792_qd-byt (quy trinh cham cuu).pdf

7/17/2019 792_QD-BYT (Quy trinh Cham cuu).pdf

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B Y T

S: 792 /Q-BYT

CNG HA X HI CH NGHA VIT NAMc lp- T do- Hnh phc

H Ni, ngy 12 thng 3 nm2013

QUYT NH

V vic ban hnhHng dn

Quy trnh k thut khm bnh, cha bnh chuyn ngnh Chm cu

B TRNG B Y T

Cn cNgh nh s 63/2012/N-CP ngy 31/8/2012 ca Chnh ph quynh chc nng, nhim v, quyn hn v ccu t chc ca B Y t;

Xt Bin bn hpca Hi ng nghim thu Hng dn Quy trnh k thutkhm bnh, cha bnh chuyn ngnh Chm cuca B Y t;

Theo ngh ca Cc trng Cc Qun l Khm, cha bnh,

Quyt nh:

iu 1. Ban hnh km theo Quyt nh ny 468 Hng dn Quy trnh kthut khm bnh, cha bnh chuyn ngnh Chm cu.

iu 2. Cc Hng dn Quy trnh k thut khm bnh, cha bnh chuynngnh Chm cuny p dng cho tt c cc c s khm bnh, cha bnhc iu kin thc hintheo quy nh hin hnh.

iu 3.Quyt nh ny c hiu lc t ngy k v ban hnh.

iu 4. Cc ng, B: Chnh Vnphng B, Cc trng Cc Qun lKhm, cha bnh, Chnh thanh tra B; cc V trng, Cc trng cc V, Ccca B Y t; Gim c cc Bnh vin, Vin c ging trc thuc B Y t, Gimc S Y t cc tnh, thnh ph trc thuc trung ng; Th trng Y t cc B,ngnh v Th trng cc n v c lin quan chu trch nhim thi hnh Quytnh ny./.

Ni nhn:-Nh iu 4;- B trng ( bo co);- Lu: VT, KCB.

KT. B TRNGTH TRNG

k

Nguyn Th Xuyn


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B Y T CNG HA X HI CH NGHA VIT NAMc lp - T do- Hnh Phc

DANH MC HNG DN QUY TRNH K THUT

KHM BNH, CHA BNH CHUYN NGNHCHM CU

(Ban hnh km theo Quyt nh s 792/Q-BYT ngy 12 thng 3 nm 2013

ca B trng B Y t)

STT

DANH MC QUY TRNH K THUT

A. K THUT CHUNG (14)1.

Mai hoa chm2. Ho chm3. Mng chm4. in chm5. Thy chm6. Cy ch7. n chm8. Cu9. Chch l10. Laser chm

11.

T chm12. Quy trnh in chm, xoa bp bm huyt kt hp ko gin ct sng c13. Quy trnh in chm, xoa bp bm huyt kt hp ko gin ct sngtht lng14. Quy trnh xoa bp bm huyt kt hp xng- tm tho dc

B. CHM T PHU THUT (85)15. Chm t phu thut ct polip mt on i trng phi ct on i trng pha trn lm

hu mn nhn to16. Chm t phu thut cng dui khp gi n thun17. Chm t phu thut ct ton b tuyn gip v vt hch c 2 bn18. Chm t phu thut ct ton b tuyn gip, mt thy c vt hch c 1 bn

19.

Chm t phu thut ct ung th gip trng20. Chm t phu thut ct tuyn v m rng c vt hch21. Chm t phuthut ct u tuyn nc bt mang tai22. Chm t phu thut glaucoma23. Chm t phu thut ly th thy tinh trong bao, ngoi bao, ra ht cc loi cataract gi,

bnh l, sa, lch, v24. Chm t phu thut lc thng thng25. Chm t phu thut ct u x vm mihng26. Chm t phu thut ct u cun cnh27. Chm t phu thut ct u tuyn mang tai28. Chm t phu thut tai xng chm trong vim tc tnh mch bn

29.

Chm t phu thut xoang trn30. Chm t phu thut ct u thnh sau hng31 Ch h h b h h


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34. Chm t phu thut ct dy thanh35. Chm t phu thut ct dnh thanh qun36. Chm t phu thut vng chn bm hm37. Chm t phu thut vch ngn mi38. Chm t phu thut ct polyp mi39. Chm t phu thut no xoang trit trong vim xoang do rng

40.

Chm t phu thut ct u nang gip mng41. Chm t phu thut ct u nang cnh c42. Chm t nh rng khn mc lch 90 hoc ngm di li, di nim mc, phi chp

phim rng chn on xc nh v chn phng php phu thut43. Chm t phu thut ly ty chn rng mt chn hng lot 2 - 3 rng, ly ty chn rng

nhiu chn44. Chm t phu thut ct hch lao to vng c45. Chm t phu thut no p xe lnh h chu46. Chm t phu thut no p xe lnh h lng47. Chm t phu thut ct 2/3 d dy do lot, vim, u lnh

48.

Chm t phu thut ct ti tha t trng49. Chm t phu thut tc rut do dy chng50. Chm t phu thut ct u mc treo c ct rut51. Chm t phu thut ct on i trng, lm hu mn nhn to52. Chm t phu thut sa trc trng khng ct rut53. Chm t phu thut ct b tr vng54. Chm t phu thut ni v trng55. Chm t phu thut ct u mc treo khng ct rut56. Chm t phu thut ct tr t 2 b tr ln 57. Chm t phu thut m thng d dy58. Chm t phu thut dn lu p xe rut tha

59.

Chm t phu thut ct rut tha v tr bnh thng60. Chm t phu thut tht tr c km bc tch, ct mt b tr61. Chm t phu thut ni nang ty - hng trng62. Chm t phu thut ct ton b thn v niu qun63. Chm t phu thut ly si m b thn trong xoang64. Chm t phu thut ct mt na bng quang v ct ti tha bng quang65. Chm t phu thut n lu thn qua da66. Chm t phu thut dn lu nc tiu bng quang67. Chm t phu thut ct dng vt khng vt hch, ct mt na dng vt68. Chm t phu thut dn lu vim ty quanh thn, p xe thn

69.

Chm t phu thut dn lu p xe khoang retzius70. Chm t phu thut p xe tuyn tin lit71. Chm t phu thut ct u si u ming so72. Chm t phu thut ct hp bao quy u73. Chm t phu thut ct ti tha niu o74. Chm t phu thut m rng l so75. Chm t phu thut ct ct c t cung76. Chm t phu thut treo t cung77. Chm t phu thut khu vng c t cung78. Chm t phu thut iu tr hp mn v ph i79. Chm t phu thut ng hu mn nhn to80.

Chm t phu thut ly si niu o81. Chm t phu thut phu thut bn chn thung


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84. Chm t phu thut ni gn gp c chn85. Chm t phu thut ly b ton b xng bnh ch86. Chm t phu thut ct ct cng chn87. Chm t phu thut khu vt thng phn mm vng u - c88. Chm t phu thut ct u lnhdng vt89. Chm t phu thut ct u nang thng tinh

90.

Chm t phu thut trn dch mng tinh hon91. Chm t phu thut ct u nang tuyn gip92. Chm t phu thut ct u tuyn gip93. Chm t phu thut ct u lnh phn mm94. Chm t phu thut ct polipt cung95. Chm t phu thut ct u thnh m o96. Chm t phu thut bc nhn tuyn gip97. Chm t phu thut ct u da u lnh, ng knh trn 5 cm98. Chm t phu thut ct u da u lnh, ng knh t 2- 5 cm99. Chm t phu thut qum

C. IN MNG CHM (53)100. in mng chm iu tr hi chng tht lng- hng101. in mng chm iu tr bo ph102. in mng chm iu tr lit na ngi do tai bin mch mu no103. in mng chm iu tr hi chng- d dy t trng104. in mng chm iu tr sa d dy105. in mng chm iu tr tm cn suy nhc106. in mng chm iu tr tr107. in mng chm phc hi chc nng vn ng cho tr bi lit108. in mng chm iu tr lit do bnh c tr em109. in mng chm iu tr lit do tn thng m ri thn kinh cnh tay tr em

110.

in mng chm iu tr sa t cung111. in mng chm iu tr hi chng tin mn kinh112. in mng chm iu tr i dm113. in mng chm iu tr thng kinh114. in mng chm iu tr ri lon kinh nguyt115. in mng chm iu tr hi chng tin nh116. in mng chm iu tr hi chng vai gy117. in mng chm iu tr hen ph qun118. in mng chm iu tr huyt p thp119. in mng chm iu tr lit dy thn kinh VII ngoi bin

120.

in mng chm iu tr tc tia sa121. in mng chm iu tr au dy thn kinh lin sn122. in mng chm iu tr tht vn ngn123. in mng chm iu tr au thn kinh V124. in mng chm iu tr lit t chi do chn thng ct sng125. in mng chm iu tr ri lon thn kinh chc nng do chn thng s no126. in mng chm iu tr khn ting127. in mng chm iu tr lit chi trn128. in mng chm iu tr lit chi di129. in mng chm iu tr au h mt130. in mng chm iu tr vim kt mc131.

in mng chm iu tr gim th lc132. in mng chm iu tr


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135. in mng chm h tr iu tr nghin ru136. in mng chm iu tr to bn ko di137. in mng chm iu tr vim mi xoang138. in mng chm iu tr ri lon tiu ha139. in mng chm iu tr au rng140. in mng chm iu tr vim a khp dng thp

141.

in mng chm iu tr vim quanh khp vai142. in mng chm iu tr gim au do thoi ha khp143. in mng chm iu tr au lng144. in mng chm iu tr di tinh145. in mng chm iu tr lit dng146. in mng chm iu tr ri lon tiu tin147. in mng chm iu tr b i c nng

D. IN NH CHM (69)148. in nh chm iu tr hi chng tin nh149. in nh chm iu tr hi chng vai gy

150.

in nh chm iu tr hen ph qun151. in nh chm iu tr huyt p thp152. in nh chm iu tr lit dy VII ngoi bin153. in nh chm iu tr tc tia sa154. in nh chm iu tr thiu nng tun hon no mn tnh155. in nh chm iu tr au au u, au na u156. in nh chm iu tr mt ng157. in nh chm iu tr hi chng stress158. in nh chm iu tr nn159. in nh chm iu tr nc160. in nh chm iu tr cm mo

161.

in nh chm h tr iu tr vim Amidan162. in nh chm iu tr bo ph163. in nh chm iu tr lit na ngi do tai bin mch mu no164. in nh chm iu tr hi chng d dy-t trng165. in nh chm phc hi chc nng cho tr bi lit166. in nh chm iu tr gim thnh lc167. in nh chm iu tr hi chng t k tr em168. in nh chm iu tr chm pht trin tr tu tr bi no 169. in nh chm iu tr phc hi chc nng tr bi no170. in nh chm iu tr cn au qun thn

171.

in nh chm iu tr vim bng quang172. in nh chm iu di tinh173. in nh chm iu tr lit dng174. in nh chm iu tr ri lon tiu tin175. in nh chm iu tr b i c nng176. in nh chm iu tr cn ng kinh cc b177. in nh chm iu tr sa t cung178. in nh chm iu tr hi chng tin mn kinh179. in nh chm iu tr tht vn ngn180. in nh chm iu tr au dy thn kinh V181. in nh chm iu tr lit t chi do chn thng ct sng182.

in nh chm iu tr ri lon thn kinh chc nng sau chn thng s no183. in nh chm iu tr khn ting


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186. in nh chm iu tr lit chi di187. in nh chm iu tr thng kinh188. in nh chm iu tr ri lon kinh nguyt189. in nh chm iu tr au h mt190. in nh chm iu tr vim kt mc191. in nh chm iu tr vim thn kinh th gic sau giai on cp

192.

in nh chm iu tr gim th lc193. in nh chm h tr iu tr nghin ma ty194. in nh chm iu tr to bn ko di195. in nh chm iu tr vim mi xoang196. in nh chm h tr iu tr nghin thuc l197. in nh chm iu tr i dm198. in nh chm iu tr ri lon tiu ha199. in nh chm iu tr au rng200. in nh chm iu tr nghin ru201. in nh chm iu tr vim khp dng thp

202.

in nh chm iu tr vim quanh khp vai203. in nh chm iu tr au do thoi ha khp204. in nh chm iu tr au lng205. in nh chm iu tr tai206. in nh chm iu tr gim khu gic207. in nh chm iu tr lit r, m ri dy thn kinh208. in nh chm iu tr ri lon cm gic nng209. in nh chm iu tr ri lon thn kinh thc vt210. in nh chm iu tr gim au do ung th211. in nh chm iu tr gim au do Zona212. in nh chm iu tr vim a r, a dy thn kinh213.

in nh chm iu tr chng tc c mt. CY CH (56)

214. Cy ch iu tr lit na ngi do tai bin mch mu no 215. Cy ch iu tr tm cn suy nhc216. Cy ch iu tr vim mi d ng217. Cy ch iu tr sa d dy218. Cy ch chm iu tr hi chng d dy- t trng219. Cy ch iu tr my ay220. Cy ch h tr iu tr vy nn221. Cy ch iu tr gim thnh lc

222.

Cy ch iu tr gim th lc223. Cy ch iu tr hi chng t k224. Cy ch iu tr lit do tn thng m ri cnh tay tr em225. Cy ch iu tr chm pht trin tr tu tr bi no 226. Cy ch chm iutr phc hi chc nng vn ng tr bi no227. Cy ch iu tr hi chng tht lng- hng228. Cy ch iu tr au u, au na u229. Cy ch iu tr mt ng230. Cy ch iu tr nc231. Cy ch iu tr hi chng tin nh232. Cy ch iu tr hi chng vai gy233.

Cy ch iu tr hen ph qun234. Cy ch iu tr huyt p thp


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237. Cy ch iu tr au thn kinh lin sn238. Cy ch iu tr tht vn ngn239. Cy ch iu tr lit t chi do chn thng ct sng240. Cy ch iu tr ri lon thn kinh chc nng sau chn thng s no241. Cy ch iu tr hi chng ngoi thp242. Cy ch iu tr khn ting

243.

Cy ch iu tr lit chi trn244. Cy ch iu tr lit chi di245. Cy ch iu tr h tr cai nghin ma ty246. Cy ch iu tr h tr cai nghin thuc l247. Cy ch iu tr h tr cai nghin ru248. Cy ch iu tr vim mi xoang249. Cy ch iu tr ri lon tiu ha250. Cy ch iu tr to bn ko di251. Cy ch h tr iu tr vim khp dng thp252. Cy ch iu tr vim quanh khp vai

253.

Cy ch iu tr au do thoi ha khp254. Cy ch iu tr au lng255. Cy ch iu tr i dm256. Cy ch iu tr cn ng kinh cc b257. Cy ch iu tr ri lon kinh nguyt258. Cy ch iu tr au bng kinh259. Cy ch iu tr sa t cung260. Cy ch iu tr hi chng tin mn kinh261. Cy ch iu tr di tinh262. Cy ch iu tr lit dng263. Cy ch iu tr ri lon tiu tin khng t ch

E. IN CHM (48)264. in chm iu tr hi chng tin nh265. in chm iu tr huyt p thp266. in chm iu tr thiu nng tun hon no mn tnh267. in chm iu tr hi chng stress268. in chm iu tr cm mo269. in chm iu tr vim amidan270. in chm iu tr tr271. in chm iu tr phc hi chc nng cho tr bi lit272. in chm iu tr h tr bnh t k tr em

273.

in chm iu tr lit tay do tn thng m ri cnh tay tr em274. in chm iu tr chm pht trin tr tu tr bi no 275. in chm iu tr phc hi chc nng vn ng trbi no276. in chm iu tr cn au qun thn277. in chm iu tr vim bng quang278. in chm iu tr ri lon tiu tin279. in chm iu tr b i c nng280. in chm iu tr sa t cung281. in chm iu tr hi chng tin mn kinh282. in chm iu tr lit t chi do chn thng ct sng283. in chm iu tr ri lon thn kinh chc nng sau chn thng s no284.

in chm iu tr hi chng ngoi thp285. in chm iu tr khn ting


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288. in chm iu tr chp lo289. in chm iu tr au h mt290. in chm iu tr vim kt mc291. in chm iu tr vim thn kinh th gic sau giai on cp292. in chm iu tr lc c nng293. in chm iu tr ri lon cm gic nng

294.

in chm h tr iu tr nghin thuc l295. in chm h tr iu tr nghin ru296. in chm iu tr vim mi xoang297. in chm iu tr ri lon tiu ha298. in chm iu tr au rng299. in chm iu tr au do thoi ha khp300. in chm iu tr tai301. in chm iu tr gim khu gic302. in chm iu tr lit do tn thng m ri dy thn kinh303. in chm iu tr ri lon thn kinh thc vt

304.

in chm iu tr gim au do ung th305. in chm iu tr gim au do zona306. in chm iu tr lit do vim a r, a dy thn kinh 307. in chm iu tr chng tic c mt

G. THU CHM (73)308. Thu chm iu tr hi chng tht lng- hng309. Thu chm iu tr au u, au na u310. Thu chm iu tr mt ng311. Thu chm iu tr hi chng stress312. Thu chm iu tr nc313. Thu chm iu tr cm mo, cm

314.

Thu chm iu tr vim amydan315. Thu chm iu tr bo ph316. Thu chm iu tr lit na ngi do tai bin mch mu no317. Thu chm iu tr hi chng d dy t trng318. Thu chm iu tr sa d dy319. Thu chm iu tr tr320. Thu chm h tr iu tr bnh vy nn321. Thu chm iu tr my ay322. Thu chm iu tr bnh vim mi d ng323. Thu chm iu tr tm cn suy nhc

324.

Thu chm iu tr bi lit tr em325. Thu chm iu tr gim thnh lc326. Thu chm iu tr lit tr em327. Thu chm iu tr bnh t k tr em328. Thu chm iu tr lit do tn thng m ri cnh tay tr em 329. Thu chm iu tr chm pht trin tr tu tr bi no 330. Thu chm iu tr phc hi chc nng vn ng tr bi no331. Thu chmiu tr cn ng kinh cc b332. Thu chm iu tr sa t cung333. Thu chm iu tr hi chng tin mn kinh334. Thu chm iu tr thng kinh335.

Thu chm iu tr ri lon kinh nguyt336. Thu chm iu tr i dm


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339. Thu chm iu tr hen ph qun340. Thu chm iu tr huyt p thp341. Thu chm iu tr thiu nng tun hon no mn tnh342. Thu chm iu tr lit dy thn kinh VII ngoi bin343. Thu chm iu tr au dy thn kinh lin sn344. Thu chm iu tr tht vn ngn

345.

Thu chm iu tr au dy V346. Thu chm iu tr au lit t chi do chn thng ct sng347. Thu chm iu tr lon chc nng do chn thng s no348. Thu chm iu tr hi chng ngoi thp349. Thu chm iu tr khn ting350. Thu chm iu tr ri lon cm gic u chi351. Thu chm iu tr lit chi trn352. Thu chm iu tr lit hai chi di353. Thu chm iu tr sp mi354. Thu chm h tr iu tr nghin ma ty

355.

Thu chm h tr iu tr nghin thuc l356. Thu chm h tr iu tr nghin ru357. Thu chm iu tr vim mi xoang358. Thu chm iu tr ri lon tiu ha359. Thu chm iu tr au rng360. Thu chm iu tr to bn ko di361. Thu chm h tr iu tr vim khp dng thp362. Thu chm iu tr au do thoi ha khp363. Thu chm iu tr vim quanh khp vai364. Thu chm iu tr au lng365. Thu chm iu tr sp mi366.

Thu chm iu tr au h mt367. Thu chm iu tr vim thn kinh th gic sau giai on cp368. Thu chm iu tr lc c nng369. Thu chm iu tr gim th lc370. Thu chm iu tr vim bng quang371. Thu chm iu tr di tinh372. Thu chm iu tr lit dng373. Thu chm iu tr ri lon tiu tin374. Thu chm iu tr b i c nng

H. XOA BP BM HUYT (71)

375.

Xoa bp bm huyt iu tr lit chi trn376. Xoa bp bm huyt iu tr lit chi di377. Xoa bp bm huyt iu tr lit na ngi do tai bin mch mu no378. Xoa bp bm huyt iu tr hi chng tht lng- hng379. Xoa bp bm huyt iu tr lit do vim no380. Xoa bp bm huyt iu tr chm pht trin tr tu tr bi no381. Xoa bp bm huyt phc hi chc nng vn ng tr bi no382. Xoa bp bm huyt iu tr cng khp chi trn383. Xoa bp bm huyt iu tr cng khp chi di384. Xoa bp bm huyt iu tr chong, ngt385. Xoa bp bm huyt iu tr bnht k tr em386.

Xoa bp bm huyt iu tr chng tai387. Xoa bp bm huyt iu tr gim khu gic


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390. Xoa bp bm huyt h tr iu tr nghin thuc l391. Xoabp bm huyt h tr iu tr nghin ma tu392. Xoa bp bm huyt iu tr tm cn suy nhc393. Xoa bp bm huyt iu tr hi chng ngoi thp394. Xoa bp bm huyt iu tr au u, au na u395. Xoa bp bm huyt iu tr mt ng

396.

Xoa bp bm huyt iu tr hi chng stress397. Xoa bp bm huyt iu tr thiu nng tun hon no mn tnh398. Xoa bp bm huyt iu tr tn thng r, m ri v dy thn kinh399. Xoa bp bm huyt iu tr tn thng dy thn kinh V400. Xoa bp bm huyt iu tr lit dy thn kinh s VII ngoi bin401. Xoa bp bm huyt iu tr sp mi402. Xoa bp bm huyt iu tr vim thn kinh th gic sau giai on cp403. Xoa bp bm huyt iu tr lc c nng404. Xoa bp bm huyt iu tr gim th lc405. Xoa bp bm huyt iu tr hi chng tin nh

406.

Xoa bp bm huyt iu tr gim thnh lc407. Xoa bp bm huyt iu tr vim mi xoang408. Xoa bp bm huyt iu tr hen ph qun409. Xoa bp bm huyt h tr iu tr tng huyt p410. Xoa bp bm huyt iu tr huyt p thp411. Xoa bp bm huyt iu tr au thn kinh lin sn412. Xoa bp bm huyt iu tr hi chng d dy- t trng413. Xoa bp bm huyt iu tr nc414. Xoa bp bm huyt iu tr vim khp dng thp415. Xoa bp bm huyt iu tr au do thoi ho khp416. Xoa bp bm huyt iu tr au lng417.

Xoabp bm huyt iu tr vim quanh khp vai418. Xoa bp bm huyt iu tr hi chng vai gy419. Xoa bp bm huyt iu tr chng tic c mt420. Xoa bp bm huyt iu tr ri lon cm gic u chi421. Xoa bp bm huyt iu tr tc tia sa422. Xoa bp bm huyt iu tr ri lon kinh nguyt423. Xoa bp bm huyt iu tr au bng kinh424. Xoa bp bm huyt iu tr hi chng tin mn kinh425. Xoa bp bm huyt iu tr to bn426. Xoa bp bm huyt iu tr ri lon tiu ho

427.

Xoa bp bm huyt iu tr ri lon cm gic nng428. Xoa bp bm huyt iu tr b i c nng429. Xoa bp bm huyt iu tr ri lon thn kinh thc vt430. Xoa bp bm huyt iu tr bo ph431. Xoa bp bm huyt iu tr ri lon chc nng vn ng do chn thng s no432. Xoa bp bm huyt iu tr lit t chi do chn thng ct sng433. Xoa bp bm huyt iu tr gim au sau phu thut434. Xoa bp bm huyt iu tr gim au do ung th435. Xoa bp bm huyt iu tr i dm436. Xoa bp bm huyt iu tr hi chng phn ly

I. CU (30)437.

Cu iu tr hi chngtht lng- hng th phong hn438. Cu iu tr au u, au na u th hn


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441. Cu iu tr khn ting th hn442. Cu iu tr ri lon cm gic u chi th hn443. Cu iu tr lit chi trn th hn444. Cu iu tr lit chi di th hn445. Cu iu tr lit na ngi th hn446. Cu iu tr lit dy thn kinh s VII ngoi bin th hn

447.

Cu iu tr au vai gy cp th hn448. Cu iu tr gim thnh lc th hn449. Cu h tr iu tr bnh t k th hn450. Cu iu tr chm pht trin tr tu tr bi no 451. Cu iu tr di tinh th hn452. Cu iu tr lit dng th hn453. Cu iu tr ri lon tiu tin th hn454. Cu iu tr b i th hn455. Cu iu tr sa t cung th hn456. Cu iu tr au bng kinh thhn

457.

Cu iu tr ri lon kinh nguyt th hn458. Cu iu tr i dm th hn459. Cu iu tr au lng th hn460. Cu iu tr gim khu gic th hn461. Cu iu tr ri lon thn kinh thc vt th hn462. Cu iu tr cm cm th hn463. Cu iu tr ri lon tiu ha th hn464. Cu h tr iu tr nghin ma ty th hn

K. GIC HI (4)465. Gic hi iu tr ngoi cm phong hn466. Gic hi iu tr ngoi cm phong nhit

467.

Gic hi iu tr cc chng au468. Gic hi iu tr cm cm

Tng s: 468 Hng dn quy trnh k thut chuyn ngnh chm cu


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1.MAI HOA CHM

1. I CNG

Mai hoa chm l phng php dng kim hoa mai (5 7 chic kim nh

cm vo u mt cn g) g trn mt da, nhm mc ch cha bnh hocphng bnh. y l mt hnh thc pht trin ca chm cu.

2. CH NH

Ni chung l g kim hoa mai c th dng cha tr cc bnh nh

ho chm vn thng lm. Phng php ny t rathch hp nht i vi cc

loi bnh: suy nhc thn kinh, au u mt ng, au dy thn kinh lin

sn, lit dy thn kinh VII, cn au d dy t trng, tiu ho km, au bng

kinh, i dm, sa trc trng, sm da, mn nga ngoi da...

3. CHNG CH NH

Nhng trng hp sau y khng c g kim hoa mai: va n no,

say qu, i qu, ang v m hi, ph n c thai, bnh ngoi da b vim lot

chy nc vng, chym.

4. CHUN B

4.1. Ngi thc hin: Bc s, Y s c o to v chuyn ngnh y hc c

truyn c cp chng ch hnh ngh theo quy nh ca php lut v khm

bnh, cha bnh.

4.2. Phng tin

-Kim hoa mai: ngy nay ngi ta thng dng 2 loi kim l

+ Kim chm.

+ Kim xo hnh gng sen.- Bng cn st trng.

4.3. Ngi bnh

-Ngi bnh c khm v lm h s bnh n theo qui nh.

- T th ngi bnh nm nga, nm sp hoc ngi.


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5. CC BC TIN HNH

5.1. Phc huyt

Mai hoa chm khng s dng phc huyt nh th chm m iu tr

theo vng, khu iu tr trn c th. Ngoi cch phn chia mt da lm 12 khutheo kinh in, ngi ta cn quy c mt s phn chia khc tin hnh

iu tr, theo c th c chia ra cc vng:

- Vng u mt gm: khutrn, khu trc nh u v hai bn u, khu nh

u, khu u sau, khu mt, khu mi, khu mi, khu g m, khu tai v khu thi

dng.

- Vng c gm: khu sau gy, khu trc c, khu c c n chm.

- Vng chi trn gm: khu trong cnh tay, khu trong khuu tay, khu trong

cng tay, khu trong c tay, khu gan bn tay, khu ngoi cnh tay v khu ngoi

cng tay, khu mu bn tay v khu ngn tay.

- Vng chi di gm: khu trc i, khi trc cng chn, khu sau i v

vng khoeo chn, khu sau cng chn, khu m trong i v cng chn, khu

m ngoi i v cng chn, khu trc c chn v mu chn, khu gan bn

chn, khu xng bnh ch, khu mt c trong v mt c ngoi.

- Vng ngc gm: khu xng c, khu lng ngc.

- Vng bng gm: khu bng trn, khu bng di, khu np bn.

- Vng lng gm: khu lng trn, khu lng gia, khu lng di, khu xng

b vai, khu c thang v trn vai.

5.2-Th thut

- Cch cm kim hoa mai: ngn tay ci v ngn gia cm cht 1/3 cn kim,ngn nhn v ngn t thn cn vo lng bn tay, ngn tr t ln cn

kim. Lc g ch yu l c ng nhp nhng c tay, trc tip b kim tip xc

thng gc vi mt da.

- Th thut g kim hoa mai: c 3 cch g l g nh, ng va v g mnh.


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+ G nh: g rt nh nhng trn mt da, hon ton khng au. Ngi bnh

cm thy thoi mi, d chu, th thut ny c tc dng t b, tng sc kho

choNgi bnh, thng dng cho chng h hn.

+ G va: sc khng nh, khng mnh, c tc dng bnh b bnh t, thngdng trong cc chng bn biu bn l, khng h khng thc.

+ G mnh: g mnh sc hn, sc bt ca c tay kho hn, tuy nhin Ngi

bnhvn sc chu ng, th thut ny c tc dng t, p dng vi cc

chng thc nhit.

- Trnh t g kim hoa mai: cn g theo mt th t nht nh, trc ht g

vng thng quy ri g khu trng im sau g khu kt hp.

Trng hp trong cng thc iu tr khng c thng quy m ch c

khu trng im v khu kt hp th g khu trng im trc, khu kt hp sau.

Nu g theo vng th g vng u, vng lng trc, g vng ngc,

bng, chn sau.G vng u th g khu trn trc, ri g khu thi dng,

khu nh u v cui cng l khu chm.

- Thi gian: 20- 30 pht cho mt ln g mai hoa chm

5.4. Liu trnh iu tr

- G kim mai hoa ngy mt ln.

- Mt liu trnh iu tr t 10 - 20 ln.

6. THEO DI V X TR TAIBIN

6.1. Theo di: Ton trng Ngi bnh.

6.2.X TR TAIbin

6.1. Vng chm:Ngi bnh hoa mt chng mt, v m hi, mch nhanh,sc mt nht nht. X l: lau m hi, m, ung nc ch ng nng, cho

ngi bnh nm ngh ti ch. t Ngi bnhnm sp, g nh khu tht

lng mi ng g 10 ln theo hng ngc t di ln trn. Theo di st

mch, huyt p.


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6.2. Ni nhng nt trn da: do da ngi bnh qu bn, lc g li khng

st trng bng cn. Xl: tm ngh iu tr vi ba ngy, v sinh c th sch

s, xoa cn vo vng ni mn.


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2.HO CHM

1. I CNG

Ho chm l phng php s dng kim nh (ho kim, 4-6cm)

chm vo huyt trn c th nhm mc ch phng v tr bnh.Ho kim l loi kim c thn kim rt nh, mi kim nhn, c nhiu loi

di ngn khc nhau. Loi kim ny c s dng iu tr nhiu loi bnh

v c dng ph bin hin nay.

2. CH NH

- Bnh c nng v triu chng ca mt s bnh nh ri lon thn kinh tim,

mt ng khng r nguyn nhn, km n, y bng, tiu chy, to bn, cm

cm, b tiu chc nng, nc,...

- Cc chng au cp v mn tnh: au do ng gip, chn thng, au sau

m, au cc khp hoc phn mm quanh khp, au trong cc bnh l v

thn kinh...

- Mt s bnh do vim nhim nh vim tuyn v, chp, lo....

3. CHNG CH NH

- C th suy kit, sc khng gim, ph n c thai.

- Trnh chm vo nhng vng huyt c vim nhim hoc l lot ngoi da.

- Tt c nhng cn au nghi do nguyn nhn ngoi khoa...

4. CHUN B


truyn c cp chng ch hnh ngh theo quy nh ca php lut v khm bnh,

cha bnh.4.2. Phng tin:

- Kim ho chm v khun dng mt ln.

- Khay men, km c mu, bng, cn 700

4.3. Ngi bnh


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-Ngi bnh c khm, lm h s bnh n theo quy nh.

-Ngi bnh nm t th thoi mi, chn t th sao cho vng c

chm c bc l r nht.

5. CC BC TIN HNH5.1. Th thut:

-Bc 1:+ Xc nh v st trng da vng huyt

+ Chn kim c di ty thuc dy ca c vng chm

-Bc 2:Chm kim vo huyt theo cc th sau:

Th 1:Tay tri dng ngn tay ci v ngn tr n, cng da vng huyt;

Tay phi chm kim nhanh qua da vng huyt.

Th 2:y kim t t theo huyt o, kch thch kim cho n khi tc

kh (Ngi bnhc cm gic cng, tc, nng va phi, khng au vng

huyt va chm kim, Ngi thc hin cm gic kim mt cht ti v tr

huyt).

-Bc 3. Rt kim, st khun da vng huyt va chm.

5.4. Liu trnh

Chm ngy 1 ln, thi gian 25- 30 pht/ln.


6.1. Theo di

Theo di ti ch v ton thn

6.2. X TR TAIbin

- Vng chm:Ngi bnh hoa mt, chng mt, v m hi, mch nhanh, sc

mt nht nht. X l: rt kim ngay, lau m hi, m, ung nc ch ngnng, nm ngh ti ch. Theo di mch, huyt p.

- Chy mu khi rt kim:dng bng v khun n ti ch, khng day


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3. MNG CHM

1. I CNG

Mng chm l hnh thc kt hp gia trng chm v c chm c in trong

Thin Cu Chm (sch Linh Khu).K thut mng chm l k thut dng kim to, kim di chm theo huyt o

tc l chm xuyn t huyt ny sang huyt kia trn cng mt ng kinh

hoc trn hai ng kinh khc nhau c tc dng iu kh nhanh, mnh hn

nn c tc dng cha ccchng bnh kh nh chng au, chng lit...

Kim chm trong s dng Mng chm l kim c di t 15 cm, 20 cm, 30

cm c th ti 60 cm, v ng knh t 0, 5 n 1 mm. Ty tng huyt o

trn c th m ta c th s dng cc kim chm c di tng ng.

2. CH NH

- Cc chng lit (lit do ti bin mch mu no, di chng bi lit, lit cc

dy thn kinh ngoi bin...)



thn kinh...

- Chm t phu thut.

3. CHNG CH NH


- Trnh chm vo nhng vng huyt c vim nhim hoc l lot ngoi da.


4. CHUN B:4.1. Ngi thc hin: Bc s, Y s c o to v chuyn ngnh y hc c


bnh, cha bnh.

4.2. Phng tin:


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- Kim mng chm v khun


- My in chmhai tn s b t

4.3. Ngi bnh-Ngi bnh c khm, lm h s bnh n theo quy nh


chm c bc l r nht.

5. CC BC TIN HNH

5.1. Th thut:

-Bc 1: +

Xc nh huyt o v st trng da vng huyt

+ Chn kim c di ty thuc dy ca c vng chm




Th 2:y kim t t theo huyt o, mt tay y mt tay n u kim sao

cho hng kim i ng theo ng huyt o c xc nh, kch thch

kim cho n khi tc kh (Ngi bnhc cm gic cng, tc, nng va

phi, khng au vng huyt va chm kim, Ngi thc hincm gic kim

mt cht ti v tr huyt).

-Bc 3. Kch thch huyt bng my in chm

Ni cp dy ca my in chm vi kim chm vo huyt theo tn

s b- t ca my in chm:

- Tn s (t tn s c nh): Tn s t t 5 - 10Hz, Tn s bt 1 - 3Hz.- Cng : nng dn cng t 0 n 150 microAmpe (tu theo mc

chu ng ca ngi bnh).

+ Thi gian: 20- 30 pht cho mt ln in mng chm.



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5.3. Liu trnh iu tr

- Mng chm ngy mt ln


6.1. Theo diTheo di ti ch v ton thn

6.2. X TR TAIbin


mt nht nht. X l: rt kim ngay, lau m hi, m, ung nc ch ng

nng, nm ngh ti ch. Theo di mch, huyt p.



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4. IN CHM

1. I CNG

in chm l phng php cha bnh phi hp gia tc dng cha

bnh ca chm cu vi kch thch bng dng in.Hin nay thng s dng my pht raxung in c tnh nng n nh,

an ton, iu chnh thao tc d dng, n gin. Kch thch ca dng xung

in c tc dng lm gim au, kch thch hot ng cc c, cc t chc,

tng cng dinh dng cc t chc, gim vim......

2. CH NH

- Cc chng lit (lit do ti bin mch mu no, di chng bi lit, lit cc

dy thn kinh ngoi bin, cc bnh l au nh au u, au lng, au thn

kinh ta, bnh ng quan nh gim th lc, gim thnh lc, tht ngn, chm t

trong phu thut...)



thn kinh...

- Bnh c nng v triu chng ca mt s bnh nh ri lon thn kinh tim,

mt ng khng r nguyn nhn, km n, y bng, tiu chy, to bn, cm

cm, b tiu chc nng, nc,...

- Mt s bnh do vim nhim nh vim tuyn v, chp, lo....

- Chm t phu thut

3. CHNG CH NH

- C th suy kit, sc khng gim, ph n c thai.- Trnh chm vo nhng vng huyt c vim nhim hoc l lot ngoi da.


4. CHUN B

4.1. Ngi thc hin:


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Bc s, Y s, Lng y c o to v chuyn ngnh y hc c truyn c

cp chng ch hnh ngh theo quy nh ca php lut v khm bnh, cha bnh.

4.2. Phng tin:

- Kim chm cu v khun dng mt ln- Khay men, km c mu, bng, cn 700

- My in chm hai tn s b t

4.3. Ngi bnh

-Ngi bnh c khm, lm h s bnh n theo quy nh


chm c bc l r nht.

5. CC BC TIN HNH

5.1. Th thut:

-Bc 1:+ Xc nh v st trng da vng huyt

+ Chn kim c di ty thuc dy ca c vng nh chm.




Th 2:y kim t t theo huyt o, kch thch kim cho n khi tc

kh (Ngi bnhc cm gic cng, tc, nng va phi, khng au vng

huyt va chm kim, Ngi thc hin cm gic kim mt cht ti v tr

huyt).

-Bc 3. Kch thch huyt bng my in chm

Ni cp dy ca my in chm vi kim chm vo huyt theo tns b- t ca my in chm:

- Tn s (t tn s c nh): Tn s t t 5 - 10Hz, Tn s b t 1 - 3Hz.

- Cng : nng dn cng t 0 n 150 microAmpe (tu theo mc

chu ng ca ngi bnh).


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+ Thi gian: 20- 30 pht cho mt ln in mng chm.


5.2. Liu trnh

Chm ngy 1 ln, thi gian 25- 30 pht/ln.6. THEO DI V X TR TAIBIN

6.1. Theo di

Theo di ti ch v ton thn

6.2. X TR TAIbin


mt nht nht. X l: rt kim ngay, lau m hi, m, ung nc ch ng

nng, nm ngh ti ch. Theo di mch, huyt p.



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5. PHNG PHP THY CHM

(Tim thuc vo huyt)

1. I CNG

Thy chm (hay tim thuc vo huyt) l mt phng php cha bnhkt hp ng- Ty y,phi hp tc dng cha bnh ca chm kim theo hc

thuyt kinh lc ca YHCT vi tc dng cha bnh ca thuc tim.

C nhng loi thuc tim c tc dng ton thn, c nhng loi thuc

ch c tc dng tng cng v duy tr kch thch ca chm kim vo huyt

nng cao hiu qu cha bnh.

2. CH NH

Ging nh ch nh ca chm cu. Thy chm c dng cha

mt s bnh mn tnh nh: thp khp, au d dy, hen ph qun, au u,

mt ng, au thn kinh ta

3. CHNG CH NH

Ging nh chng ch nh ca chm cu: Ngi bnhau bng cn

theo di ngoi khoa, bnh tim nng, trng thi tinh thn khng n nh, va

mi lao ng mt, i.

Khng c dng nhng thuc m ngi bnhc mn cm,d ng,

cc loi thuc c tc dng kch thch gy x cng, hoi t cc vng c dy

thn kinh v cc cKhng thy chm vo nhng huyt vng c mng,

pha di l tng ph, khp,dy chng, gn c,dy thn kinh, mch mu...

4. CHUN B

4.1. Ngi thc hin: Bc s, Y s c o to v chuyn ngnh y hc ctruyn c cp chng ch hnh ngh theo quy nh ca php lut v khm

bnh, cha bnh.

4.2. Phng tin

- Bm tim v trng 5 10ml, dng ring cho tng ngi bnh.


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- Khay men, kp c mu, bng, cn 70.

- Thuc tim: Thuc c ch nh tim bp, theo ch nh ca bc s

iu tr.

- Hp thuc cp cu sc phn v.4.3. Ngi bnh:

Ngi bnhc khm v chn on theo YHH v YHCT.

T th nm nga hoc nm nghing ty theo v tr nh tim.

* Trc khi iu trcn gii thch cho Ngi bnhhiu r c im ca

phng php iu tr ny v nhng phn ng thng thng c thxy ra

nh: au, cng tc, nng, n vng tim4.4. H s bnh n:

Ngi bnhc khm v lm h s bnh n theo qui nh.

Chn huyt v thuc thch hp.Nn chn nhng huyt c phn ng r

rt lm huyt chnh (A th huyt) v chia nhm huyt mi ln tim khng

qu nhiu huyt lm Ngi bnhau, thng chn 5 - 6 huyt cho mt ln

thy chm.

5. CC BC TIN HNH

5.1. Kim tra h s

Xem h s c ng vi ngi bnh khng ? Cc ch nh cn lm ?

5.2. Kim tra ngi bnh

Kim tra tnh trng ngi bnh hin ti, t th nm, bc l cc vng nh

thy chm.

5.3. Thc hin k thutBc 1.Ly thuc vo bm tim

Bc 2. Th phn ng thuc theo quy nh

Bc 3. Tin hnh thy chm theo cc th sau:

Th 1: St trng da vng huyt,


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Tay tri: Dng hai ngn tay n v cng da vng huyt

Tay phi: Chm kim nhanh qua da, y kim ti huyt, Ngi bnhthy cm

gic tc nng ti v tr kim chm

Th 2:t t bm thuc vo huyt, mi huyt t 0,5- 3 ml thuc.Th 3:Rt kim nhanh, st trng v tr tim.

5.3 Liu trnh iu tr :

Thy chm mt ngy mt ln, mi ln thy chm vo 2- 5 huyt.


6.1. Theo di

Theo di ti ch v ton thn6.2. X TR TAIbin

-Sc phn v: X trtheo phc

- Vng chm:

Triu chng:Ngi bnh hoa mt, chng mt, v m hi, mch nhanh, sc

mt nht nht.

X l: rt kim ngay, lau m hi, m, ung nc ch ng nng, nm ngh

ti ch. Day bm cc huyt Thi dng, Ni quan. Theo di mch, huyt p.

- Chy mu khi rt kim:dng bng v khun n ti ch, khng day.


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6. CY CH

1. I CNG

Cy ch phng php chm cu kt hp c truyn v hin i, c tinhnh bng cch dng mt loi protein l (ch catgut) vi vo huyt phng

v cha bnh. Ch cattgut l ch t tiu c bn cht l mt protein, do

trong qu trnh t tiu n lun to ra kch thch c hc ln huyt, pht huy

tc dng cha bnh ca huyt .

2. CH NH

- Cc bnh mn tnh

3. CHNG CH NH


- Da vng huyt b vim nhim hoc mc bnh ngoi da.

- D ng vi ch Catgut.

4. CHUN B:

4.1. Ngithc hin: Bc s, Y s c o to v chuyn ngnh y hc c


bnh, cha bnh.

4.2. Phng tin:

- Panh, ko, bng, cn st trng, gc v trng, cn it, bng dnh.

- Kim chc ng sng c G18, ch Catgut s 2/0 dng cho ngi ln. Kim,

ch m bo v trng.

- Kim chc ng sng c G20, ch Catgut s 3/0 dng cho tr em; kim, chm bo v trng.

- Khay men, kp c mu, bng gcbng dnh

- Hp thuc chng chong .

4.3. Ngi bnh


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- Ngi bnh c khm, lm h s bnh n theo quy nh.

-Ngi bnh nm t th thoi mi, chn t th sao cho vng huyt.

cy ch c bc l r nht.

5. CC BC TIN HNH5.1. Th thut:

- Ra tay sch, i gng tay v trng.

- Ct ch Catgut thnh tng on khong 1cm. Lun ch vo nng kim.

- Xc nh chnh xc huyt nh cy ch.St trng vng huyt

- Chm kim nhanh qua da v y t t ti huyt.

- y nng kim ch nm vo huyt, t gc v trng ln huyt va cy

ch, n tay ln ri rt kim ra, dn bng dnh ln gi gc.

Ch nhiu huyt chm vng mt nn cn thn trng khi lm th thut

trnh gy tn thng nhn cu hoc chy mu.

5.3 Liu trnh iu tr :

- Mi ln cy ch Catgut c tc dng trong khong 710 ngy , sau thi

gian ngi bnh n iu tr liu trnh tip theo.


6.1. Theo di : Ton trng Ngi bnh trong thi gian mi ln lm th

thut

6.2. X TR TAIbin :

- Chy mu: Dng bng gc kh v khun n ti ch, khng day

- au sng ni cy ch: chm nng, thuc chng ph n hoc khng sinh

ung nu nghi ng nhim khun


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7. N CHM

1. I CNG

n chm l va chm va cu trn cng mt huyt.2. CH NH

Bnh l c nguyn nhn h hn.

3. CHNG CH NH

- Cc trng hp bnh l c nguyn nhn thc nhit (c st cao...).

- Khng nn tin hnh n chm cc vng c nhiu gn, da st xng, vng

mt ...v c th gy bng, c bit l nhng vng b mt cm gic.

4. CHUN B

4.1. Ngi thc hin

Bc s, Y s c o to v chuyn ngnh y hc c truyn c cp chng

ch hnh ngh theo quy nh ca php lut v khm bnh, cha bnh.

4.2. Phng tin

- Kim chm cu v khun dng mt ln.


- Mi ngi hoc iu ngi.

- La (dim, bt la...).

4.3. Ngi bnh

-Ngi bnh c khm, lm h s bnh n theo quy nh

-Ngi bnh nm t th thoi mi.

5. CC BC TIN HNH5.1. Th thut

- Chm kim vo huyt theo phc iu tr

- C th dng ba cch lm nng kim n chm:


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+ Xuyn kim qua mi ngi cu gin tip trn huyt.

+ Lng mt on iu ngi vo cn kim ri t.

+ H iu ngi gn cn kim cho kim nng ln, sc nng theo kim.

truyn vo su.5.4. Liu trnh

n chm ngy 1 ln, thi gian 25- 30 pht


6.1. Theo di: Ton trng ca ngi bnh.

6.2. X TR TAIbin

-Bng (thng gy bng I)

+ Triu chng: ngi bnh thy nng rt sau khi cu, trn mt da vng

huyt c cu xut hin phng nc.

+ X tr:dng thuc m bi v dn bng trnh nhim trng.

- Chy:do mi ngi ri khi ngi Ngi bnhvng vo qun o hoc

chn m gy chy. Cn ch theo di st Ngi bnh khi thc hin k

thut cu.

- Vng chm:

+Triu chng:Ngi bnh hoa mt, chng mt, v m hi, mch nhanh, sc

mt nht nht.

+ X l: rt kim ngay, lau m hi, m, cho ung nc ch ng nng.

Nm ngh ti ch. Theo di mch, huyt p.

- Chy mu khi rt kim: Dng bng kh v khun n ti ch, khng day.


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8. CU

1. I CNG

Cu l dng sc nng tc ng ln huyt d kch thch to nn phn ng cac th phng v iu tr bnh. Cu thng dng l ngi cu kh ch

thnh ngi nhung ri lm mi ngi hay iu ngi cu.

- Cu bao gm cu trc tip, cu gin tip. Cu gin tip bao gm cu cch

gng c tc dng n trung tn hn, cu cch ti c tc dng tiu vim tr

c, cu cch mui c tc dng hi dng c thot....

2. CH NH

Bnh l c nguyn nhn h hn.

3. CHNG CH NH

- Cc trng hp bnh l c nguyn nhn thc nhit (c st cao...).

- Khng nn cu cc vng c nhiu gn, da st xng, vng mt ...v c

th gy bng, c bit l nhng vng b mt cm gic.

4. CHUN B

4.1. Ngi thc hin

Bc s, Y s, Lng y c o to v chuyn ngnh y hc c truyn c cp

chng ch hnh ngh theo quy nh ca php lut v khm bnh, cha bnh.

4.2. Phng tin

- Mi ngi hoc iu ngi.

- La (dim, bt la...).

- Gng, ti, mui (s dng khi cu gin tip).- Dao loi nh, sc, Khay men ng dng c.

4.3. Ngi bnh

-Ngi bnh c khm, lm h s bnh n theo quy nh.


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- Ngi bnh nm t th thoi mi, huyt c cu hng ln trn,

mt da nm ngang mingi t ln da c vng vng, khng b ri.

5. CC BC TIN HNH

5.1. Th thut- Ty bnh tt v huyt cn cu m chn cch cu trc tip hay gin tip.

- Cu trc tip: Dng mi ngi t vo huyt ri t. Khi mi ngi chy s

sinh nhit tc ng ln da vng huyt c cu. Khi mi ngi chy c 1/3

n 2/3, ngi bnh c cm gic nng, rt ni cu th nhc mi ngi ra sau

thay bng mi ngi khc. Sau khi cu xong ch cu thy m v c qung .

- Cu gin tip:l cch cu dng lt gng, ti hoc mui... lt vo gia da

v mi ngi. Trong khi cu, nu ngi bnh thy nng nhiu th nhc lt

gng, ti ln gim nng sau tip tc cu. Cng c th lt thm mt

lt gng, ti khc gim sc nng ca mi ngi. Ty theo bnh m chn

th ny hay th khc lt mi ngi.

- Th t trong khi cu: Huyt trn trc - huyt di sau, huyt kinh dng

trc - huyt kinh m sau, huyt ch tr trc - huyt phi hp sau.

5.2. Liu trnh

- Mi huyt c cu t 1- 3 mi ngi, trung bnh 15 pht/huyt, tr em v

ngi gi th thi gian cu ngn hn.

- Cu ngy 1 ln.


6.1. Theo di

Ton trng ca ngi bnh6.2. X TR TAIbin

-Bng (thng gy bng I)

+ Triu chng: ngi bnh thy nng rt sau khi cu, trn mt da vng

huyt c cu xut hin phng nc.


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+ X tr:dng thuc m bi v dn bng trnh nhim trng.

- Chy:do mi ngi ri khi ngi Ngi bnhvng vo qun o hoc

chn m gy chy.

+ phng: Khng cu nhiu huyt v trn nhiu Ngi bnh mt lc.Theo di st, khng c ri Ngi bnhkhi cu.


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9.CHCH L

1. I CNG

Chch l l phng php cha bnh khng dng thuc c cha ng ta

s dng t ngn xa. Chch (cn gi l Trch) l dng kim tam lng hockim ho chm m nh vo huyt hoc ch m nht ca vng da ng

huyt hoc vng ng huyt (ni c mu c ng), khi rt kim mu t

vt chy ra ngoi. L (cn gi l Nh) l vo da ln, dng kim m nh vo

ng im t huyt hoc xut huyt, mu khng t chy ra m phi dng tay

nn cho mu ra. y l phng php trc tip loi b cc cht c v mu

c ra khi c th khai thng cc kinh mch, gip cho kh huyt c

iu ho.

2. CH NH

Chch l c ch nh iu tr mt s bnh ton thn cng nh ti

ch, t cc bnh ni thng n cc chng ngoi cm, cc bnh cp tnh v

mn tnh. Hin nay, chch l c ch nh trong mt s chng bnh nh

sau:

- Trng phong (giai on cp), cn tng huyt p (khi khng c sn trong tay

thuc h p).

- Mt s trng hp ph n cc chi do vim tc ng mch, vim tc tnh

mch.

- Mt s chng au cp: au lng, au thn kinh toa...

- Tc tia sa.

- Chp lo.- au u do ngoi cm.

3. CHNG CH NH

+ Ngi bnh c chnh cp cu ngoi khoa.

+ Ngi bnh ang st ko di hoc mt nc, mt mu.


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+ Suy tim, lon nhp tim.

+ Bnh a chy mu, Ngi bnhsuy gim min dch.

4. CHUN B

4.1. Ngi thc hinBc s, Y s, lng y c o to v chuyn ngnh y hc c truyn c

cp chng ch hnh ngh theo quy nh ca php lut v khm bnh, cha

bnh.

4.2. Phng tin

- Kim tam lng v khun, kim chm cu v khun loi 4 - 6 cm, dng ring

cho tng ngi bnh.

- Khay men, km c mu, bng, cn700, gng tay v khun

4.3. Ngi bnh



5. CC BC TIN HNH

5.1-Phc huyt

Tu theo tng chng bnh m Ngi thc hinchn phc huyt

khc nhau, di y xin numt s phc chnh.

- Trng phong (giai on cp): Thp tuyn, Nhn trung, Thi dng, n

ng.

- Chp lo: Ph du, Nh tim (Can nhit huyt).

- Tc tia sa: Kin tnh, Thiu trch.

- au lng cp: Nhn trung, Hu kh, U trung.- au u do ngoi cm: Khc tr, Thi dng, n ng.

5.2-Th thut

Xc nh v st trng da vng huyt cn chch l. Nn dn cho mu

tp trung v vng huyt. Dng ngn tay ci v ngn tr tay tri vo bp


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mnh da vng huyt; ngn ci v ngn tr tay phi cm kim mt cch chc

chn, chm kim thng gc, mnh v dt khot qua da ng gia vng huyt.

Rt kim ra v nn mu t t, n m su vo y im au lm cho mu c

tro ra l chch l. Nn ht mu c (mu bm) th st trng li vtchch l.

5.3. Liu trnh iu tr

- Bnh cp tnh: mi ngy chch l 1 2 ln, mi liu trnh iu tr t 5 10 ngy.

- Bnh bn cp v mn tnh: mi ngy chch l mt ln, mt liu trnh iu tr

t 10 20 ngy, ngi bnh ngh 5 7 ngy iu tr liu trnh tip theo.



6.2.X TR TAIbin

6.1. Vng chm:Ngi bnh hoa mt chng mt, v m hi, mch nhanh,

sc mt nht nht. X l: rt kim ngay, lau m hi, m, ung nc ch

ng nng, cho ngi bnh nm ngh ti ch. Day bm cc huyt: Thi

dng, Ni quan. Theo di st mch, huyt p

6.2. Mu chy qu nhiu khi rt kim: dng bng kh v khun n ti ch,

khng day, sau dng ming gc v khun bng p li bng bng dnh.

6.3. Nhim trng vt chch l:biuhin bng sng au tai ch chch l. X

l: tm ngng vic chch l, st trng vng da b sng bng dung dch cn

Iod, dng khng sinh ng ung.


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10.LASER CHM

1.I CNG

Mt trong hai ng gp to ln cho khoa hc k thut ca ngnh vt ltrong th k 20 l laser. Nm 1960, chic my laser u tin ra i do nh

bc hc Maiman (M) ch to, v t thnh tu ny c ng dng rng

ri trong cc chuyn ngnh khc nhau trong c y hc. Hin nay laser

c ng dng rng ri trong cc chuyn ngnh khc nhau ca y hc bi n

c cc tnh cht rt c bit, l: tnh n sc, nh hng v chi

ph rt cao. Vic s dng nh sng n sc pht ra t mt thit b laser cng

sut thp (


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-Ngi bnhsau khi iu tr vi cc thuc c ch min dch, corticoid liu

cao ko di.

-Ngi bnhng kinh.

-Ngi bnhsuy tim mt b, lon nhp, suy mch vnh.-Ngi bnhcng gip.

- Khng chiu laser vo vng thp, u cc xng di ca tr v thnh nin,

cnh cc tuyn ni tit (tuyn gip, tinh hon...)

4. CHUN B

4.1. Ngi thc hin



4.2. Phng tin

-My pht laser cng sut thp: thng s dng laser He Ne, laserdiode

hng ngoi .

- Knh bo h cho Ngi thc hinvNgi bnh.

- Quy trnh iu tr laser cng sut thp.

4.3. Ngi bnh



5. CC BC TIN HNH

5.1-Phc huyt

Cc huyt c s dng trong iu tr bng laser chm cng tng t

nh cc huyt trong phc ca chm cu truyn thng. Tuy nhin, shuyt c chn trong laser chm t hn, thng t 4 n 10 huyt.

5.2-Th thut

Xc nh chnh xc vng huyt, dng k thut chiu im (chiu tia

thng gc vi huyt), u pht tia cch mt da 0,5cm. Gi u pht ti ch


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cho n khi ht thi gian iu tr, khi my s pht ra tn hiu m thanh v

u chiu t ng ngng pht tia.

Chiu ln lt tng huyt cho n khi ht cc huyt theo phc .

5.3. Liu iu trLiu iu tr ph thuc vo tng loi huyt v tnh trng ca bnh

(bnh cp tnh dng liu thp, bnh mn tnh dng liu cao). Liu iu tr

c tnh bng J/cm2.

Loi huyt Liu

A th huyt 12 J / cm2

Huyt gip tch 24 J / cm

2

Huyt chm cu ngi ln 13 J / cm2

Huyt chm cu tr em 0,51,5 J / cm2

Thi gian iu tr tu thuc vo liu iu tr v s huyt c la chn.

Thng thng thi gian iu tr bng laser chm t 5 10 pht/ln.

5.4. Liu trnh iu tr

- Bnh cp tnh: mi ngy iu tr 1 2 ln, mi liu trnh 5 10 ngy.

- Bnh bncp v mn tnh: mi ngy iu tr 1 ln, mi lit trnh iu tr t

2 - 4 tun.Bnh mn tnh c th iu tr cch ngy.


6.2.X TR TAIbin

Ngi bnh xut hin cc nt da, mn nga (do c a qu mn

cm vi nh sng), tt my laser, tm dng iu tr 1 3 ngy cho n khiht cc nt .

6.3. Ch khi iu tr bng laser chm

- Khng c chiu thng gc tia laser vo mt v c th lm tn thng

vng mc.


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- Da trn cc vng huyt khng c bi du, m hay cc loi kem, gell v

s lm tia laser b phn x mt phn v nh hng n mc m xuyn

ca tia.


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11.T CHM

1.I CNG

T xa xa, con ngi bit s dng nam chm t nhin (t trng)

vo mc ch cha bnh. Ngy nay, t trng v ang c ng dng chiu qu trong rt nhiu lnh vc lm sng nh: ni khoa, ngoi khoa, vt l

tr liu v cc chuyn khoa khc.

ng hnh vi y hc hin i, y hc c truyn cng s dng nam

chm vnh cu thay cho cy kim chm cu truyn thng phng v iu tr

rt nhiu chng bnh bnh, gp phn ng k trong vic bo v v nng cao

sc kho cho nhn dn. y l mt trong nhiu phng php kt hp gia

Y hc c truyn vi Vt l tr liu v c gi l t chm.

2. CH NH

T trng chm l mt phng php tr liu an ton, t c hi v c

hiu qu. Mt s ch nh ca t chm l:

- Gim au: au c gy, au quanh khp vai, vim mm trn li cu, hi

chng ng c tay, au lng hng, au thn kinh to...

- Chng vim: cc vng vim nh, nng (mn, nht), cc vim ni tng

(vim i trng co tht, vim lot d dy hnh t trng.

- iu ho trng lc thn kinh: hi chng thn kinhh suy nhc, au u,

mt ng, ri lon thn kinh thc vt.

- iu ho v n nh huyt p.

3. CHNG CH NH

- Khng s dng t chm trong cc trng hp sau:-Nhng Ngi bnhc my to nhp tim.

- Ph n trong thi k mang thai, ph n trong thi k kinh nguyt: khng

iu tr vo vng bng, vng tht lng v xng cng.

-Ngi bnhsau nhi mu c tim cp.


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- Bnh h thng v bnh mu (mu chm ng...).

- Cc vng ang chy mu hoc c nguy c chy mu.

4. CHUN B

4.1. Ngi thc hinBc s, Y s c o to v chuyn ngnh y hc c truyn c cp chng


4.2. Phng tin

- Vin nam chm vnh cu cc loi vi cc thng s cng t trng

khc nhau (t 10 50 mT).

- Bng dnh.

- Bng cn.

4.3. Ngi bnh



5. CC BC TIN HNH

5.1-Phc huyt

Cc huyt c s dng trong iu tr bng t chm cng tng t

nh cc huyt trong phc ca chm cu truyn thng. Tuy nhin, s

huyt c chn trong t chm t hn, thng t 2 n 6 huyt.

5.2-Th thut

Xc nh chnh xc vng huyt, lau sch b mt da vng huyt bng

bng cn, ch cho b mt da kh th t cc vin nam chm ln v tr ca cc

huyt theo phc iu tr, dng bng dnh dn cht li.Cng nh chm cu truyn thng, tu theo yu iu ho kinh kh

trong c th m ngi ta s dng cc th thut b v t. Khi s dng vim

nam chm gn ln cc huyt th cc Nam (k hiu l S) tng ng tc dng

t (nu gim au, nn dng cc Nam thng c mu ), cc Bc (k hiu


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l N thng c mu en) tng ng tc dng b (nu dng iu ho

trng lc thn kinh , nn dng cc Bc).

Nam chm vnh cu c th s dng 5 10 nm vn cha b suy gim

t tnh. Khi iu tr xong nn ct i c th dng li ln sau.5.3. Liu iu tr

Liu iu tr ca t chm chnh l tr s ca cng t trng, n

v tnh ca cng t trng l dng trong t chm l millitestla (mT).

Cng t trng khi p dng t chm nn dng liu thp v trung bnh

(1040 mT).

Thi gian lu cc vin nam chm trn vng u mt c khng qu 20

pht. Cc huyt khc lu vin nam chm 30 40 pht.

5.4. Liu trnh iu tr.

- Bnh cp tnh: mi ngy iu tr 1 ln, mt liu trnh 5 10 ngy.

- Bnh bn cp v mn tnh: mi ngy iu tr 1 ln, mt liu trnh t 15 -

20 ngy.


6.1. Theo di

Ton trng Ngi bnh.

6.2.X TR TAIbin

Mt s t trng hp c cm gic mt mi, vng vt khi iu tr t

trng, hoc b d ng vi vin nam chm (do cht liu lm v bc vin nam

chm). Cho Ngi bnh tm ngh 1 2 ngy cho ht tnh trng vng vt

hoc d ng. Nu bnh s dng li t chm m Ngi bnhvn c cc triuchng trn th khng tip tc iu tr bng t chm m chuyn phng php

iu tr khc.


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12.QUY TRNH KO GIN CT SNG C

1. I CNG

Hi chng au ct sng c thng gp trn lm sng v do nhiunguyn nhn khc nhau. Ngi bnhau ct sng c v tht lng ch yu

c iu tr theo phng php ni khoa (90%), ch 10% cch nh phu

thut.

Phng php ko gin iu tr hi chng au ct sng c bng my

ko gin c lp trnh vi tnh chng minh c hiu qu iu tr trong thc

t. Ngi thc hintrc khi ch nh phng php ny ngoi vic nh gi

trn lm sng cn phi c y cc kt qu cn lm sng, phim chp Xq

thng thng v MRI, o mt xng xc nh nguyn nhn, mc

bnh tt ca Ngi bnh.

2. CH NH

- Thoi ha ct sng

- Li, phnh, thot v a m

- Sai khp ct sng mc nh (giai on u)

- Hi chng ct sng c

- au lng thng thng

- Cong vo ct sng (c nng)

3. CHNG CH NH

- C tn thng ty sng, bnh ng sng

- Lao, ung th ct sng- Vim ty, abces vng ct sng

- Long xng III

- Tng HA

- Chn thng ctsng


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4. CHUN B

4.1. Ngi thc hin


ch hnh ngh theo quy nh ca php lut v khm bnh, cha bnh.4.2. Ngi bnh

Kim tra cn nng, tho ai np, dy chuyn, hoa tai, kp tc v chun b

tinh thn trc khi thc hin ko gin.

4.3. Phng tin

My ko gin, ai ko c trong tnh trng hot ng tt.

5. CC BC TIN HNH

- Gii thch cho Ngi bnh.

- Sp t t th cho Ngi bnhtrn ging ko gin.

- Kim tra v lpai ko cho Ngi bnh.

- Bt my, xc nh lc v thi gian ko gin (cng thc: ct sng c bng

1/3 trng lng 10kg).

- Tt my khi hon thnh quy trnh ko gin, Ngi thc hin t t tho b

ai ko c cho Ngi bnh.

- Hng dn Ngi bnh nm ngh t nht 2 pht sau ko gin v cch

nghing ngi ngi dy ra khi ging ko gin.

- Liu trnh iu tr:Ngy 01 ln x 10 15 pht, iu tr theo liu trnh 10

20 ln ko gin lin tc.

6. THEO DI X TR TAI BIN

y l mt phng php iu tr rt an ton khi tun th ng chnh, ng quy trnh ko gin. Trong qu trnh thc hin ko gin ct sng

lun cn c Ngi thc hintheo di ton trng Ngi bnh, theo di tnh

trng hot ng ca thit b ko gin v c y cc phng tin h tr khi

xy ra cc vn ngoi . Trong khi ko gin, Ngi bnhcm thy ai


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ko khng va cn tt my v lp li ai, nu Ngi bnh xut hin trng

thi kh chu, au vng c gy, cm gic kh th Ngi thc hincn dng

ngay ko gin, Ngi bnh nm ngh trn ging ko, kim tra mch,

HA, ng vin Ngi bnhv c cc x tr tip theo


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13.QUY TRNH KO GIN CT SNG THT LNG

1. I CNG

Hi chng au ct sng tht lng thng gp trn lm sng v donhiu nguyn nhn khc nhau. Ngi bnhau ct sng tht lng ch yu

c iu tr theo phng php ni khoa (90%), ch 10% c ch nh phu

thut.

Phng php ko gin iu tr hi chng au ct sng tht lng bng

my ko gin c lp trnh vi tnh chng minh c hiu qu iu tr trong

thc t. Ngi thc hin trc khi ch nh phng php ny ngoi vic

nh gi trn lm sng cn phi c y cc kt qu cn lm sng, phim

chp Xquang thng thng v MRI, o mt xng xc nh nguyn

nhn, mc bnh tt ca Ngi bnh.

2. CH NH

- Thoi ho ct sng.

- Thot v a m ct sng mc nh v va.

- Cc chng au lng thng thng.

- Vo ct sng (c nng).

3. CHNG CH NH

- Cc trng hp bnh l ct sng gy chn p tu, bnh ng tu.

- Lao, ung thct sng.

- Vim ty, p xe vng lng.

- Chn thng ct sng c gy xng.- Vim khp dng thp.

- Hi chng ui nga.

- Thot va m vo trong thn t (thot v Schmorl).

- Long xng III.


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- Ph n c thai.

4. CHUN B


truyn c cp chng ch hnh ngh theo quy nh ca php lut v khmbnh, cha bnh.

4.2. Ngi bnh: Kim tra cn nng, b tho ai np v chun b tnh thn

trc khi thc hin ko gin.

4.3. Phng tin:My ko gin, ai ko trong tnh trng hot ng tt.

5. CC BC TIN HNH

- Gii thch cho Ngi bnh.

- Sp t t th cho Ngi bnhtrn ging ko gin.

- Kim tra v lp ai ko tht lng cho Ngi bnh.

- Bt my, xc nh lc v thi gian ko gin (ct sng tht lng bng 2/3

trng lng 10kg).

- Tt my khi hon thnh quy trnh ko gin, tho b ai tht lng cho

Ngi bnh.

- Hng dn Ngi bnh nm ngh t nht 2 pht sau ko gin v cch

nghing ngi ngi dy ra khi ging ko gin.

- Liu trnh iu tr:Ngy 01 ln x 10 15 pht, iu tr theo liu trnh 10

20 ln ko gin lin tc.


y l mt phng php iu tr rt an ton khi tun th ng ch

nh, ng quy trnh ko gin. Trong qu trnh thchin ko gin ct snglun cn c Ngi thc hintheo di ton trng Ngi bnh, theo di tnh

trng hot ng ca thit b ko gin v c y cc phng tin h tr khi

xy ra cc vn ngoi . Trong khi ko gin, Ngi bnhcm thy ai

ko khng va cn tt my v lp li ai, nu Ngi bnh xut hin trng


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thi kh chu, au lng, au bng, cm gic kh th Ngi thc hincn

dng ngay ko gin, Ngi bnh nm ngh trn ging ko, kim tra

mch, huyt p, ng vin Ngi bnhv c cc x tr tip theo


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14. QUY TRNH TM DC THO

1. I CNG

Tm dc tho l phng php chm sc phc hi sc khe v chabnh c truyn c lch s hng ngn nm. Hin nay,vi mc ch chm

sc ton din, ngi ta kt hp xng hi, ngm thuc, tm dc tho,

chm ngi cu, xoa bp bm huyt nhmpht huy ti u tc dng ca cc

phng php ng thiem li nhng gi tr c bit cho ngi bnh.

2. CH NH

- Cc chng au, chng lit.

- Cm cm do phong hn.

- Hi chng cng thng tm l, mt mi,...

3. CHNG CH NH

- St nhit.

- Bnh l tim mch, huyt p.

- ng kinh, tm thn, say ru bia, kch ng,...

-ph n ang rong thi k c thai, hnh kinh.

- Trng thi qu no hoc qu i.

4. CHUN B

4.1. Ngi thc hin

Bc s,Y s, Lng y c o to v chuyn ngnh y hc c truyn

c cp chng ch hnh ngh theo quy nh ca php lut v khm bnh,

cha bnh.4.2. Phng tin

- Bn ngm, nc m, nc tho dc m, cc loi tho dc c tinh du,

ti chm...

4.2. Ngi bnh


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-Ngi bnhc kim tra mch, huyt p... trc khi tm thuc.

5. CC BC TIN HNH

Ngi bnh tm sch trong 2 pht bng nc m tip

5.1.Ngm ngi trong bn g (th tch t 250 300 lt) bng nc thodcnhit ngang bng nhit c th (37-400C), trong thi gian t 7 -10

pht.

Tc dng: gii cm, chng mt mi, chng au lng, cha thn kinh ta.

5.2.Ngm bn sc bng nc m sch trong thi gian 5 - 7 pht.

Tc dng: cha cc bnh ngoi da, lm sn chc da, tiu vim, tnh thn.

5.3.Xng hi kh hoc t bng l tho dc trong vng 57 pht, tip

ngm chn nc gng.

Tc dng: gii cm, gii c t v gim au.

5.4.Tm trng gii cm trong thi gian 3 pht.

5.5. Ngi bnh c k thut vin p ti chm ngi m cha dc tho,

kt hp day n cc im au ti vng tht lng, c gy v vai, hai tay v hai

chn.

Tc dng: tng cng gin cc khi c su cc vng b au.

Thi gian thc hin ton b quy trnh nu trn l 30 pht.

Liu trnh:2 ngy lm 1 ln, mt liu trnh iu trt 5 n 7 ln.


y l mt phng phpan ton khi tun th ng ch nh,ng quy

trnh. Trong qu trnh thc hin cn c Ngi thc hintheo di ton trng

Ngi bnhv c y cc phng tin h tr khi xy ra cc vn ngoi.


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B. CHM T PHU THUT

15.CHM T PHU THUT GLCM (GLAUCOME)

1. I CNG

- L phng php v cm phu thut mt.

- Mc ch: m bo v cm cho phu thut mt tin hnh thun li v an ton.

2. CH NH

-Nhng bnh nhn b glocom, bong vng mc ti pht, ghp gic mc, phi m

li t 2 ln tr ln c ch nh phu thut ca chuyn khoa mt.3. CHNG CH NH

-Ngi bnh di 18 tui

-Ngi bnh c bnh tm thn, ng kinh, bnh tim nng

-Ngi bnh khng hp tc vi chm t

- Ph n c thai

-Ngi bnh c huyt p cao trn 180/110mmHg.

4. CHUN B

4.1. Ngi thc hin:Bc s, Y s c o to v chuyn ngnh y hc c truyn

c cp chng ch hnh ngh theo quy nh ca php lut v khm bnh, cha

bnh.

4.2. Phng tin

- My in chm hai tn s b, t.

- Kim chm cu v trng loi: 6- 8-10cm

- Bm tim v trng 5ml, bng, cn st trng, km c mu.

- Thuc: + Atropin sunphat 0,25mg x 01 ng

+ Seduxen 10mg x 01 ng

+ Morphin 10mg x 01 ng


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+ Fentanyl 5mg/10ml x 01 ng.

- Cc phng tin, dng c, thuc hi sc cp cu.

4.3. Ngi bnh

- c lm h s bnh n chuyn khoa mt theo quy nh.- c gii thch bit cm gic cng tc nng tay v vng mt khi chm t.

5. CC BC TIN HNH

5.1. Phc huyt

- Hp cc -Ni quan

- Thi dng - Quyn liu

- Ton trc xuyn Ty trc khng - phong

5.2. T th Ngi bnhnm nga, hai tay dang.

5.3. Th thut

-Bc 1: Xc nh v st trng da vng huyt




Th 2: y kim t t ti huyt, kch thch kim cho n khi tc kh (bnh

nhn c cm gic cng, tc, nng va phi, khng au vng huyt va chm kim,

thy thuc cm gic kim mt cht ti v tr huyt).

Chm t cc huyt 2 bn:

- Hp cc : chm kim nghing 45, su 1-2 thn.

-Ni quan : chm kim nghing 60-70, su 1,5-2,5 thn.

Chm t cc huyt bn m:

- Ton trc xuyn Ty trc khng: kim nghing 15.

- phong: chm kim nghing 60-70hng v pha mt m, su 3-4 thn.


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- Thi dng: chm kim nghing 35, su 1-1,5 thn, a kim qua khe xng

nh gia cung g m v xng thi dng, khi c kh bnh nhn c cm gic tc

su vo sau hc mt.

- Quyn liu: chm kim thng gc, phi a c mi kim vo khe bm hm,bnh nhn c cm gic tc vo sau hc mt.

5.4. Kch thch huyt bng my in chm

Ni cp dy ca my in chm vi kim chm vo huyt theo tn s t

ca my in chm:

- Tn s (t tn s c nh): cao ngay t u 25-55Hz.

- Cng : nng dn cng t 0 n 300 microAmpe

- Thi gian: kch thch ban u t 20-30 pht s t v duy tr kch thch trong sut

qu trnh phu thut.

5.5. Thuc h tr:

a.Tim tnh mch chm 5-10 pht trc khi rch da:

- Atropin sunphat 0,5g/1kg cn nng.

- Seduxen 0,2mg/kg cn nng.

- Morphin 0,2mg/kg cn nng.

b. Tim tnh mch chm khi cn thit tng cng

- Fentanyl 2g/kg cn nng.


6.1. Trong khi chm

- Chm huyt Quyn liu nu su qu, kim s vo trong ming, phi chnh kim

nng hn.

- Chm huyt phong vng xng hm trn v di, khng t yu cu v

su v gy au: rt kim ra v chm li.

- Vng chm: ngi bnh ra m hi, lnh tot. X l: rt ht kim, bm huyt

Nhn trung. Ch 15 pht, chm li nu vn vng chm th rt kim, i phng


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php v cm; nu ngi bnh bnh thng th li tip tc chm tin hnh phu

thut.

6.2. Sau khi chm

Nu chy mu sau khi rt kim, dng bng kh v khun, n cm mu ti ch,khng day.

7. NH GI KT QU

Khi kch thch my, bnh nhn c cm gic t b, nng lan t u ngn tay ln.

Sau 20-25 pht cm gic ny lan n khuu tay, bnh nhn khng nhc c bn

tay, cng tay, ng thi vng mt c cm gic t b, cng, nng. l thi im bt

u tin hnh phu thut.


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16. CHM T PHU THUT QUM

1. I CNG

- L phng php v cm phu thut mt.- Mc ch: m bo v cm cho phu thut mt tin hnh thun li v an ton

2. CH NH

-Nhng bnh nhn bi bnh qum c ch nh phu thut ca chuyn khoa mt.

3. CHNG CH NH

-Ngi bnh di 18 tui



- Ph n c thai


4. CHUN B



cha bnh.

4.2. Phng tin





+ Seduxen 10mg x 01 ng- Cc phng tin, dng c, thuc hi sc cp cu.

4.3. Ngi bnh

- c lm h s bnh n chuyn khoa mt theo quy nh.

- c gii thch bit cm gic cng tc nng tay v vng mt khi chm t.


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5. CC BC TIN HNH

5.1. Phc huyt

- Hp cc -Ni quan

- Thi dng - Quyn liu- Ton trc xuyn Ty trc khng - phong


5.3. Th thut








Chm t 2 bn cc huyt:


-Ni quan : chm kim nghing60-70, su 1,5-2,5 thn.

Chm t bn m cc huyt:




nh giacung g m v xng thi dng, khi c kh bnh nhn c cm gic tc

su vo sau hc mt.

- Quyn liu: chm kim thng gc, phi a c mi kim vo khe bm hm,

bnh nhn c cm gic tc vo sau hc mt.

5.4. Kch thch bng my in chm

- Tn s: cao ngay t u 25-55Hz.


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- Cng : tng dn t 40-300micro-Ampe


qu trnh phu thut.

5.5. Thuc h tr:Tim tnh mch chm 5-10 pht trc khi rch da:

- Seduxen 0,2mg/kg cn nng .

- Atropin sunphat 0,5g/1kg cn nng

6. THEO DI V X TR TAI BIN

6.1. Trong khi chm


nng hn.



- Vng chm: ngi bnh ra m hi, lnh tot. X l: rt ht kim, bm huyt Nhn

trung. Ch 15 pht, chm li nu vn vng chm th rt kim, i phng php v

cm; nu ngi bnh bnh thng th li tip tc chm tin hnh phu thut.

6.2. Sau khi chm

Nu chy mu sau khi rt kim, dng bng kh v khun, n cm mu ti ch,

khng day.

7. NH GI KT QU



tay, cng tay, ng thi vng mt c cm gic t b, cng, nng. l thi im btu tin hnh phu thut.


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17.CHM T PHU THUT LC THNG THNG

1. I CNG


- Mc ch: m bo v cm cho phu thut mt tin hnh thun li v an ton.2. CH NH

-Nhng bnh nhn b lc mt hoc 2 bn mt c ch nh phu thut ca chuyn

khoa mt.

3. CHNG CH NH

-Ngi bnh di 18 tui



- Ph n c thai


4. CHUN B



cha bnh.

4.2. Phng tin





+ Seduxen 10mg x 01 ng,+ Morphin 10mg x 01 ng



4.3. Ngi bnh


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- c lm h s bnh n chuyn khoa mt theo quy nh.

- c gii thch bit cm gic cng tc nng tay v vng mt khi chm t.

5. CC BC TIN HNH

5.1. Phc huyt- Hp cc -Ni quan




5.3. Th thut








Chm t 2 bn cc huyt:



Chm t bn m cc huyt:





su vo sau hc mt.

- Quyn liu: chm kim thng gc, phi a c mi kim vo khe bm hm,

bnh nhn c cm gic tc vo sau hc mt.


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- Tn s: cao ngayt u 25-55Hz.


- Thi gian: kch thch ban u t 20-30 pht s t v duy tr kch thch trong sutqu trnh phu thut.

5.5. Thuc h tr:

a.Tim tnh mch chm 5-10 pht trc khi phu thut:







6.1. Trong khi chm


nng hn.






thut.

6.2. Sau khi chmNu chy mu sau khi rt kim, dng bng kh v khun, n cm mu ti ch,

khng day.

7. NH GI KT QU


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u tin hnh phu thut.


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18.CHM T PHU THUT

LY TH THU TINH TRONG BAO, NGOI BAO, RA HT CC

LOI CATARACT GI, BNH L, SA, LCH, V

1. I CNG


- Mc ch: m bo v cm cho phu thut mt tin hnh thun li v an ton.

2. CH NH

-Nhng bnh nhn c ch nh phu thut ly th thu tinh trong bao, ngoi bao,

ra ht cc loi cataract gi, bnh l, sa, lch, v ca chuyn khoa mt.

3. CHNG CH NH

-Ngi bnh di 18 tui

-Ngi bnh c bnh tm thn, ngkinh, bnh tim nng


- Ph n c thai


4. CHUN B



cha bnh.

4.2. Phng tin


- Kim chm cu v trng loi: 6- 8-10cm- Bm tim v trng 5ml, bng, cn st trng, km c mu.


+ Seduxen 10mg x 01 ng,



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4.3. Ngi bnh

- c lm h s bnh n chuyn khoa mt theo quy nh.- c gii thch bit cm gic cng tc nng tay v vng mt khi chmt.

5. CC BC TIN HNH

5.1. Phc huyt

- Hp cc -Ni quan




5.3. Th thut








Chm t 2 bn cc huyt:



Chm t bn m cc huyt:




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su vo sau hc mt.

- Quyn liu: chm kim thng gc, phi a c mi kim vo khe bm hm,bnh nhn c cm gic tc vo sau hc mt.



- Cng : tng dnt 40-300micro-Ampe


qu trnh phu thut.

5.5. Thuc h tr:








6.1. Trong khi chm


nng hn.






thut.


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6.2. Sau khi chm


khng day.

7. NH GI KT QUKhi kch thch my, bnh nhn c cm gic t b, nng lan t u ngn tay ln.



u tin hnh phu thut.


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19.CHM T PHU THUT U XVM MI HNG

1. I CNG

- L phng php v cm phu thut u x vm mi hng.

- Mc ch: m bo v cm cho phu thut u x vm mi hng tin hnh thunli v an ton.

2. CH NH

- bnh nhn c ch nh ct u x vm mi hng ca chuyn khoa tai mi hng.

3. CHNG CH NH

-Ngi bnh di 18 tui



- Ph n c thai


4. CHUN B



cha bnh.

4.2. Phng tin


- Kim chm cu v trng loi 6- 8- 10cm

- Bm tim v trng 5ml, 10ml,bng, cn st trng, km c mu.

- Thuc: + Seduxen 10mg x 01 ng

+ Atropin sunphat 0,25mg x 01 ng- Cc phng tin, dng c, thuc hi sc cp.

4.3. Ngi bnh

- H s bnh n chuyn khoa tai mi hng theo quy nh.

- c gii thch bit cm gic cng tc nng tay v vng m khi chm t.


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5. CC BC TIN HNH

5.1. Phc huyt

- Hp cc -Ni quan

- Amidan - Thin t- Thng lim tuyn. phong

5.2. T th Ngi bnhnm nga, vai k gi u nga ra sau, hai tay dang.

5.3. Th thut








Chm t:

- Hp cc 2 bn: chm kim nghing 45, su 1-2 thn.

-Ni quan 2 bn: chm kim nghing 30, su 1,5-2,5 thn.

- Amidan 2 bn: chm su 1,5-2,5 thn hng v gc li cng bn.

- Thin t: chm su 0,5-1 thn.

- Thng lim tuyn: chm su 1-1,5 thn, hng kim v gc li.

- phong 2 bn: chm kim nghing 60-70hng v pha m





qu trnh phu thut.

5.5. Thuc h tr


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Tim tnh mch chm trc khi m 10-15 pht:

- Atropin sunphat 0,25g x 01 ng.

- Seduxen 10mg x 01 ng.

6 THEO DI V X TR TAIBIN6.1. Trong khi chm

- Vng chm:ngi bnh ra m hi, lnh tot. X tr: rt ht kim, bm huyt



thut.

6.2. Sau khi chmNu chy mu sau khi rt kim, dng bng kh v khun, n cm mu ti ch,

khng day.

7 NH GI KT QU



tay, cng tay, ng thi vng m c cm gic t b, cng, nng. l thi im bt

u tin hnh phu thut.


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20.CHM T PHU THUT U CUN CNH

1. I CNG

- L phng php v cm phu thut u cun cnh.

- Mc ch: m bo v cm cho phu thut u cun cnh tin hnh thun li van ton.

2. CH NH

Bnh nhn b khi u cun cnh c ch nh phu thut

3. CHNG CH NH

-Ngi bnh di 18 tui



- Ph n c thai


4. CHUN B



cha bnh.

4.2. Phng tin


- Kim chm cu v trng loi 6- 8- 10cm



+ Seduxen 10mg x 01 ng+ Morphin 10mg x 01 ng

+ Fentanyl 5mg/10ml x 01 ng


4.3. Ngi bnh


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- c lm h s bnh n chuyn khoa phu thut tim mch theo quy nh.

- c gii thch bit cm gic cng tc nng tay v vng m khi chm t.

5. CC BC TIN HNH

5.1. Phc huyt- Hp cc -Ni quan

- phong - Nhn nghinh

- Kh x - Khuyt bn

5.2. T th Ngi bnhnm nga, hai tay dang, k gi cho c nga ti a.

5.3. Th thut








- Chm t 2 bn cc huyt:

+ Hp cc: chm kim nghing 45, su 1-1,5 thn

+ Ni quan: chm kim nghing 30, su 1-1,5 thn

+ phong: chm kim nghing 30, su 2-2,5 thn

+ Nhn nghinh: chm kim nghing 30, su 2-2,5 thn

+ Khuyt bn xuyn Kh x chm kim nghing 30, su 1-1,5 thn



- Cng : tng dn t 40-300micro-Ampe.


qu trnh phu thut.


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5.5. Thuc h tr



- Seduxen 0,2mg/kg cn nng.- Morphin 0,2mg/kg cn nng.




6.1. Trong khi chm

- Vng chm: ngi bnh ra m hi, lnh tot. X tr: rt ht kim, bm huyt Nhntrung. Ch 15 pht, chm li nu vn vng chm th rt kim, i phng php v

cm; nu ngi bnh bnh thng th li tip tc chm tin hnh phu thut.

6.2. Sau khi chm


khng day.

7. NH GI KT QU



tay, cngtay, ng thi vng c c cm gic t b, cng, nng. l thi im bt

u tin hnh phu thut. Trong qu trnh m bnh nhn phi hon ton tnh to,

phi hp c vi k thut vin kim sot c ging ni.


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21.CHM T PHU THUT CT U TUYN MANG TAI

1. I CNG

- L phng php v cm phu thut u tuyn mang tai.- Mc ch: m bo v cm cho phu thut u tuyn mang tai tin hnh thun li

v an ton.

2. CH NH

-Nhng bnh nhn b u tuyn mang tai c ch nh phu thutca chuyn khoa

tai mi hng.

3. CHNG CH NH

-Ngi bnh di 18 tui



- Ph n c thai


4. CHUN B



cha bnh.

4.2. Phng tin



- Bm timv trng 5ml, bng, cn st trng, km c mu.- Thuc: + Atropin sunphat 0,25mg x 01 ng





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- Cc phng tin, dng c, thuc hi sc cp cu khi cn.

4.3. Ngi bnh

- c lmh s bnh n chuyn khoa tai mi hng theo quy nh.

- c gii thch bit cm gic cng tc nng tay v vng mang tai khi chmt.

5. CC BC TIN HNH

5.1. Phc huyt

- Hp cc -Ngoi quan

- phong - An min II

- Phong tr - Thng lim tuyn

-Nh mn - Nhn nghinh.

- Thnh hi


5.3. Th thut








Chm t hai bn cc huyt :

- Hp cc: chm kim nghing 45, su 1-2 thn-Ngoi quan: chm kim nghing 60-70, su 1,5-2,5thn

Chm t bn m cc huyt:

- phong: chm kim vung gc vi mt da, su 1,5-2 thn.

- Phong tr xuyn An min II: chm t, su 1,5-2 thn, phi t c kh.


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- Nhn nghinh xuyn Thng lim tuyn: chm kim nghing 10-15, su 1,5-2

thn.

-Nh mn xuyn Thnh hi kim nghing 100- 150su 1- 1,5 thn

5.4. Kch thch bng my in chm- Tn s: cao ngay t u 25-55Hz.



qu trnh phu thut.

5.5. Thuc h tr








6.1. Trong khi chm

-Vng chm: ngi bnh ra m hi, lnh tot. X l: rt ht kim, bm huyt



thut.

6.2. Sau khi chm

Nu chy mu sau khi rt kim, dng bng kh vkhun n cm mu ti ch,

khng day.

7. NH GI KT QU




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tay, cng tay, ng thi vng mang tai c cm gic t b, cng, nng. l thi

im bt u tin hnh phu thut.


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22.CHM T PHU THUT CT U TUYN NC BT MANG TAI

1. I CNG

- L phng php v cm phu thut u tuyn nc bt mang tai.

- Mc ch: m bo v cm cho phu thut u tuyn nc bt mang tai tin hnhthun li v an ton.

2. CH NH

- Nhng bnh nhn b u tuyn nc bt mang tai c ch nh phu thut ca

chuyn khoa tai mi hng.

3. CHNG CH NH

-Ngi bnh di 18 tui



- Ph n c thai


4. CHUN B



cha bnh.

4.2. Phng tin




- Thuc: + Atropin sunphat 0,25mg x 01 ng+ Seduxen 10mg x 01 ng,





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4.3. Ngi bnh

- c lm h s bnh n chuyn khoa tai mi hng theo quy nh.

- c gii thch bit cm gic cng tc nng tay v vng mang ta i khi chm

t.5. CC BC TIN HNH

5.1. Phc huyt

- Hp cc -Ngoi quan

- phong - An min II

- Phong tr - Thng lim tuyn

-Nh mn - Nhn nghinh.

- Thnh hi


5.3. Th thut








Chm t hai bn cc huyt :

- Hp cc: chm kim nghing 45, su 1-2 thn

-Ngoi quan: chm kim nghing 60-70, su 1,5-2,5thnChm t bn m cc huyt:

- phong: chm kim vung gc vi mt da, su 1,5-2 thn.

- Phong tr xuyn An min II: chm t, su 1,5-2 thn, phi t c kh.


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- Nhn nghinh xuyn Thng lim tuyn: chm kim nghing 10-15, su 1,5-2

thn.

-Nh mn xuyn Thnh hi kim nghing 100- 150su 1- 1,5 thn

5.4. Kch thch bng my in chm- Tn s: cao ngay t u 25-55Hz.



qu trnh phu thut.

5.5. Thuc h tr








6.1. Trong khi chm

-Vng chm: ngi bnh ra m hi, lnh tot. X l: rt ht kim, bm huyt



thut.

6.2. Sau khi chm

Nu chy mu sau khi rt kim, dng bng kh v khun n cm mu ti ch,

khng day.

7. NH GI KT QU

Khi kch thch my, bnh nhn c cm gic t b, nng lan t ungn tay ln.



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tay, cng tay, ng thi vng mang tai c cm gic t b, cng, nng. l thi

im bt u tin hnh phu thut.


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23.CHM T PHU THUT VIM TAI XNG CHM TRONG

VIM TC TNH MCH BN

1. I CNG

- L phng php v cm phu thut vim tai xng chm trong vim tctnh mch bn

- Mc ch: m bo v cm cho phu thut vim tai xng chm trong vim

tc tnh mch bn tin hnh thun li v an ton.

2. CHNH

-Nhng bnh nhn b vim tai xng chm trong vim tc tnh mch bn c

ch nh phu thut ca chuyn khoa tai mi hng.

3. CHNG CH NH

-Ngi bnh di 18 tui


-Ngi bnh khng hp tcvi chm t

- Ph n c thai


4. CHUN B



cha bnh.

4.2. Phng tin


- Kim chm cu v trng loi: 6- 8-10cm- Bm tim v trng 5ml, bng, cn st trng, km c mu.





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4.3. Ngi bnh

- c lm h s bnh n chuyn khoa tai mi hng theo quy nh.- c gii thch bit cm gic cng tc nng tay v v

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