭĐƚŚӅƚǀăŽƚƌӌĐƚƌăŶŐƚŚƵҺĐŐŝңŵĜĂƵ ƚƌƵŶŐӇҿŶŐ͘

ϱ͘dŚƵҺĐƚŝҲŶŵġ͘

- >ăƚŚƵҺĐĚƶŶŐĐŚŽďҵŶŚŶŚąŶƚƌӇӀĐŬŚŝŐąLJŵġŚŽҭĐŐąLJƚġĜҳůăŵĐĄĐƉŚҧƵ ƚŚƵҨƚƚӉŶŚҹĜұŶůӀŶŶŚҪŵŵӅĐĜşĐŚ͗

- EŚҪŵůăŵŐŝңŵŵӈĐĜҾůŽůҩŶŐĐӆĂďҵŶŚŶŚąŶǀăĐŚҺŶŐƐӌŐŝңŝƉŚſŶŐƋƵĄ ŵӈĐĂĐŚĞŶĂůŝŶŶҾŝƐŝŶŚ͕ŶŐƵLJġŶŶŚąŶŐąLJңŶŚŚӇӂŶŐdžҤƵĜұŶƚŝŵŵҢĐŚƚƌŽŶŐ ƉŚҥŶůӀŶĐĄĐƚŚƵҺĐŐąLJŵġĜҭĐďŝҵƚůăŚҸŚĂůŽŐĞŶ͘ŽǀҨLJŶŐӇӁŝƚĂƚŚӇӁŶŐƐӊ ĚӅŶŐ͗

- WŚĞŶĞƌŐĂŶ;ĂŶƚŚҥŶ và kháng histamin)

- Meprobanat

- Atarax

- EŚҪŵůăŵŐŝңŵƚŝұƚĚҷĐŚŵăƚŝұƚĚҷĐŚůăŚŝҵŶƚӇӄŶŐŐąLJŬŚſĐŚҷƵǀӀŝŶŚӋŶŐ ďŝҳƵŚŝҵŶŶŚӇƚҩĐŶŐŚҰŶƉŚұƋƵңŶ͕ŬŚſŬŚӂŝŵġ͕ĚҴĐſďŝұŶĐŚӈŶŐǀҲƉŚҼŝƐĂƵ ƉŚҧƵƚŚƵҨƚ͕ĜҳŬŚҩĐƉŚӅĐŶŐӇӁŝƚĂƐӊĚӅŶŐĂƚƌŽƉŝŶŚŽҭĐƚҺƚŚҿŶůă

scopolamin

EŚӇǀҨLJĜҺŝǀӀŝŶŐӇӁŝƚƌү͕ŬŚŽү͕ƚƌӇӀĐŬŚŝŐąLJŵġƚӉϯϬƉŚƷƚĜұŶϭŐŝӁĐҥŶ ƚŝġŵǀăŽďҩƉƚŚҷƚŚҽŶŚӄƉƚŚƵҺĐƚŝҲŶŵġŐһŵ͗

sşĚӅ͗ĂƚƌŽƉŝŶůăŵŶŚҷƉƚŝŵŶŚĂŶŚǀăŐŝĆŶĜһŶŐƚӊ͕ĚŽůĂƌŐĂŶ͕ƉƌŽŵĞĚŽůǀăĜҭĐ ďŝҵƚůăĨĞŶƚĂŶLJů;ƚŚƵҺĐŐŝңŵĜĂƵƚҼŶŐŚӄƉͿůăŵĐŽĜһŶŐƚӊǀăƐƵLJƚŚӂĐƹŶŐŶŚӇ ңŶŚŚӇӂŶŐƚӀŝŶŚҷƉƚŚӂ͕ƐĞĚƵdžĞŶůăŵŵҲŵĐҿ;ĐŚŽŶġŶŬŚƀŶŐƐӊĚӅŶŐĐŚŽ ďҵŶŚŶŚąŶďҷďҵŶŚŶŚӇӄĐĐҿͿ͘͘͘

ϲ͘EŚӋŶŐƚŚƵҺĐƐӊĚӅŶŐƚƌŽŶŐŐąLJŵġ͘

ϲ͘ϭ͘dŚƵҺĐŵġďĂLJŚҿŝǀăƚŚҳŬŚş͗

>ăŶŚӋŶŐƚŚƵҺĐďҺĐŚҿŝĜҳŐąLJŵġ͕ǀŝҵĐƐӊĚӅŶŐĐŚƷŶŐĚӌĂƚƌġŶĐҿƐӂĐĄĐďŞŶŚ ďĂLJŚҿŝǀăĐĄĐŬŚşӂĜҥƵƌĂĐӆĂĐĄĐďŞŶŚŶăLJĜӇӄĐƚƌҾŶƚŚĞŽƚӏůҵŶŚҤƚĜҷŶŚ͘

ϲ͘Ϯ͘EŚӋŶŐƚŚƵҺĐŐąLJŶŐӆĜӇӁŶŐƚšŶŚŵҢĐŚ͘

EŚӋŶŐƚŚƵҺĐŶăLJĐſĐҤƵƚƌƷĐŚŽĄŚҸĐĐҿďңŶŚŽăŶƚŽăŶŬŚĄĐƐŽǀӀŝĐĄĐƚŚƵҺĐ ŐąLJŶŐӆƚŚҳŬŚş͕ŬŚƀŶŐŐŝҺŶŐŶŚӇƚƌŽŶŐƐҿĜһŵƀƚңĐӆĂ'ƵĞĚĞů͘

dƵLJŶŚŝġŶ͕ĐĄĐƚŚƵҺĐŚҸďĂĐďŝƚƵƌŝĐƚŚӇӁŶŐŐąLJƐƵLJƚŚӂ͕ƚŚҨŵĐŚşŶŐӉŶŐƚŚӂĚŽ ƚĄĐĚӅŶŐĐŚҸŶůҸĐĐӆĂĐŚƷŶŐůġŶĐĄĐƚƌƵŶŐŬŚƵŚƀŚҤƉƚҢŝŚăŶŚŶĆŽ͘

dŚĞŽĚƁŝƚƌġŶůąŵƐăŶŐĐŚŽƚŚҤLJƚĄĐĚӅŶŐĐӆĂĐĄĐƚŚƵҺĐŶăLJŚŽăŶƚŽăŶŬŚĄĐ nhau

EŚӁĐĄĐŵĄLJŵſĐŚŝҵŶĜҢŝĜңŵďңŽĜŝҲƵŬŚŝҳŶŚƀŚҤƉĐŚŽďҵŶŚŶŚąŶ͕ŶŐӇӁŝ ƚĂĐſƚŚҳƐӊĚӅŶŐƚŚƵҺĐŐŝĆŶĐҿǀŞŵӅĐĜşĐŚŶăLJ͘

ſϮůŽҢŝƚŚƵҺĐŐŝĆŶĐҿ͗

- Nhóm phenothiazine: largactil, nozinan

- ĄĐĚҧŶĐŚҤƚĐӆĂƚhioxanthine: taractan

- Nhóm bytyrophenone: haloperidol, sedalande

ϲ͘ϱ͘dŚƵҺĐůŝҵƚŚҢĐŚ͗

ĄĐƚŚƵҺĐŶăLJĜӇӄĐƐӊĚӅŶŐƚƌŽŶŐĐĄĐƉŚҧƵƚŚƵҨƚĐŚңLJŵĄƵŶŚŝҲƵ͘^ӊĚӅŶŐ ĐŚƷŶŐŶŚҪŵŵӅĐĜşĐŚůăŵŚҢŚƵLJұƚĄƉ͕ĜŝҲƵŬŚŝҳŶĜӇӄĐǀăƉŚӅĐŚһŝĚҴĚăŶŐ ŶŚҪŵŐŝңŵĐŚңLJŵĄƵƚҢŝǀƶŶŐŵҼ͘

dŚӇӁŶŐĚƶŶŐůăĐĄĐƚŚƵҺĐƐĂƵ͗

Arfonad, pendiomite, hexamethonium, loxen

dŚĞŽĐĄĐŚƉŚąŶůŽҢŝŶŚӇǀҨLJĐĄĐƚŚƵҺĐůŝҵƚŚҢĐŚƚҢŽƌĂŶŚӋŶŐĜŝҲƵŬŝҵŶƚŚƵҨŶ ůӄŝĐŚŽŐąLJŵġǀăǀŝҵĐƐӊĚӅŶŐƉŚҺŝŚӄƉĐŚƷŶŐůăĐҿƐӂĐӆĂŬŚĄŝŶŝҵŵŵӀŝǀҲ gây mê ti ҲŵŶĉŶŐ͘

ϳ͘DҾƚƐҺďŝұŶĐŚӈŶŐ͕ƚĂŝŶҢŶǀăƉŚŝҲŶŶҢŶĐӆĂŐąLJŵġ͘

ϳ͘ϭ͘dĂŝďŝұŶǀҲƚŝŵŵҢĐŚ :

ġŶĐҢŶŚŵҾƚƐҺƚĂŝďŝұŶşƚŶŚŝҲƵŐąLJŬŚſĐŚҷƵŶŚӇ͗ƌҺŝůŽҢŶŶŚҷƉƚŝŵ͕ŵҾƚǀăŝ ĚҢŶŐŶŐŽҢŝƚąŵƚŚƵ͕ŶŚҷƉŶŚĂŶŚdžŽĂŶŐŚŽҭĐŶŚҷƉŶŚĂŶŚƚŚҤƚ͕ĐҥŶƉŚңŝĐŚƷlj ĜұŶŵҾƚƐҺůŽҢŝƚĂŝďŝұŶůăŵŶŐӉŶŐƚŝŵĜҾƚŶŐҾƚĐӅƚŚҳůă͗

- EŐӉŶŐƚŝŵŶŐƵLJġŶƉŚĄƚŶŐĂLJŬŚŝŬŚӂŝŵġƐĂƵǀăŝŶŚҷƉƚŚӂ͗ŵҢĐŚƚĉŶŐƌҤƚ ŶŚĂŶŚ͕ƐĂƵĜſŶŐӉŶŐĜҾƚŶŐҾƚ͕ĜһŶŐƚӊŐŝĆŶǀăĐŚұƚƚӈĐŬŚҩĐŵăĐĄĐƉŚӇҿŶŐ ƉŚĄƉĜŝҲƵƚƌҷŚҥƵŶŚӇŬŚƀŶŐĐſŬұƚƋƵң͘

- EŐӉŶŐƚŝŵƚŚӈƉŚĄƚ͗ ůăƚĂŝďŝұŶĐӆĂǀŝҵĐĚƶŶŐƋƵĄůŝҲƵƚŚƵҺĐŵġ͕ǀӀŝĐĄĐďŝҳƵ ŚŝҵŶƚƌӇӀĐŬŚŝŶŐӉŶŐƚŝŵŶŚӇƌҺŝůŽҢŶŶŚҷƉƚŝŵ͕ŵҢĐŚLJұƵĚҥŶ͕ĜһŶŐƚӊŐŝĆŶ ŶŚĂŶŚ͕ŐŝңŵǀăƐƵLJƚŚӂ͕ƚŚҨŵĐŚşŶŐӉŶŐƚŚӂŬĠŽĚăŝ͘dƌŽŶŐƚƌӇӁŶŐŚӄƉŶăLJ ĐҥŶƉŚңŝŶŐӉŶŐŶŐĂLJƚŚƵҺĐŵġƚŚҳŬŚş͕ĐŚŽďҵŶŚŶŚąŶƚŚӂŽdžLJ͕ƚŝұŶŚăŶŚŶŐĂLJ

ĐĄĐŬӎƚŚƵҨƚŚһŝƐӈĐǀҲƚŝŵŵҢĐŚŶŚӇĠƉƚŝŵŶŐŽăŝůһŶŐŶŐӌĐŚŽҭĐďſƉƚŝŵ ƚƌӌĐƚŝұƉƚƌŽŶŐůһŶŐŶŐӌĐ;ĜҺŝǀӀŝĐĄĐƉŚҧƵƚŚƵҨƚŵӂůһŶŐŶŐӌĐͿ͘

EŐҤƚƚŚӈƉŚĄƚŚŽҭĐĚŽƚŚŝұƵŽdžLJĐҿƚŝŵŵăŶŐƵLJġŶŶŚąŶĐŚӆLJұƵůăĚŽƚŝŵ ŚŽҭĐĚŽƉŚҼŝ͕ŚŽҭĐĚŽĚƶŶŐƋƵĄůŝҲƵƚŚƵҺĐƚŚƵҾĐŚҸŚĂůŽŐŽŶĞ;ĐŚůŽƌŽƉŚŽƌŵĞ͕ chlorure - etyle, cyclopropane)

- <ŚŝƉŚĄƚŚŝҵŶŶŐӉŶŐƚŝŵĐҥŶƉŚңŝƚŝұŶŚăŶŚĜŝҲƵƚƌҷĐҤƉĐӈƵŶŚĂŶŚǀăĐſŚŝҵƵ ƋƵң͗

ϳ͘Ϯ͘dĂŝďŝұŶǀҲŚƀŚҤƉ͗

Cá ĐƚĂŝďŝұŶůŝġŶƋƵĂŶƚӀŝ͗

- dŞŶŚƚƌҢŶŐƉŚҼŝƚƌӇӀĐƉŚҧƵƚŚƵҨƚ͗

ĄĐďҵŶŚůljǀҲƉŚҼŝĐſƚӉƚƌӇӀĐŶŚĂŶŚĐŚſŶŐĚҧŶĜұŶĐĄĐƌҺŝůŽҢŶƚƌŽŶŐǀŝҵĐ ĜŝҲƵƚŝұƚŚҤƉƚŚƵŽdžLJǀăĜăŽƚŚңŝK2͘,ŝҵŶƚӇӄŶŐƚŚŝұƵŽdžLJĜұŶŵҾƚŵӈĐŶăŽ

ĜſƐҰůăŵƐƵLJŐŝңŵĐŚӈĐŶĉŶŐŶĆŽ͕ƚŚҨŶ͕ƚim và gan

dŚŝұƵŽdžLJŵĄƵǀӀŝďŝҳƵŚŝҵŶůąŵƐăŶŐůăƐƵLJƚŚӂŶŚĂŶŚǀăŶƀŶŐ͕ŵҢĐŚĐŚҨŵǀă ŵҢŶŚ͕ƐĂƵĜſŵҢĐŚŶŚĂŶŚŬğŵƚŚĞŽƌҺŝůŽҢŶǀҲŶŚҷƉǀăĐſdžƵŚӇӀŶŐƚƌӅLJ ŵҢĐŚ͘

EұƵƚŝұƉƚӅĐďҷƚŚŝұƵŽdžLJŵĄƵďҵŶŚŶŚąŶƐҰĚҧŶĜұŶĐĄĐƚĂŝďŝұŶŶҭŶŐŚҿŶ͕ ŬŚƀŶŐƚŚҳĐӈƵĐŚӋĂ͘

- DҾƚƐҺƚŚƵҺĐƐӊĚӅŶŐ͗

- EŚӋŶŐƚŚƵҺĐŚҸďĂƌďŝƚƵƌƌŝĐǀăŵŽƌƉŚŝŶŚĂLJĨĞŶƚĂŶLJůĐſƚŚҳŐąLJƌĂĐĄĐƌҺŝ ůŽҢŶƚƌҥŵƚƌҸŶŐǀҲŚƀŚҤƉŶŐĂLJĐңŬŚŝĚƶŶŐǀӀŝůŝҲƵƚŚҤƉ͘

ŝҲƵƋƵĂŶƚƌҸŶŐůăĜҺŝǀӀŝĐĄĐƚƌӇӁŶŐŚӄƉƐƵLJƚŚӂĐҥŶƉŚңŝďŝұƚĜŝҲƵƚƌҷƚҢŵ ƚŚӁŝďҪŶŐĐĄĐƉŚӇҿŶŐƉŚĄƉ͕ƉŚӇҿŶŐƚŝҵŶƚŚƀŶŐŬŚşŬҷƉƚŚӁŝǀăƚŚƵҺĐĜҺŝŬŚĄŶŐ ӂĐƵҺŝĐƵҾĐŐąLJŵġ͘

dҤƚĐңĐĄĐƉŚҧƵƚŚƵҨƚƚƌġŶĐĄĐĐҿƚŚĂŵŐŝĂŚƀŚҤƉ;ƉŚҧƵƚŚƵҨƚŶŐӌĐ͕ďӅŶŐͿ ĜҲƵůăŵŶҭŶŐƚŚġŵƚŞŶŚƚƌҢŶŐƐƵLJŚƀŚҤƉ͘

- dŞŶŚƚƌҢŶŐĐҤƉĐӈƵ͗

ĄĐƉŚҧƵƚŚƵҨƚĐҤƉĐӈƵĐſƚŚҳŵĂŶŐĜұŶϮůŽҢŝƚĂŝďŝұŶƚƌӌĐƚŝұƉŚŽҭĐŬŚƀŶŐ ƚƌӌĐƚŝұƉĜҺŝǀӀŝĐŚӈĐŶĉŶŐŚƀŚҤƉ͗ƚƌăŽŶŐӇӄĐǀăŶƀŶ͘ ŚƷŶŐƐҰůăŵĐңŶƚƌӂ ĜӇӁŶŐƚŚӂ͕ǀŝġŵƉŚұŶĂŶŐĚŽŚşƚƉŚңŝĚҷĐŚĂdžŝƚǀăƉŚƶƚŚĂŶŚŬŚşƋƵңŶ͘dҤƚĐң ŶŚӋŶŐƚĂŝďŝұŶŶăLJŶŚĂŶŚĐŚſŶŐĚҧŶĜұŶƚŚŝұƵŽdžLJŚŽҭĐƚĉŶŐK2 ŵĄƵŵăǀŝҵĐ ĜŝҲƵƚƌҷůăŚƷƚǀăůŝҵƵƉŚĄƉŽdžLJ͕ŬŚĄŶŐƐŝŶŚ͘

- ĄĐŵĄLJŚƀŚҤƉ;ŵĄLJŐąLJŵġͿ͗

^ӈĐĐңŶǀăŬŚŽңŶŐĐŚұƚĐӆĂĐĄĐŵĄLJŚƀŚҤƉĐſƚŚҳĚҧŶĜұŶŵҾƚƐҺďŝұŶĐŚӈŶŐ ĐӌĐŬLjŶŐƵLJŚŝҳŵ͘

EŚӋŶŐďŝұŶĐŚӈŶŐƚŚӇӁŶŐŐҭƉůă͗

- dĉŶŐŬŚŽңŶŐĐŚұƚ͕ĚҧŶƚӀŝӈĜҸŶŐƋƵĄŵӈĐK2 ŵăŚҨƵƋƵңůăƚĉŶŐK2 máu

- dĉŶŐƐӈĐĐңŶĚҧŶƚӀŝƐƵLJŐŝңŵƚŚӂĚŽƚŚŝұƵŽdžLJ͕ƚŚӇӁŶŐŐҭƉƚƌŽŶŐďҵŶŚŶŚąŶ ƚƌү͘

- ңŶƚƌӂĐӆĂŵĄLJƚŚӂĚҧŶĜұŶƚŚŝұƵŽdžLJ͘

- ^ĂŝůҥŵŬŚŝĚƶŶŐƋƵĄůŝҲƵƚŚƵҺĐŚŽҭĐĜŝҲƵĐŚҶŶŚŬŚşĚҧŶƚӀŝƚŚŝұƵŽdžLJŚŽҭĐ ŶŐҾĜҾĐƚŚƵҺĐŶŚĂŶŚ͘

- ĄĐǀĂŶĐӆĂŵĄLJƚŚӂ͕ŵĄLJŐąLJŵġŬŚƀŶŐŚŽҢƚĜҾŶŐ͘

EŐŽăŝƌĂĐžŶĐſĐĄĐƚĂŝďŝұŶŶŐŚҰŶĜӇӁŶŐƚŚӂĚŽĚҷǀҨƚ͕ƚӅƚůӇӃŝ͕ƌҿŝƌĉŶŐ͘<Śŝ džңLJƌĂĐҥŶŐŝңŝƋƵLJұƚďҪŶŐĐĄĐŬӎƚŚƵҨƚĐŚşŶŚdžĄĐ͘

ϳ͘ϯ͘ĄĐƚĂŝďŝұŶǀҲƚŚҥŶŬŝŶŚ͗

<ŚƀŶŐĐſƚĂŝďŝұŶƚŚŽĄŝŚŽĄŶĆŽĚŽƚŚŝұƵK2

EŚӋŶŐĐҿŶĜҾŶŐŬŝŶŚӂŐŝĂŝĜŽҢŶ//ĐŚҶƚŚҤLJƚƌŽŶŐŐąLJŵġƚŚӂŬŚş͘

ĄĐƚĂŝďŝұŶĐſƚŚҳĚҧŶĜұŶ ĐĄĐĐҿŶĜҾŶŐŬŝŶŚůąŵƐăŶŐ;ƚҼŶƚŚӇҿŶŐĚŽƚŚŝұƵ ŽdžLJŬĠŽĚăŝͿ͘ſƚŚҳĐſƌҺŝůŽҢŶƚąŵƚŚҥŶ͕ŵҤƚĜҷŶŚŚӇӀŶŐ͕ĐŚӈŶŐƋƵġŶ͕ĐŚӈŶŐ ůŽҢŶĜҸĐ͕ŬŚſǀŝұƚǀăŶŚӋŶŐďŝҳƵŚŝҵŶƌҺŝůŽҢŶƚŚҥŶŬŝŶŚƚŚӌĐǀҨƚӂĐĄĐŵӈĐĜҾ khác nhau

ҥŶĐŚƷljŬŚŝŐąLJŵġďҪŶŐĞƚŚĞƌďŝҳƵŚŝҵŶƚşŵƚĄŝƚŚҳŚŝҵŶƐӌƚĉŶŐŶŚŝҵƚĜҾĄĐ ƚşŶŚӂƚƌүƐҿƐŝŶŚ͕ŬŚƀŶŐdžƵҤƚŚŝҵŶӂƚƌүůӀŶŚҿŶ͘

- ĄĐƚĂŝďŝұŶĚŽĐŚğŶĠƉĐŚŝƚŚҳĚŽƉŚҧƵƚŚƵҨƚŬĠŽĚăŝ;ƌҺŝůŽҢŶĐŚӈĐŶĉŶŐ ƚŚҥŶŬŝŶŚĚŽĐŚğŶĠƉͿ͘

- EŚӋŶŐĚąLJƚŚҥŶŬŝŶŚƚŚӇӁŶŐďҷƚҼŶƚŚӇҿŶŐůăĜĄŵƌҺŝƚŚҥŶŬŝŶŚĐĄŶh tay, ƚŚҥŶŬŝŶŚƋƵĂLJ͕ƚŚҥŶŬŝŶŚŵƹŝ͕ƚŚҥŶŬŝŶŚĐŚăLJƚƌӇӀĐǀăƚŚҥŶŬŝŶŚŚƀŶŐŬŚŽĞŽ ŶŐŽăŝ͘ҤƵŚŝҵƵƚҼŶƚŚӇҿŶŐƚŚӇӁŶŐƚŚҤLJůăůŝҵƚŵҾƚƉŚҥŶŚŽҭĐŚŽăŶƚŽăŶ͘ ϳ͘ϰ͘dĂŝďŝұŶǀҲŐĂŶ͗

dĂŝďŝұŶǀҲŐĂŶůăĚŽŶŐҾĜҾĐŐĂŶďӂŝĐĄĐƚŚƵҺĐŵġŶŚҤƚůăƚŚƵҺĐŵġďҺĐŚҿŝ flu ŽƚŚĂŶĞ͕ƚŚŝұƵŽdžLJŬĠŽĚăŝ͕ƚӅƚŚƵLJұƚĄƉĜҾŶŐŵҢĐŚŬĠŽĚăŝ͘ŝҳƵŚŝҵŶůąŵ ƐăŶŐůăǀăŶŐĚĂǀăĐſƚŚҳĚҧŶĜұŶƚӊǀŽŶŐ͘EſŝĐŚƵŶŐŐҭƉӂďҵŶŚŶŚąŶƐӊ ĚӅŶŐĐĄĐĚҧŶdžƵҤƚŚĂůŽŐĞŶ͘

ϳ͘ϱ͘dĂŝďŝұŶǀҲƚŚҨŶ͗

ĄĐƚĂŝďŝұŶǀҲƚŚҨŶƚŚӇӁŶŐĐſďŝҳƵŚŝҵŶĂůďƵŵŝŶĞĚӇҿŶŐƚşŶŚƚҢŵƚŚӁŝŬŚƀŶŐ ůŝġŶƋƵĂŶƚӀŝĐĄĐďҵŶŚǀŝġŵƚŚҨŶĐſƚӉƚƌӇӀĐ͕ŶŚӇŶŐŶҭŶŐůġŶŬŚŝďҵŶŚŶŚąŶ ĐſďҵŶŚǀŝġŵƚŚҨŶŬұƚŚӄƉ͘

ϳ͘ϲ͘dĂŝďŝұŶĚŽŬŚƀŶŐĐŚҷƵƚŚƵҺĐ͗

dŚӇӁŶŐŐҭƉŬŚŝƐӊĚӅŶŐĐĄĐƚŚƵҺĐŐąLJŵġĜӇӁŶŐƚšŶŚŵҢĐŚ͕ǀӀŝďŝҳƵŚŝҵŶĚҷ ӈŶŐŶŐŽăŝĚĂŚŽҭĐĚҷӈŶŐƚҼĐŚӈĐ͕ǀŝġŵŵҢĐŚŵĄƵӂĚҢŶŐdžҿĐӈŶŐƚšŶŚŵҢĐŚ͕ ĜҾŶŐŵҢĐŚǀ㌎ҢŝƚӊŵҢĐŚŶŐŽҢŝǀŝŶŐŚŝġŵƚƌҸŶŐƚƌŽŶŐŶŚӋŶŐƚƌӇӁŶŐŚӄƉ ƚŝġŵŶŚҥŵǀăŽĜҾŶŐŵҢĐŚŚŽҭĐĚӇӀŝĚĂ͘

ĄĐƉŚŝҲŶŶҢŶŬŚĄĐŶŚӇŚŽ͕ŶҤĐŐąLJŬŚſĐŚҷƵĐŚŽďҵŶŚŶŚąŶǀăƚŚҥLJƚŚƵҺĐ ŬŚƀŶŐƉŚңŝůăĐĄĐďŝұŶĐŚӈŶŐĐӆa gây mê

ϳ͘ϳ͘dĂŝďŝұŶĐŚĄLJŶҼ͗

dƌӉƉƌŽƚŽdžLJƚĂnjŽƐĞǀăĐŚůŽƌŽĨŽƌŵĞůăŬŚƀŶŐŐąLJĐŚĄLJŶҼ͘ŽǀҨLJŬŚŝŐąLJŵġ ďҪŶŐƚŚƵҺĐŵġďҺĐŚҿŝĜҭĐďŝҵƚůăĞƚŚĞƌĐҥŶƚƌĄŶŚůӊĂ͘<ŚŝĜҺƚĜŝҵŶƚƌŽŶŐƉŚҧƵ ƚŚƵҨƚƉŚҼŝĐҥŶĐŚƷljǀăĐҩƚƚŚƵҺĐŵġ͘