Báo Cáo Môn CSĐSH

TRNG I HC BCH KHOA H NI
VIN IN T - VIN THNG
BO CO BI TP LN
C S IN SINH HC
ti:
TM HIU V TN HIU IN MT V CC THIT B NG DNG
Sinh vin thc hin: c Cng Ng Sn Tng Bch Hng Kin Lp : K thut Y sinh K53 Gio vin hng dn: TS. Nguyn Phan Kin
H Ni 05/2013
Bo co Bi tp ln mn hc CSSH
MC LC
MC LC .................................................................................................................................... 2 LI NI U.............................................................................................................................. 4 PHN 1: GII THIU CHUNG ................................................................................................. 5 1.1. DANH SCH THNH VIN ........................................................................................... 5 1.2. GII THIU TI........................................................................................................ 5 PHN 2: CU TO GII PHU CA MT NGI .............................................................. 6 2.1. T NG QUAN ................................................................................................................... 6 2.2. CU T O CC B PHN CHNH ................................................................................. 7 2.2.1. Gic mc (cornea) ....................................................................................................... 7 2.2.2. Thy dch (Aqueous humor) ....................................................................................... 8 2.2.3. ng t ( pupil), mng mt ( Iris) ............................................................................... 9 2.2.4. Thy tinh th ( Lens)................................................................................................. 10 2.2.5. Dch knh (Vitreuos humour or Vitreuos humor) ....................................................... 10 2.2.6. Vng mc (retina) ..................................................................................................... 11 2.2.7. C vn nhn (Muscle) ............................................................................................... 12 2.3. DN TRUYN TH GIC ............................................................................................. 12 PHN 3: BN CHT V NGUYN L HOT NG CA CC LOI TN HIU IN MT ........................................................................................................................................... 14 3.1. GII THIU CHUNG..................................................................................................... 14 3.2. IN CU MT EOG.......................................................................................... 15 3.2.1. Ngun gc ca in cu mt - EOG...................................................................... 15 3.2.2. Nguyn l thu nhn tn hiu EOG ............................................................................. 18 3.2.3. Cch t in cc v dng tn hiu thu c.............................................................. 23 3.2.4. Ghi nhn tn hiu nhiu ............................................................................................. 26 3.3. IN VNG MC .................................................................................................. 27 3.3.1. Ngun gc ca tn hiu ............................................................................................. 27 3.3.2. Nguyn l thu nhn tn hiu in vng mc ERG ................................................. 28 3.3.2.1. Nguyn tc chung ........................................................................................... 28 3.3.2.2. Phng php thc hin ................................................................................... 31 3.3.3. in cc v dng tn hiu thu c ........................................................................... 33 3.3.4. Cc dng tn hiu nhiu ............................................................................................. 36 PHN 4: CC THIT B S DNG TRONG IN MT .................................................... 38 4.1. THIT B O IN CU MT (EOG) ................................................................... 38 4.1.1. B khuch i ........................................................................................................... 38 4.1.2. B lc tn s ............................................................................................................. 40 4.1.3. My v th ............................................................................................................ 41 4.1.4. Cc in cc ghi nhn ............................................................................................... 42 4.2. THIT B O IN VNG MC (ERG) ................................................................ 42
ti Tm hiu v tn hiu in mt v cc thit b ng dng
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PHN 5: DNG TN HIU MT S BNH THNG GP ............................................... 43 5.1. VIM SC T VNG MC V CC BNH LIN QUAN ......................................... 43 5.2. CHNG LON DNG T BO NN V T BO QUE ......................................... 45 5.3. CHNG RI LON HONG IM ............................................................................. 46 5.4. NG MCH TRUNG TM VNG MC B T C...................................................... 46 PHN 6: TNG KT ................................................................................................................ 48 PHN 7: PH LC .. 50 7.1. PH LC TI LIU THAM KHO .. 50
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LI NI U
Ngy nay, nn kinh t nc ta ang pht trin mnh m, i sng x hi cng c nng cao nn vn sc khe ngy cng c mi ngi quan tm hn. Ngnh in t Y sinh cng v th cng cn pht trin hn, cn c nhng nghin cu, ng dng thc t hn. Nhng t c iu cc k s thit k ngoi nhng kin thc v k nng chuyn ngnh in t th cng cn c mt s kin thc c bn v cu to v hot ng chc nng ca cc c quan, cc phng php o c thm d chc nng ca cc c quan v h thng c quan ca c th. Qua hiu c cc phng php ng dng thm d, o c cc chc nng ny trong chun on, iu tr. Do , nhm em chn ti Tm hiu v tn hiu in mt v cc thit b ng dng. Qua ti ca mnh nhm em mong mun c th tm hiu c nguyn l c s in sinh hc sinh ra tn hiu in mt, cc phng php, k thut x l tn hiu. ng thi nhm s c nhng trang b v cc thit b ng dng hin nay. Nhm em xin chn thnh cm n thy gio Nguyn Phan Kin tn tnh hng dn, gip nhm em hon thnh ti ny. Trong qu trnh thc hin ti, do kin thc cn hn ch nn nhm em khng trnh khi sai st, chng em rt mong c s nhn xt gp ca thy bi lun ca nhm em c hon thin hn.
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PHN 1:
GII THIU CHUNG

1.1. DANH SCH THNH VIN
STT 1 2 3 H v tn c Cng Ng Sn Tng SHSV 20083278 20083008 a ch mail
cuongdoit@gmail.com nst2404@gmail.com bachhungkien@gmail.com
Ghi ch Nhm trng
Bch Hng Kin 20081428
1.2. GII THIU TI

ti Tm hiu v tn hiu in mt v cc thit b ng dng. c th theo di mt cch d dng bi lun nhm em xin a ra mt vi gii thiu s qua v ti nh sau: Trc tin c th tm hiu c bn cht ca tn hiu in mt th nhm em a ra cu to gii phu ca mt. Sau phn chnh nhm em xin i su vo tm hiu hai loi tn hiu mt ph bin c s dng trong lm sng hin nay l tn hiu in cu mt (EOG) v tn hiu in vng mc (ERG). Tip chng em xin gii thiu s qua v mt s tn hiu c chn on l bnh. Do cn hn ch v thi gian, v hiu bit cn hn hp nn nhng g chng em cp n trong bi lun cng ch mang tnh cht tng quan cha th chi tit, c th r rng c. Nhm em cng rt hi vng c th pht trin hn na c th a ra mt bi lun chi tit, y hn c th gip mi ngi trong hc tp cng nh nghin cu. Rt mong nhn c s quan tm, gp ca tt c mi ngi. Nhm em xin trn trng cm n!
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PHN 2:
CU TO GII PHU CA MT NGI

Tm hiu v cu to ca mt ban u hn ai cng t ra nhng cu hi ht sc bnh thng nh: Lm sao mt ngi c th t iu tit quan st c nhng s vt gn cng nh xa? Hai mt cng nhn s vt nhng lm sao con ngi c th thu nhn c mt hnh nh trung thc nht? Mt ngi thu nhn hnh nh nh th no, cu to ca mt ra sao?... V rt rt nhiu cu hi nh th na. c th tr li cho nhng cu hi , ng thi c th hiu v c s in sinh hc ca mt trc tin chng ta s i tm hiu v cu to gii phu ca mt.
2.1. TNG QUAN

Mt ngi nm trong hai l hc hai bn sng mi, trn c g lng my v trn, di gip xng m; l mt h thng quang hc phc tp, gip con ngi cm nhn cc bc x in t nm trong vng nh sng nhn thy. y chnh l b phn pht hin nh sng c cu trc ht sc phc tp v l iu k diu m to ha ban tng cho con ngi chng ta. Khi nh sng kch thch th ti mt s c mt h thng tip nhn v gi cc xung in dc theo thn kinh th gic n cc vng ca v no phn tch v hin th hnh nh gip con ngi cc th quan st c mi vt xung quanh.
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Mt ngi gm c nhn cu, h thn kinh v nhng b phn ph thuc nh m mt, lng mi, cc c mt, tuyn l, cc mng tip hp Nhn cu l thnh phn quan trng nht c bi cc c vn nhn, n c so snh nh mt chic my nh k diu v c tnh quang hc chnh xc ca mnh. Nhn c u g m 3 lp mng: Mng ngoi l cng mc, mng gia l mng b o, mng trong l vng mc. Nhn vo hnh 2.1 trn th mt phn cng mc pha trc mt bin i thnh gic mc. Sau gic mc l thy dch. Tip theo l ng t, mng mt, thy tinh th. Nm sau thy tinh th l khi dch lng gi l dch knh. Sau y chng ta s tm hiu r hn cu to chc nng ca tng b phn. 2.2. CU TO CC B PHN CHNH 2.2.1. Gic mc (cornea)
nh sng i vo mt thng qua gic mc. Gic mc ni tip vi cng mc li ra pha trc c bc bi mt lp trong sut gi l kt mc. y l vng c cu to gii phu rt c bit v c vai tr sinh l rt quan trng ca nhn cu. Gic mc gm 5 lp c cu to v chc nng nh sau:
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- Lp biu m gic mc Gm 5-7 lp biu m xp tng rt trt t, khng sng ha. Lp trn cng l hai hng t bo mng dt, b mt c cc vi nhung mao v cc l siu lc c nhim v trao i cht, chuyn ha cc cht v l ni bm dnh ca mng nc mt. Lp trung gian c 2-3 lp t bo a din dng xe ngn tay hoc nhnh. Cc t bo y hnh tr gn cht vi t bo y trc v lin kt vi mng Bowman. - Lp mng Bowman Lp mng ny l mng mng trong sut p st vo lp nhu m. Mng Bowman c chc nng chng li cc tc nhn gy chn thng c hc v khng khun. Khi vng ny b tn thng th t chc x mi s thay th lm cho vng mt tnh trong sut. - Lp nhu m Chim 90% b dy gic mc. Bao gm cc si lin kt bn cht l cc si collagen cng cc t bo c nh v t bo di ng. Khi gic mc b tn thng cc t bo c nh bin thnh cc nguyn bo si c kh nng phn chia, tng hp nn cht cn bn ca t chc lin kt v thc bo nhng mnh vn ca t bo vim, nhng s collagen b h hi. Cn cc t bo di ng gm cc t bo bch cu ti cc khe k gia nhng lp si, nhng t bo gic mc vng ra. Khi gic mc b vim cc t bo di ng tng cao gy nn tnh trng thm nhim bch cu vng vim. Cu trc c bit ca lp nhu m ny gp phn to nn trong sut ca gic mc. - Lp mng Descemet Mng Descemet trong sut c cu to gm cc si rt nh kt cht vi nhau nh cht cn bn lm nn c tnh tng i dai v n hi. Cc si mng ny ko di lin tc ti gc tin phng to nn cu trc b cng mc l ni dn lu thy dch t tin phng ra ngoi.
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- Lp ni m L mt lp t bo hnh lc gic xp st vo nhau tri trn mt sau ca mng Descemet. y l cc t bo vnh vin, s lng t bo l khng i t khi mi sinh ra v hu nh khng c s ti to. Khi mt vng no ca ni m b tn thng th cc t bo ni m ln cn s tri rng che ph vng b thng do mt t bo ni m gim. Do c th s dng phng php xt nghim m t bo ni m chun on mt s bnh l ca mt. Gic mc bnh thng khng c mch mu, dinh dng ca gic mc ch yu l do thm thu t hai cung mch nng v su ca vng ra t thy dch v nc mt. Gic mc phc v nh mt mn bo v trc mt v cng gip nh sng tp trung vo vng mc mt sau ca mt.
2.2.2. Thy dch (Aqueous humor)

Thy dch l mt cht lng trong sut c sn sinh bi th mi (Ciliary body) bao quanh mng mt (Iris) nui dng mt. Thy dch c y cc thnh phn cu to ca mu tuy nhin khng c t bo mu c nhim v cung cp cht dinh dng v oxy cho mt. ng thi thy dch cng c chc nng lm cng nhn cu m bo mt cu trc hnh hc thch hp cho s hnh thnh cc hnh nh r rng, chnh xc. Bnh thng lng thy dch c sn xut v dn lu cn bng nn nhn p lun n nh, duy tr mt p sut 20-25 mmHg. p sut bn trong mt (nhn p) ph thuc vo lu lng ca cht dch ny. mt ngi bnh thng th lng thy dch c to ra trong mt bng vi lng thy dch c thi ra ngoi mt. Nu thy dch b ng trong mt, p sut mt tng cao, iu c th nh hng n th lc, c th gy nn m mt nu khng c cha tr kp thi.
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Hnh 2.2 Gic mc, thy dch, ng t, mng mt, thy tinh th Tin phng v hu phng u cha thy dch. Tin phng (Anterior chamber) l khong trng pha sau gic mc v pha trc mng mt c gi. Cn hu phng (Posterior chamber) l khong trng quanh sau mng mt v phn tht ngang thy tinh th (lens). Thy dch c tit ra t th mi ti hu phng ri qua thy tinh th ti tin phng v lun c dn lu cn bng m bo nhn p n nh.
2.2.3. ng t ( pupil), mng mt ( Iris)

ng t (pupil) cn gi l con ngi mt, n lm vic ging nh mn chp ca my nh iu chnh lng nh sng i vo mt. Khi cng nh sng chiu vo mt ln, ng t s co li gim lng nh sng i vo mt. Nhng ban m, khi nh sng rt t, ng t li gin ra, cho thm nh sng vo mt ta c th nhn th y c.
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Vic co gin ca ng t ph thuc vo s co gin ca mng mt (Iris) phn bao quanh ng t, c mu en hay xanh ty thuc vo t bo sc t ca tng ngi. Mng mt c cc khi c co bp c gip ng t c th thay i kch thc. ng t ca mt ngi bnh thng c ng knh l 3.4 4.5 mm, v n co vo hay gin ra ty thuc vo lng nh sng chiu vo mt. Khi ng knh nh hn 2 mm th l chng bnh co ng t. Cn khi ng knh ln hn 5mm th l chng gin ng t.
2.2.4. Thy tinh th ( Lens)

Thy tinh th (Lens) hay thu knh mt l mt phn ca nhn cu nm sau ng t v mng mt; l mt thu knh 2 mt li, c cu trc trong sut, dy khong 4 mm, rng khong 9 mm hi t nh sng vo vng mc y mt. Thy tinh th c bao bi mt mng bn thm i vi nc v cht in gii, c chc nng iu tit vt th bn ngoi d xa hay gn cng c nh xut hin trn vng mc. Ngha l thy tinh th c th phng nn hay xp xung thay i t gip ta c th nhn mi vt cc khong cch khc nhau. i vi mt bnh thng th thy tinh th c th thay i c nhn cc vt cch mt t 25 cm n xa v cng. Khi khong cch nhn b gii hn li ch c th nhn nhng vt gn th l bnh cn th. Cn khi ch c th nhn r nhng vt xa th gi l bnh vin th. Khi thy tinh th b c (bnh c thy tinh th) th cng ging nh tm knh b m, v khng th nhn r c mi vt xung quanh. Nu b c hon ton, hnh nh s khng vo c vng mc khi s gy m.
2.2.5. Dch knh (Vitreuos humour or Vitreuos humor)

Dch knh hay cn gi l dch pha l l phn dch trong sut, th keo cha y bung sau ca nhn cu pha sau thy tinh th v trc vng mc. Dch knh chim 6/10 dung tch ton b nhn cu. Cu to gm 99 % l nc, c l collagen. Ton b khi dch knh c bao bc bi mng hyaloid m bn cht l s c c ca dch knh phn ngoi bin. Mng hyaloid pha trc dnh cht vi mt sau thy tinh th bi dy chng Wieger. Pha sau mng hyaloid dnh vi vng mc hong im, gai th v i khi cn dnh vi nhng mch mu vng mc.
ti Tm hiu v tn hiu in mt v cc thit b ng dng Page 11
Dch knh c nhim v tip truyn cc tia sng t ngoi vo i ti vng mc; ng thi n cng tham gia vo vic nui dng thy tinh th, vng mc v gi cho lp thn kinh ca vng mc dnh vi lp biu m sc t. Khi dch knh thay i cu trc v thnh phn ha hc c th gy nn rt nhiu bnh khc nhau.
2.2.6. Vng mc (retina)

Vng mc (retina) l mt mng bn trong ca y mt. Vng mc c cu to bi 10 lp. Lp ngoi cng cha sc t (ngn cn s phn x nh sng trong nhn cu) v vitamin A (thnh phn cn thit thnh lp quang sc t). Cc lp tip theo c cu to bi cc nron chnh: Cc t bo nn v t bo que, t bo ngang, t bo lng cc, t bo amacrin, t bo hch. Si trc ca t bo hch hp li thnh dy thn kinh th gic ri khi mt ti vng gai th. Vng ny khng c t bo cm th nh sng nn khi c nh ri vo im y cng khng nhn thy vt. chnh l im m (punctum caecum)
Hnh 2.3 Cc lp t bo vng mc T bo cm nhn nh sng l t bo que v t bo nn. Mt cc t bo ny khng u trn vng mc. Cc t bo que di rt nhy vi nh sng cho ta nhn s vt trong iu kin thiu nh sng, gip cho tm nhn c xa hn. Cn t bo nn li cn nhiu nh sng, nhng li cho ta nhn bit cc chi tit nh ca vt ta nhn
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vo, m bo tp trung th lc vo mt im v gip phn bit cc mu khc nhau.Mt cc t bo ny khng u trn vng mc: cng xa trung tm vng mc th cc t bo nn cng t v t l cc t bo que cng cao. T bo nn nm tp trung vo mt ch v n quyt nh tinh tng ca mt. Ti hong im (macula) phn trung tm ca vng mc ch c cc t bo nn, l vng c phn gii cao nn nhn r nt tng chi tit. Phn ln nht ca vng mc xung quanh hong im l vng mc ngoi vi (peripheral retina) c phn gii thp hn, gip cho chng ta nhn c xung quanh. T bo th gic (hay t bo cm nhn nh sng) gm 3 vng: on ngoi, on trong v vng Synap. on ngoi cha nhiu a, bn trong cha quang sc t. on ngoi ca t bo gy mnh, ca t bo nn dy hn, hnh chop. on trong cha nhiu ty th. Vng Synap tip xc vi t bo ngang v t bo lng cc.
2.2.7. C vn nhn (Muscle)

C vn nhn c tc dng nhn cu v tham gia vo cc vn ng ca nhn cu.
Hnh 2.4 C vn nhn Mi mt c 6 c vn nhn ngoi lai v 2 c vn nhn ni ti. 6 c vn nhn ngoi lai bao g m 4 c thng (c thng di, c thng trn, c thng trong, c thng ngoi) v 2 c cho (c cho ln v c cho nh). 2 c vn nhn ni ti l c th mi v c co tht ng t.
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2.3. DN TRUYN TH GIC

C ch cm nhn nh sng l c ch quang ha hc v do t bo que cm nhn. Cn c ch nhn mu do t bo nn m nhn. Nhn l s phi hp ca c hai c ch ha hc v vt l, c s tham gia ca nhiu b phn nh h thng thu knh hi t ca mt, ng t, vng mc, cc receptor, ng dn truyn thn kinh v tring tm nhn cm c m gic ca v no. S kch thch nh sng ph hp vi mt l nhng tia sng nhn c, c ngha l trong di bc sng khong 400 700 nm. Khi nh sng n mt th s tip nhn kch thch trc ht l do t bo th gic vng mc m nhn. Sau thn kinh th gic chuyn xung ng ln n trung tm nhn trn v no vng thy chm. Nh c s kt hp hnh nh ca vt trn hai vng mc v trn hai thy chm ca v no m con ngi c th quan st mi vt xung quanh. Trn y l nhng kin thc c bn nhm v cu to gii phu ca mt ngi. N chnh l c s chng ta tm hiu v tn hiu in mt. Trong phn tip theo nhm em xin trnh by v bn cht ca tn hiu in mt v cch thc thu nhn cc tn hiu .
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PHN 3:
BN CHT V NGUYN L HOT NG CA CC LOI TN HIU IN MT

Theo nh tm hiu Phn I, th receptor nhn cm nh sng l t bo que v t bo nn vng mc. T bo que th c kh nng nhn cm sng ti, gip nhn c vt c cng sng t mnh n m v nhn c vt trong bng ti. T bo nn th ch nhy cm vi nh sng c cng mnh, gip phn bit r cc ng nt v mu sc ca vt. V tn hiu in mt da trn nhng p ng ca hai loi t bo ny vi s kch thch nh sng khc nhau. Sau y nhm em xin trnh by chi tit hn v hai phng php thu nhn tn hiu in mt phc v trong chn on v iu tr cc bnh v mt.
3.1. GII THIU CHUNG

Trc y th ngi ta quan nim, mt l mt v tr c trng in t n nh v khng lin quan g n nh sng kch thch. Thc, trng ny c pht hin vi mt trong bng ti hon ton, hoc vi mt nhm li. in th ngh gia gic mc v dy thn kinh th gic c a ra bi mt bo co ca DuBois-Reymond nm 1849. Sau gic mc c pht hin l c in th dng hn so vi vng mc v in th vng gic mc c a ra t . Vng mc v gic mc c th c m t nh mt lng cc c nh vi cc dng ti gic mc v cc m ti vng mc. Cng ca in th gic mc vng mc ny nm trong khong t 0.4 n 1.0 mV. Mt phn in th vng gic mc ny c th c o bi cc in cc t trn b mt gn mt. Do , in th o c ph thuc vo hng ca mt v c s dng ghi nhn s chuyn ng ca mt trong in cu mt in nhn . V Elwin Marg t tn l phng php ny l electro oculogram nm 1951 (EOG electro oculograp). n nm 1962 Geoffrey Arden pht trin ng dng lm sng u tin. Bng cch lp li s chuyn ng ca mt theo cng mt gc, ng thi o in th trc v sau khi thay i v tr mt v ghi li s khc bit gia hai v tr mt, bn ghi c ghi nhn do lin tc v gin tip o in th vng gic mc.
nh ngha in cu mt in nhn (EOG electro oculograp) ny thng c s dng trong cc nghin cu hin nay. Ban u th in th gic mc v vng mc c coi l khng i. in cu mt (EOG electro oculogram) c ghi nhn da trn s thay i in th tng i ghi nhn c gia hai in cc t trn da quanh mt. Nhng nhng nghin cu sau ch ra rng in th gia vng mc v gic mc cn ph thuc vo cng ca nh sng kch thch. in th vng gic mc ch n nh sau mt khong thi gian chiu sng lin tc thng l 90 pht. Khi cho kch thch sng ti kch thch mt cch lin tc, tun hon, v rt nhanh (nh sng flash) vo mt th s to ra mt s thay i in th. V in vng mc (ERG Electroretinogram) c xy dng da trn s thay i in th ny.
3.2. IN CU MT EOG 3.2.1. Ngun gc ca in cu mt - EOG

in cu mt hay cn gi l in nhn (EOG electro oculograp) c xy dng da trn pht hin v s chnh lch in th gia gic mc v vng mc. Nh chng ta bit ngun gc chnh ca nhng tn hiu in sinh hc l c to ra bi nhng m d b kch thch nh t bo c, t bo thn kinh. Tuy nhin cng c mt s nhng tn hiu in sinh hc t pht sinh khc, chnh l in cu mt (EOG). EOG khng c to ra bi nhng m d b kch thch nhng c to ra bi s phn cc tnh in gia in th gic mc v in th vng mc ca mt. Thng qua s di chuyn ca mt to ra s thay i in th, v ta c th c o xung quanh mt. S xut hin ca cc b khuch i in t nhng nm u ca thp nin 20 ca th k cho php ghi nhn nhng tn hiu in c to ra t bo thn kinh v c vi nhng in th rt nh. S ghi nhn chc nng ca c tim bi b khuch i in tm v nhng tn hiu tng t nhng nh hn l tn hiu in no (EEG). in th o c trn mt l nhng thay i ca chuyn ng mt c pht hin v l c s cho tn hiu in nhn hay in cu mt (EOG). Tn hiu in c ghi nhn t s chuyn ng ca mt c xc nh bi s chnh lch in p
vi gic mc mang in th dng hn vng mc. in th vng gic mc c o bi in cc trn da gn mt th thay i theo nhng hng chuyn ng khc nhau ca mt. in th gic mc c sinh ra nh hot ng chuyn ha, trao i cht ca vng mc, ch yu l do cc biu m sc t vng mc. V cng ging nh bt k mt ngun in mt chiu no th cn c mt lp ngn cch hay cch ly gia in th dng v in th m duy tr s chnh lnh in p, c nhng mi lin h cht ch gia cc t bo biu m sc t phc v cho chc nng ny. in th chnh lch hai bn cc t bo kt ni gic mc v vng mc c phn tn trn ton mt bi s dn truyn trn ton b mt. Cc t bo biu m sc t ny duy tr mt in th ngh khong vi mV. in th chnh lch c bn ghi nhn c nh in cc t trn da quanh mt thay i l do s chuyn ng tng i ca vng mc v gic mc so vi cc in. in th ny c o trong thc nghim vo khong 0.4 n 1.0 mV. Php o in th mt chiu ny l phng php o tn hiu in nhn (EOG) v y chnh l mt phng php c bn kim tra chc nng ca vng mc.
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Hnh 3.1 Ngun gc sinh l ca tn hiu EOG
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Ngun gc sinh l ca tn hiu EOG kh phc tp. nh sng kch thch lm tng cc kch hot c th c to ra bi cc receptor nhn cm nh sng, ci m lin kt vi cc receptor ti b mt nh ca cc t bo biu m sc t. Cc ni bo truyn dn kch hot to cho b mt y ca cc t bo biu m sc t kh cc vi dn Cl tng. Do ti b mt y ca t bo biu m sc t tn ti mt in tch m. V in th ny c o gin tip nh l s thay i in th trn vng mc, iu to nn s chnh lch in th gia gic mc v vng mc. in th ny c th n nh trong php o th tnh trng ca cc t bo biu m sc t cng nh mi lin h ca n vi cc receptor nhn sng phi cn nguyn vn. V th tn hiu EOG suy gim khi m b bong vng mc hoc ri lon, thoi ha chc nng ca cc receptor nhn sng hay t bo biu m hay c hai. in th ngh ca vng mc khng phi l mt trng n nh. Dao ng chm vn lun tng ln v gim xung ngay c khi t trng thi n nh ca s thch nghi nh sng. Trong php o EOG in th nh sng nh t c sau khi thch nghi vi nh sng khong 7-12 pht v in th y thp nht t c sau khong 12 pht khi thch nghi vi bng ti. y chnh l dao ng chm m ta o c bng php o EOG lm sng. Thc t, dao ng chm ny khng phi l p ng li ca cc t bo biu m sc t. nh sng hp th bi cc receptor nhn cm nh sng lm gim nng ion K ngoi bo to ra s phn cc b mt nh ca t bo biu m v ta o c ging nh sng c ca kch thch nh sng flash ca php o ERG xy ra trong khong 2-5 giy sau khi kch thch. Hn na, in th t bo biu m t n nh nhanh sau khong 60-75 giy sau khi kch thch nh sng. y chnh l hin tng dao ng nhanh v c to ra bi s phn cc ca mng y ca t bo biu m sc t p ng li s gim nng K ngoi bo ca cc receptor nhn cm nh sng. Sng c v dao ng nhanh khng c ghi nhn trong lm sng thng thng. Ngc li, EOG lm sng l php o dao ng chm ca in th ngh ca cc t bo biu m sc t m khng lin quan n s gim st nng K ngn.
+ + + -
khong di vng mc v khng b nh hng bi tc nhn nh sng kch thch
Trong phng php o in mt, s thay i in th vi p ng nh sng l ngun gc cho nhng ghi nhn s chuyn ng ca mt v chng c xt n trong sut qu trnh thc hin vic kim tra in vng mc ERG. Nhng s thay i in th ny din ra chm hn trong khong thi gian 5 10 pht, do nhng thay i ca nh sng kch thch trong phng c th chp nhn c khi o tn hiu EOG.
3.2.2. Nguyn l thu nhn tn hiu EOG

Nguyn tc ca k thut ghi nhn l ghi li bt k s chuyn ng no ca mt lm thay i in th gia hai in cc quanh hc mt. in th thay i t l thun vi gc chuyn ng ca mt. Bng s chuyn ng lp i lp li ca mt trn cng mt gc, in th c ghi nhn t l vi in th hin c gia gic mc v vng mc. in th t khi mt v tr nhn thng n khi mt chuyn ng c s dng thit lp mc tham chiu 0. in th c duy tr mc 0 khong 1,5 giy trc khi mt di chuyn sang mt v tr mi. Mt giy sau khi mt chuyn ng in th li c a v gi tr 0. S di chuyn ca mt c thc hin trong mt phng ngang theo nhng v tr cch u theo phng dc. Ch nhng in th khc nhau gia cc v tr ca mt c ghi nhn. Khi mt nhn thng th v tr ca in cc trn mt so vi vng mc v gic mc l i xng nn in th thu c l xp x gi tr 0 V. Khi mt chuyn ng theo phng ngang th s chnh lch in th tng i gia vng mc v gic mc vi in cc cng thay i. Mt bn ghi c nh v s chuyn ng ca mt l cn thit cho s miu t chi tit v phn tch hot ng c ca mt. Php o nhiu c tnh quan trng ca s chuyn ng ca mt nh bin , tr, vn tc c th c thc hin o mt cch chnh xc khi chuyn ng ca mt c ghi li. Yu t chnh ca vic ghi nhn l kh nng nh r s chuyn ng ca mt l mt hm ca thi gian, do vic ghi nhn thng c hin th trn giy nh l mt th v tr ca mt vi in p t l c th c phn tch in t hoc chuyn thnh bn ghi th bi mt my ghi biu . Phng php chp nh hay video i khi cng c s dng, v mi khung phi c phn tch v tr ca mt cho mt lot cc v tr so vi thi im
c th c v.
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in cu mt (EOG) l mt phng php chun bi s chuyn ng ca mt c ghi trong phng th nghim chuyn ng lm sng ca mt. Thut ng in cu mt (EOG) v in rung nhn thng c thay th cho nhau bi trong mt khong thi gian di th vic o s rung git cu mt v s chuyn ng ca mt c thc hin bi phng php EOG. Cng ngh mi hn c thay th cho phng php EOG trong mt s trng hp v mt s phng th nghim, v hu ht cc nghin cu c a ra hin nay s dng nhng phng php chnh xc hn o s chuyn ng ca mt. S hiu bit v nhng li th v nhng hn ch ca cc phng php khc nhau ghi nhn chuyn ng ca mt v th l rt cn thit.
Hnh 3.2 S minh ha s thu nhn tn hiu in nhn EOG Hnh 4.1 minh ha cch thu nhn in th mt chiu do s chuyn ng ca mt vi in th trn da. in th ny c ghi nhn s thay i theo mi pht bi dng gia hai in cc. Mt v da to thnh mt mch in hon chnh vi cc in cc v cc b khuch i. in th o c ph thuc vo tr khng ca mch, do tip xc gia da v in cc phi c duy tr sao cho c mt mc tr khng n nh trong sut qu trnh o. S phn bit in th m v in th dng nn mi mt ging nh mt lng cc in, v hng ca in cc ny quyt nh in p. i vi mi mt nhn theo chiu ngang th dng cc ca mt ny s gn vi m cc ca mt khc ti v tr gn mi. Do v tr gn mi c coi l im 0 V. in th o c bi s ghi nhn in th trn mi mt l in th so vi in th gn 0 ca im gn mi ( Hnh 4.2).
Hnh 3.3 Hai cch ghi nhn in th trn mt a) Ghi nhn s thay i in th trn mi mt b) Ghi nhn s thay i in th trn c hai mt Hnh 4.2 minh ha hai cch ghi nhn in th thay i ca mt. Hnh 4.1 a) in cc t trn hai bn ca c hai mt o s chuyn ng ca mi mt. in cc dng c t hai bn sng mi vi v tr tng ng, cn in cc dng c t hai bn thi dng. V vng mc mang in th dng hn gic mc nn khi mt chuyn ng sang bn phi th ta thu nhn c in th dng v ngc li. Hnh 4.2 b) Ghi nhn in th trn c hai mt vi in cc t ging nh hai lng cc t ni tip. Khi mt chuyn ng sang bn phi th in cc t ti khe mt gn thi dng tri s dng hn in cc t ti khe mt gn thi dng phi. V i vi mt bnh thng in th thu c trong trng hp b) s ln gn gp i so vi in th thu c ca mi mt trong trng hp a) . Khi ghi nhn tn hiu gia hai in cc t hai bn khe mt th s thu c tn hiu ln hn, khi mt chuyn ng sang hai bn th mt bn khe mt l in cc dng ca mt ny v in cc m nm bn khe mt cn li. Vic ghi nhn in th trn c hai mt s cho tn hiu mnh hn, nhng chng ta khng th kim tra c s chuyn ng ca tng mt. Kim tra chuyn ng ca mt phi c ki m tra cn thn trc bng phng php ghi nhn in nhn vi mt mt. Tt nht l chng ta nn t bn in cc vi u ra c th ghi nhn in cu mt cho mi mt hoc cho c hai mt. Sau khi kim tra chuyn ng ca tng mt tm ra mi
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lin quan, sau vi in cc t hai bn khe mt chng ta c th s dng o tn hiu in nhn c c tn hiu ln hn. c nhng tm hiu r hn hy quan st bng tm tt cc tiu chun ca in nhn EOG sau:
Bng 3.1 Nhng ch tiu c bn ca in nhn EOG

Phng php lm sng
Trang b cho bnh nhn - Khng iu tit khi nh sng c cng p ng khong 400-600 cd/m2 - Gin ra nu nh sng kch thch c cng yu khong 50-100cd/m2 Hai in cc da t trn m i mt v t cng gn khe mt cng tt
S iu tit ca ng t
V tr t in cc
Cc mt lun phin chuyn ng v cc bn sau m i 1-2.5 Lic mt nhanh (Di giy (hon thnh m i chu k t tri qua phi v phi qua tri chuyn mt mt cch t sau m i khong chu k l 2-5 giy); ti thiu l 10 chu ngt) k/pht trong sut bi kim tra Phng sng c cng sng 35-70 lux trong khong hn 15 pht trc khi tin hnh pha ti; trnh nh sng mt tri chiu trc tip, nhng tia phng x trong sut 60 pht lm kim tra C hai phng php la chn: T s Arden: l t s gia nh cao nht vi kch thch l nh sng v y thp nht vi kch thch l bng ti nh sng tt, gi tr EOG o c khong 15 pht trong bng ti th bin nh nht (y thp nht) ghi c thng xy ra sau khong 11-12 pht T s nh cao nht ng vi kch thch nh sng v i ng c bn thch nghi vi bng ti Thch nghi vi bng ti sau khong hn 40 pht, gi tr EOG ghi c khong hn 5 pht trc pha sng thit lp bin c bn ca s thch nghi vi bng ti
Giai on thch nghi
Pha ti
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Pha sng
nh sng n nh c kch hot v tn hiu EOG c ghi nhn n khi t c bin ln nht t c, nu khng quan st thy th tip tc bi kim tra khong hn 20 pht Bin chuyn ng mt t ngt (lic nhanh) v tnh ton t s gia nh cao nht ca kch thch nh sng v nh thp nht ca kch thch nh sng hoc nh cao nht ca kch thch nh sng v ng c bn thch nghi vi bng ti Mi phng th nghim thit lp mt gi tr tiu chun ring Tnh trng m phng php t s EOG c s dng bao gm tr ca nh cao nht ca kch thch nh sng v bin ng c bn hoc y thp nht ca kch thch nh sng
Thc hin o EOG
Gi tr tiu chun
Cc bo co v EOG
Cc cng ngh c bn
nh sng kch thch Trng kch thch Trng kch thch l trng hinh nh trn it pht sng nh sng vi gc nhn 300 theo phng ngang c th nhn mt cch y vi c pha sng v pha t i in cc da Vt liu lm in cc Tr khng in cc gn Lm sch Ag/AgCl hoc vng Tr khng 10 k ng vi tn s o t 30 n 200 Hz Da ra sch vi cn, in cc s dng cn dn in tt Lm sch dng c sau m i ln s dng Ngun sng nh sng tt nht l nh sng trng. Xc nh r cng sng xem ng t nn dn ra hay khng gin ra (theo di phn s iu tit ca ng t cp trn). iu chnh cng sng bng b lc kim tra s co gin ca ng t mt bnh nhn
Mc tiu c nh
iu chnh sng
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nh chun
sng ca trng chiu sng c o bng photo k theo mt phng php khng thng nht. S hiu chun tn s li ph thuc vo h thng s dng
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Thit b ghi nhn tn hiu H thng khuch i B khuch i mt chiu vi b lc thng thp vi tn s ct l 100Hz v b lc thng cao vi tn s ct l 0.05 Hz v trit tn 50 Hz. H s khuch i khong 103 ln Bn cht dng sng hin th trong khi ghi nhn tn hiu v th c th nh gi c s n nh v cht lng ca b ghi nhn Bnh nhn cn c cch ly v in khi thc hin php o
H thng hin th
Cch ly bnh nhn
3.2.3. Cch t in cc v dng tn hiu thu c

in cu mt thng c s dng ghi nhn s chuyn ng ca mt trong lc ng v m v c ghi nhn chng git cu mt hin tng nhng chuyn ng mt cch mt t ch din ra trong sut qu trnh b chong vng hay chng mt. EOG cn c s dng trong cc bnh vin hoc cc phng nghin cu in sinh l mt nh gi kh nng ca in th gic vng mc trong sut nhng thay i ca iu kin nh sng xung quanh. Mt s s ri lon ca vng mc bt thng hay thiu ht th hin trn in th gic vng mc trong sut qu trnh thch ng vi nh sng v bng ti. i vi th nghim ny bnh nhn cn di chuyn i mt ca mnh tp trung vo hai bng n c nh t lch 150 so vi trung tm mt to ra nhng in th thay i xen k ph thuc vo in th gic vng mc. Vi nhng iu kin nh sng xung quanh thay i lm thay i in p v to ra mt th in cu mt. Trong qu trnh ghi nhn tn hiu EOG, in cc da c s l in cc Ag/AgCl hoc vng c t v tr trung tm gn mi v gn khe mt ca mi mt; v c kt ni vi b ghi nhn l mt b khuch i DC vi u vo cn bng. in th ngh gia vng mc v gic mc c ghi nhn gin tip khi mt chuyn ng qua li ca mt nhn vo hai mc tiu c nh trc (Hnh 4.3). Cc mc tiu nh v v tr lch khong 150 so vi phng thng ng v bn tri v bn phi ca mt (Hnh 4.4). Cc mc tiu sn gip cho bnh nhn nh v c di chuyn mt mt cch chnh xc trong sut qut trnh ghi nhn tn hiu EOG.
Bnh nhn c hng dn nhn ln lt mi v tr nh v sn ny hon thnh
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mt vng chuyn ng ca mt t phi qua tri v t tri qua phi vi chu k l 2-5 giy.
Hnh 3.4 V tr t in cc da Mt in cc trn mi v mt in cc trn khe mt hai bn ca mi mt
Hnh 3.5 Mc tiu nh v trong ghi nhn tn hiu EOG
Kt qu ca php o EOG ghi nhn c l dng xung vung vi chiu cao ca sng chnh l bin ca tn hiu EOG. Tm li, php o EOG l mt php o gin tip in th ngh ca vng mc thng qua in ch chnh lch gia gic mc v vng mc. Php o trc tip bng cc s dng in cc gic mc c th thc hin c vi cc cng ngh c bit. V kt qu gin tip v trc tip o c so snh vi nhau. Nh trnh by trn in th thu c thay i ng vi v tr tng i ca mt so vi v tr t in cc tng ng vi chuyn ng lic tri, lic phi ca mt theo nhng mc tiu c nh sn. Lic mt c cp n y l s chuyn ng nhanh ca mt t im c nh ny sang im c nh khc (tc c th t n 20-7000/s). in cc dng gn khe mt phi s gn vi vng mc khi ta lic sang tri v gn vi gic mc khi ta lic sang phi.
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Hnh 3.6 Dng tn hiu EOG Dng sng EOG hin th bi h thng ghi nhn c th cho bit kh nng v cht lng ca s linh hot ca mt. Nu lic qu tm hay khi lic mt m nh v v tr mc tiu khng chnh xc th cng gy nn s thiu chnh xc ca php ghi. Bnh nhn mc chng git cu mt hay mt lc vi gc ln c th khng th thc hin c php o EOG. Vic kim tra EOG cng khng th thc hin c vi nhng ngi khng th hp tc thc hin c s lic mt nh v theo mc tiu nh sn mt cch chnh xc.
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Hnh 3.7 in th thu c vi cc gc v cc hng lic mt khc nhau in th thu c t l vi gc m mt lic c v ph thuc chiu lic ca mt l bn tri hay bn phi. Cng in th thu c tng khong 5-20V/0 .
3.2.4. Ghi nhn tn hiu nhiu

C hot ng cng to ra mt s in p c th c o bi in cc di da v n c th gy nn nhng tn hiu nhiu lm nhiu tn hiu EOG. Mt chuyn ng ngang bao gm nhng chuyn ng c bn ca nhn cu, do in th vng gic mc o c gn nh l chnh xc. Kch ho t ca c theo phng ngang th nh hng t da. Tuy nhin, s chuyn ng ca mt theo phng dc s chu nh hng ca s chuyn ng ca m mt rt nhiu. Do o in th da s khng s dng phng php o s chuyn ng ca mt theo phng dc. Tuy th nghin cu s chuyn ng theo chiu dc ca mt cng rt quan trng a ra nhng thng tin v chp mt v s chuyn ng ca m mt. Hin tng chp mt s gy nhiu cc tn hiu chuyn ng ca mt theo chiu ngang cng nh theo chiu dc, do ghi nhn nhng tn hiu ny vi in cc c nh hng theo chiu dc cho php nhn dng v loi b nhng chuyn ng chp mt hay chuyn ng theo
chiu dc nh nh s chuyn ng hin thi ca mt theo chiu ngang. in cc t
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mt cch cn thn th ghi nhn theo phng ngang c th trnh c nhng tc ng ca ghi nhn theo phng dc, nhng s nh hng qua li l kh trnh khi v ng thi nhng thng tin ghi nhn theo phng dc c th gp phn lm r hn thng tin. Tn hiu EOG thu nhn c rt hu dng trong vic nghin cu chuyn ng ca mt. Mt ng dng c bit ca EOG l trong vic o lng chng git cu mt, l biu hin ca nhng chuyn ng nh ca mt. Tn hiu thu c gi l in rung nhn cu k. N ph thuc c vo h thng th gic v h thng tin nh v cung cp thng tin lm sng hu ch lin quan n mi h thng trn. Mt s thng tin chi tit lin quan n EOG, v n lin quan n chuyn ng ca mt, bao gm c chng git nhn cu mt, c ni ti trong cc phn sau.
3.3. IN VNG MC 3.3.1. Ngun gc ca tn hiu

Tn hiu ERG c pht hin ra trong mt ng vt vo nhng nm 1800s v nhng u tin m tn hiu ERG c ghi nhn trn ngi u tin l nhng n m 1920s. Trong lm sng, php o ERG c p dng vo nhng nm 1940s, v nm 1989, tiu chun lm sng v trng tn hiu ERG c cng b bi Hi quc t v in sinh l lm sng ca Vision ISCEV. Tiu chun ERG c ph duyt li 3 nm mt ln, v lun c cp nht mi. Nhng tiu chun gn nh khng c g thay i trong nhng nm gn y (Quan st bng 3.2) Phn ng ERG c to ra bi s chuyn ng ca cc ion ti vng mc khi xy ra hin tng cm ng nh sng. Hin tng ny c o gin tip ti gic mc bi in cc ghi nhn. Cc chuyn ng ch yu l ca cc ion dng K+ v Na+ din ra do ng m (qu trnh kh cc v phn cc) ca cc knh dn mng t bo. Nhng t bo vng mc c si trc thn kinh c kch thc nh v ngn nn s thay i hot ng ion ca mt phn t bo cng nh hng n hot ng synap ca n. C t bo nhy sng v t bo khng nhy sng ca vng mc u gp phn vo vic to ra dng in dn truyn. Trng tn hiu ERG gn nh khng to thnh t cc t bo hch vng mc m c to thnh t cc hch thn kinh th gic. Cc t
bo hch hot ng theo c ch p ng tt c hoc khng v c nhiu p ng hn vi kch thch ca ERG mu. Trng tn hiu ERG o ton b p ng ca t bo nn v t bo que ca vng mc v l bi kim tra in sinh l nh gi hot ng ca t bo que. Tn hiu ERG l mt yu t cn thit trong cc php chun on nhiu bnh ri lon nh chng lon dng nn, chng bong vng mc bm sinh, qung g bm sinh, chng m bm sinh, t bo que n sc, khi u vng mc. Php o ERG nn kt hp vi cc bi kim tra mt mt cch k lng v l cn thit vi cc bi kim tra nh kim tra kh nng nhn v xt nghim bng tia X. Tn hiu ERG khng cung cp thng tin v v tr ca bnh, v tn thng hong im c cch ly cha chc lm gim p ng ca tn hiu mt cch ng k.
3.3.2. Nguyn l thu nhn tn hiu in vng mc ERG 3.3.2.1. Nguyn tc chung
Nguyn l ghi nhn tn hiu in vng mc ERG l ghi li s thay i ca in th vng gic mc khi mt chu kch thch l cc nh sng sng ti c cng thay i mt cch tun hon. in th vng mc gic mc l phng php o gin tip v khng lin tc. Thc nghim thc hin vi in th vng mc ng vi nng lng ca bc x hng ngoi, nh sng nhiu mu sc bao gm nng lng bc x hng ngoi v nh sng nhiu mu sc vi bn cht l bc x hng ngoi. Kt lun l nng lng bc x hng ngoi trong th nghim trn khng ng gp ngha i vi cc kch thch to in th vng gic mc ngi khi s dng c bc x hng ngoi v nh sng nhiu mu sc. Nng lng bc x ca nh sng nhn thy l dao ng khng ch c s dao ng nhanh v chm. S thay i in tr da hoc in th ca da c th khng ng nh s ng gp quan st dao ng trong in th vng gic mc khi ghi nhn bi phng php gin tip. Nh cp trn, in th vng mc v gic mc ph thuc vo cng ca nh sng kch thch. in th vng gic mc ch n nh sau mt khong thi gian chiu sng lin tc thng l 90 pht. Hai dao ng c th c quan st trong
in vng mc ERG l dao ng chm v dao ng nhanh.
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Sau y l nhng quy tc chung nht v php ghi in vng mc ERG.
Bng 3.2 Tm tt chun quc t v php ghi in vng mc ERG

Phng php lm sng
Trang b cho bnh nhn Gin n ca ng t Mt c nh thuc ng t gin ti a 20 pht thch ng vi bng ti trc khi ghi nhn p ng S thch nghi ban u v i ca t bo que nh sng hoc bng ti 10 pht thch ng vi nh sng trc khi ghi nhn p ng ca t bo nn Trnh qu trnh chp mch mu bng X quang v chp nn Trc khi tip xc vi nh trc khi thc hin ERG; cn 1 gi thch ng vi bng ti l cn thit trc khi thc hin ghi nhn ERG sau qu trnh Sng chp trn o v ghi nhn tn hiu EOG Php o tn hiu ERG o bin v o thi gian
Bnh thng th khng i hi, n gip cho vic pht hin L y gi tr trung bnh cc cc tn hiu yu; loi b l cn thit trong h thng l y gi tr gi tr lp li trung bnh Gi tr tiu chun M i phng th nghim thit lp mt gi tr tiu chun nhng c gii hn cho mi p ng ERG c th v gii hn tin cy l 95% Hin th dng sng cng vi bin , thi gian ca gi tr chun v c s bin i ca n; cng kch thch v mc thch nghi vi nh sng a ra gi tr xc thc
Bo co ERG
Ghi nhn gi tr ERG

Gy t hay gy m Mc tiu c nh in cc Trng kch thch l trng hinh nh trn S dng hoc khng s dng gy m; S gy m hon ton c th lm thay i p ng, to ra t kt qu hn ERG so vi vic ch gy t in cc kch thc nh
p ng ERG hon thin trong sut thi k cn nh; p Gi tr in cc chun v ng ERG c so snh vi nhng tn hiu chun cng tui phng php o khc
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p ng c trng
1. p ng ring ca t bo que vi nh sng flash n sau khi thch nghi ti vi flash tc 2.5 th m hn flash tiu chun (chnh lch 2s gia 2 loi flash) 2. T hp cc i nhng t bo que v t bo nn p ng vi nh sng flash n sau khi thch nghi ti chnh lch 10s so vi flash chun 3. in th dao ng Flash chun( 15 giy gia flash thch ng ti hoc 1.5 giy gia flash thch ng sng, thng di ca b lc thay i ti 75-300 Hz) 4. p ng sng ca t bo nn sau khi thch nghi sng v i flash tiu chun l >=0.5s 5. p ng nh sng chp chn tn s 30Hz ca t bo nn sau khi p ng vi flash tiu chun
Cc cng ngh c bn
in cc S ghi nhn in cc tip xc vi thy tinh th hay in cc trn gic mc, cn gy t cc b cho cc loi in cc tip xc v i thy tinh th Cc in cc tip xc cht ch vi th y tinh th hoc cc in cc ri nh in cc da t 2 bn khe mt hoc trn trn in cc t trn da c n i xung t, thng t in cc ny trn trn,hoc trn tai in cc gn trn da c tr khng 5K, c o gia tn s 10 v 100Hz in p n nh khi khng c nh sng kch thch Lm sch v kh trng sau m i ln s dng Ngun sng Thi gian Bc sng Cng Thi gian flash chiu sng 5ms Nhit ngun pht sng khong gn 7000K, pht ra nh sng trong di nh sng nhn c 1.5 4.5 cd s/m2. nh sng flash c cng nh vy c gi l nh sng flash chun iu chnh sng v ly m u
Cc loi in cc
c im in cc da S n nh Lm sch
iu chnh kch thch v H thng c kh nng lm suy gim bc sng Flash vt iu chnh cng nh qu phm vi t nht l 3log vi bc 0.3 log m khng lm sng nn thay i thnh phn ca bc sng Bc sng nh sng flash c o bi mt my o sng tch Chun kch thch v nh hp t ti v tr ca mt. Cn nh chun khc nhau cho kch thch vi flash n v nh sng flash lp li nhiu ln sng nn chi nn ca nh sng nn c o bi my o quang Hiu chun Tn s hiu chun ph thuc v h thng s dng Thit b ghi nhn B khuch i Di thng sau lc v trc khi qua b lc nm trong ph m vi 0.3 Hz n 300Hz, tr khng ca trc khi qua b lc ph i 10M
Dng sng tn hiu c hin th mt cch nhanh chng, h Hin th d liu v ly gi thng hon ton c th thay th cho b lc thng di khng tr trung bnh suy gim Cch ly bnh nhn Bnh nhn cn c cch ly v in khi thc hin php o
3.3.2.2. Phng php thc hin

Mt gm hai receptor nhn cm nh sng l t bo que v t bo nn. T bo que th c kh nng nhn cm sng ti, gip nhn c vt c cng sng t mnh n m v nhn c vt trong bng ti. T bo nn th ch nhy cm vi nh sng c cng mnh, gip phn bit r cc ng nt v mu sc ca vt. in vng mc ERG khi mt thch nghi vi bng ti l khi ghi nhn ERG sau mt chu k t nht l 20 pht; nhng tt nht l t 30 40 pht cc t bo que thch nghi hon ton c vi bng ti. Ghi nhn s thch nghi vi bng ti l nhng tn hiu do t bo que to nn mc d t bo nn nu kch thch c s dng l nh sng chi. p ng ERG thch nghi vi nh sng c ghi nhn sau t nht 10 pht khi thch nghi vi nh sng. S thch nghi vi nh sng ghi nhn c l tch ri nhng nh hng ca nh sng phng. Tt nht l cho bnh nhn thch nghi vi nh sng phng sau 10 pht. p ng vi nh sng cn c th b nh hng bi s thay i ca cc t bo que.
nh sng flash s dng c to ra bi mt ngun hnh nh trn. nh sng flash c cng 1.5 4.5 cd s/m2 c gi l nh sng flash chun. Tuy nhin, nh sng c cng 10 12 cd s/m2 gp phn to nn sng a mt cch tt nht nh gi hot ng ca cc receptor cm nhn nh sng.
Hnh 3.8 Nhng p ng c bn ca tn hiu ERG

Dao ng chm ca in th vng gic mc l ng b vi nhng pha sng v ti kch thch lin tc vi thi gian l 12,5 pht. Dao ng nhanh ng vi kch thch l nhng pha sng v ti lin tip trong khong thi gian 1,1 pht. Bin ban u tng l do s gim ban u ca in th, ko di trong khong 0,5 n 1,5 pht sau khi kch thch c bt ln. in th vng gic mc t cc i sau 8 9 pht, v gim xung cc tiu sau 23 24 pht. Bin ca in th vng gic mc tng vi
nh sng v gi m ng vi bng ti trong sut qu trnh dao ng chm. Ngc li
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in th vng gic mc li tng ng vi bng ti v gim vi nh sng trong dao ng nhanh. Dao ng chm vn tip tc khi chu k kch thch ca pha sng v pha ti l 1,1 pht, ngha l nhng dao ng nhanh to ra chng ln nhng dao ng chm. Kch thch ca bc x hng ngoi khng lm thay i ng k in th ca vng gic mc. Khng c du hiu ca bt k s tng hay gim ca mt pha no hay s nhanh hay chm ca mt dao ng no ca in th vng gic mc. Nu sau 90 pht thch nghi vi bng ti, ta kch thch cc pha sng v ti trong khong thi gian 1,1 pht th dao ng nhanh c th chng ln dao ng chm. Tuy nhin, dao ng chm s tt dn v cui cng s bin mt, trong khi cc dao ng nhanh vn tip tc din ra. Dng tn hiu chun:
Hnh 3.9 Dng tn hiu ERG chun
3.3.3. in cc v dng tn hiu thu c

C mt vi in cc c s dng trong ghi nhn ERG, trong loi in cc Burian Allen v Dawson Trick Litzkow (DTL) l hai loi in cc ph bin nht. V tr t in cc l rt quan trng c th t c mt tn hiu ERG chnh
xc. V cng cn thc hin vic lm sch, kh trng theo ng yu cu ca nh sn
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xut. Tn hiu in thu c l in th so snh vi in cc tham chiu c t trn trn hoc tai.
Hnh 3.10 Cc loi in cc ghi nhn ERG in cc Burian Allen l loi in cc tip xc trc tip vi thy tinh th, lm gim s nh hng ca s chp mt. Thuc gy t c s dng, v vi in cc Burian Allen th bnh nhn phi chu liu thuc t hn in cc DTL. in cc Burian Allen cng c nhiu kch c khc nhau. in cc DTL ghi nhn in th ca cc t bo Muler. S gy m tip xc khng m bo, i hi kh nng chu ng ca bnh nhn ln hn hn in cc tipxc Burian Allen v in cc Jet. So vi in cc Jet th in cc DTL c bin i ln hn v bin cng nh hn. in cc da khng ghi c tn hiu ERG mt cch chnh xc nhng n hp l khi s dng cho tr nh khi mt cha th dung np c vi cc in cc tip xc. in cc da th tn hiu thu c nh hn v tn hiu khng n nh nh in cc tip xc. Dng sng tn hiu thu c:
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Hnh 3.11 Dng tn hiu thu c Sng a dng sng gic mc m Sng b dng sng gic mc dng Sng a l sng gic mc m, sng b l sng gic mc dng. Bin ca sng a c tnh t ng trc ta n nh m ca sng; cn bin ca sng b c tnh t nh m ca sng n nh dng ca sng. tr ca mi sng c tnh t thi im bt u xy ra kch thch n nh sng. Thi gian ghi nhn thng l
250 ms.
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p ng ca t bo que c c trng bi sng b nhng khng c trng bi sng a v in th hot ng ca t bo que l kch thch rt nh. Nhng tn hiu ny c khuch i rt ln bi t bo bn trong vng mc. S kt hp c p ng ca t bo que v t bo nn ta c sng a v sng b ring bit. in th dao ng thng bao gm nhng gn sng ln v theo sau l nhng gn nh hn trong giai on tng dn ca sng b. Cc gn sng theo th t xut hin l OP1, OP2, OP3, OP4 nh hnh v. p ng ca t bo nn c c trng bi c sng a v sng b. p ng ca t bo nn vi nh sng flash tn s 30 Hz th ch bao gm sng b v cung cp cho ta mt phng php chc chn o p ng ca t bo nn
3.3.4. Cc dng tn hiu nhiu

Tn hiu nhiu do ngun cung cp ln hn rt nhiu tn hiu ERG, do c th lm nh hng n tn hiu ghi nhn c. Nhiu ny thng l nhiu in li 50, 60 Hz v c th khc phc bng cch tt i cc thit b dng cng in li c th gy nhiu. V mch thu nhn tn hiu c b trit tn, loi b tn s gy nhiu ny. ng thi s hot ng ca tim, c, no cng gy nn nhng tn hiu nhiu.
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Hnh 3. 12 Mt vi loi tn hiu nhiu
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Nhng tn hiu nhiu ny thng khng nh hng n tn hiu ERG chun v tn hiu nh v khng nh hng n nhng ci khc. Tuy nhin nhng nhiu do hin tng git, co tht ca m mt v s chuyn ng ca mt thng cn tr vic ghi nhn tn hiu ERG chun. Cc nhiu thng c loi b bng cch chn loi in cc, v tr t in cc ph hp vi loi thuc gy m cng vi s c gng ca bnh nhn gi in cc c nh.
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PHN 4 CC THIT B S DNG TRONG IN MT

Hu ht cc phng th nghim u s dng cc my mc thit b thng mi khuch i v thu d liu in mt. Nhng thit b ny c cu to nn bi cc b khuch i, b lc, v cc b thu nhn tn hiu nh gn v tin li. Tuy th, mt s phng th nghi m a dng cc linh kin ri cho mi phn chc nng ca my bi v mc ch nng cao li ch hoc v s linh ng. Cc in cc c t trn c th bnh nhn c th gy sc khi cc in cc ny dn in. Do , tt c cc thnh phn my mc in c gn ln c th ngi bnh cn phi c cch in hon ton nhm trnh gy sc, v tt c cc bnh vin u kim tra mt cch nh k my mc m bo s an ton ca cc thit b ny. Hu ht cc my mc thng mi ny thng c thit k tng i an ton, nhng ngoi ra, bt c thit b mi hoc thit b thay th no cng c th gy ra nhng iu ngoi mun. Tt c my mc thit b c kt ni ti h thng cp ngun, v cng c kt ni ti ngi bnh thng qua cc in cc, do yu cu phi ch cch in hon ton. Nhng bnh nhn phi s dng ng thng tim hoc phi dng my iu ha nhp tim c dy ni qua da ngi bnh th khng c php tri qua cng on kim tra in mt, bi v h l nhng ngi v cng nhy cm vi dng in cho d l nh.
4.1. THIT B O IN CU M T (EOG) 4.1.1. B khuch i

in th ca Electro-Oculogram c sinh ra bi s chuyn ng ca mt l rt nh, cng tng khong 5-20 V trn mt chuyn di ca mt. in th ny cn c khuch i ln khong 103 ln c th s dng dng cho vic iu khin ghi biu hoc ri rc ha (s ha) bng my tnh. Ngoi in th to nn bi s di chuyn ca mt, cc in cc cn nhn thm in th khng mong mun t cc ngun sinh hc khc nh s hot ng ca cc bp c, v c ngun in c trong cc loi dy dn trong phng. Cn xa b in th tp ca cc thnh phn tn s khng mong mun ca tn hiu in. B lc y l nhng khi dng
chn in p tn s khng mong mun v thng c tch hp trong cc b
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khuch i. Tn hiu in p EOG cn c bin i thnh dng th hin bng ha nhm phc v cho cng vic phn tch v to ra mt bn ghi c th quan st c. My v th bin i in p thnh nhng ng trn giy bng cch s dng mt bt mc hoc mt bt nhit. My thu ghi thng c cu to cng vi b khuch i chng l mt phn ca cc thit b c t sn mt b iu khin. Khi cc b phn ring l ca cc thit b c lp rp li vi nhau khuch i, lc v ghi tn hiu EOG, mi phn ca cc thit b ny c th c mt vi b iu khin. Trong trng hp ny, tt nht l nn yn tt c chng y, tuy nhin, mt b iu khin ca mi loi c thit lp mc c nh. Thm na, iu quan trng cn bit l kt qu tng th ca vic truyn tn hiu qua cc phn ca thit b c th l khc nhau, c bit vi p ng tn s, t bt k mt thit lp ring l no. Thit b in o in cu mt bao gm nhiu knh phc hp cho php ng thi thu ghi tn hiu cng lc. ng k nht l 3 knh phc v cho vic thu ghi tn hiu ca s dch chuyn mt sang tri, sang phi theo phng ngang mt cch c lp cng nh mt knh thu tn hiu theo phng dch chuyn thng ng ca mt. Cng nhiu knh hu ch ng thi thu nhn cc kch thch cng vi vn tc dch chuyn ca mt. S phn bit l ch cc thit b in t to ra mt in p t l vi s bin i, hoc t l vi tc ca mt in p EOG ph thuc v tr. Tc ca tn hiu c th l hu ch cho vic phn tch s chuyn ng nhanh ca mt, nhng vi tn s cao, mc nhiu trong vic ghi tn hiu EOG c phn bit thnh tn hiu c nhiu cao hn, iu ny ni chung l khng cho php nh gi chnh xc vn tc mt. Mi knh trong phn khuch i ca thit b EOG thng cha 4 khi iu khin quan trng: khi tng ch, offset, khi p ng tn s thp v khi p ng tn s cao. Khi tng ch ca phn khuch i l thay i c ph hp vi s chuyn ng ca mt, v d vi s di chuyn i 10 o, vi in p EOG lin kt ca n, c th khuch i ln mt in p nh trc hoc c th di chuyn bt v th i mt khong cch nh trc (gi d l 10mm). iu chnh khi tng ch cho php mt phng php trc tip v n gin lin quan gia cc ng trn th ti s di chuyn ca mt. Trong v d tip theo, mi mm trn giy th tng ng vi 1o di
chuyn ca mt. Khi tng ch c th tng ln tng chi tit cho chuyn ng ca mt c th quan st c, hoc gim xung m rng s di chuyn ca mt khng to ra nhng ng ngoi gii hn trn biu . Thit lp khi tng ch thng c iu khin bi 2 nm tch bit nhau, mt dng iu chnh th vi cc ci t trong phm vi c nh, v mt nm dng iu chnh tinh. iu khin b, i khi cn c gi l chnh im khng, cho php vi mt v tr c bit ca mt- l theo hng thng, c biu din bi mt in p c nh, hu ht thng l in p 0, n s l tm ca bt ghi. V in p EOG b tri theo thi gian, nn vic iu chnh li c khi tng ch v khi b l iu cn thit theo nh k trong sut qu trnh ghi tn hiu. in p EOG c o ti cc in cc trn b mt c cha nhng dao ng nh, chng khng c quan h vi s di chuyn ca mt v c xem nh l nhiu. Mt ngun nhiu m u cng c l nhiu cng nghip- nhiu 60Hz do s pht bc x in t trng bi tt c nhng ngun nng lng in. in cc EOG v dy ca n hot ng nh mt ng- ten v thu nhn sng 60Hz ny. B khuch i vi sai c u vo c thit k sao cho c kh nng loi tr in p chung ca c 2 in cc v ch khuch i in p chnh lch gia chng. Khi c hai in cc cng thu nhn chung mt nhiu cng nghip, n s khng c khuch i trong khi tn hiu EOG c khuch i. in p t l vi s di chuyn ca mt, cc yu t quan tm y l tn hiu v tn hiu th lun lun b tp m lm nh hng c gi l nhiu khng mong mun.
4.1.2. B lc tn s
B lc tn s cao v b lc tn s thp kim sot vic loi b nhiu khng mong mun v hin tng tri in p, n nh hng ti s chnh xc ca qu trnh thu tn hiu. Nhiu khng mong mun c th c tch ra t in p da trn tn s. iu c ngha l hu ht nhiu thuc khong tn s cao, nhng tri li, chuyn ng ca mt thuc tn s thp hn. Thit b in t m cho in p tn thp i qua ng thi lm suy gim in p nhiu tn s cao c gi l b lc tn thp. Tn s gii hn trn ca mt b lc l tn s m ti in p b suy gim i 3dB. Thit lp tn s i qua b khuch i EOG c iu chnh tng bc khong 0.05Hz t i 100Hz. Thit lp ny l mt s cn bng, bi v mt vi thng tin hu ch c trong
bn ghi chuyn ng ca mt li thuc tn s cao ging nh nhiu. Gii hn ca nhng tn s loi ny s lm mo nhng phn c trong tn hiu thu c v khng o c chnh xc nhng chuyn ng mt vi tn s cao. Nghin cu v tn s ca chuyn ng mt cho thy rng c t thng tin b mt nu tn s cao trn 100Hz c lc ra, v hu ht thng tin c tn s di 100Hz. Ngng ca tn s cao c th c thit lp cng cao cng tt, nhng khi EOG vn c tp m th thit lp ny thng b gii hn ti thp hn 100Hz. Gi tr khong 30Hz s cho ra mt tn hiu thu c th chp nhn c, v nhng thit lp thp hn c th s dng khi th biu din tp m vt mc cho php, nhng s c php o vn tc thp v c v nh gi to. tng l, tt c cc thit b c s dng s c th ti lp li mt cch chnh xc s thay i nhanh xut hin trong s chuyn ng ca mt. Mt vi my v th, d bng cch no cng khng th dch chuyn bt ghi nhanh n mc ghi li tn hiu tn s cao. V ngng gii hn ca tn s cao s thc s b gii hn bi c tuyn tn s ca my thu ghi. xem xt vn mt cch cn thn cn phi thc hin s ha trn my tnh. Tc ri rc ha (s ha ) cn phi thp nht l 100Hz v c th cao hn, cc b lc c mt tn s gii hn khng vt qu mt na tn s ly mu, cn m bo iu ny trc khi tn hiu c a ti b ly mu, nhm ngn nga hin tng rng ca.
4.1.3. My v th
Sau khi tn hiu EOG c khuch i mt mc thch hp v c lc, chng phi c ghi li hnh dng bng my v th, nhng ng m tng ng vi s chuyn ng ca mt. Cc phng php bao gm: s ha trc tip, lu tr trn cng, hoc bng FM. Tt c nhng phng php ny c th c s dng ng thi. Nhng bn ghi chi tit tn hiu EOG c th c ti 8 knh thng tin: 2 knh th hin v tr theo phng ngang, 2 knh theo phng dc, mt knh cho v tr ch, v thm vo 4 knh b xung cho vn tc ca mi tn hiu v tr. B ghi vi s knh cho php t hn s yu cu c b chuyn mch cho u vo tn hiu cung cp d liu quan tm chnh cho mi phn ca ENG. Giy v c in cng vi h thng li vi ng k nh, thng vi khong cch 1mm v tc giy c iu chnh thng qua phm vi ca dng c o dng minimeters trn mt giy. Bt nhit nh du trn
giy l mt phng php chung ca tn hiu c thu v c nhng u im l n gin v sch s. Bt ghi bng cch s dng mc in di p lc thng phc tp hn, i hi thi gian sy kh mc, v rt ln xn, nhng giy thng d dng hn x l bng cch gp, v th hin c th c tt hn. Hu ht cc u ghi hin i c un cho thng hoc cng gn thng v cc li o lng thng nh hn.
4.1.4. Cc in cc ghi nhn

Cc in cc ghi nhn v cch t in cc ta cp n mc 3.2.3 trn.
4.2. THIT B O IN VNG M C (ERG)

Cc thit b o in vng mc cng ging nh cc thit b o in nhn (EOG) trn nhng c mt s c im khc sau (Quan st thm bng 3.2): Tn hiu ERG c bin nh ch vo khong vi trm V v c nhiu ln nn vic ly trung bnh tn hiu l rt quan trng. B tin khuch i ERG thng c bng thng t 0.3Hz n 300Hz H s khuch i t 103 n 104 ln Tr khng u vo nh nht l c 10 M in cc ghi nhn th khc vi EOG v c cp n trong mc 3.3.3
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PHN 5:
DNG TN HIU MT S BNH THNG GP

Du hiu lm sng ca cc bi kim tra in sinh l mt c rt ra cng vi s pht trin ca cng ngh in sinh hc. V d nh, vi s pht trin nhanh ca in vng mc, ta c th nh gi c chc nng ca vng mc. Da trn vic so snh cc tn hiu thu c vi tn hiu chun v nhng ch tiu c rt ra th ta c th chn on c cc bnh c bn. Khi quan st tn hiu in nhn (EOG) hay tn hiu (ERG) thy xut hin nhng triu chng bt thng, khc so vi tn hiu chun th chnh l biu hin v bnh. Vi mi loi bnh khc nhau th c mt dng tn hiu in mt thu c l khc nhau. Da trn nhng nghin cu lm sng m cc nghin cu c th a ra nhng biu hin ca tng loi bnh khc nhau. C loi th suy gim tn hiu EOG nhng tn hiu ERG khng h b thay i, c loi th cc trng tn hiu ERG b suy gim. Ty vo cc tn hiu thu c, cng vi nhng hiu bit v lm sng m cc bc s c th a ra nhng chn on chnh xc v bnh. Sau y chng ta s i phn tch mt s tn hiu ghi nhn pht hin cc bnh thng gp.
5.1. VIM SC T VNG MC V CC BNH LIN QUAN
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Hnh 5.1 p ng ERG trong bnh vim sc t vng mc RP
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Quan st ton b tn hiu ERG trong bnh vim sc t vng mc (RP Retinitis pigmentosa): C p ng ca t bo que v t bo nn u suy gim khi mi pht hin bnh RP vi s suy gim mt cch r rt l p ng ca t bo que. Khi bnh tin trin th gn nh cc tn hiu b suy gim ht. Rt t trng hp xy ra hin tng l sng b b suy gim ch cn li sng a suy gim t hn trng hp p ng tng hp ca t bo que v t bo nn vi kch thch bng ti.
Hnh 5.2 Tn hiu ERG ca ngi n ng 52 tui b bnh vim sc t gic mc bt i xng Quan st tn hiu ERG thu c ca mt ngi n ng 52 tui b mc chng bnh vim sc t vng mc khng cn i gia hai mt. Hnh v c phn gii 20/20 vi c hai mt. Hnh trn cho thy hin tng bt i xng gia hai mt. Mt
phi khng thy p ng ERG, mt tri th b suy gim. Cn quan st trc quan
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hnh di th ta thy hin tng cc sc t vng mc kt thnh cc v c hai mt lng mch mu suy gim nhiu.
5.2. CHNG LON DNG T BO NN V T BO QUE

Ngi mc bnh ny, tn hiu ERG thu c: Tn hiu p ng vi nh sng ca t bo hnh nn b suy gim rt nhiu so vi s suy gim p ng ca t bo hnh que v s kt hp p ng ca hai loi t bo ny vi kch thch bng ti.
Hnh 5.3 Tn hiu ERG thu c ca ngi n ng 47 tui mc bnh ri lon chc nng t bo nn v t bo que
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5.3. CHNG RI LON HONG IM
Hnh 5.4 Tn hiu ERG v tn hiu EOG ca ngi n ng 31 tui mc bnh ri lon hong im Nhn thy, tn hiu ERG thu c hon ton bnh thng, ch c tn hiu EOG l b suy gim mnh.
5.4. NG MCH TRUNG TM VNG MC B TC

Bnh ng mch trung tm vng mc b tc, vit tt l CRAO (Central Retinal Artery Occlusion). Quan st in vng mc ca mt bnh nhn 77 tui b mc bnh CRAO mt mt bn phi nhn thy: Cc trng tn hiu thu c u b suy gim mt cch nghim trng. Trong p ng tng hp ca t bo que v t bo nn vi p ng bng ti th sng b b suy gim nhiu hn sng a. Quan st hnh v bn di.
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Hnh 5.5 in vng mc ca mt bnh nhn 77 tui mc bnh CRAO mt phi Trn y, nhm em ch cp n mt s tn hiu bnh khi quan st bng in vng mc v in nhn . Khi thy s bt thng trong tn hiu th ta u c th chn on l mt loi tn hiu bnh. Cn xem xt, so snh k vi tn hiu chn on bnh tiu chun c th a ra kt lun chnh xc nht.
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PHN 6:
TNG KT
Trn y l nhng tm hiu ca nhm em v in cu mt (EOG) v in vng mc (ERG). Qua bi lun nhm em mong mun c th cung cp cho ngi c nhng thng tin c bn nht v hai loi tn hiu in mt trn. Ngi c c th tm thy nhng thng tin v ngun gc in sinh hc, phng php thu nhn tn hiu, nhng tiu chun cn thit khi thc hin php ghi nhn, dng tn hiu chun thu cng thi qua ti, chng em cng hc tp c rt nhiu iu, v d nh: C c hi p dng nhng kin thc hc vo thc t, nng cao kh nng tm hiu, phn tch vn Nng cao c k nng tm kim ti liu, tip cn hn c vi ting Anh chuyn ngnh in t Y sinh. Nng cao kh nng lm vic theo nhm
Hin nay, ngnh in t Y sinh ang trong giai on pht trin. L nhng sinh vin chuyn ngnh in t Y sinh chng em cng rt mong mun c iu kin pht trin ti, c th c nhng bo co y chi tit hn na, cung cp c nhiu thng tin hn na. Trong qu trnh thc hin, chng em cng gp khng t nhng kh khn: K nng tm ti liu cn km nn mt rt nhiu thi gian tm m ti liu thu c khng phi u ph hp Kh nng c dch ting Anh cn km v c nhiu t chuyn ngnh chng em khng tra c ngha c th Kh nng phn tch vn cn cha su, cha trit Kin thc cn hn hp nn tnh logic ca bi lun cha cao
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Tuy bi lun ca nhm em cha hn ton vn, nhng l kt qu ghi nhn qu trnh phn u ca chng em. Nhm em rt mong nhn c s quan tm, gp ca tt c mi ngi nhm c th pht trin ti hn na. Mt ln na cho php nhm em gi li cm n thy gio Nguyn Phan Kin tn tnh hng dn, gip nhm em hon thnh ti ny. Trong qu trnh thc hin ti, do kin thc cn hn ch nn nhm em khng trnh khi sai st, chng em rt mong c s nhn xt gp ca thy v tt c mi ngi bi lun ca nhm em c hon thin hn. Nhm em xin chn thnh cm n! H Ni, ngy 30 thng 05 nm 2013 Nhm sinh vin thc hin:
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PHN 7:
PH LC
7.1. PH LC TI LIU THAM KHO MCH X L TN HIU Y SINH (2010) PGS.TS NGUYN C THUN GII PHU SINH L & BNH V MT (2009)- ThS.BS V
Thnh Lim EOG TEST , UW MEDICINE UNIVERSITY OF WASHINGTON MEDICAL CENTER Eyeboard Electrooculography (EOG) System Blog.makezine.com
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Báo Cáo Môn CSĐSH

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Báo Cáo Môn CSĐSH

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TRNG I HC BCH KHOA H NI

VIN IN T - VIN THNG

TM HIU V TN HIU IN MT V CC THIT B NG DNG

ti Tm hiu v tn hiu in mt v cc thit b ng dng

ti Tm hiu v tn hiu in mt v cc thit b ng dng

ti Tm hiu v tn hiu in mt v cc thit b ng dng

GII THIU CHUNG

Ghi ch Nhm trng

Bch Hng Kin 20081428

1.2. GII THIU TI

ti Tm hiu v tn hiu in mt v cc thit b ng dng

CU TO GII PHU CA MT NGI

2.1. TNG QUAN

ti Tm hiu v tn hiu in mt v cc thit b ng dng

ti Tm hiu v tn hiu in mt v cc thit b ng dng

ti Tm hiu v tn hiu in mt v cc thit b ng dng

2.2.2. Thy dch (Aqueous humor)

ti Tm hiu v tn hiu in mt v cc thit b ng dng

2.2.3. ng t ( pupil), mng mt ( Iris)

ti Tm hiu v tn hiu in mt v cc thit b ng dng

2.2.4. Thy tinh th ( Lens)

2.2.5. Dch knh (Vitreuos humour or Vitreuos humor)

2.2.6. Vng mc (retina)

ti Tm hiu v tn hiu in mt v cc thit b ng dng

2.2.7. C vn nhn (Muscle)

ti Tm hiu v tn hiu in mt v cc thit b ng dng

2.3. DN TRUYN TH GIC

ti Tm hiu v tn hiu in mt v cc thit b ng dng

ti Tm hiu v tn hiu in mt v cc thit b ng dng

BN CHT V NGUYN L HOT NG CA CC LOI TN HIU IN MT

3.1. GII THIU CHUNG

3.2. IN CU MT EOG 3.2.1. Ngun gc ca in cu mt - EOG

ti Tm hiu v tn hiu in mt v cc thit b ng dng

Hnh 3.1 Ngun gc sinh l ca tn hiu EOG

ti Tm hiu v tn hiu in mt v cc thit b ng dng

khong di vng mc v khng b nh hng bi tc nhn nh sng kch thch

3.2.2. Nguyn l thu nhn tn hiu EOG

ti Tm hiu v tn hiu in mt v cc thit b ng dng

ti Tm hiu v tn hiu in mt v cc thit b ng dng

Bng 3.1 Nhng ch tiu c bn ca in nhn EOG

Giai on thch nghi

ti Tm hiu v tn hiu in mt v cc thit b ng dng

Thc hin o EOG

ti Tm hiu v tn hiu in mt v cc thit b ng dng

ti Tm hiu v tn hiu in mt v cc thit b ng dng

Cch ly bnh nhn

3.2.3. Cch t in cc v dng tn hiu thu c

Bnh nhn c hng dn nhn ln lt mi v tr nh v sn ny hon thnh

ti Tm hiu v tn hiu in mt v cc thit b ng dng

Hnh 3.4 V tr t in cc da Mt in cc trn mi v mt in cc trn khe mt hai bn ca mi mt

Hnh 3.5 Mc tiu nh v trong ghi nhn tn hiu EOG

ti Tm hiu v tn hiu in mt v cc thit b ng dng

ti Tm hiu v tn hiu in mt v cc thit b ng dng

3.2.4. Ghi nhn tn hiu nhiu

chiu dc nh nh s chuyn ng hin thi ca mt theo chiu ngang. in cc t

ti Tm hiu v tn hiu in mt v cc thit b ng dng

3.3. IN VNG MC 3.3.1. Ngun gc ca tn hiu

in vng mc ERG l dao ng chm v dao ng nhanh.