LIEN QUAN VA DIEU HOA CHUYEN HOA
Hinh 7.1: Sd d6 thi nghiem dd rut ra dinh luat Donnan va ap^sua't do keo
Dinh luat Donnan 1: stf can blng se dat dtfdc khi tich sd cua cac ion khudch tan cd cung mot to
erf h mm nhia ciia mang ban tham. „
GoiX do ban dau cua cac ion la a.b cdn xla nong dp cua ion khuech tan, ta co:
(a + x) (x) = (b - x) (b - x)
_ b2
x" a + 2b
Dinh mat Donnan 2: Khi cd stf can bang, tong dien tich cua cac ion dtfdng bang to'ng di6n tich
^^^^TL, Donnan, ap In, tha'm tha'u cua ndi cd chtfa chat keo
protein^Jcang Id^hdn ap l.c thlm f udndi ^^d^£%£Z r=s^kc::::chtn^
ThSh mach la mot mang ban tha'm ngan each huye't ttfdng va dich g.an bao. Do do nong
do cua Sc chaTd en giSi'va cac chat htfu cd cd phan ttf Itfdng nho trong huyet ttfdng va d,ch g.an
do cua cac cnai men gi tron h - ( M(J nen ap
bao khong khac nhau connong QP™ e ^ •" ^ ^ ,,( ^ ttr
suat tham thau cung thap hdn. Stf cnenn iecn ve ap *u
Do do, thy theo tffng phan khac nhau cua ne macn co v
ap ltfc tha'm tha'u ma ntfdc se dtfdc van chuye'n theo cac htfdng khac nhau 3X3. Stf trao ôfi nutfc va cha't dien giai giffa khu vtfc ngoa. va trong te bao
Mang tdbao ngan each hai khu vtfc cho ntfdc qua lai ttf do va chi cho qua chon loc cha't dien giai va cac chat hda tan khac. Thanh phln cha't dien giai dhai phia cua mang khac nhau
nong do protein d dich trong te bao cao hdn ngoai te bao.
^Cac chat dtfdc van chuydn qua mang theo nhieu cd che khac nhau trong do cd cd che van chuyen chii dong nham duy tri tinh trang chenh lech vd ndng do cua cac cha't, dam bao cho td
bao hoat dong binh thtfdng.
Stf trao doi ntfdc giffa hai khu vtfc nay cd lien quan chat che ddn stf trao doi cac cha't dien giai qua mang te bao, nhat la stf trao ddi ciia cac ion Na+, K+, Ca ++, CI'.
3.2. Didu hoa su* trao ddi ntfdc va cac cha't di§n giai
Cd the d trang thai sinh ly binh thtfdng cd bilan ntfdc bang 0.
Khi ntfdc dtfdc nhap vao, cd the dap tfng dii nhu cau cac cd quan, ltfdng ntfdc thtfa se
dtfdc dao thai ra ngoai theo cd quan bai tiet.
Cd che dieu hda stf trao ddi ntfdc va cac chat vo cd gdm cac yeu td than kinh, noi tiet,
thong qua mot so'cd quan, dac biet la than.
3.2.1. Cd ch^'thdn kinh
Ovung ha nao cd trung tarn than kinh dieu khien stf can bang ntfdc va cac chat dien giai thdng qua cam giac khat, stf kho niem mac, stf tang ap sua't tham tha'u ciia dich ngoai bao
3.2.2. Cd che noi tiet
Cd nhieu hormon tham gia dieu hda qua trinh trao ddi ntfdc va cac cha't vo cd
Vidu:
- Hormon chong bai nieu vasopressin cd tac dong tang stf tai ha'p thu ntfdc ddng than.
- Aldosteron (hormon vo thtfdng than) cd tac dong de'n stf tai ha'p thu va bai xua't Na+ va
K+dong than.
- Cortison va aldosterol cd tac dung gitf ntfdc.
- Hormon tuyen giap gay tang bai tiet ntfdc tieu va md hdi.
3.3. Ro'i loan trao doi ntfdc va cac cha't dien giai
Trong cd the khi cd stf ro'i loan qua trinh trao ddi ntfdc va cac cha't dien giai, cd the dan
den tinh trang if ntfdc, ii* muo'i hay mat ntfdc, mat mudi.
Ngoai ra, cac ro'i loan nay con dtfdc phan biet theo khu vtfc ngoai te bao, trong te bao; la
ro'i loan ddn thuan hay pho'i hdp.
3.3.1. Rd'i loan ddn thuan
3.3.1.1. Tinh trang tf ntfdc va muo'i If ntfdc trong tebao:
Nguyen nhan: khi ud'ng qua nhieu ntfdc hay tiem truyen nhieu dich, se gay tang san xua't day tf dong ntfdc ndi sinh do cd the khong dao thai dtfdc ntfdc ra ngoai; khi dd khu vtfc ngoai te bao trd nen nhtfdc trtfdng, ntfdc se chuyen vao khu vtfc trong te bao gay if ntfdc keo theo tf mudi.
Cac tdbao chtfa nhieu ntfdc se cang phdng len cung nhtf the tich mau giam cd the gay so'c.
If ntfdc ngoai tebao
Nguyen nhan: do tang ap ltfc mau tinh mach, giam protein mau, tang tinh tha'm thanh mach, suy giam chtfc nang dao thai ciia than, nhap qua nhieu NaCl theo dtfdng an uo'ng hay tiem truyen, benh ly thtfdng than, tang san xua't aldosterol lam giam bai xua't Na+ qua than va tf dong
trong cd the.
- Hau qua: gay tinh trang bi phu do Itfdng ntfdc toan phan va ntfdc d cac khu vtfc tang.
- Xet nghiem: chat dien giai va cac thanh phan trong mau giam do mau bi pha loang.
3.3.1.2. Tinh trang ma't nufdc va muo'i
Mat ntfdc toanphan vd mat muoi t ..
....„- Nguyen nhan: Xay ra khi ntfdc va mudi cd trong_cac dich thoat khoi cd the qua nhieu do
non dtf doi hay keo dai, tieu chay lien tuc, mat dich do dan ltfu....
- Hau qua: bilan ntfdc <0(-), mat ntfdc dtoan bo cac khu vtfc, khat ntfdc, da khd, nhan,
sut can, sot, rdi loan tarn than, hi lln, hoang ttfdng, non me.
-Xet nghiem: chat dien giai va cac thanh phin trong mau tang do mau bi co dac.
Mat ntfdc vd mat muoi khu vtfc ngoai tebao
-Nguyen nhan: Do mat mau, mat dich nhidu (phdng), tieu chay giai doan dau, non nang.
- Hau qua: Khdi ltfdng huydt ttfdng giam, mau bi co dac ; ntfdc dkhu vtfc ngoai te bao
giam con ntfdc dkhu vtfc trong tdbao chtfa bi anh htfdng.
- Xtf ly: dung huydt thanh dang trtfdng.
3.3.2. Cac ro'i loan pho'i hdp . r , _
If ntfdc ngoai te'bao +md't ntfdc trong te'bao: bidu hien ben ngoai la phil nhtfng lai co cac trieu
chtfng mat ntfdc trong tdbao. r ^ v
- Nguyen nhan: thtfdng do suy than, khu vtfc ngoai te bao bi tf muoi gay tinh trang tfu trtfdng, tang ap sua't tham tha'u ngoai tdbao va ntfdc trong tdbao se bi chuyen ra ngoai.
- Xtf ly: ldi tieu thai mudi ke't hdp bu ntfdc.
Mat ntfdc ngoai te bao + itnitdc trong tebao:
- Nguyen nhan: khu vtfc ngoai td bao bi ma't ntfdc va mudi do non, tieu chay cap ...
nhtfng dtfdc bu b^ng ntfdc nhtfdc trtfdng khong cd mudi gay tinh trang nhtfdc trtfdng ngoai te bao
nen ntfdc se tran vao khu vtfc trong tdbao.
- Hau qua: ma't ntfdc nhtfng lai kem theo cac trieu chtfng tf ntfdc trong te bao nhtf phu -Xtf ly: bd sung mudi cho khu vtfc ngoai td bao bang each tiem truydn cac dung dich tfu
trtfdng.
TAI LIEU DOC THEM
1 Bo mon Hda sinh-Trtfdng Dai hoc Yha Noi. Hda sinh, NXB Yhoc Ha Ndi, 2001.
2 Bo mon Hda sinh -Dai hoc Ydtfdc TPHCM, Hda sinh yhoc NXB Yhoc TP HCM 2003 3 Bo YTd Vu Khoa hoc va Dao tao, Hda sinh hoc, NXB Yhoc Ha Noi, 2005 ^
4.R.K. Murray, D.K. Granner, V.W. Rodwell-Harper's Illustrated Biochemistry 27 edition-
Lange Medical Books/McGraw-Hill, 2006. ; • ^ 1
5. F. Percheron, R. Perles, M.J. Foglietti, Biochimie structurale et metabohque, Tome 1,
Masson, 1992.
6 P Valdiguie, Biochimie clinique, EM Inter, 1993:
1. CA. Burtis ,E.R. Ashwood, D.e. Bruns -Tietz Textbook of Clinical Chemistry and Molecular
Diagnostics 4th edition- Elsevier saunders, 2006.
CAU HOI TlT Ll/dNG GIA Chon mot cau tra ldi dung
1.Trong can bang xua't nhap ntfdc, khi chtfc nang than bi rdi loan, ta cd:
a. bilan = 0 b. bilan < 0 c. bilan > 0 d. bilan > 0
2. Cac chat dien giai dong vai tro quyet dinh stf phan bd va van chuyen ntfdc trong cd the do tao
nen:
a. ap sua't tham tha'u b. ap sua't thiiy tinh c. ap sua't keo d. Tat ca deu diing
3. Tinh trang tf ntfdc ddn thuan trong te bao xay ra do:
a. uo'ng qua nhieu ntfdc b. tiem truyen nhieu dich
c. tang san xua't hay if dong ntfdc noi sinh d. Tat ca deu diing
4. Kha nang tai ha'p thu ion bicarbonat d 6'ng than chiu anh htfdng ciia :
a. pC02 ciia cd the
b. Stf tai ha'p thu Na+ d d'ng than c. Ndng do CI" va K+ trong mau
d. Tat ca deu diing
5. Ntfdc ttf do:
a. ltfu thong
b. dtfdc phan bd' d khu vtfc trong te bao
c. dong vai tro van chuyen cha't dinh dtfdng va dao thai cha't can ba.
d. tham gia ca'u tao te' bao
:. Ldi tieu thai muo'i ket hdp bu ntfdc la bien phap xir ly tinh trang:
a. U ntfdc ddn thuan trong hay ngoai te'bao b. Mat ntfdc toan phan va mat muo'i
c. Lf ntfdc ngoai td bao + ma't ntfdc trong te bao d. Mat ntfdc ngoai te'bao + tf ntfdc trong te bao 7. Khi mat ntfdc toan phan va mat muo'i:
a. Bilan ntfdc <0, cac cha't dien giai va thanh phan trong mau tang b. Bilan ntfdc <0, cac chat dien giai va thanh phan trong mau giam c. Bilan ntfdc >0, cac chat dien giai va thanh phan trong mau tang d. Bilan ntfdc >0, cac chat dien giai va thanh phan trong mau giam
8. Kha nang tai ha'p thu HCO3" ciia te'bao than chiu anh htfdng ciia cac ye'u to':
a. Stf tai ha'p thu Na+ d dng than.
b. PC02 ciia cd the
c. Ndng do CI" trong mau.
d. Ndng do Na+ trong mau
9. Vai tro quan trong ciia cac muo'i vd cd trong cd the la:
a. tao ap sua't tham tha'u b. tham gia ca'u tao te' bao c. tao cac he tho'ng dem
d. binh on protein d trang thai keo trong te'bao va md
10. Ntfdc ket hdp:
a. Ltfu thong
b. Dtfdc phan bd'd khu vtfc ngoai te' bao c. Tham gia ca'u tao te'bao
d. Chiem 55% ltfdng ntfdc toan phan d cac td chtfc
CAU HOI NGHIEN CLfU BAI HOC
1. Cac ydu to' anh htfdng de'n kha nang tai ha'p thu ion bicarbonat d d'ng than.
2. Neu bien phap xii ly tinh trang if ntfdc ngoai te'bao pho'i hdp vdi mat ntfdc trong te'bao. Giai
thich.
CHl/ONG 8