Tài liệu ôn tập cho kỳ thi tuyển viên chức ngành y tế năm 2017 giao trinh gay me gay te II flie 1

1 ' I I I i I ~ i ~ ~ -.~ " L:'" Q~ z I J o , I" C' ~, leO tc r» 15~ ,., r =s :r 12 =- _ - _.- = t~ "'_ 0;.-_ " ' i ~ 0", ~ t:' :::l Q" - -0)' 0" -e- ~ ·0 ~ (j _, ~ ~(" t:: '1Ci I.~'-,;;;::;:~- ,=-~ .~ E ti I > >(' » Z ~ f'*', -" ~ -0 V#'~ \:i.J (~ I~) I l~ 12" 'r~ ~ ,-,.-~ ~ ~~ ~ ~h I~ 1;';- e: i>o-' ~ " J » ~ ; < ~ ~ ;';, I 'I iI ~i' ~ ~ ===1 0: ,- , ~: Muc tieu hoc t~p: Neu duoc khai niem gay me Neu duoc cac khai niem gay teo Neu au(!c cac yeu cdu cua goy me Neu duoc cac phuong phap gay me L D,~.IClrONG Khai niern v~ vo cam vo cam , la lam eho benh nhan khon_g can dau dOn va an toan de chiu dung duoc cuoc ph~u thuat SIJ phat trien cua ph~u thuat hien dai khong chi bi can tro boi su thi~u hiSu bi~~§ qua trinh benh 1y, giai ph~u, v§ nhiem trung ngoai khoa rna can thuc hien ky thuat gay me h6i SlJC an toan va dang tin cay Tir tnroc toi nay, gay me da phat triSn tir thu6c me ho h~p d~n thuoc te -+ gay te tai ch6 ,\ gf.iy te vung va cuoi cung la gay me tinh mach, gay me noi kill quan va tuk hoaD ngoAi co th~ f)~ Gam baD cho vo cam cho nguo'i b~nh, nguai ta phai ti~n h2mh cae phUOTlg phap gay me ho~c gay teo !Huh nghIa gay (Jay me me , - 1a dllngJ_hu6c - uk c1Qng vao -_._ - h~ thilQ.J;lDb_truIl~rong ' d6 If.1n1 eho b~nh nhfln l~~tjri giac, cam ~iac) v1.I2,_d~?gnhu/trong mQt gi~c ngll r~t say nhm~ cAe co quan khac v~n hOSitdong nhu binh fu_uixng,_ _ B~nh nghia gay te Gay te la dungJhll_QS;tac oQng o~n_b~_!_h_~_19nll._y!gg';li_ vi d~ ngan_s:h?D ~l1'd~ lruy~n xung dOng Lh~Ilkinh.1ir Dg_Q_ai viv~ tnmg Hong Ism eho hi)nh nhi1.n mAt giac -_' cam rt~_~_ r 1/4-'/( ~·b _, _ _.·c _ "'" ~ t':'':"~W.;';.t,(~~"tta~~~~ii:"": =::;:.;a 6~i\~·L!; Kh6ng O~lai di chung sau mo " _ ., " f" ,,"" y Khong oQc y Sau m6 h6i tinh nhanh va cac chirc nang song ciing phuc h6i nhanh va C[,1m bao an to 2111 Muon lam OUyC nhu vay nguoi gay me h6i sue phai hi~u duoc cac qua trinh sinh ly, sinh 1y benh, Iy ngoai khoa noi chung, cac benh ky thuat gay me, h6i sire va di~u tri giai phau, qua trinh benh ly chuyen khoa kern theo, duoc ly hQCva cac benh ca truce, va sau ph~u thuat II LICH SU VO cAM Tren th~ gi6'i 1.1 Tnro'c nam 1846 Truce nam 1846 mot vai phuong tlnrc lam giam dau cho ph~u tl1U~toa duoc dung ).> Cho uong ruou say, cho b~nh nhan dung thu6e phi~n ~ Thinh thoang phuong phap v~t 1y cung dUQ'estr d\mg d~ lam giam c:iau(nblI g6i chan tay bang ho~c lam thi~u mall v6i mQt garo) ~ Lam mAt tri giae b~ng each danh m(;1nhVaG d~u ho~c bClp co eho nghet m(;l.ehmau d~ lam me man, dTnhien 1aphai tnl gia kha o~t >- Phuong phap ph6 bi~n nh~t thucmg duQ'c SlY dvng d~ d(;1tdu'Q'c yen t(nh m6 dan gian 1a dung suc m"mh d~ ki~m ch~ b~nh nhfm Vi v~y, tai bi~n ho~c nguai b~nh ch~t ph~u thu~t co xu huo'ng ho~c d~n luu abees tv nhien M6 m6 r~t cao Do d?c diem do, chi la m6 c~p ctm Vi dv: c~t Cl;lt chi khl gily 11& 10n kh6ng th~ ti~n hanh tren b~l1h nhan bO'i kh6ng lam gi2il11dau duQ'c thfch dang o Do hi~u bi~tv§ sinh ly ~nh va chi dinh ct~ di~u tri b§ng ph~u thu~t ~~O'd~ng o K y thli?t ti~ttlimg va ng311 ngt.ranhi@mtrLmgv@tm6 chua dUQ'cbi@Ld~n o Chua lam mAt c2tm giac ciuQ'choan toan da la mQt tr6 ng0i chinh .tC)56 1.2 Ttr1846 trO' d~ E-\(\_Q_\ -) Cb'tlfc _i Nl'·[,(lt,C; C;:a.LJ.(Vl.P , Me the : ' _, Po:':! J,8-i -£8u I me theq,9mYQg vao c4~_ !!!.!!PC, ~ '8 (_'0'2-" Phuong phap gay me h!! hgp (gay me mask, g[lY me n()i khf qWln): Phuong ph~p thuang aua VaGcac thu6c me th~ (N20, Cyclopropan) ho~c thu6c me b6c hoi (Ete, Halothane, Isoflura ) qua QUang he)h~p cho b~nh nhan me o Phuong'phap gay me tlnh mach: Phuong phap thuang dung v6i Cclc thu6c me duang tTnh m tremg: La phuong phap bam thu6c me qua QUang trvc trang Hi~n nay, It dlll1g vi khong hon gi cac phuong phap khac Tn1 mQt s6 trucmg h9'P d?c bi~t nguai ta dung him gay me cO' ~:~~~~",?_~~~~!!.~.!'"~~~~_::~J'fII11 ro."~~I'7.~r."~Ic:/!~~~~n~'1B.~' Phuo'ng phap nfil'3 kin: o ~l!0'ng 1!~j~6 phap nal: cau tao cua I1_~thcin_g_me nen 11l_Qng C_O:t h~_nb nban hit _g_ao_h_Ql1 ~i y,Ey nguoi ta Jam YEQT ~&~\ d@ tho m9t phAn IOn hai tho' (chu y~u b CO2) / g_~nJDifQ_~ua ~~Db-,nh,an eta: bay ngoai, o Tuy nhien, nSu van th& ct~ kh6ng clung ho?c k5' tlm?t khong t6t cling co , th@ gay r6i lO?l1trao de,i CO2 >- Phu'o'ng pilap gay me kin h03n toim: o Trong phUOTIgphap nay, ngrl'oi tA c6 thE dCmg lo~li may: ~lay_'jQLJI:li" ho?c he th~g_kin o Klli dLll1gh~ th6ng kin nguoi taphili dLll1g ky thuill_LW_fup C~ Q.illJg~ta,., Q." v' ,\' t rJ ~'R ()'" ~"', ~ ,~ "'J P 2.- ~1r) I f VIA/Cc? [bin ] ,u' (IV: rl ~ V1J>'((J J i1).L.vvJ._ , Ie i"'t rr1J" Phan ~ mu g21Y te pt [/7, • 1' eo ,j\-"';'L 'I~ I , " /!:\ cC' \f\b ~vt;;>.' ,,,-,,, o;n I!LJ v"/ v vv~ Y[./ ) f) j,- • (J 2.1 Gii y t~ t?i d,q~V3 gay te ti.!'~g l&p '" c· {', I· " ~ I b'J 0"" Mil f '(1)"",,- Gay te o to-i ch6 13 bam thu6c te VaG vlmg dinJ1 GaU thi te d~n No -khae v6i gay te b2 m~t -_._ -th~n kinh rna te (;(1ncmg va s3jJ, _. _ _ '_ '." ",_",'" a ch6 m6, thu6c tf ngarn d(;n n6 khong nhflng Jam te _ng'.1n rUXfng Lao dang Ky thuat Y te 11 B9 man Gay me H~6isue t:i.ii1rii:~~).otji.i-\1.ili:;~iiii~El1ii.,i;r:"ii:';:';~~ wLll'Oi _ • den th~no lonz ~"'"''o'~'o''' \N Sa." sa sinh manu "0 (i'viilipl'\' \ • ~ ~ j' l(?- j 1£ r thuonz -~·"O ,h'mo cho tl"P nhi?, nh~t ~-"O nhi~ll -'-~ - - ~) , ~ ••121 ~ Tn", ,,~ , OtLk -eli"' ) NL ~ ~ Bang 1.~lHmrng d~n-? chon co' Bng noi uuan duO-fig mieng • J, ) • til" :+ f~ii~U diti_'_l Tu6i ,N;& qLlt~ bJl6' ~ \:tJ&l t~ 6,1• lron So sinh i-tl~"jGte" '~( (: ~ rib" , 12 Thi~u thang t G '" , !-, tr~ng'(~rri)~ n'" I- D~iY7fki~t I I 3- ,5 £)11thang - 12 + tu6i 12 + tu6i/4 Treem N(i~c/\J.("'- NgU'O'i Ion ~V) cl'c -1ft/" felt' Nil - I -:-) I(~d.~(r&- '0 f'J,£i ~~l dl~ k~"c ~ ((f'Y) 1ft " - t~Q_ , 19 -20 20 - 22 7,5 - 8,0 Nam -,$'llIL/ k[?u' r g,v Cb ~~):.t I t k~ '£[~L CUD, " M9t ue ~ larp_llong' (Mandrin), ong noi , '/.'" lL~' cfttr 0' 1i.rm Z _L~M,nplM~:fr~'J=f7f:ii'f',:~cp:;:;nr~~7iTi:::Wn~ o rhn~n ~ '-" "'.a1l1:1 cac H11,r\{' hi ~I ~_ 1'I,.J1.!L~"'l'.J""" Etomid~L.t.~_, ~tp K etamin m~ T"';Anpl1thfll1 TLJ' J l-'.1 I." ;m·iu~n z."_~_ • '-"-.1 , ! .J L.l.'-'.t"_ I l.\ 1.0_ l !., L"'- L-/ '-I.L.J I L ' l l.L.l., Fentanyl, Sulfentanyl, Halothane, Isoflurance, Enflurance, Sevoflurance o Chuan hi cac thuoc ? " AV en~fc_l.lLy Q ' gian co: Suxamethonium, Esmeron, Norcuron, Arduan, Pavulon o Chuan - /' v -f L(H" ~ri chulzn bi cae thu6e ti~n me, thu6e gi!in co, h6i sue o Chu~n bi cac thu6c ti~n me: Mizazolam, Seduxen, Dolargan, Morphin, Di~edro,l, !:\!r?pi_t1,Aminazin o Chu~n bi c8.C thu6c me: Thiopenthan, Diprivan, Etomidate, Ketamin, Fentanyl, Sulfentanyl, Halothane, Isoflurance, Enl1urance, Sevo:f:1urance · -. -p;~~-1-7- ~~~t!~~~Ufii!!'~~Q~'!~_l2 !"2:."£:4-;~.U~;u~~~UIiil'I.'ie2'?' ! ~~'~_!1'~£!!{§:=~!";~:! ~;i!!~;f ~~rn~g~f"_'b-"ill."P-'t1t~!GI~61Y.IMfI~"'l"Ill£ "itivaf;ep =:i~tlwi"JW.l"N Giao trinh GfvfGTCI3 J- C'ao ci(1ng GNf ' - J({ ~~, /'~/Vftc~ Ph~u thu~t vien phai th~n tr9ng ki@m tra l?i tiSn hanh ph~u thu?t (] nhfrng bQ ph?n d6i xling Clla co th~ nguai b~nh Sau cUQcph~u thu~t, bac S1 gay me h6i sue va ph~u thu?t vien khong duQ'c di qua xa ph?m vi b~nh vi~n va d~ l?i 9ja ~~iJ~ r~~g_l~j: ?~_!1_h_'1i~n, ~t Ilh~~trong 24 gi.a d~~ ~~.thea d5~va xu ~Ykip tl1_ai nhfrng di~n biSn x~u ella nguai b~nh cAe RU.C TIEN nANH III Cl) THE 1,·Alen me'" 1trm::~4tr~!~~~~~~~5f~A'"'~~~~:li'li""~fW~'·r~~~'D""P~~~"~~ r ~ !!!!.!.~!.r_;~:'E~f\·U~J~Q!:V.""£:~·,~.:m.'iJ:1!I\5;6.!mtriW Gicw trinh GhJGTCB 1- Cao dcing GJyt .~d!":!!(;:iU'1~ h· P~ie-21 ? kTha' J1/1 , ' vl, fr1JY",'("anl! ,,,\ /b ,·J InO I, o Thuc hien nhieu truce mo o Trong khuon kh6 kham ben ngoai benh vien d6i voi cac benh nhan m&ngoai tru o Viec tham kham nguoi gay me h6i sire thirc hien o Cac s6 lieu duoc ghi mot tai lieu kern thea to phieu gay me o Thu t1,1Chanh chinh nhan benh: Ki~m tra dung ten - loai m6 - yell ciu dac biet cua loai mE>- nhtmg xet nghiem chinh v~ tim, phoi va ti~t nieu - giac ngu va dau dem tnroc - thut thao - ngung an va uong o S~p xep, chuan bi va thiet lap cac phuong tien o Kiern tra may va phuang tien giup tho, phurrng tien khai thong duong tho luon s~n sang ho~t d(>ngco hi~u qua va phu hgp b~nh nhan, may htlt o Ki~m tra thao b6 rang gia L~p d~t cac phuong ti~n thea d5i (m~ch, huy§t ap, 6ng nghe, ECG, thong khi, phan tich Oxy, CO2,, nhi~t kS t6i th~u phal co huySt ap va 6ng nghe) o Cac g6i chen, day bUQCdu ch~t lTl.3 kh6ng gay t&n thuang thin kinh V8 tu~n hoan, anh sang VLIa phai, khong chiSu Qen thing VaGnguo'i va m?t b~nh nh~1.ncho t6i da me ho~c b~t d~u ph~u thu~t o £)~t tu thS dung b~nh nhan tren ban m& lien quan d§n lo~i ph~u o KhiJh£Y,g&i tu: thS d.t d@t1,1thuySt ap nen phai thay d&ittl tll' * ~~ •• - ~ Cho thu6c tiin - me: ,~ •• ~' • " •• _ .••• -_ ••• -_ •• Co ml,{C aich o La an th~, giam dau, giam 10 sg va lam ng~t bOtgiai do~ kfchthich Clla gay mt.~ o Giim chuy~n hoa co ban o Ch6ng l~i cac phan Xj.'.!:ri~lo:am3JiT;iW!l·,.1II!'tl:.t."' zut3ru~~ t-.r"n; $(t:iilM;.ll;MlSS3l~t."'~"L"'JI ~d ~!':IU;;l',l.~";Jj1~';l;- ! Day la giai dean benh nhan d~n 6n dinh, Giai doan chi phiu thuat nho kh6ng c~n gian ~o Bi€u hien tren lam sang: o Benh nhan nam yen o Nhan cau CU GQng, dong tir co oMit phan xa nuot oMit phan xa mi mat o Ho hip G~U co nhip tho cham o Mach, huyet ap dong mach binh thuong C~ct-j1fuw;t -Nl:r) NEn d~'t cky -Ii J> rt ncig Til nhan c~u dung yen a gifra eho dSn benh nhan tho 3.21 Giai doan cham, co lien siron hoat dong y§u Bi€u hien tren lam sang: o Giai dean benh nhan tho d~u nhirng thuong hru giam o Nhan c~u dung yen oMit a gi Ira, dong tir co phan xa h~u hong o Mach va huyet ap tra l~i binh thuemg o Giai do~n co th@d~t dllQ'C6ng nQi quan Day la giai do~n ph~u thi@t t6t vi co gian vtra phai, cae diu hieu sinh t6n 6n dinh 3.31 Giai do~n Til cac lien suem giam ho~t dQng dSn ngling ho~t dQng, khong nen a giai do~n qua lau cu6i giai do~n bi€u hi~n lam sang: cJ k/~fh ~ J c/w H,A 2. TIt ,I' Jo Ho hip nong (li~t eo b\lng, li~t d~n cae co lien sU'Cm,ho~t d9ng go/hoa~ ~-9~ nr:t /;!VI ~ , binh thuemg) b~nh nhan tha b\lng nhanh nong t[i me D6ng tu gian nh~,phan x~ giac m~c m~t, m~eh va huy@t ap giam nh~ 3.41 Giai do~n 4: Giai do~ b~nh nhfu1ngilng tha hoan toan, co nhao, d6ng ill gian to, m~t pharr x~v6'i cinh sang, m§_th§t cac pharr x~ m~t kh6 day la giai do~ chuy€n dk d~n thm kY ng9 dQcthu6c me Bi€u hi~n tren lam sang: o H6 h~p nong kl10ng d@u, ho~t d9ng giam r6i ngung tha (cac co lien smill -ri~fnoantO~ll1, ho~t dQng co hoanh giam dAn) o M~ch ch~m d~n, huy~t ap dQng m~ch t\1t S3_U o Kill thea d6i b~nh rman n&u th§y nhung d~u hi~u 6' £.,iaido~n eua thm nglmg thu6c me l~p nrc, n~u kh6ng b~nh nhful se bj ngQdQcthu6c ky ill, phai me va dfrn aSn tLr vong ~.t"~~'IDtffti 2!!~ ! ~~.!~~~~!i.!"HJ·"''5'~~';!E~~~3.;.r.,i!a;DY~~~'E!t~~~~:!!·!y:~r:'~~~.~§"~~fJ.!.'!:::!._'l~§.~!~,'i;{.~~~~r.Zlii~P?r.ii.r5i:5J}~;.~~clH:."I i.'~lJ"lli.C£J~-m~~'!i~i; Gioo trinh GAfGTCB J- Cao tiling GJ~1 · Page 27- " rTr'I'J·.'·' r nm -= , TV Kj' /,1 \ • \ ~ (tnoi xy ngo -+,,- "." GQC tnuoc A"\ me) Luc D- DJNH DO ME - DANH CIA NHU cAuruuoc ME co th~ nr vong TREN LAM SANG Thirc t~ tren lam sang hien kh6ng th~ sir dung phuong phap cua Gueldel et@ xac dinh d(> me vi cac loai thuoc me cang ly tuong kh6ng trai qua thai ky rna chuyen sang thai ky dS ph~u thuat } D~n na1111943 Gillespie eta hoan chinh bang bang each them vao nhimg pharr X? dap irng cua co th~ kill TI:tchda d~ m6 nhu phan X? h~u, quan, chay nuac m~t Do d6, ngum ta nghien CLmcach xac d!nb nhu c~u thu6c me d6i vOi b~nh nhan tren lfun sang bfuIg nhi~u phuong phap va nguCrita nh~ th~y ~g n6ng d(>thu6c me trong_mau Q6ng mach quy~t dinh tri~u chUng tren lam sang, v~y dS duqc n6ng d9 thu6c me " mau d(>ngm?ch ~ >- va r~t kh6 thvc hi~n H011 nila, gay me su dVng nhi~u lo?i thu6c me ph6i hqp, do r~t kh6 xac dinh d9 me Vi v~y, nguai gay me h6i suc phai dva vao d~u hi~u Him sang ella b~nh nhan 1a sv dap ling cua co th~ d6i v6i ph~u thu~t hay gQi la "cac muc d9 kfch thich" );> Hi~n nguai nguai gay me c~n dlla tren nhung phan {mg d6i khang ella co th~ b~nh nhan vai ph~u thu~t d~ danh gia d9 me, no kh6ng dUQ"c rang nhung sat v6i thgc t& >- Dva vao SlJ kich thich va sg d6i khang Clla CCI thS b~nh nhan d5i v6i ph~u thu~t nguai ta chia lam muc d(>me: o DQ me trmyc m8 (Nh~ chu'a oil d~ m6): BiSu hi~n tren lam sang Clla b~nh nhln la: 10 rna, m~t do, nSu kich thich thi chay nuac m~t, 1?0Ch nhanh, 1l!:!J6t ap ~- tang, tang truang Ivc co ~ o DQ me ph~u thu?t (me vira du d~ rna): I< hi chuy~n tu d(> me truac mE> sang dC)me ph~u thu~t bi~u hi~n Clla b~nh nhan qua cac tri~u chCmg sau: 1\tRh d( ~.1frtphan x?- mi m~t 1£ , tnrung 1vc ca gay t\1t h'am Gwm A , " {fA rtc10 -30% -HA iSt t7J BNB! \({'va,-{i~"''''~Oiiiii~m'rUiiiiii ~iiiiii'ii;"," me Hoi sire Benh nhan nam yen khong dap ling voi cac kich thich cua phau thuat D6ng tir benh nhan co 006, mit irot o -DQ me sau (qua li~u thuoc me): Bieu hien tren benh nhan: Huyet ap tut, r6i 10~mnhip tim neu keo dai co th~ ngirng tim Mit kho , dong tir gian Da lanh nhot nhac, co nhao IV ANH HUONG MUC DO DAU TRONG QuA TRINH PHAU THU~ T o Khi danh gia nhirng phan ung ella ca th~ Woodbridge da dS nghi gay me c~n hru y cac ySu t6 sau: earn giac, van dong, tinh than va cac phan Xtrinh GjVIGTCB I- Cao cking GAt P(Ig