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18.thomaysosinh

18.thomaysosinh

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Published by: Le Manh Cuong on May 03, 2014
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THO MAY SO SlNH

l. ÐAl CÜONG THO MAY SO SlNH
1. Moc tico giop tbo:
On dính íum sung vu khï muo o moc líO
2
vu up íoc thup nhut.
2. Cac pboong tboc tbo dong cbo trc so sinb:
u. Th! máy thông thý"ng, Kieåm soaùt aùp löïc (Pressure Control): dong cho tut
cu bonh íy guy soy ho hup o tro so sính. Cho do nuy kíom sout dooc up íoc,
thoí gíun hït vuo, tho ru, nhong khong kíom sout dooc tho tïch khï íoo thong
tVt), khong tho to dong thïch ong khí do dun phoí thuy doí. Do do noo
bonh nhun to tho ru vuo gíuí doun co nhíp muy so khong dum buo khï íoo
thong vu tung ngoy co do khï.
b. Thôû maùy taàn soá cao (High frequency ventilation (HFV): Co 3 íouí:
- Hígh íroqooncy posítívo prossoro vontííutíon tHlllV): co tho up dong tuí khou.
- Hígh íroqooncy ¡ot vontííutor tHl¦): ït dong vì guy buy khï do tho ru tho dong.
- Hígh íroqooncy oscíííutor tHlO): híon dung dooc ou choong.
HlllV: 1ho muy co hoc o tun so 60 – l50 íun/phot. Vt= 4mí/kg, l/L <
0.3, tho ru tho dong. HlllV co íoí díom hun cho tình trung chong muy, gíum
nho cuo xo dong thooc un thun
Hl¦: 1un so l00 – 600íun/phot, tho ru tho dong, do do co tho bí o CO
2

HlO: tho muy tun so cuo tí = 5 – 30Hz, t!c 300 – l500 íun/phot) voí tho
tïch khï íoo thong bung houc nho hon khoung chot gíuí phuo t 2 – 3mí/kg), tho
ru cho dong. Kíoo tho nuy cho phop dong MAl cuo do trunh xop pho nung, to
do cuí thíon ty ío thong khï tooí muo. HlV co tho dum buo do thong khï mu
vun trunh dooc thuy doí tho tïch phoí nhíoo vu trunh dooc ton thoong phoí
kom. Vì vuy, HlV co tho íoí ïch trong khï pho thong mo ko phoí vu trun khï
mung phoí.
HlV co chî dính khí thut bu í vo í cho do tho muy tho ng
thoong, duc bíot khí do khï, khï pho tho ng mo ko phoí. 1oy
nhíon, muy du t tíon.
ll. CHl Ð]NH THO MAY
l. Con ngong tho nung > 20 gíuy houc kom chum nhíp tím, thut buí voí
thooc vu NClAl voí l ! 6 cmH
2
O vu líO
2
> 0.8
2. luO
2
< 50 mmHg khí líO
2
> 0.8 ttro bonh tím bum sính tïm).
3. luCO
2
> 60 mmHg kom toun muo koo duí.
4. Soy ho hup huo phuo.
lll. THÜC HANH THO MAY
Khí cuí dut trí so up íoc hït vuo toí du bun duo lll tlll = ll + lLLl),
non toy thooc vuo up íoc do dooc tron bop bong, toy thooc vuo tong bonh
nhun vu bonh íy.
1. Cac troong bop kbong ton tboong pboi
" Modo lrossoro Controí.
" 1un so 30 - 40 íun / phot, 1í 0.4 – 0.5s, l/L ¹.
" ll = l0 - l5 cmH2O do dut V1 to 6-8 mL/kg
" lLLl = 4 cmH2O.
2. ßcnb mang trong:
Do dun phoí so cuí thíon rut nhunh suo dong Soríuctunt, cun íoo y trunh
ngoy co do khï.
" 1ho muy thong thoong:
- Modo lC.
- 1un so cuo: 60 íun/ph, co tho tung íon l00íun/ph, 1í 0.3 – 0,4s, l/L
l/l.
- ll = l4 - 20 cmH
2
O do dut V1 to 4 - 6 mL/kg
- lLLl cuo = 5 – 6 cmH
2
O, co tho tung don 8 cmH
2
O.
- Chup nhun PCO
2
cuo hon trí so sính íy do gíum chun thoong up íoc.
" 1ho muy tun so cuo:
- Modo HlO.
- lroqooncy = l5Hz tkk: 900 íun/p). 1ro do thung: l = l0Hz, non thung:
l5Hz, l/L l/l.
- Stroko voíomo tumpíítodo): 1ho tïch íoo dong khï tkhong phuí íu tho tïch
khï íoo thong). Khoí duo 24 – 34 cm H2O .
- MAl = lLLl. Dut trí so bung MAl tkhí tho muy thong thoong) +
2cmH
2
O.
- Sígh lrossoro t louk lrossoro) = lll = MAl + 6 cmH
2
O .
Loo y : Anh hoong Ampíítodo tron lCO2
AmpIitodc FCO2
1ung 3 cmH2O Cíum 2 – 4mmHg
6 5 – 9
9 l0 - l4
Kíom tru Xqoung phoí: lhoí no don moc xoong soon 9 – l0 suo.
3. Hoi cbong bít pban so:
1uc doong tho cup, xop phoí tong vong kom o khï do phun xo tuo vun l
chíoo, suo l2 – 24 gío íu gíuí doun víom guy ton thoong pho nung.
" 1ho muy thong thoong:
- Modo lC
- 1un so: Noo chou víom phoí tun so 25 íun / phot, 1í= 0.6s, l/L = l/3.
- Kom víom phoí: # tun so 40 - 60 íun / phot, 1í 0.5s, 1o do: 0,5 – 0,7
gíuy. l/L ¹. Co tho # l/L=l/l. Noo co buy khï, co tho tung 1o íon 0,7 – l
gíuy, gíum lLLl xoong 4 cmH
2
O
- ll = 20 – 25 cmH
2
O co tho tung don 35 cmH
2
O do dut V
1
to 6-8 mL/kg
- lLLl trong bình = 5 cmH
2
O gíop gíum tuc nghon, gíum tình trung buy
khï.
4. Tboat v| boanb:
Co tho kom thíoo sun phoí bon thout ví vu cuo up phoí guy shont tl) – t1)
qou ong dong much , ío buo doc.
" 1ho muy thong thoong:
- Modo lC.
- 1un so 40 íun / phot, 1í 0.5s, l/L ¹.
- ll = l5 –20 cmH2O do dut V1 to 6-8 mL/kg
- lLLl = 4 - 5 cmH2O
- líO2 = l00% noo bonh nhí tïm, suo do gíum dun
- Loo y non gío ll o moc thup nhut do trunh tuí bíon trun khï mung phoí
bon khong thout ví. Khí thut buí voí tho muy thong thoong: SuO
2
< 80%,
luCO2 > 60mmHg: 1ho muy tun so cuo
" 1ho muy tun so cuo:
- Modo HlllV.
- 1un so l00 íun / phot, 1í 0.3s, l/L l/l
- lll = 20 cmH
2
O.
- lLLl = 0 cmH
2
O
S. Hao pbao Ho tbanb bong bam sinb – Tboat v| coong ron:
Cíuí doun huo phuo up íoc o bong gíu tung guy chon op co hounh.
- Modo lC.
- 1un so 40 íun / phot, 1í 0.5s, l/L ¹.
- ll = l8 - 20 cmH2O do dut V1 to 6-8 mL/kg
- lLLl = 4 - 5 cmH2O
6. ßcnb pboi man: ton thoong pho nung, doong dun khï, xo phoí, xop phoí.
- Cuí dut thong so toí thíoo gío SuO
2
= 90% - 92%, chup nhun luCO
2
cuo
55 – 65mmHg, pH > 7,25.
- Modo lC.
- 1un so thup 20 – 40 íun / phot, 1í duí 0.5 – 0,7s, l/L l/3 – l/2.
- ll th"p = 20 - 30 cmH2O do dut V1 to 5 -8 mL/kg
- lLLl = 5 - 8 cmH2O.
7. Tom Iooc cac tbong so cai dat ban dao va dico cbínb tbong so:
lF
(cmH
2
O)
FFFF
(cmH
2
O)
kk
(l/p)
Ti
(s)
l/F
ßcnb mang trong:
C $ R %

14 - 20

5 – 6

60

0.4

1/1
Dío o chînh 8 80 -100 1/1
Ho i cbong bít pban so:
C $ R #

20 - 25

5

40

0.5

1/2
Dío o chînh 35 8 1/3
Tboat v| boanb:
cao aùp phoå i, FRC $

15 – 20

5

40

0.5

1/2
Dío o chînh 0 100 0.3 1/1
ßcnb pboi man:
C $ R # xô phoå i

20

5

20

0.5 - 0.7

1/3 –1/2
Dío o chînh 30 8 40

lV. CAl MAY
4.1. Ðico kicn cai may:
- ßonh ngoyon on dính.
- Kíom sout nhíom trong: víom phoí boí nhíom, nhíom trong hoyot.
- On dính hoyot dong hoc.
- Hct 36 – 45%, khong roí íoun nooc díon gíuí kíom toun. Cong cup do
nung íoong.
- 1hong so muy tho: líO
2
< 50%, lll < 20 cmH
2
O.
- Khï muo: pH > 7.3, luCO
2
< 50 mmHg, luO
2
> 60 mmHg.
Trìnb to cai may:
" Cíum dun cuc thong so muy tho:
- Cíum líO
2
moí 5% don 40%.
- Cíum ll moí 2 cmH
2
O don l0 –l5 cmH
2
O
- Cíum tun so tho moí 5 íun/phot don 20 íun/phot.
" Choyon cho do tho: co huí íou chon
- 1ho ClAl qou NKÇ
l = 4 – 6 cmH
2
O
líO
2
! íoc tho muy 5 – l0%, suo do gíum < 30%.
- 1ho lMV tcho tro < 2 kg):
Cíum tun so don 20 íun/phot,
ll < 6 cmH
2
O,
líO
2
< 30%
4.2. Tico cboan rot noi kbí qoan
- Lum sung : nhíp tho doo, khong gung soc.
- SuO
2
> 90% houc luCO
2
< 50 mmHg, luO
2
> 50 mmHg
- Noo tho muy > 7 nguy: Doxumothusono l mg/kg/nguy chíu moí 6 gío 1M
trooc rot noí khï qoun l – 2 nguy.
- Nhín un trooc l – 2 gío.
4.3. Sao rot noi kbí qoan:
- 1ho NClAl, up íoc 4 - 5 cmH2O, líO2 but duo bung houc cuo hon íoc
tho muy 5 – l0%, suo do gíum don 2l%
- Nguy suo rot NKÇ noo co duo kho tho thunh qoun: Khï dong Adronuííno
0.l% 2 mí phu l mí NuCí 0.9%, co tho íup íuí suo 2 – 4 gío.

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