2.7.

7
C nhiu cch khc nhau tnh ton ci stroke volume (th tch tm thu) ( v
trong cc thng s h qu hemodynamic khc) : s dng tn hiu tr khng, cc
im c trng trn mu sng tr khng v cc thng s m t kch thc vt l
ca cc b phn c phn tch trn c th con ngi. vic s dng cc cng
thc khc nhay c th dn n vic s lch ng k ca cc kt qu. Trong lch s,
cng thc u tin l Lubicek [39,40], bt ngun t cng trnh ca Nyboer[62,63].
Di y l m t ngn gn mt vi cng thc v phng php c s dng trong
lch s:
Cng thc ca Nyboer
Atzler v Lehman[3], ln u tin ch ra rng nhng thay i trong tr khng in
ca phn ngc c lin quan ti s dch chuyn v tr khi lng mu trong ngc
ang c kim tra trong sut chu k tim. Cc s kho st c pht trin bi
Nyboer [62,63], ngi gii thiu cng thc Nyboer, m m t mi tng quan
gia s thay i th tch mu trong bt k phn no trn c th vi s thay i tr
khng ca chng.
2

V = . L0 Z 0

Trong , V l s thay i th tch mu ca phn c th (cm3), l in tr sut

ring ca mu [ cm],

L0

l khong cch gia cc in cc nhn [cm], Zo l tr

khng c bn ca phn c th c gii hn bi cc in cc nhn [], Z l s

thay i tr khng c gii hn bi cc in cc nhn [].
Thng thng, nhng s thay i trong cc tr khng ngc gy ra ch yu bi s
y mu ra t bung tri ti ng mch ch v t l vi stroke volume (SV). Kubicek
et [39] ngh cch gii thch ny vo nm 1966.
Cng thc Kubicek
Kubicek nghi s chnh l li cng thc Nyboer rng Z = (dz/dt)max.ET v thay
th V =SV, trong mt phin bn ca phng thc tr khng [39,40] , kt qu ny
dn ti vic thit lp cc cng thc tim tr khng c bn m c t tn l
Kubicek:
2

SV = . L0 Z 0

(dz/dt)max.ET

Trong , SV l stroke volume [cm3], (dz/dt)max l mc ti a trong s pht sinh

u tin ca tn hiu tr khng [X / s], ET, thi gian y mu ra t bung tri c
xc nh bi s la chn ca cc im c trng trn vch tn hiu (dz/dt), (cc k
hiu khc c gii thch ti cng thc Nyboer bn trn)

Cng thc Sramek

Sramek xut mt phng php tnh ton Stoke Volume bng 3 thnh phn:
th tch ca m tham gia mang tnh in (VEPT l c trng ca gii tnh bnh nhn
bao gm cn nng v chiu cao), thi gian y mu ra ca tm tht(VET), ci m c
ngha tng t nh LVET hoc ET trong cng thc Kubicek v ch s co rt giai
on y mu ra (EPCI), chnh l sn phm bin ti a ca tn hiu (dz/dt)max v
TFC. tng ca ng y ch ra trong cng thc rng SV t l thun mt cch trc
tip vi kch thc ca cc bnh nhn v t l thun vi khong thi gian vn
chuyn mu vo ng mch ch. V SV t l thun vi lu lng mu nh ti ng
mch ch. Do , c cng thc sau y:
SV = VEPT x VET x EPCI
Trong , VEPT, th tch ca m tham gia mang in (ph thuc vo gii tnh , cn
nng, chiu cao bnh nhn), VET l thi gian y mu ra ca tm tht, EPCI l ch
s co rt giai on y mu ra.
Khi thay th cc k hiu bn trn bng biu thc c s dng trong cng thc
Kubicek th c:
SV =

(0,17 H )3 dz
x
max x ET
4.25 x z 0
dt

( )

Trong , H l chiu cao ca i tng [cm], (dz/dt)max l bin ti a ca tn

hiu dz/dt [/s], ET l thi gian y mu ca tm tht tri [s], Z0 l tr khng c s
ca cc b phn c gii hn cc cc in nhn[].
i khi cng thc trn c vit nh sau:
SV =

L30
dz
x
max x ET
4.25 x Z0 dt

( )

Cng thc ny da trn gi nh rng ngc l mt hnh nn ct vi chiu di L v

chu C theo mc hnh li lim [4,5,84,86]. N c kim tra rng t s C/L
bng 3.0 bt chp tui hay gii tnh.
Bernstein v Lemmens a ra cng thc khc c gi l N (Bernstein). Cng thc
l:

SV =

V ITBV

( dzdt )max ET
Z0

Trong ,

V ITBV

= 16

W 1.02 [ml], cng thc thc nghim cho s c lng th

tch mu bn trong ngc khi W c th hin bng [kg].

H xc nhn cc kt qu bng cch s dng N vi nhng ci c xc nh bi
phng php thermodilution trong 106 bnh nhn sau khi phu thut tim v t
c s tng thch tt hn gia s o c trong so snh vi vic s dng cc cng
thc khc.
Cc cng thc Kubicek, Sramek v Sramek-Benstein da vo cc gi nh v
phng php khc nhau nhng u c th cung cp s c lng tin cy v SV.
TaskForce monitor method
Cng thc Kubicek l kt qu ca m hnh tr ca lng ngc c p dng trong
nhng cn nhc v mt l thuyt. Sramek ghi ch rng m hnh ny qu n gin
a ra nh ngha chnh xc cho SV. ng t b m hnh tr ca lng ngc v gi
nh rng ngc l hnh nn ct vi cc thng s ph thuc vo cc thng s nhn
trc hn l vic a ra th tch ca m tham gia mang in m ph thuc vo gii
tnh, chiu cao v cn nng ca bnh nhn. The task force monitor, ci cch ca
vic s dng cc bin php nhn trc hc c tnh th tch tham gia mang in
ca lng ngc c t tn theo (Vth)
H ch thch rng hnh dng ca c th khng l mt hnh nn ct cng khng
phi hnh xi lanh nhng t nhiu cng c xc nh thc nghim bi thc t t c
bnh nhn thiu cn, bnh thng hay bo ph. Ngi thiu cn th c xu hng
ngc hnh tr hn trong khi ngi bo ph c ngc hnh nn ct nhiu hn. Cc lp
nc/ m c th c c lng bi ch s khi lng c th (BMI), theo , ch s
BMI 25 c coi l ranh gii gia ngi bnh thng v ngi tha cn.
H s dng mi tilt test xc nh s nh hng ca cc thnh phn c th
cng nh tr khng c s Z0 trn Vth. Do , Vth c m t theo cng thc sau:

V th =C1 . H 3

BMI
m
Z0

Trong , C1 , m v n c quyn khng tit l.