KHOA HOC KY THUAT THtJ Y TAP XXIV SO 8-2017
Sir DUNG flIEN JAM 0 0 TRONG CHAN fiOAN ROi LOAN NHjP TIM TREN CHO
Phan Vinh Ty Phie^g, Nguyin Van Phdt, Nguyen Van Nghla Khoa Chdn nuoi-Thu y, Truang Dai hoc Nong Ldm Tp. HCM
TOM TAT
Myc tieu cua nghign cdu la phdn tich mdt s6 ca logn nhjp tim dign hinh d chd. Tren dien tdm do cua 27 chd cd rdi logn nhjp tim, da ghi nhgn dugc nhigu nhdt la sd ca day nhi trai (25/27 ca), ngoai ra cdn cd cdc ca day nhi phai, ddy thdt trai, day that phai, day vach tam that, ngogi tdm thu nhi, bide AV do 1, bloc nhanh trdi, tran dich mang phdi, phdc hgp QRS dien thd thdp.
Tir khoa: chd, dien tam dd, rdi logn nhip tim, chan doan
Use of electrocardiography (ECG) in diagnosing cardiac arrhythmias in dogs Phan Vinh Ty Phuong, Nguyen Van Phat, Nguyen Van Nghia
SUMMARY
The objective of this research aimed at analyzing several typical cardiac arrhythmias cases in dogs. Study on the ECG of 27 dogs with cardiac arrhythmias indicated that most of the eases were left atrial enlargement (25/27 cases), in addition, there were also the cases of right atrial enlargement, left ventricular enlargement, right ventricular enlargement, ventricular septal hypertrophy, premature ventricular atrium, atrioventricular block first degree, the left branch block, pleura! effusion, low-voltage QRS complexes.
Keyword: dog, electrocardiography, cardiac arrhythmia, diagnosis.
I. DAT VAN DE
Cling vdi su phat trign cua khoa hgc ky thuat trong y hgc, rdt nhigu ky thuat chSn doan hinh anh dugc ra ddi hd trg cho cdng tac chdn doan benh tim mach tren lam sang nhu X - quang, sigu am, dien tam dd, chup cat ldp vi tinh va cdng hudng tu hat nhan. Trong dd, ky thuat dien tam dd dac tnmg cho viec chan doan cac rdi logn nhip tira, ho trg phat hien tim phi dai vd dugc chi dinh trong cdc chiing rdi logn dign giai, acid - base, rdi logn cd tinh he thdng hay rdi logn chuyen hda, Nghien cdu nay dugc thuc hign vdi myc dich: Phdn tich mgt sd ca rdi logn nhip tim dien hmh d chd.
H. DOI Tl/ONG, NOI DUNG VA PHU'ONG PHAP NGHIEN CUtJ 2.1. Soi tu-gng
Chd cd benh lien quan den he tim mgch dugc kham tu ngdy 01/03/2012 dgn 01/09/2012 tgi Benh
vien Thu y Trudng Dai hgc Ndng Ldm Tp. Hd Chi Minh va Phdng kham Thii y Chg Ldn, 321 Nguyen Thi Nhd, phudng 16, quan 11, Tp. Hd Chi Minh.
2.2. No! dung Cac loai rdi loan nhip tim:
+ Ngogi tam thu nhi + Bloc dan tmyen + Tim phi dai + Tran dich mang phdi + Phdc hgp QRS dien thg thdp.
2.3. Phuong phap nghien cihi 2.3.L Kiim tra lam sdng
Cac con chd trudc khi tign hanh nghien ciiu dugc kiem tra tinh trang sue khde, kham Iam sang hg tim mach, hdi vg lich su benh va nhiing kilm tra hoac dieu tn trudc day.
2.3.2. Ghi ai^n tam do 2.3.2.L Cdch gan di$n cue
Cdc dign cue dugc gdn vdo da ph^n chdn cia chd nhu trinh bdy trong bdng 1.
Bang 1. Cdc day di#n c\jfc Qwac ky higu theo mau sac (Ngu6n Martin, 2007)'
Vj tri chdn H | th6ng chuan H|th6ngMy Chan trudc phai
Chan trudc trdi Chdn sau trdi Chan sau phdi
Dd Vdng Xanh Id
Den
Trdng Den
06 Xanh la
2.3.2.2. Tinh tdn so tim + Tdc do giay 25 mm/gidy:
HR (nhip/phiit) = 1500 / dd ddi didi gian R - R + Toe do gidy 50 mm/gidy:
HR (nhip/phiit) = 3000 / do ddi thdi gian R - R (Ngudn Martin, 2007).
2.3.2.3. Xdc dinh nhip tim
Hinh 1. Minh hga each do luvng phOv hgp P - QRS - T (Nguon Martin, 2007) + Xdc dinh cdc phuc hgp cd ddy dii khdng (mgt sdng P cho moi phdc hgp QRS va ngugc lai).
+ Xdc dinh cac khodng each P-P, R-R (giua cdc phdc hgp lign kg) cd dgu khdng. Do ludng cdc sdng (Hinh 1) thuc hign tren chuyen dao DII (toe dd gidy 50 mm/giay, khdng dung tmh nang Igc).
2.3.2.4. Cdch tinh true di$n tim
Tinh tnic dign tim tren hai chuygn dgo DI va Dili. Ddu tign, do bien do ciia phuc hgp QRS, tiln hdnh nhu nhau trgn cd hai chuygn dao DI va DIII.
Danh ddu hai bien do phdc hop vua tim dirge Ien tam tryc kgp Bayley, sau dd ve dudng thdng vuong gdc vd di qua diem dugc ddnh ddu d mdi chuyln dao. True di$n tim la vecta xu4t phdt tii tam 0 din giao diem ciia hai dudng vudng gdc vdi hai chuyln dao Diva DHL
Hinh 2. ifiyc tinh tryc di$n tim Trgn Cling mdt dien tdm db. Bien do ciia phiic hgp QRS d chuyln dao DI la + 6 (Q = 0 va R = + 6), d chuyln dgo DIE Id + 6 (S = - 2 vd R = + 8).
Ta ddnh ddu hai bign dO, ve dudng vudng gdc nhu hinh 2 thi dugc tryc chuyln dao la + 60"(Ngu6n Martin, 2007).
2.4. Xd ly so lifu
So heu dugc t6ng hgp, xd ly bdng Microsoft Excel vd phan tich thdng kg bdng phan mem SPSS 16.0. Muc dg '^ nghia dugc thilt lap d mdc P < 0,05.
HI. KET QUA VA T H A O L U ^ N Trong 27 ca cd r6i logn nhjp tim, cd 25 ca day nhi h-di (6 ca ddy nhi trdi don thuAn va 19 ca 6 dgng kit hgp vdi cdc rdi logn khac), 6 ca day DM
20
KHOA HQC K f THUAT T H C Y TAP XXIV SO 8 - 2017
p h ^ , 5 ca phi d^i t h i t h-ai, 3 ca phi dai that phdi v i ctv (2005), t i t c i c4c tnrang hop co d i y nhi trai d^u a dang kk h ^ p . K^t qua cho t h i y ty 1? phdt trgn di?n tam d6 dfiu cho t h i y h6i am ciia d i y nhi hif n c i c bieu hien tim phi dai tren dien tara do r i t trgn sieu am tim, digu nay c6 nghia la dien t i m do cao, dac bi$t la day nhT trai 25/27 ca. Theo Scares c6 g i i tn tien doan t6t.
Bang 2, Cac ca co roi loan nhjp tim
Ddy Ddy Phi dai Phi dai Day Ngo^i Bloc Bloc Tran dich Phi^c hop TT nhT nhT that thSt vdch tam AV dp nhanh mang QRS dien trai phai trai phai tam that thu nhT 1 trai phoi th^ th^p
1 X X 2* X X
3 X X 4 X X
5 X X
10 11 12 13 14 15 16 17 18 19 20*
2 1 * 22- 23 24 25 26*
27 T6ng cpng
(*): cac ca dgi dien duac phdn tich
Tuy nhign theo Miller vd ctv (2009), chan dodn phi dai tim Id mgt trong nhirng hgn che cua dign tdm dd. Vi du nhu dign thi cua cdc chuyln dao chi va dac biet Id cdc chuyen dao trudc tim bi dnh hudng bdi khoang each gida cdc dign cyc va tim.
Vi vdy ma cdc tieu chuan vg dign the cd thg khdng cd gia tri cho thu chua trudng thdnh, thu gky hoac thu cd nguc hep. Ngoai ra, trdn dich mdng tim, tran dich long ngye, tran khi mdng phdi, beo phi va thdm chi cac may dign tam do thuong mai cd thg lam gidm bien dg ciia phuc hgp QRS dugc ghi nhan tren be mat co dig. Chinh vi vdy ma cdn phdi c6 sy h6 ti-g cua X - quang nguc vd sigu dm tim dl chdn dodn tim phi dai dugc chinh xdc han.
Trong 4 ca phuc hgp QRS dien thi thdp, cd 1 ca chd bi bgo phi, day cd thg Id nguyen nhan gdp phdn lam gidm bien dg phdc hgp QRS.
Trong 6 ca day 2 nhT thi chi cd 1 ca kit hgp vdi phi dai that trdi. Trong 5 ca phi dai thdt trdi, cd 3 ca ket hgp vdi ddy vdch tdm thdt. Ngoai ra, cdn cd 2 ca ngoai tam thu nhT, 2 ca bide AV dg 1, 1 ca bide nhanh trai vd 1 ca tran dich mdng ph6i.
3.1. Ngogi tam thu nhi
Lich sd bgnh; chd due, 18 nam tudi, gidng Nhdt, 7,3 kg, bi sdi mdt, dugc chu dua din phdng kham vi ho nhieu td 9 thang trudc vd cu tdi di tai lai.
Kiem tra ldm sang: niem mgc hdng hdo, thdi gian dd day mau mao mach < 2 gidy.
Kiem tra cgn ldm sdng: Dign tdm dd ghi nhdn
d toe dg gidy 25 mm/s, 1 inin/mV cho thay tin st tim khodng 135 nhip/phiit, niup xoang khong deu.
Sdng P 0,15mV x 0,07s, sdng R 3,lmV, thdi gian QRS 0,07s, thdi gian PR 0,14s, tryc dien tim 67°.
Chdn dodn: Sdng P kgo dai (0,07s) va rdng cua cho thdy ddy nhT trdi. Ngogi tdm thu nhT vdi song P'cd khi dm, cd khi chdng Ign sdng T tmdc do.
Phdc hgp QRS ciia ngogi tam thu nhT cd hinh dgng hrong hr nhu phdc hgp QRS cua nhip xoang. Nhip xoang khdng diu do ngoai tam thu nhT lam giSn dogn sy bat dau ciia nhip xoang binh thudng.
Cd sy phyc hdi mgt phdn ciia niit AV, sdng P' dugc ddn truyen vdi doan P' - R ddi. Cd khoang nghi khdng bu. Nd dugc ghi nhan khi doan R-R cua hai phdc hgp xoang binh thudog ma trong do c6 chda phdc hgp ngogi tam thu nhi ng3u han so vdi dogn R - R cua ba phdc hgp xoang Uln nhau.
Digu ndy do su dSn truygn ngugc tu ngogi tam thu nhT den niit SA ngn lap lgi sy phat sinh xung d^ng tu niit SA, digu chinh lgi nhip xoang binh thudng.
Ngoai tdm thu nhi don dgc hoac khdng thudng xuyen thi khdng gdy ra nhimg bdt dn vl huylt dgng hgc hogc dien tim ngn khdng cdn dilu trj.
Nguygn nhdn cua ngoai tam thu nhT cd the do day nhT, do qud tdi thg tich (vi dy nhu bgnh trao nguac, van tim bam sinh hogc mac phdi, hoac bgnh c6 ludng thdng trai - phdi bdm sinh) (Miller va ctv, 1999). Theo Aptekmann va ctv (2010), ty Ig cho dugc chdn dodn ngogi tam thu nhT tren dien tam dd Id 3,5% (13/380).
Hinh 3.Di$n tam d6 tr§n chd bj ngo^i tam thu nhT (P' lin IUH^ am va chong ten s6ng T cua ph(Fc hgp phia tntoc}, day nhi trii (s6ng P 0,07s) (25 mm/s. 10 mm/mV)
KHOA HOC Kt THUAT THO Y TAP XXIV SO 8 - 2017
3.2. Bl6c dSn truyln 3.2.L Bide AV dpi
Lich sd bgnh: chd cai, 10 nam tudi, gidng Coaam, nang 14 kg. Chd cd nhilu khdi u tren da.
Khd thd, mgt khi di chuyln. Bdt ddu ho each day 3 thdng, chuyln sang ho nhilu vao 1 tudn tnrdc, ho sudt dem trudc ngdy dugc do dien tam dd.
Kiem tra lam sdng: guong mui khd, niem mac chuygn sang mau thdm.
Kiem tra cdn ldm sang: X - quang nguc cho thdy bong tim to, cd dich mdng phdi, ddy vdch phi quan - phdi. Bigu hign tren dien tam dd: tdn sd tim 111 nhip/phut, nhip xoang khdng deu vdi bide AV
do I. Sdng P 0,3mV x 0,06s, thdi gian PR 0,16s, sdng R 2,55mV, thdi gian QRS 0,06s, cd sdng Q d chuyln dao I, II, III, aVR, aVF. Sdng Q sdu d chuyln dao II (0,55 mV).
Chdn doan: Sdng P rpng (0,06 s) do day nhT trai. Thdi gian PR keo dai (0,16 s) cho thdy bide AV do 1. Sdng R cao (2,55 mV), thdi gian QRS keo ddi (0,06 s) do phi dai thdt trdi. Phi dgi thdt trai ket hgp vdi cd sdng Q rdng (0,02 s), sau d chuyln dao I, II, aVR, aVF, sdng Q sau (0,55 mV) d chuyen dgo II cho thdy day vach tara that. Ket qua chdn dodn dign tdm dd phu hgp vdi kit qua thd bi tim to tren X - quang. Theo Aptekmann vd ctv (2010), ty 1? chd dugc chan doan bldcAVdg 1 tren dien tam dd la 7,8% (29/380).
Hinh 4. Di$n tam do tren cho bi bloc AVd^l (thd'i gian PR keo dai 0,16s), day nhi trii (tiim gian P 0,06 s), phi daii that trai va ddy vAch tam thit (S6ng R cao 2,55mV, tiiai gian QRS keo dai 0,06s, song Q rgng 0,02s vii siu
& chuyin dao I, II, aVR, aVF, song Q sau 0,55mV & chuyen dao II) (50 mm/s, 10 mm/mV)
3.2.2. Bloc nhdnh trdi
Lich su bgnh: chd dye, giong ngi, 12 nam tudi, 17 kg. Chd khdng di dugc, khdng tigu dugc, ho, mau mgt, thd hdn hen.
Kilm tra cdn ldm sang:
Tren X - quang: gan, than teo nhd, sdi than, bien ddi cdu tnic thSn, dich mang phdi, tran khi mdng phdi, loang xuong, thoai hda cdt sdng, khdp chgu dui, cd khdi tang sang ngodi tiidoh bdng quang.
Kit qua sigu am: gan thd, echo hdn hgp, hai than teo, nhieu sdi.
Kit qud dign tdm &h\ nhip xoang khdng deu,
tdn sd tim 122 nhip/phiit, sdng P 0,2mV x 0,06s, thdi gian PR 0,1 Is, thdi gian QRS 0,07s, doan ST chgnh xudng 0,15mV.
Kgt qud xet nghigm mau (phu lyc 1):
- Tdng sd bach cdu tang (18,1 >' lOV/iL). Cdc chi sd hdng cdu (2,7 x lOVpL), hematocrit (16 %), hemoglobin (4,2 g/dL) deu giam.
- Cdc chi sd the tich trung binh cua hemoglobin trong mdt hdng cau (MCH - mean corpuscular hemoglobin) 20pg, ndng do hemoglobin trung binh trong 100 ml hdng cau (MCHC - mean corpuscular hemoglobin concentration) 30 g/dL, diu thap.
23
- Cac chi sd phan b6 thg tich hdng cdu (RDW - red cell distribution width) 26%, t h i tich d u n g binh ciia tilu cdu (MPV - mean platelet volume) I6,62fL, dgucao.
K i t qud xet nghigm sinh hda: Cdc chi sd BUN (blood urea nitrogen - ham lugng nitrogen urea trong mdu) 50,4 mg %, creatinine 3 mg %, acid uric 1,6 mg %, ALT (alanine aminotransferase) 102 U/L, alka - phosphatate 210 U/L, CPK (creatine phosphokinase) 232 U/L, dgu cao.
Chdn doan: Cac kit qud xet nghiem mau cho thdy chd hi thilu mdu ngng. Trong xet nghigm sinh hda, kit qua cho flidy chd bi suy than, tdn thuong gan.
Kit qua chdn doan X - quang va sigu am cho thdy thii bi suy thgn man. Kit hgp cac kit qud xet nghigm mau, sinh hoa, chdn dodn X - quang va sieu dm, ta kit ludn thii bi suy than man ddn den thieu mau va loang xuong. That vdy, theo Phgm Van Bui (2007), khi hon 50 % nephron hi buy, the tich than se bat ddu giam ddn, ddn din teo thgn. Tren hinh anh, teo thdn hai ben la yeu td rat quan trong de chdn doan suy than man. Loan duong xuong do than la tdn thuang xuong lign quan vdi cac tien trinh sinh ly benh thdn man. Dd la hau qua ciia hien tugng mem xuong do
gidm tdng hgp vitamin D vd cudng tuyIn cgn gi^
thd phdt (do hg calci mau gdy ra). Khi do loc ciu than giam khoang 40 - 50%, da cd gidm kha nang loai thdi phosphate cua than. Dg d dgng nay tang theo tien dign cua suy tiian. Tang phosphate mau gdy giam calci mdu tuong iing theo hdng so tich so phosphocalci. Gidm calci mau cdn ngng hon do giam tdng hgp dang hogt dgng cua vitamin td thgn. CJ benh suy thSn mgn, bgnh nhdn thudng bi thilu m ^ kem dung nap vdi gang sdc, nhiing bdt thudng dien tam dd cd thg gay ra do cdc rdi logn dien gidi va do phi dai thdt trdi tuang ung vdi sy thay ddi ciia dogn ST hay bide nhanh trgn dien tim.
Trgn dien tdm dd: Sdng P keo ddi (0,06s) cho thdy ddy nhi trdi. Thdi gian QRS keo dai (0,07s), phdc hgp QRS rgng vd duong d chuyen dao I, n, m , aVF, am d chuygn dgo aVR, khdng cd sdng Q d chuygn dgo I cho thay chd hi bloc nhanh trdi. Ketqua chdn dodn dign tdm dd phii hgp vdi ket qua khong phdt hien phi dai tim tren X - quang xoang ngire.
Vgy thu bi suy than man tinh d&i den thilu mau ngng nen bieu hign trgn dign tam dd Id bloc nhanh trdi do thigu mau ngng gay ra. Theo Aptekmann va ctv (2010), ty Ig chd dugc chan doan bide nhanh trai ti-gn dign tam dd la 0,5% (2/380).
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Hinh 5. BiSn tim do tren cho bl bloc nhinh trii (QRS keo dii 0,07 s, QRS rdng vi daomgi chuyen d^o I, II, III, aVF, im d- chuyen dao aVR vi khong CO song Q & chuyin dao I),
diy nhi trii (P 0,06s) (25 mm/s,10 mm/mV)
KHOA HOC KY THUAT THU Y TAP XXIV SU8-2Ui/
3.3. Tim phi dai
3.3.1. Ddy hai nhi, phi dgi thdt trdi Lich su benh: chd cai, 13 nam tudi, gidng Nhdt, nang 5,7 kg. Da bi ho hon 1 nam, 10 ngay trudc day trd lai ho nhieu.
Kiem tra cdn ldm sang: X - quang bdng tim to (VHS: 11,5), gan vd than hda thd nhd, dudi lach dgng khdi trdn. Bigu hign trgn dien tam dd: tdn sd tim 142 nhip/phut, nhip xoang khdng diu, sdng P
0,4 mV X 0,06 s, thdi gian PR 0,09 s, sdng R 2,25 mV, thdi gian QRS 0,06 s, bign dg sdng T cao hon 25 % bign do sdng R.
Chdn dodn: P rdng (0,06 s) va cao (0,4 mV) cho thdy ddy hai nhi. Sdng R cao 2,25 mmV, QRS rgng (0,06 s) va bign do sdng T cao ban 25 % bign do sdng R cho thdy phi dai thdt trdi. Kit qua chdn doan dign tam d^ phu hgp vdi ket qua chan doan tun to trgn X - quang.
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Hinh 6. Di§n tim do tren cho bj diy hai nhT(P rgng 0,06 s vi cao 0,4 mV), phi d^i thit trii (R cao 2,25 mmV, QRS rgng 0,06 s vi song T cao han 25 % R) (50 mm/s, 10 mm/mV)
3.3.2. Ddy nhi trdi, phi dgi hai that vd ddy vdch tdm thdt
Lich sd bgnh: chd due, gidng Cocker, 5 nam tudi, ho nhieu.
Kigm tra ldm sdng: nigm mac hdng hao, thdi gian do ddy mdu mao mach < 2 gidy.
Kilm tra cdn ldm sang: Kit qua X - quang xoMig nguc: vigm phi qudn (tang tu&i hoan phdi, nhilu ndt vdi hda phdi), kich thudc gan to hon binh tiiudng, bdng tun to (VHS: 11,5). Bilu hign fa-en dign tdm dd: tdn s6 tim 93 nhip/phut, nhip xoang khdng diu, sdng P 0,25 mV x 0,06 s, sdng R 2,5 mV, thdi gian QRS 0,07 s, sdng Q rdng 0,02 s, sdu 1,5 mV (chuyln dao I, II, aVR, aVF), sdng T
cd khi cao nhon, khi gian rdng, khi thi 2 pha, true dien tim 125°.
Chdn doan- Sdng P rdng (0,06 s) vd rang cua do day nhi trai. Bien do R cao (2,5 mV), thdi gian QRS gian rgng (0,07 s) cho thdy chd bi phi dgi thdt trdi. Phi dgi that trai ket hgp vdi true dign tim lech sang phai (125°) cho thay chd hi phi dai cd hai thdt. Phi dai that trai kgt hgp vdi sdng Q rgng (0,02 s) vd sdu d chuygn dao I, II, aVR, aVF cho thay chd bi day vdch tdm thdt. Vdy chd bi ddy nhi trai, phi dgi hai thdt va ddy vdch tam thdt. Kit qua chdn dodn dien tdm dd phu hgp vdi ket qua chdn doan tim to trgn X - quang.
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Hinh 7. £)/#n tim do tren cho b; diy nhi trai (P rdng 0,06s), phi dai hai that va diy vach tdm that (R cao 2,5 mV, QRS gian rgng 0,07 s, tr^jc dien tim lech sang phai (125'), song Q rgng 0,02s vi sau & chuyen dao I, II, aVR, aVF) (50 mm/s, lOmm/mV)
3.4. Tran dich mang phSl
Lich su bgnh: chd cdi, gidng Pme, 3,5 thdng, 1,1 kg. Thd bi tieu chdy mau, di da 3 ngay.
Kiem tra ldm sang: thu rat yeu, khdng cu dgng, sdt 40,1''C.
Kiem tra can lam sang: Ket qud X - quang xoang ngye Id thu bi viem phdi, dich ngye. Trgn dien tdm dd, nMp xoang deu, tan sd tim 282 iiMp/
phiit. Sdng P 0,3 mV x 0,04 s, thdi gian PR 0,05 s, sdng R 0,4 mV, thai gian QRS 0,03 s, sdng Q 0,02
s, thdi gian QT 0,14 s, ti lg T/R> 0,25, tiuc dien tim 105^
Chdn dodn: Sdng P gian rdng (0,04 s) do d^y nh! trdi, thdi gian PR ngan (0,05 s) tuong ung vdi tan sd tim nhanh (282 nhip/phut). Bign do R thdp (0,4 mV) cd thi do trdn dich mang tim hoac trdn dich mang phdi hoac do gidm lugng mdu. Ket hgp ket qud bign do R thdp vdi kit qua X-quang cd dich nguc, vigm phdi nen kit Mn thu bi tran dich mang phdi.
Hinh 8. Di^n tam a6 tren ch6 bj trin dich mang ph6i (R thap 0,4 mV, kit qua X- quang co djch ngtFC, vi%m phoi), day nhi trai (Pgian rgng 0,04 s) (50 mm/s, 10 mm/m)
KHOA HQC KY THU^T THO Y T ^ P XXIV SO 8 - 2017
3.5. Phirc hop QRS difn thi thap Lich su benh: chd cdi, gidng ndi, 4 nam tudi, 7,4 kg. Den khdm b$nh vi chd bd an.
Kiem tra can lam sang: Chdn doan X - quang cho thay cd khdi u ldn d ria gan, gdn dudi than phdi den tu cung. Ket qua sidu dm: chd cd khdi u d gan, td cung. Bieu thi tren dign tdm dd: tdn s6 tim 142 nhip/phut, nhip xoang khdng diu. Sdng P 0.2 mV X 0,06 s, sdng Q 0,02s d chuyln dgo I, II, aVR, aVF, sdng R 0,4 mV, thdi gian QRS
0,04 s, sdng T det, cd khi gdn nhu ddng dign.
Chdn doan: P rdng (0,06 s) vd rang cua do day nhT trdi. R 0,4 mV, sdng T det cd khi gdn nhu ddng dien cho thdy thd bi phuc hgp QRS dien thi thdp. Phdc hgp QRS dien thS thdp frgn chd cd thg do beo phi, do tran dich (mdng tim, mdng phdi), do cd trudng, suy giap, tang kali mau, tran khi mang phdi, benh hd hap, giam the tich mau.
Do Igc cao cua may dien tdm dd ciing cd the lam gidm dang ke bien dd cua phuc hgp QRS.
Hinh 9. Dien tim do tren cho bj phOv hgp QRS dien th4 thip (R 0,4 mV) (50 mm/s, 10 mm/mV)
IV. KET LUAN
Nghign cdu ghi nhan cdc logi rdi logn nhip tim nhu tim phi dgi (day nhi trai, ddy nhi phai, phi dgi thdt trai, phi dgi thdt phai, day vdch tdm thdt), ngoai tdm thu nhT, bide AV dd 1, bide nhanh trdi, trdn dich mdng phdi, phuc hgp QRS dien thi thap. Trong do, sd ca chilm ty le cao nhdt id day nhi trdi (25/27, 92,6%), ddy nhi phdi (6/27,22,2%), sd ca chilm ti le thdp nhdt Id bide nhdnh trai va ti-an djch mang phdi diu bdng 1/27 ca (3,7%).
TAI LIEU THAM KHAO 1. Aptekmann K.P., Vailati C.F., Fortuna
O.M., Schwartz D.S., 2010. Prevalence of cardiac arrhythmias and conduction disturbances m dogs and cats in Botucatu, Brazil (2003-2007). In BraziUan Journal of Veterinary Research and Animal Science, volume 47 (5) Sao Paulo, p.p. 371 - 379 2. Martui M., 2007. Small animal ECGs
An introductory guide. Second Edition.
Blackwell Publishing.
3. Miller M.S., Tilley L.R, Smith F.W.K., Fox PR., 1999. Electtocardiography. In Textbook of canine and feline, cardiology principle and clinical practice. W. B. Sanders company.
United states of America, pp. 67 - 106.
4. Phgm Van Bui, 2007. Cdc b$nh ly, sinh ly b^nh thdn ni^u. Nhd xudt ban Y hgc, Hd Ngi, 277 trang.
5. Soares E.C., Larsson M.H.MA., Yamato RJ., (2005). Chronic valvular disease: correlation between clinical, electrocardiogr^hic, radiogn^hic and echocardiographic aspects in dogs. In Medicina Veterindria et Zootecnia, volume 57, number 4, pp. 436-441,2005, Sao Paulo.
Nhan ngdy 10-8-2017 Phdn bien ngdy 30-8-2017
Phu luc 1. Ket qua xet nghifm mau, xet nghiem sinh hoa ciia ca benh a muc 3.2.2.2 Ten xet nghiem
WBC Lym Neu Mono Eos Baso RBC HtJ Hot MCV MCH MCHC RDW PUT MPV
BUN Creatinine Acid uric AST ALT GGT NH, Alka - phosptiatate
Amylase/m^u CPK Lipase
18,1 3,01 11,98 1,4 0,6 0,12 2,7 4,2 16 63 20 30 26 427 16,62
60,4 3,0 1,6 21 102 8,7 37 210 489 232 437
Ket qua
25,13 100,00 11,69 5,01 1,00
Chi so tham chieu M A U
5,4-16,3 1-4,9 2,7-12,85 0,1-1,4 0,1-1,49 Rate 5,5-8,5 7,5-11,1 29,8-57,5 6 0 - 7 2 22,2-25,4 34-36,6 12,2-14,9 175-500 6,6-10,9 SINH HdA
8-30 0,5-1,6 0,2-0,9 9-60 8,2-80 0,1-9,7 19-120 10-122 270-1900 14-120 100-750
0 - 51 1 - 0 - 0 -
-38 - 8 4 -a -9 -1
Do'n vj 10>/pL 10>/pL(%) io';pL(%) 10>/pL(%) 10'/(JL(%) 10>/pL(%) 10"/pL g/dL
%
fL pg g/dL%
lO'/pL fLm9%
m9%
mg%
U/L U/L U/L mg/dl U/L U/L U/L U/L
