Tài liệu ôn tập cho kỳ thi tuyển viên chức ngành y tế năm 2017 giao trinh gay me gay te i flie 5 het

5--:7-:-Gay tetll~nKinnnong

nreo drr(rngphta-trlfrr~

- Tu the benh nhan: Nam ngira.
- Vat lieu: Kim

s6 220

dili 15cm.

1. Oai chau truce tren 2. Mau mu 3. M~y chuyen 100 4. Day TK hong

1. Day chang ben 2. Mau chuyen 100 3. Vi tri choc gay te
Mac gay te th~n kinh hong duo-ng & phia trurrc

129


,

,...-1

Dung mot but rmrc ve mot dirong cung dui til g~i chau truce tren xuong
g~j_l!!Y·Til m~u chuyen 100 n6i cac m~u chuyen

..,,<-'-

..---._

-~-.-

_- -- ---

a phia

truce duong nay .chay
"

-.

song song voi _CUQK
Qui. Til:.4i~mrn6i 1(3 giira voi 1/3 trong cua cung dui, ke 111<)t

-.

--

- -. -.- - - - -- -- --

.:;:

[T(

1'17 V\QA, -

q CV i'11.; \ -

Duong vuong goc voi cung ~d~i~vadUbng 'il~ye~t dirong nbi gitra cac mau chuyen 121

diem choc kim. Ch9C kim vuong goc voi mat c~t DUOngn6i gitra cac rnau chuyen la

di€m choc kim. Choc kim vuong goc vai mat da cho tai khi ch't!!!.xuang.
Sau do hirong lai kim VaGtrong va khoimg 5cm ra phia sau, kim se nam
trong khoang mach than kinh. C<1ntiem til
-

Ili: 30mlJthu6c te XyIocain

1% .

,:

5.8. Gay te th~n kinh hong khoeo trong/rr hom- khoeo
.

,,-

Tir thS benh nhan: N~m s~p hoac n~m nghieng, chi c<1ngay te d~ len tren.

Ky thuat:
L<1ym6c la QQn~J!_1~ch
khoeo

a ngay giira horn khoeo. Kim 12£m~~h9c

vuong goc vai m?t da va ngay ben ngoai dQng m?ch. Kim oi 9.~alop din nong
co cam giac svt rbi m~t suc can. Da s6 truOng hc;rpthS la du, cling co th€ tim
~~m. C<1~hu6c

te du gay teo

130

di


1. D9ng m,,£h khoeo

2-:-Ca bung

changiTI'a 3-:-Ca15\mg cnan b-en 4. Trrfth RinD

chay 5. Th~n kinh mac chung 6. Dong mach bap chan 7. TInh mach hi~n trong
8. Thftn kinh bap chan.

1. Dong mach khoeo
M~c gay te th~n kinh hong khoeo trong if hom khoeo

5.9. Gay te day th~n kinh chay sao 0' c8 chan
Ttr th~ benh nhan: N&m s~p hoac nam nghieng sang ben m6.
- V;ftt lieu: kim 22G dai 5cm.

Ky thuat:
Choc kim

a mat

ca trong phia ngoai la gan Achile, phia tropg }a 4Qng mach

~h~y va huang kim ra tnroc, vuong g6c voi

lJ22.~~hay~fi.cF~ ~wili~fC~h-in
gi;ftt

hoac di cam thi tiem thu6c hoac tiem do nr ngoai

vao trong

thea bo trong cua wang

chay, Cftn 5ml thuoc te la du (chong chi dinh tuyet d6i dung Adrenalin )
---'~~'
---_ ...

,.

Chu

y:

R~ g6t c6 th~ tach ra

a tren r~t cao, chay ra sau bao boc l~y gan Achile.

C6

th~ gay te bang huang kim v~ phia gan Achile va tiern vao ba trong eua gan Achile.

5.10. Gay te cae day th~n kinh ke ngon
- V?t li~u: Kim 22G dai 3cm

131


-- ~ Ky thuat; Ngon -c~ngay te .-taGR-rieng-sG-v&·i-Ga€-ng-eD
-ffiae-. Gh~G--k,i-m-Er---g6c ngon, 0 vung mu chan vuong goc voi mat da cho toi khi cham vao lap da
cua gan chan.

-\
,
(

~., ').

~

Tir do vira bom thu6c te vira rut d~n kim ra, tiem m6i ben khoang 1ml

'. '

m6i ben ngon chan (chong chi dinh tuyet d6i dung adrenalin).
6.

cAe BIEN CHUNG THUONG G~P CVA GAY TE-cAcH XU'TRI

Cac bien clnrng cua gay te thirong g?P trong cac tnrong hop:
- Dung qua liSu thu6c teo
- Phan irng nhay cam voi thu6c teo
- Tiem thu6c vao mach mau,
Do vay, d~ ngan ngira cac biSn clnrng nay c~n:
- Khai thac tiSn str cua benh nhan can than.

- Khong dung qua liSu thuoc teo
- Khi gay te diroi da c~n phai vira hut bam vira tiern thuoc, neu d~ kim c6
dinh tai ch6 phai hut tnroc khong co mau moi tiem thu6c teo

* Cach

xu tri:

N~u b~nh nhan co bi~u hi~n ng~t thoang qua, bu6n non, non, chfm tay co
ca.m giac ki~n bo ....thuemg cac bi~n chlmg mlYtv d(>ngh~t.
N~u b~nh nhan me rna ho h~p tll~n hoan v~n duy tri t6t thi nen cho b~Q.h
. \ nhan th6 Oxy; thvc hi~n n19t duemgtfuy~ncd€l:ruyShdich va h6i sue khi cfrn:'"
NSu b~nh nhan ngirng tho phai bop bong oxy, d?t nQi khi quan, ho h~p
nhan t(;10n~u c~n.
N~u b~nh nhan co tut huySt ap - IJUlchch~m: TruySn btl kh6i IUQ11gtw~n
hoan b~ng cac dung dich tinh th~ d~ng truang, tho oxy, tiem tInh m(;1chetrQPjl1
O,5mg nSu m(;1chch~m. NSu sau~khong

cO__Q.aL1hi~nti~n hanh pha lmg

adreaali.n_vao 500ml dung dich NaCl 0,9%, nhc gi9t b~t d~u®_~

tang

IDem 1Dgi9tlphM n~ll..sa.u.._5_pbut
khong hi~u gua, ho?c hoa 1mg adrenal in thanh
19m1, m6i l~n tiem Hnh mC;lchtrvc ti~p Urn!,

l?p l(;1i
1_:LL~nsau .5-1 0 phut. KSt

hqp tho oxy.
NSu ngirng tim: B~t d~u ngay h6i suc nhu cac buac h6i suc ngirng tu~n
hoan ho h~p c~p.
132


NSu b~llhnnan -m ~FC'anilieo
~

aoi cinttr~-;--nh~-tllldj-~u-tIi-bfuIgm-az~-

tiem tinh mach hoac thiopell.tal tinh mach li~u nho 50mg, Tho oxy.
Co that phe quan, ngua~ Co th~ tir hSt hoac di~u tri bang tiem ,,_
O,5mg

~~lin

duoi da hoac dung thu6c khang histamin 1-2mg/kg.

,.
"-'i'"'~ '/,

v.,\.._~
1

f (()2 /TM
[[) oio

)

[

11M

~~~"'_rnat~
~~ fry nco
r"LQr:J J'U)ttm~
A~d_~JJ ~

133

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"

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_

TRONG GAY ME.CACH DE PHONG VA CHUA TRI.
M!lC lieu hoc l{lp:

1. Kd ra duoc cdc bikn chung thuong gq.p trong gay me.
2. Trinh bay duac trieu chung.nguyen nhdn cac bikn chung gay me.
2. Neu ra duoc cac bien poop du phong

va thai d(Jxu tri cac bikn chung do.

1.D~I CUONG
Qua trinh gay me diSn bi~n qua cac giai doan: Ti~n me, khoi me, duy tri

me, thoat me (hoi tinh) va giai

doan sau

m6. Trong

b~t ky giai doan nao d€u

cling co th~ xay ra cac tai bi~n va bi~n chimg.
, rC' b1 '%"

Nguoi gay

t1~

~o"'-'~L ~~~:,-'"

'Ii

me c~n phai

tham kham, danh gia, tien hrong tinh trang benh

~haJt~UDC m6 d~ co kth04.ch__ga.y_miliili_$J!sh.qp~bng

;:_tt.J~9 : cla.n'"

,

7r~:,i·dn i"if 1w~.§L~ath~Dh-uh_ful
tr_?ngva s~lI.~a:t l~~ nham kip thai

thai c~n phai theo
,

pb.~!hi.~nva :Qll' !ri cae ~~.en

?o.~~,~__.._~_ chUng co th~ xay ra, dam bao an toan cho b~nh nhan.

,~:tG~~!-t~1~-;~uY
F:l~q

)-\,.1,>10 \_~-')

'let 0 _,5

'I
.

CO

vA BIEN

r

CHUNG

GAY ME

"

2.1. Cae bien chung ve ho hap
2.1.1. Tai bi~n do d~t nQi khi quan
T6n thuang khid~t 6ng gay d~p moi, gay ding, chay mau vung h~u h9ng.
Th~t b~i do kh6ng d~t duQ'c nQi khi quan,d~t nh~rn vao d? da-y,d~t 6ng
sau sang ben phai,gay ch~n thuong khi t1~t6ng.
f)~

phong va tranh dUQ'cbi~n chUng nay khi d?t nQi khi qual1 d911gtac

phai nhtt nhang, sau khi d~t phai ki~m tra d.n th~n b~l1g Qghu2E§J__
Y~_~2~~92

lsbLtho.xa D~ d~ phong c~p_th_amkham_kSJ2~.l1ll-nh@truDc m6,
dQ,d~~_ilQLkhLquan k..q.Q_d~
co SlJ chu~l1 bi truDc, chu~n
dl,mg C\l cho d~t nQi khi quan khO.
2.1.2. Co th~t ph~ quan
- Nguyen nhan:

+ B~nh nhan co ti~n Slr hen phS qual1 til truDc.
134

bi

9al}h_gi~_~"D1rC

s~n sang phuong ti~n


+ Cac thu6c gay dT{mgl:m0rPfiin,D'tuoocuranne ..

·-r

+ Kich thich duong ho hap tren do dich tiet, chat non, mau va cac dung cu
dat van hau hoac khi quan,
- D~phong:

+ TiSn me sau va c1~yau cho nhirng benh nhan co nguy ca.
+ Khoi me phai darn bao ngu sau va phun xylocaine 50/0 tnroc khi dira cac dung
,

vlv

AD 'J" .

C\l van vung hau hong, thanh quan.

- Xu tri:
+ Ki~m tra 6ng NKQ va co th~ keo nhe ra khi co kich thich 0 vung cira phe quan
rna do co th~ la nguyen nhan gay co that.

+ Gay me sau bang thuoc me ho hap hoac tinh mach
+ Tang nong dQ O2 khi tho vao.
+ SU dung cac thuoc gian phe quan nhu:
fA YJS;"
Phun Sabutamol 2 l~n ([OOrllcg) cir 3 - 4 gio /1~n

Aminophylin 5mg/kg/30 phut lieu d~u va duy tri 0,5-1mg/kglgia
C6 th~

suo dung them

ph~ quan m?nh ). f(:h.(

adrenalin (lieu thap 0,25-1mcg/phut co tac dung gian

{<:O (_{i~

f.:'"

Juny v:

td

G®

mC}Lf;; r:J:~Jlk ~

Corticoid tuy tung truang hQ'P(Hydrocortisol 100 mg,ho~c
Me1hy~I~dnisolQn 30-60 mg t1nh m?ch 6gia /l~n).
",'t

P,lL ,

2.1.3. Co that thanh quan

8,'~~t'

_Nguyen nhan:

~~ jim

,

'"

f

C fJ&; cfN-d

U;

~l¥J' : "Vii~

TOO.

Tuang tv nhu co th~t ph~ quim !Q!l'angxay ra khi duang ho h§p tren
t.hich, kbi con me nong, thuimg

-r=e.{;;uf-e:cLJt.-)

hi kich

xay ra_6 tre em.

+ B~nh nhan c6 ti~n su hen ph~ quan tu truac.
+ Cac thu6c gay di ling (Morphin,D'tubocurarine ... )
+ Kich thich duang ho h~p tren do dich ti~t, ch~t non, mau va cac d\lng C\l
d~t van h§u ho~c kili quan.
- Lam sang:

+ N~u c.9th~t khong hoa~.toan thi th~y t,ho kho khe ho~c tho rit.
135


--- --+ N~H-S§tth~t hoc'm toc'm- thi Ge-bi~u hi-~fl-l}Q-h&p_oao 'ng!!S!e;

-mQng_1tt6ng-

mask.

khi duac b~ng

Hau qua cua co th~t thanh quan se dira dSn

tM1U2XY, tang CQ2, tO~9

h~p, him mach nhanh, huyet ap tang cao, r6i nhanh chong dfrn d~n tut huyet ap,
m~ch cham va ngirng tim nSu khong duoc c~p ciru kip thai .

.:t!_i~u !dJ
+ Cho

~u s~u bang thuoc me tinh mach, ngung cit ca cac kich thich, dung thu6_~_gj~11

cq li~u nho ~uccin2icholin 10-20 mg co th~ lam gian co van cua thanh quan.

+ Up
+

mask va bop bOI].gvoi 02100% nSu c_othiit khong ho~oan.

N~u co that hoan toan thi phai giai phong duong ho hap bang each choc mot

kim to 'qua mang nh~ngiap (kim lu6n ngan s6 16-14 voi ngiroi Ian) va bop bong
voi 02100% qua duong nay.

+ Dat

n(>i khi qulin ngay va kSt hop xoa bop tim ngoai long ngirc neu co ngung

tu~n hoan .

-1!!vphOngj
+ Cho

benh nhan tho 02100% vai philt truac khi khoi me nh~m tang dlJ

tm O2 trong mau.

+ Phun

xylocain truac khi d~t cac dVng C1,l van h~u hQng, khi quan.

+ Cho ngu du sau.
2.1.4. Non, trao nglf(}'c

t~::~.~~:

Day la m(>t trong nhfrng bi~n chUng nguy hi~m. gay me toan than lam m~t

l~~hr~d~·th~
(~ cac phi'm x::tbao v~ duang tho d~ dang bi bi~n chUng trao nguqc do non.Cac y~u
~; <>ki.t nlffi CI' tnm ,
"
!t tat' hCi1.h0f. ,M:6 thJ.l?~ lqi cho trao nguqc nhu qa ~~y day, ~ d~n& d!9h do tac ~u(>t,hEppmon vi,
"
,d
':5 '1u.cu.
,let'
ct>. ~1\1 nho.l'\. 'i' i~"f rot)'! II) I lZit /lU'"1,t I Itch I'm,
llh l,qJ~;1~ c[bthoat vi nghEpt, hon me, soc, Q.hu nil co thili, bee b~u ...

rf!ll
.~
cl . Xi).. Ii e.'l em ff-J o£_ .
C{" 1\l!il't.hi~,~r' ~ cl~ ch~ , n{u.)wV!- «( f) i) ,~ttln eu h' I~'JI, !M .. q UD,n

;!lc~«f".~~
(

9

fr ~i t>'1fijX<~rg

~t

f\lh" +oj
,,'

tuy th.eo m~c

~vmI)M~1SYl.co the gay co that phe qulin, XEppphoi,

r'~
Y~ J\l·
,

161>

l~m simg

XQ

It..c.

""

"'".

~

,,':.

d(\ co the IiI nh~ 1m triim tr~ng. Neu n;ing

thieu O2 mau, m?ch nhanh va huyet ap tl,lt.

- Xu tri:
D~
phong la chinh, nh~t·la cac , d6i, tuan. g co nguy ca ca~. T~t" ca cae be.nh
"
nhfm mo cap elm, d?c bi~t trong mo lay thai, cho dung cac thuoc khang tiet

r!
]'51',
~ioJl Pc..

h.~,: Nhtc·-t

'tQ~~

N~rs ~ -tiro,

-t,

ftC, 1'\Ilt~c(tl'!Im..'

11. c:

'f\%)

I

'-1

X'~

t

lh}()l

"f

c<;:,

_~\.Qt ~& f

I~'

~'n'l~

r

136

lti'lOA

i\iQ.~ ~J:lQ"'..t" HA

,J__......

CJ'~ J-w'
rJ\UvJ1 J

em hen
tn)'J rJu.r,

ttf'iJ

P«L

(U.p" _'

)

...v " 'J""\,

.

l

"i ,;

~ ~!!t(i~,_61\)
r-«

,J\\'.. CtiiJ

,,',

i~t"

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C 1-

Ql[ E

i

I

..

:cf 6

,......
) .........

r~'" Vi:b

[C~ci!1hEr

4f;" - -

lQ-j

c.1 "htm

•

A~II
{.,

(J

•

'

1(li.
&'1.---

--QUang tiern hoac u6ng cimetidine, raniiiGine ..., Tam gUlm tn~tlchQfcfi v! b~ng
rnetocloprarnide (Primperan).

,

ap-

Benh nhan co nguy co trao nguoc n€u p'h~u thuat cho phep thi Den""
dl.)~ ky thuat gay te

thai gian cuoc mb lai.

N€u phai gay me toim than Q~mb thl nen.dat xong da day d~ hut h€t dich
-

K'1l61" tciio vi

ir dong va rut xong ra-vtruac khi khoi me. Nen

ap

d\lug phuong phap kb6i me

nhanh va phai ap dung thu thu~t Sellick trong suot qua trinh khoi me cho toi khi
born diroc bong chen cua 6ng noi khi quan .
• ~<~

Khi co trao nguoc rna dirong tho chua duoc bao v~ bang bng noi khi quan

thi phai d?t benh nhan 0 nr th€ d~u thap, quay nghieng d~u va hut sach duong ho
h~p tren rbi ti€n hanh d?t nQi khi quan. Phai hut sach bng nQi khi quan truac khi
ti€n hanh thong khi d~ tranh d~y cac dich hit vao sau hon trong duang tho. Soi
ph€ quan d~ l~y di v~t va rua Qb€ quan n€u c~n thi€t. Phai xet nghi~m khi mau,
chl,lpphim ph6i va di~u tri khang si~€t
2. 1,5. Thi~u oxy mall

h9'P cortico~=-

d'l/

Bi: VI (e. t~ o;S"--1),'L

- Nguyen nhiin:

+ Do cung c~p oxy khong d~y du
+ Giam thong kll1
+ Thay d6i ty l~ ho h~p - tu~n hoan (ty l~ thong kll1 - tilai mau) vi/)( ; oJ{ + Giam v~n chuy~n oxy llhu thi€u mau, lr tr~ tu~n hoan,

AI!L'

40 ngQ dQc t€ bao.

- Didu trj: C~n nhanh chong tim ra nguy~n nhan gay thiSu oxy d~ di~u tr! theo
tung nguyen nhan C\l th~.

2.1.6. Tang CO2 rnau

(lfU

than)

- Nguyen nhan:

+ Giam thong klll
+ Co th~t phS quan
+ Tran mau, trim khi mang ph6i

+ Tang CO2 nQi sinh nhu tang chuy~n hoa, rbi lo?n toan ki~m, C?P dQng
m?ch chli, thao garrot, hit l?i khi CO2 do

SlJ

hSt tac dl)ng.
137

c6 van tho ra clla may tho, voi soda


l(J..

P, to."

~1
~j
\I~

V

4 ~G~I .h

V .::

~ ~O
+ T ang
c

d

r

1() ~ !t

\J,

'/'1\ WI 'II ,

"nh
2-ngo~u-sl

"'V

'YV

J

e'y=)

Ul,V?\'Iz, r

'114~1Tl\._ l'(,~

l (I

DQo

EVe \~lLI

Mo') n~'O!,' ,,~cr/r:

no

·1h.i)' (tJ,./ kd Mvj
J
O'

J.-

nh tr b mn ~ -ytrong moz m;n
.:.I ~.

•
SOT:--

-

- --- -

-_

- Dieu tri:

+ DiSu chinh t~n s6 tho va th~ tich khi hru thong d~ sua chua CO2 cao.
+ DiSu tri theo tirng nguyen nhan gay tang CO2 mau.
2.1.7. Tran khi mang ph6i
- Nguyen nhdn:

+ Thong khi ap hrc duong voi ap lire bam vao va th~ tich cao d~n tci ch~n
thirong ep va phe nang.

+ D~n hru phoi khong t6t.
+ T6n thtrong mang phoi trong qua trinh phau thuat vung c6, nguc h?~c vung
bung cao duoi co hoanh.

+ BiSn chirng sau khi choc tinh mach duoi don, canh trong, ch<;>cdo mang ph6i,
mang tim ...
T-'''''~'',._.;-,
...~..

~~ft

•• __

._;_""",_,*:"(

:Chan
aoan: \
.__~-._._--_.
Ch~n doan tren lam sang thuang kho khan. Co th~ quan sat th~y .~h9:J
kh~~.
t~__
~l}:~.~_~!lg~c:.~~.ph6i,~:~~ang,t~12g:~E.ll;rc
9~!IJb._hiLyaQ,
r' -,
.~

..
~.---;-1

-!Xu'trq

!~
....
~~
..-~.-._.-.....- .•l!>

NSu tran khi mang ph6i ~p h,rc thl c~n d§.n lUll ngay b~ng catheter co 1416G ch<;>cvao gian suan 2-3 tren duemgJr.]Jng don d~ d~n luu khi. Sau do ph:ii
__

? .,

-:-'.

."---

"--._o.__.__
"._._"".

dan lUll mang phoi toi thieu va. hut lien t1,lc.
2.1 .8. Tic nghen oU'cmg
Do dam giai, mau

t\}

ho h~p

B,n

..llH._ d{l);) :

r'G_,)r';5~:>

_r; _

'

treD

vung c6, tl,lt luoi, cac di V?t duang ho h~p tren, ..

2.1.9. X~p ph6i
Do t~c duemg tho boi dam giai, do hut n9i khi quan b~ng 6ng hut qua to va htlt
qua lau ho?c do d?t 6ng sfm vaG m9t ben ph6i.
2.1.10. Phil thanh mon c~p
HiSm g?P, thuang do t6n thuang thanh mon khi d?t n9i khi quan, d?t 6ng qua to
ho?c 0 b~nh nhan dang bi viem thanh quan c~p.
1.8. Suy thO'va ngirng thO'
138


MQt sb thu6c diroc

sir dung luc-ti~nmenIllillenzo(fiazepih~c,tc-thubc

n:h6m-"-

Morphin.cac thuoc me tinh mach Thiopentan,~~!~.ire ch§ trung

tam ho

hap co nguon gbc trung irong.tac dung tren ho h~p cua thuoc phu

thuoc van nong dQ va tbc dQtiem.tiern nhanh ngimg tho se nhanh han.
Gay te_~~:y_~_~~g,r:~jlng
ctrng t~bc

leI!_gmi cao..

Giai doan h6i tinh lien quan d§n .!bub_Q_gliillldau ho tporphin,cac

thuq~

giaIL-C-Q(chi rut ong noi khi quan khi du di~u kien. Cho benh nhan tho oxy qua
(

mask sau khi E.~t~ng nQi.khi quan, bop bong hoac d~t lai noi khi quan neu benh

nhan khong tu tho duoc).
- Suy tho do t~c nghen:
+T~c nghen do di vat.Rang gay.d] vat.hay tai nan khi d~t bng nQi khi quan,
+ T~c nghen d~c hieu: Khbi mau tv gay ngat sau ph~u thuat tuyen giap trang.liet

tro lai hai ben sau c~t b6 tuy~n giap hoan toan do ung thu.

2.2. Cae bi~n ch.rog v~ huy~t d{mg

2.2.1. H~ huy~t ap, trl,lY tim m~ch

* Nguyen

nhan:

- Suy giam

CCl

tim, /u'U /u(YYlgtim giam:

+ Cac thubc gay me duemg h6 h~p (halothan,

eflurance,fofance

ch~ co bop co tim),cac thubc barbituric,benzodiazepine

co tac dVng uc

cling co tac dVng uc ch~

co tim trgc ti~p ph\! thuQc van li~u va each tiem.

+ Cac thu?~ u..c~~~ betq,u,~ ch~ calci lam uc ch~ co tim,giam lUll lUQ'llg tim,tl,lt
I
:.., c,. ~tf&"~ Pt\°YNl,(l{)!t;N\
i'J ·Jes.:Lf
2 Y-~.ffJ chili '1,,:- ,Ne' ·l1uyet ap."lUfJJ'frkat

,,-,I,..)

l1l_

,'Nl!l».citpll'-·-)i.

~

J

-;

bCUl rYlB

I
-1

I

I

r"H

k4'o&' -t i(,,/

.L

,_

'I~fu

t(

~aJI!;).

,

+ B~nh m<;lchvanh,nI16i mau co tim,giam calci mau,b~nh van tim,toan hay kiem
mau n?ng ... Ia cae nguyen nhan co th~ lam giam suc co bop co tim,tvt huy~t ap.
+ Ng<) dQc thu6c te d~n d~n uc ch~ co bop co tim.
+ Nhip tim ch~m ngu6n g6c phan X<;lph~ vi co th~ d~ d~n 11)thuy~t ap.

- Giam sitc can mgch mau:
Do tac dVng cua cac thu6c kh6i me gay gian m<;lchtIVc ti§p (halothan),
gay gian m<;lch gian ti~p do lam ki~m ham giai phong cathecolamin

nQi

sinh,tang ti~t Histamin (cac thu6c h9 rnorphin, thu6c gian co).
Cac thu6c gay me co th~ gay uc ch~ trgc ti~p co tim lam giam S\T co bop
cua eo tim ..


-Cac thuoc benzodiazepine

lieu cao.dac-biet

khi-phoi hqp-v6i cac-thu6c ho

morphin li~u manh .

Uc chS giao cam thuong

g~p trong gay te tuy song rnang cling qua cao

,Cac phan irng di irng gay tut huyet ap nang.soc nhiem trung gay giai
phong ch~t hoat hoa mach ...
- Nguyen nhdn giam kh6i IU(J11gtwin hoan:

+ Cac tnrong hop co giam kh6i hrong tuan hoan do mat mau, djch tir
truce m6 hoac dang chay rnau mot each dQt ngot va

6 at. ..

Nguyen nhdn giam tro v~ cua mau tinh mach:

+ Chen ep tinh mach chu tren.chu diroi do phau thuat.nr cung co thai de
ep

VaG

tinh mach chu duoi.

+ Tang ap hrc trong nhi phai.khi ap hrc trong nguc tang I;3y kho khan cho
mau tinh mach tro v~:Tran khi rnang phoi.ho hap nhan t?O vai th~ tich lUll thong
v

1~""C'

I.-f('~tft

cao ho~c tha PE'Ep,m~l' S9 b~nh van tim,t~c nghen tim.
1"Q1) Jp wt-@ jl{" (~ "1tic / rrEP rr Nfl V54U a;r1 PEEP, 5 c..mflz f)
PMng va dieu trf:'
~.
,
I

+ C~n b6i phl) d~y du th~ tich tu~n hoan bi thiSu truac m6

+ ChQn c~c thu6c gay me it gay t11thuySt ap cho cac truemg hqp s6c, giam th~
k.ft_..tz.__

tich tu~n hoan.

i

IE.1--?

+ U~t b~nh nhan a tu thS d~u th~p, lam d~y th~ tich tu~n ho~mb~ng truy~n
dich, truy~n mau va Slrd\1ng cac thu6c vm?ch khi c~n thiSt.

+ Sua chua cac ySu t6 hi nguyen nhan gay ra tl)t huySt ap.
2.2.2. Tang huy~t ap
- Nguyen nhan:

+ Ti~n Slrtang huySt ap, u tuySn thuqng thcTtn,tang ap ll)'cnQi SQ.
+ B~nh nhan duqc d~t nQi khi quan khi con me nong, giam dau khong d~y duo
+ ThiSu O2 va tang CO2 mau
+ SU dl)ng cac thu6c co m?ch, truy~n dich qua mlIc ...
- Di~u trf:

+ Cho thu6c an th~n d~y du ch6 nhUng b~nh nhan qua 10 sq .

+ Khai me du dQ sau, phun thu6c te lidocain truac khi lam cac thu thu?t
vung h~u hQng, duy tri me sau, giam dau t6t, thvc hi~n cac dQng tac phai thcTtt
nh~ nh~mg, ILl}~hla

a cac truemg hgp co ti~n su tang huySt ap.

+ Tranh va di~u tri kip thai tinh tn;mg thiSu O2 va tang CO2 mau.
140


,~~--

+ Sir d\mg cac thubc h? ~hui~t ap nh~mh, duemg tIllh-iiwch lilii c~n.-

2.2.3. R6i loan nhjp tim
2.2.3.1. Nhjp ch~m xoang
- Nguyen nhdn:

+ Do cirong day

x hoac

ph6 giao cam (kich thich 0 vung ph6i -da day.o

trung th~t gay cham nut xoang -nhi.co keo phuc mac hoac thirng tinh.ep true
tiep nhan c~u hoac xoang canh trong cac phfru thuat vung c6 hoac nguc.phan X?
day

x trong d~t bng thong tinh mach trung irong ... )
+ Do gay te mang cimg va gay te tuy song.

+ Do tac dung cua thuoc me
+ Kich thich vung h~u hong khi d~t noi khi quan ~/
+ TiSn sir benh tim,' dang diSu tri cac thubc lam cham nhip tim
+ Thi~u thS tich tuan hoan .,.
- Di~u tri:

+ Ngung cac kich thich th~n kinh phe vi

+ Atropin liSu 0,3 -0,8 mg tinh mach 1t,&0 ,j,an,h .
+ B6i phu thS tich tu~n hoan bi thi~u
+ Giam cac liSu thubc me dang dung ...
2.3.2. Nhjp nhanh xoang
- Nguyen nhan:

+ Thi~u khbi lugng tu~n ho':m, sbc, dau dOn, thi~u oxy, thira CO2,sbt,sbt cao ac
tinh,u tuy~n thuQ1lgth?n,buau dQc giap ...

+ MQt sb thubc gay m?ch nhanh nhu thubc gian co (pancun;mium), adrenal in,
fi)o._
I

atropin, ephedrin ...

vu. iffY;

+ Cac rbi lo?n nhip tim nhu rung nhI, cu6ng ~I, nhip nhanh th~t, xo~n di!J-h..
- Dieu trj:

-

-

/){)(}111- '7/), ."

" 1/ {j (j tI(/t'!'t v

~.._'.'

-

_ ''_'

0

))" ~

: f' t l.1t:l
InAt
J

+ Sua chua cac nguyen nhan gay tang nhip tim nhu cung c~p oxy, b6 sung thS

tich tu~n hoan, giam dau, ngu sau ...

+ N~u wlillJlh~.clLp.bat

tren th§t co thS ~I) nhan c~u, ~n xoang dmh.

+ SLrdVng cac thubc chbng lo?n nhjp nhu UC ch~ beta, UC ch~ calci, liQQcaiD-'"
" ~ I t' "IJ
e};v"
Uv

2.3.3. Ngo~i tam thu

J .

- Nguyen nhan:

141

.

I

j

/V/lCUlJ---,

, ;

- - +- Co ngoaitam thu (NiT) tir tnroc=do -til: durrgcua thu6-c-me, -rrhfttlfe halothan, tang catecholamin n9i sinh, thi~u oxy, thira CO2, do ha kali mau ...
- DiSu tri:

+ N~u NTT nhi thi thirong khong c~n diSu trio
+ N~u la N._I!_tE~trna nh~t la NTT nhip doi thi c~n phai di~u chinh cac ySu t6
thuan loi gay xuat hien NTT thi co th~ dung lidocain 1mg/kg tiem tinh mach
,

-====-=-==,=~=<"-,.

cham, duy tri I-Zrng/phut truyen tinh mach.

3.

cAc BIEN CHUNG KHAc

3.1. N~c
N~c hay con goi la sir co that tung can ella co hoanh.do cac phan xa dap
irng kich thich noi tang nhu la gian da day.nac co th~ d~n d~n kich thich hoac
tang tnrong lire ph~ vi .

- Nguyen nhdn: Hay gap trong cac phau thuat vS bung nh~t la vung bung tren
(gap trong tnrong hop da day d~y hoi.do cac dong tac 10i keo phil t9.ng ma me
khong dil sau va gian cO'da giam tac dvng) .
,

- Dieu trj:
+ Lam ng~t quang t9.mthai cac kieh thich do ph~u thu~t gay ra
+ Cho gay me sau them, eho them thu6e gian ca.
+ Lam r6ng d~ day b~ng hut xong dq day

+ Cho thu6e ~hlopromazi!tdLTCmgtInh m~ch (5 mg).
_:::..A Y'I)f'11. t2.0v."
L

3.2. Di rrng va soc phan~v~

S6e phan v~ va d9.nh phan v~ 1atai bi~n r~t n?ng,kh6ng dv ki~n truac, xay ra b§t
nga,phai nhanh chong diSu tr!

D~phong:

+ Tham kham b~nh nhan c~n khai thac tiSn su dj ting,cae thu6e gay dj
+ Thu test cae 1o?i thu6c te,me trong diSu ki~n an toan cho phep
+ Tranh su dl,mg cae thu6c gay giai phong Histamin nhiSu "".
Dieu

ung ...

trt:

+ Ngirng ngay dUCmgti~p xuc v6i di nguyen
+ Cho oxy 100%, d?t NKQ va ho hftp nhan t?O n~u c~n thi~t
+ DiSu tri tvt huy~t ap vai cac lo?i dung dich, n~u c~n co th~ su d\.mg cac thu6c
v~n m?ch .su dVng Corticoide liSu ca~.
33. Cac bi~n chung khac
142


- Ha nfiT~t QQ
- Tang nhiet oQ

- Dau don
- Cac bien chirng v~ m~t ...
3. KETLU~N
Qua trinh gay me phftu thuat co th~ xay ra r~t nhi~u tai biSn va bien chung.
Nguoi gay me h6i sire phai hSt sire canh giac d~ ngan ngira va t6t nh~t 1a tranh diroc

cac biSn chirng do xay ra. NSu co bien chimg xay ra thi phai nhanh chong phat hi~nlva

xu tri kip thoi d~ dam bao an toan tinh mang cho nguoi benh,

,I-'

143


".::.

""

TE NIEM M~C ~ TE NGAM

M \lC tieu bai hQC:
1. Trinh bay duac chi dinh va chong chi dinh cua ley thudt gay te tai ch6,te ngdm.
2. Trinh bay duac nhiing nguyen t6c khi thuc hien ley thudt gay te tai ch6,te ngdm.
3. Trinh bay duoc viec chudn bi phuong tien dung cu,thu6c va benh nhdn cho
mot cas gay te tai ch6, te ngdm.
4. Trinh bay duoc uu dzim va nhuoc diem cua ley thudt gay te tai ch6,te ngdm.
5. Trinh bay duoc tai biin khi gay te va each

1. J)~I

xu tri don gian.

ctroxc

.).

Gay te tai ch6,te niem mac.te ngam la nhtrng ky thuat thirong duoc ap
dung trong cac ph~u thuat ngan.nho dan gian rna khong c~n dQ gian ca.
1.1. Chi djnh

- Cac phau thuat

a phan mem

- Thoat vi ben,dui,viem tai xuang chum.phau thuat mui xoang
- Cac ph~u thu?t ngon tay,ngon chan
- Cac truOng hQ'Prilln xuang
1.2. Chang chi djnh
- B~nh nhan khong hQ'Ptac
- B~nh nhan di ting vai thu6c te
- B~nh nhan bi ghi~m trlin,g,ho?i thu sil)h hg:i
2. NGUYEN

TAc KY THU~T

- Thu6c te du n6ng dQ va mili kim di truac mili dao.Phai gay te tUng lap

!ir~ --------_.
nong d~n lap s':l1:l,phaiton tn;mg thai gian c~n thi~t d~ thu6c te Ian toa van

d~u mut cac day th~n kinh.

144


--~Tuy~t

d6ilqi

d\mg cac c-an mac trongliliTgay-re-.-Khi

gC:llfmQt-m~mg-thi~--

19'i dung tinh dan h6i cua mang d~ bam mot hrong 100 thuoc te vao.sau do nho
tinh dan h6i cua cac lap can va mang lam cho thuoc te Ian toa nhanh chong.

_Phai Iuon luon thea d5i sat benh nhan trong suot qua trinh gay teo

3. KY THU~T GAY TE
3.1. Chuan b] b~nh nhan
_ Tham kharn ky benh nhan.khai ti~n sir benh.tien sir di irng nhat la tien SIT v~ di
ling voi cac 10C:li
thuoc teo
_ Chuan bi duong truyen tinh mach ngoai bien voi cac loai dung dich tinh the.

- Thutest

tbu6c !e

_ Giai thich.dong vien benh nhan d~ benh nhan yen tam va h9'P tac t6t voi nguoi

gay te
,;_

_ Dung thuoc tien me tnroc d~ benh nhan bot 10 S9'nhung co b&tloi la benh nhan
khong noi len du9'c cam giac cua minh trong qua trinh gay teo
3.2. Chu~n bi phtf(Yng ti~n d\lng cl,I,thu6c men.
3.2.1. Dl,Ing C1} gay te
- Bam kim tiem lOml; 20ml
- 01 kim co duang kinh Ian d~ hut thu6c te
- 01 kim co duang kinh nho,dai d~ gay te ( n~u c~n)
3.2.2. Thu6c gay

te

_ Co nhi~u 10C:li
thu6c dung d~ gay te nhung thong dl,mgnh&t hi~n nay Ia:

+ Lidocain 2%

+ Xylocain 5%,10%
+ Octo cain
_ Dung dich nuac c&tho~c nuac mu6i sinh
_ Thu6c A~ne

1y de pha loang thu6c

te

de pha them vao dung dich thu6c te vai m\lc dich:

+ De lam co mC:lchnha v~y rna v~t mb dO'chay mau

+ Thu6c te ng&m ch~m han nen keo dai du9'c thai gian tac d\lng
+ Giam luqng thu6c te va tranh duqc dQc tinh qua li~u thu6c te
3.2.3. Dl}ng cl},phU'O'ng ti~n,thuAc c~p

CtfU

145

h6i

SITC


- -- H~th.6ng -exy,ox-y,day-th6

-

- May gay me,h~ thong d~n tho.mask

phil h9'P voi benh nhan

- Ampu,Airway

- B(> dung cu d~t n(>i khi quan:
+ 01 can den va 03

ca hroi den

+ 03 6ng noi khi quan cac cO' ( 6ng chinh dira van ngon ap ut cua benh nhan)
+ Cay thong nong
+ Gac
+ Bam tiem bam cuff

+ Bang dan.Vaseline
- May do huyet ap.ong nghe

- Bam kim tiern cac loai
- Djeh truyen

.'t.

- Cac 10~ithuoc h6i sire:

+ Depersolon
+ Canxiclorua
+ Adrenaln
+ Atropin
+ H9P chong soc ...
3.3. Ky thu~t ti~n hanh
3.3.1. Ky thu~t gay te tai chS
- Khi gay te nen d~t benh nhan 6 nr th~ n~m,d~ d~ phong benh nhan qua 10 so,
xuc cam d~n den tut huyet ap.ngat,
- Nguoi gay te dung bam kim tiem co chua dung dich thu6e te ti~n hanh gay te
tai vi tri dn ph~u thuat. Gay tS tung lap di tir nong den sau, bao gom bam thu6e te

trong da, dum da, dum can ca va mang xuang. truac khi bam thu6c te C§11 hut nguQ'c.
pit tong xem co mau khong r6i mm tiem thu6c teo
- Trong qua trinh bom thu6c te phai Iuon thea doi,quan sat di~n bi~n cua b~nh

nhan n~u co gi b~t thuang thi phai ngll'ng tiem thu6c te ngay.

146


-=-Sau KJii-tien1 thuoc te-xorig cha mQt tnoi giand~tfiu&C1e

phat' huy tac d\lng-rot--

moi ti~n hanh ph~u thuat,
_ Tr~fuwhuat

o

c~n ,.-=tiem ."'~._"~~_.
them thuoc
te d~ tranh benh
nhan dau dan.
_~
•

* Chu y:
Khi gay te

a

cac dau chi, gocduong vat, khong nen sir dung thuoc

Adrenalin d~ pha vao dung dich thu&c te vi Adrenalin lam co mach mau.cac G~U
chi kh6ng duoc nuoi dirong d~y GildS dira G~nhoai nr.

3.3.2. Ky thu~t gay te b~m~t- te ng~m
Ky thuat gay te b~ mat ap dung cho niem
m'ilc va da mongo U6i voi niern
..,
mac co hai each ap dung:
- Bam bui ( Sprayjvao vung dinh m6.
- T~m bong thuoc te len vung dinh mo.thuong hay ap dung voi .s~t polype
~i ...Thu6c

te

hay dung la ~docaine

5%~

Thu6c te chi th:1m d~n

Q9 sau

@_UcTI5rriffi]
Ngoai ra co th~ dVng Kelene (thu&c nay vua 1a thu6c me qua duang h6
h:1pvua co tac dl,mg gay te b~ m~t) d~ te b~ m~t d6i v6i cac~va

147

nhQt.


Dung bong tAm th u&c te d~ gay

te vung dinh rna

.y,

Boom bui (Spray)

4. UU DIEM

vA NHlfOC DIEM

4.1. If u di~m

- Ky thuat

thuc hien dan gian

- Re tien.It t6n kern
- Benh nhan tinh,theo doi ph~u thuat va hau ph~u d€ dang.it tai bi~n
- Tranh duoc nhfrng bi~n clnrng do gay me.sir dung t6t cho nhirng benh nhan
da day d~y,b~nh v~ phoi.
4.2. Nhurrc di~m
148

co


- M~t nhi@uthoi gian vi tiem thuoc te nhieu 1k,cha thu6c te phat huy tac dung lau,

- Khong gian co
- T6n nhieu thuoc te

- Khong sir dung diroc trong cac tnrong hop nhiSm khu~n 0 da va nhiSm trung
Ian rong

;::i thu6c

te khong co tic d\lng trong moi truemg toan.

5. Cac tai bi~n khi gay te
5.1. Nhi~m

oQC thu8c te

6&ZiliIh kinh

Nhiem d9C thuoc te tac dong

trung uang

ya alilll) Thong

thuong bi~u hien nhiem d9C than kinh va nhiem d9C tim hay g~p voi cac thu6c te
manh, BiSn clnrng nhiSm d9C thuoc te la nguyen nhan de doa ill vong dum gay te tai
ch6,te niem rnac.te ngam. BiSn clnrng nay co th~ xay ra m9t each d9t ngot, vi V?y tit

ca cac 10C;li
gay te tai ch6,te ngb,e~n
5.1.10 Nguyen
ii.'

phai co bien phap dir phong,

nhan

-Do thu6c te dung 1i@ucao
-Do thu6c te duoc tiem vao mach mau qua nhanh
-Do trC;lngthai th~n kinh b9nh nhan qua sQ',dS kich d9ng

,"",-

,

..

-Do ti~n me khong t6t

.Y

5.1.2.Tri~u chung

* Tri¢u chung

sam (kich thich than kinh):B9nh nhan sO'hai,h6t hoang, kich thich
..t....._....

-

,_

V?t
va ho~c b9nh nhan n6i

,,__
- qua nhi@u.
- V@tu~n hoan :M~~~.lli1!!h,huyS!Jl2,Jang.

* Tri¢u chung

giai aogn ~'rcchi-

- M9.ch nhanh nh6
'--'

- HuySt ap d9ng m9.ch giam
do gian m9.ch,giam co bop cO'tim
r..--'-' _ ..
- V@h6 h~p :R6i 10(;1nh6 h~p,co th~ ngung tho.

- Co

th~ m~t tri giae,co gi?t: BiSu hi9n chu ySu b~ng can co gi?t toan than, co

tru'ang hQ'p nht; bi~u hi9n nhu: run chi, co cam giac co Clmg 0 moi mi9ng, elmg
lu6'i, chciy nuac mui nhi~u, u tai.

·5.1.3. Phong ngira bi~n chung nhi~m dQc thu6c ie
NhiSm d9C thu6c te trong da s6 tnrang hQ'p c6 th~ d\l' phong b~ng each:
-Tru6c khi gay te phai giai thich r5 vai b9nh nhan v@vi9C gay te d~ m6,nSu b9nh
nhan kh6ng d6ng

y thi

kh6ng du9'c gay teo
149


/13011'2('.)

-Phai tien me that tot .Sir dung nhorn Barbituric hoac ~d~en.
- Ap dung ky thu?t gay te dung.
- Chon Iva thuoc te thich hop:
- Phai sir dung liSu thu6c te nhc>m'a dat dw),c ml)c..dich,n6ng d9 th_~6c !~
phai loang (tuy thea yeu cau cua ky thuat).

- Bam thuoc qua nhanh cling can phiti tranh vi gay gia tang dot ngot nong

d9 thuoc

trong mau do t6c dQ tiern nhanh se lam hap thu thuoc nhanh.

- Theo doi benh nhan chat che trong va sau khi tiem thuoc

5.1.4. Xu tri nhi~m dQc thuBc te
Phai khan tnrong.dong bQ neu diSn biSn nhanh va nang
- Can dong kinh keo dai trong vong 1phut

se gay nen tinh trang thiSu oxy

va iru than. Vi vay phai nhanh chong cung c~p ox):' cho benh nhan.neu c~n lam
ho h~p h6 tro.ho h~p nhan tao co oxy.
- TruySn dich voi kh6i Iuong nhiSu (co the 2-3 duong truyen) va cho chay vai
t6c dQ nhanh.

- NSu l:!gySt ap dQng m:;tch tam thu 60-70 mm_tlg thi, dungc§EE~dnn)tiem Hnh
m~ch ( nSu c~n co th6 dung Adrenalin ho~c Dobutamine).
- C~t can dQng kinh ngay b~n_g:

+ Benzodiazepine

(diazepam,

midazolam),

ho~c Thi~ental,

liSu su dVng

khoang [00-200r1jgJ
. - Theo d5i ~satvS'ho h~p,tu~n hoan va th~n kinh cua b~nh nhan.
·5.2. Di ",ng

va

sSc phan v~

ThuCmg xay ra 6 nhfrng nguai co ca dia di lmg.Thai gian di ling thuong 1a
ngay sau khi dung thu6c.co th6 ch?m han (12 gia sau khi dung thu6c)

5.2.1. Tri~u ch tfng
Cac tri~u chUng gi6ng nhu nhu'ng truo'ng hqp di {rng thu6c khac

* Thi nh?: N6i m~n ngoai da,nglra,nhi~t dQhm tang,co th6 l1g~tmili,kho th6 nht;.
* Thi nq.ng (shock pheIn v¢): DiSn biSn nhanh,tri~u chung toan than r~m rQ

- B~nh nhan m~t nhqt nh~t,bun run chan tay.Kho th6 n~ng .
- M~ch nhanh,nh6,khong

b~t duqc .

- HuySt ap giam khong do duQ'c

150

,~


- _-Co th~ngirng tim.ngirng tho.hon me. N~u khong c~p ciru kip thai ty 1~tu vong

cao.
5.2.2. D~ phong
Phai hoi benh nhan xem co tiSn sir di irng voi cac thu6c te khong. Phai thu
phan img thuoc te truce khi dung thu6c.
5.2.3. Xfr trt
- ~g@g ngay viec ,tiem thuoc.
- Neu benh nhan ~o

duoc ~ho tho oXY.,N~u khong t\1'Jh9' can ~op bong co

oxy.hoac d~t poi khi qWln lam ho h§p nhan tao .
- Thi~t I?p duong tmySn dich .NSu huyet ap tut thi truyen dich nhanh bang cac
dung dich sinh

1Y.

- Adrenalin la thuoc co ban d~ cap ciru s6e phan v~ :Tiem duai da tl1112d~n 01
6ng (lmg) d6i voi ngiroi lon.Hoac Tre em 6ng 1mg pha 9 ml nuoc c§t tiem
0.1mllkg. Hoac 0.01 mg/kg eho ca tre em Ifrn nguoi Ian. Cir 15 phut tiem nhac
lai cho den khi huyet ap tro vS binh thuong.
- SU dung corticoid. tiem tinh mach .
- N~u ngimg tim :Ep tim ngoai I6ng ng\1'Cva ho hfip nhan t<;10.
- NSu co th~t ph~ quan dung thu6c gian ph~ quan ya kJl_angHistamin.
- N~u m<;1chch~m Atropin 0,5 mg tiem tInh m<;1ch.
5.3. Nhi~m khu§n
-La tai biSn co th~ g~p 0 b§t cu ky thu?t gay te nao.Do kh-au vo khu~n
khong t5t nhu vo khu~n phuong ti~n,dt;mg q.l gay te va vo khu~n cua chinh
nguai gay teoNhi~m khu~n co th~ g~p Ia nhi~m khuin t<;1ichb ho~c nhi~m khu~n
huy~t (Tri~u ehUng va xu tri nhu m<)ttruang hqp nhiSm khuin huy~t)
-5.4. BO'm thu6c

te vilO m~ch

mall

Tri~u chUng gi6ng ng<)d<)cthu6c teo
5.5. Tai bi~n do tbllBc co m~ch gay ra
5.5.1.Tri~u chrrng
Trong m9t s6 truang hqp gay te,nguai ta pha them Adrenalin VaGthu6c te
d@keo dai thai gian tae dl.,mgeua thu6e te va phong tai bi~n trong gay teo M9t s6
b~nh nhan co th@co cac d§u hi~u sau:
- Hbi h<)pdanh tr6ng ngue
151


- Mach nhanh, manh

- H6t hoang, 10 lang.nlnrc d~u.

5.5.2. f)~ phong
- Nen dung li~u nhe) Adrenali~ khi pha tron voi thu6c te
- Dung ~dl!~n

trong tien

/'

me.

, .
,

152


"

,?

-

A

-"

-

A

-

.!:..

-

,,-

-~.

VAl TRO,VI TRI CUA GAY TE. NGUYEN TAC AN TOAN
TRONG GAY TE. TAl BIEN GAY TE

1. Neu len duoc vai tro va vi tri cua gay te
2. Neu duoc nhiing nguyen tftc an toan trong gay te
3. Trinh bay duoc nguyen nhdn.trieu chung .cach

a~phong

va

xu tri cac tai biin

cua gay te do thu6c te gay ra
4. Trinh bay duoc nhiing tai biin do cac leY thudt gay te khac nhau
5. Trinh bay ra dirac cac tai bien do thuoc co mach gay ra.

L -I)~I CUONG

Viec SLr dung cac thuoc te voi cac ky thuat gay te duoc ap dung rong rai
hien nay t<:1Othuan loi tien hanh nhieu 10<:1i
phau thuat tren benh nhan rna benh
nhan khong co cam giac dau .viec cham soc hau ph~u va thea d5i sau m6 cho
benh nhan nhe nhang han gay me .
Song ben canh do.gfty te cling co th~ gap mot s6 tai bien co th~ gay nguy

n

. hi~m toi tinh m<:1 bg~nh nhan .Trong do bao g6m: Cac tal biSn do thu6c te gay
ra ,cac tai biSn do ky thu~t gay te,cac tai biSn do thu6c co m<:1chgay ra ...
Thong thuemg lo<:1ithu6c gay nhi~m dQc nh~ la xylocain. Nhi~m dQc n~ng nh~t
khi S11 d\mg 10<:1i
thu6c te m<:1nhnhu etidocain hay bupivacain.
2. VAl TR()'

VI TID eVA GAY TE

2.1. Dinh nghia
Gay te la dung thu6c tac dQng dSn h~ thftn kinh ngo<:1ivi d@ngan
ch~n s~r d~n truy~n xung dQng th§.n kinh tll' ngo<:1ivi v~ trung uang lam cho
b~nh nhan m~t cam giac ho~c v~n d9ng cua mQt vung ca th~ trong khi do
b~nh nhan v~n tinh tao.

153

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