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CHM SC BNH NHN SAU GY T- GY M

BS. CKI. NGUYN V NG TH

MC TIU HC TP
1.K c cc phng php v cm 2. Cc thuc dng trong gy m, gy t: S lc tc dng chnh v tc dng ph

3. Hiu r cc tai bin v bin chng ca cc phng php v cm


4. Bit cch tip cn bnh nhn sau gy m, gy t, cc vn cn phi theo di. 5. Rt Ni kh qun ti hi sc 6. Pht hin v x tr kp thi cc tai bin v bin chng.

CC PHNG PHP V CM
CC PHNG PHP V CM L CC PHNG PHP GY M, GY T TO RA S MT CM GIC, C HOC KHNG MT THC TM THI NHM GIP BNH NHN AN TON V KHNG AU TRONG SUT QU TRNH PHU THUT, TH THUT. CNG TC NY DO BC S GY M HI SC M NHIM

CC PHNG PHP V CM
1. GY M 2. GY T

1. GY M
1. GY M TON TH - BNH NHN C GY M TON DIN VI TNH TRNG MT THC, KHNG AU, DN C V QUN. - PHI HP CC LOI THUC AN THN, THUC M ( BC HI & TNH MCH), DN C V GIM AU. - GIP TH QUA NKQ

GY M (2)
2. M TNH MCH - TRUYN HOC CHCH LP LI THUC M TNH MCH + THUC GIM AU, C TH C HOC KHNG THUC DN C. - BNH NHN C TH T TH HOC C GIP TH QUA NKQ, MT N THANH QUN. - THNG DNG TRONG NHNG PHU THUT, TH THUT NGN HOC LIN QUAN NG TH, HOC NHNG BN C CC DNG THUC M BC HI

GY M (3)
3. M TH KH - CH DNG THUC M BC HI KHI M V DUY TR M - C HOC KHNG THM THUC GIM AU V DN C

GY M (4)
4. TIN M - CH DNG CC LOI THUC AN THN V GIM AU. - THNG PHI HP VI GY T TI CH. - DNG CHO CC TH THUT, PHU THUT NGN, HOC NHNG BN C BNH L HN CH DNG CC LOI THUC M.

GY M (5)
TRN THC HNH, C TH CHIA THNH CC LOI NH SAU: - M NI KH QUN - M MT N THANH QUN - M TNH MCH

- TIN M, T TI CH.

2. GY T
CHIA LM 2 NHM CHNH: 1. GY T TRC THN KINH TRUNG NG

2. GY T THN KINH NGOI VI

GY T (2)
1. T TRC THN KINH - T TY SNG

- T NGOI MNG CNG


- T XNG CNG

GY T (3)
2. T THN KINH NGOI VI - CHI TRN: T GIAN C BC THANG, TRN N, DI N, TNG NCH

- CHI DI: T TK I, TK TA, TK HIN, C CHN


- T CNH CT SNG

- TAP BLOCK ( TRANSVERSUS ABDOMINIS PLANE)

CC THUC THNG DNG TRONG GY M, GY T


1. THUC AN THN - Benzodiazepines: Midazolam ( Hypnovel), diazepam ( Valium, seduxen), lorazepam ( Ativan) - Tc dng: gy an thn, gim lo u, gy qun - tc dng bt li: + dn mch nh, c th gy h HA + c ch h hp

CC THUC THNG DNG (2)


2. THUC PHIN - Morphine, meperidine ( Pethidine), fentanyl, sufentanil, alfentanil, remifentanil. - Tc dng: gim au, liu cao, c th dng nh thuc m ( trong phu thut tim) - Tc dng bt li: c ch h hp, co cng c h hp, nn v bun nn, b tiu

CC THUC THNG DNG (3)


3. THUC M TNH MCH 3.1. PROPOFOL - Tc dng bt li: gy h HA, c ch h hp 3.2 KETAMIN - C tc dng gy m, gim au v khng gy h HA - Tc dng bt li: c ch h hp nh, o gic, tng tit m,

CC THUC THNG DNG (4)


CC LOI THUC M H HP - H Halothane nh Isofluran, sevoflurane, desflurane - Thng dng duy tr m, i khi c dng dn m. - kch thch ng h hp

- Gy khi pht st cao c tnh.

CC THUC THNG DNG (5)


THUC DN C - Dn c kh cc: Suxamethonium: L thuc dn c ngn, dn c nhanh, thng c dng cho BN c d dy y. Gy khi pht st cao c tnh. - Dn c khng kh cc: thng c tc dng trung bnh hoc di. C th gy tn d thuc dn c trong giai on hi tnh=> phng BN suy h hp.

TAI BIN V BIN CHNG THNG GP SAU GY T, GY M

- SUY H HP( RT LI, CO THT THANH, CO THT PH QUN, TC NGHN NG TH, TN D THUC DN C) L TAI BIN THNG GP NHT, C TH GY T VONG. - H TIM MCH: RI LON NHP, H HUYT P, TNG HA - CHUYN HA: H NG HUYT( HN M, NHIM CETON) - VIM PHI HT

TAI BIN & BIN CHNG ( tt)


- NN I - B TIU, TIU T.

- AU
- RI LON THN NHT: H THN NHIT, TNG THN NHIT C TNH

- CHY MU SAU M

TAI BIN V BIN CHNG SAU GY T, GY M


- I VI BNH NHN SAU GY T, NGOI CC VN K TRN, CN C TH GP: + AU U SAU CHC D TY SNG

+ AU HOC T CHI, MT VN NG HOC CM GIC ( MU T, TN THNG TK)


+ T CAO ( NHP TIM CHM, H HA, LIT H HP)

+ AU LNG, AU GY

TIP CN BNH NHN SAU V CM

- NH GI NHANH TRI GIC V SINH HIU - TNH TRNG H HP - TNH TRNG HUYT NG - PHNG PHP M - PHNG PHP V CM

- THI GIAN M
- CC VN XY RA TRONG M NU C.

TIP CN BN SAU V CM (2)


=> CC VN CN THEO DI TIP.

TIP CN BNH NHN SAU V CM (3)


1. NH GI TRI GIC TNH HON TON HAY NG, TT NHT L NH GI THEO THANG IM GLASGOW NU BN CN NG => PHNG SUY H HP DO RT LI, TC NGHN M NHT. M SNG: GIM NHN THC, TH , NG G KCH THCH, VT V

TIP CN BNH NHN SAU V CM (4)


2. NH GI TNH TRNG H HP - L NG TC QUAN TRNG NHT, SUY H HP VO THI K GY THIU OXY MU RT NHANH, C TH E DA TNH MNG. - BNH NHN CN NKQ HAY KHNG - NU BN T TH, HA GII THUC DN C HAY CHA( NEOSTIGMIN + ATROPINE) - T TH HAY PHI H HP H TR( BP BNG, TH MY, BIPAP) - BNH NHN T TH TT KHNG( TN S, SPO2, C NG LNG NGC, TING TH RT,)

NH GI TNH TRNG H HP (2)


- CC NGUYN NHN GY SUY H HP + CO THT THANH QUN + CHN P NG TH T BN NGOI DO KHI MU T + LIT DY THANH 1 HOC 2 BN + SUY H HP NHNG BNH NHN C BNH L PHI TRC + XP PHI TRONG V SAU M

TIP CN BNH NHN SAU V CM (TT)


3. NH GI TNH TRNG HUYT NG - H HUYT P: THNG GP + NGUYN NHN: THIU TH TCH TUN HON, GIM CUNG LNG TIM, GIM TRNG LC MCH MU DO THUC M, THUC

=> CN XEM XT LNG DCH, MU


TRUYN TRONG M

NH GI TNH TRNG HUYT NG (tt)


- AU NGC GI NHI MU C TIM, THIU MU C TIM CHU PHU - RI LON NHP: NHP NHANH, CHM, KHNG U CN C THEO DI ST V BO BS. - TNG HUYT P: THNG GP + NGUYN NHN: THA SN C, KHNG

C DNG THUC H P TRC M; AU:


LO U; TNH M

TIP CN BNH NHN SAU V CM (tt)


4. THEO DI NC TIU - TIU T ( <0.5 ml/ kg/ gi): biu hin tt suy thn cp. - B TIU: TR BNG QUANG, DO MT TRNG LC BNG QUANG, THNG

GP SAU GY T. C KH NNG GY SUY


THN CP, V BNG QUANG.

TIP CN BNH NHN SAU V CM (tt)


5. THEO DI THN NHIT - H THN NHIT RT THNG GP, NHT L SAU CUC M KO DI, NGUY C KHI PHT NMCT, RI LON NHP, RLM - LNH RUN CNG THNG XY RA BN GY T TRC TK

- SI N => NGUY C BNG


- MN SI RT TT CHO BN H THN NHIT SAU M

THEO DI THN NHIT (tt)


- TNG THN NHIT HIM GP HN + DO BNH NHIM TRNG + PHN NG VI THUC HOC CH PHM MU. + TNG THN NHIT C TNH HIM GP, KHI PHT SAU GY M BI THUC M HI V SUXAMETHONIUM, L BNH L E DA T VONG VI T L > 80%

TIP CN BNH NHN SAU V CM (tt)


6. NN V BUN NN SAU M - THNG GP

- NGUY C HT CHT I NHNG BN M


SNG

TIP CN BNH NHN SAU V CM (tt)


7. PHNG PHP M V THI GIAN M V PP V CM - CN XEM TRONG PHIU TNG TRNH PHU THUT V PHIU GY M BIT S LC CC THNG TIN SAU:

+ THI GIAN PHU THUT & GY M


+ CC VN XY RA TRONG M => D PHNG CC TAI BIN V BIN CHNG C TH XY RA.

TIP CN BNH NHN SAU V CM (4)


8. CC VN KHC - TY THEO TNG LOI PHU THUT

- CHY MU SAU M L VN CN QUAN


TM I VI MI PHU THUT.

RT NKQ
+ BS PHI THM KHM V Q RT NKQ

+ RT NKQ SM: KH NNG SUY H HP


+ RT NKQ MUN: GY KH CHU CHO BN

RT NKQ
IU KIN RT NKQ: - C TH THC HIN Y LNH N GIN ( M MT, NM CHT TAY, GI U KHI GING > 5S - HT NH NHNG NG NKQ PHA TRN BNG CHN - SAU KHI HT CHO BN TH OXY QUA MASK

KT LUN
SUY H HP L VN QUAN TRNG HNG U CN THEO DI, C NGUY C T VONG. CN THAM KHO THM CC VN TRONG M C K HOCH THEO DI HP L. BO NGAY VI BS PH TRCH KHI PHT HIN CC BT THNG.