Tài liệu ôn tập cho kỳ thi tuyển viên chức ngành y tế năm 2017giao trinh gay me gay te II flie 2

Truong Cao dang j(y tnuat 1te 11 oo J11.onLJay me riot sue ~;,S!iii ~~.~~~~~~iiSimi~~~~ilii~\.~~w.;l6~~s,.~~;;-rii.il;;iliJ.~~~~~'t~u.n.t;ruii~£!.~~iil~il~ m-~~.':;;.iwilni5iif,~w~m~~~~~llliiii&.~~ii"i,::t; c6 16t dern ngang Q!J:Qi vai, @~ ke tren mot vong tron lam s~n db giir d~u kh6ng bi di dong (nghieng nga) Khi g~p benh nhan co c6 ng~n phai dS Q~U~ui!~~EE_()'~_v~i dS giup dS dang ph~u thuat (trong ph~u thuat buou co) 1,2 :v i, tri d~ b~ thudng ton Hinh Tu th~ n~m ngfra Ttf th~ n~m s~p Fr cf-U_r;.;)i Tu th§ nk s~p duoc ap dung dSph~ll thu?t cac benh ly mat sau cua than thirong g~p rm§.ttrong ph~u thuat c_§ts6ng Trong tnrong hop chi ph~u th~t tir c6 xuong khong phai ph~uthu?t xuong chfunthi ~t benh nhan nr th~nhu sau: - Sau gay me toan than va d~t nQi quan, Q~Ub~nh nhan Quqc d~t n~m J1_ghieng_mQ_t_Q~!) ho~c n~m sfr_Qn~u c6 dVng cv than hinh n~m s~p tren ban, hai ben Il~ hong k6 l11()t g(1i tron khclC, d~u (t1vao tran ella b~nh nhan), ke hai g_~i tr9_l!dS hqEQng_!lc, ngang co dt) dan h6i t6t (thuemg lam b~ng d~m mllt) d~,than eua b~nh nhan kh6ng ti sat xu6ng ban - Sau th1!c hi~n xong, ki§m tra b~ng each tho tay vio bVng b~nh nhan, th~y bl:mg hong tren g6i 1a da: thlJc hi~n clung ky thu?t, ,v6i tu th§ mlY se tiilodi~u ki~n h6 h~p duqc dS dang Nguai gay me va ph~u thu?t vien phili chu ~&~ ~frp,c~n_~e m9t_g;~iJ.rAnnsay y d~n hai ban chan luc d~t tu th~ du6ic~ c~.~~.9~_t~~~ ~~i~~n ~~~~.~.6I1g_~L_ sai kh6p Hai canhSay d~ithuang v~ phia d~u theo tu thS co n~ng ho~c d.~~Q~ t_heoJlgucci. Page 31 r -' i Hinh Ttl' th~ narn sflp Ttl' th~ n~m nghieng , , Y3' -W~(; 1\/ [(I ,-I/ / (LLic~'t' 'V (Q_ ' AI I n~'~·~.r~9 '3 -') ? I' Il~(V ?' P 71/ ' t).'Ci _, li~1' _ ' Tir the nam nghieng tliuemg duoc ap dung p~hu_?t (than, nieu quan dean tren) va ph~u thuat cac co quan du~_g_.!i~Lni~u a J2,D.g pgy-c (phoi, mang phoi, phe quan), 3.1 Phau thuii: tlu'o'ng tiit nieu o Benh nhan QUQ'ed?t nam nghieng, lung hoi g~n canh ben mat ban ph~u thuat, g6i ke du6i xuong suem, ngang mire xuang suort X XI]d~ dua than len cao Jam cho cac khoang siron gian dong thoi nang cac co quan c~n can thiep len i'\ l1T"t, mIO' flf,,' "": (than, nieu quan) cho d~ dang thao tac ph~u thuat, b£o in- ~~ 11Ri~' tkti cf~~' ;!J)' -a;- ir-~ , o Binh thuong voi cac phgu thuat kh6ng phirc tap (l~y soi than, ni~u quim ho?c cit th?l1 mat chuc nang s6i), d6i v6i chi tren, 1e:y_cuab~nh nhan I)~m b,en Quai (ben phai ho~c trai thea vi tri can thi~p ph~u thu?t) d~t hqp v6'i than mQt goc 90,~ va d~t canh - ban tay du6i thing tren t~m n~m ke tay, a tay thong thuong c1uqe k@thqp d~t may huy~t ap kh6ng xam nh?p o 13.):: I2hia tren (t~t dubng truy~n tlnh m~~ a~truy~n dieh, truy~n mau, o D6i vm chi duo-i,chan du6'i ~p (ciing chan gApvao aui, aui g~p vao than) o Chan~n d_0j thiing ke g6i ngang giCTahai chan (tranh chan tren ti de chan dum) o Ngoai d~ t[anh di dQng qua trinh ph~u thu?t thuemg co ~6' mong, _'_ va mat obi di~n, d6ng thai dung @y co ban Ian QgQc ban mb n~c 6' tu pen D~~Y-~ng ben xuang chi;iu hong _._ - ~~ iE~!~~5~.?f~~~~i~~2!~oƠ~~~?!~~'!lf~~'!:0:'.:ll:Er;~~'~~_!~~~ilJ!l:~.E!.::!t:!:E~g-:.::;"Ê -~'ã~!!.:::::~'~~E!:~~~!E:~r;.".'".:i.'.~~~'?~Êr~~~1Đ~'!'~~~~"i!i~~~:~~~i.t~~~Ơ~~E~~~ Giclo trinh GMGTCB J.- Cao [lan,s GA} Page 32 Truong Cao dling Ky thu¢t Y td 11 ~~iiirr.Z:,1."~~~,%-f.'~~~'7~~~~ B(J man Gay me Hoi S7)'C ~~m~~~~ti~'GJ.!!IruJ(";ffi~>WiW::lif~y'~j~iYiw.~~m=ii~~~,~~tii;r~i;i O r\V,\T '-/ ,'"l )' a0," ap suat; ~neng Do khcnz it) mAt ··t"l",;-Y)l, _i:-J.l.LU.l.l "'f"'l1 ~~nr "1:r0 U : l.uy: L.1lU,J.1.Ll 'u.~.; Po.OL k"Khi' =- h~ "0 p an cua 760 mmHg 1' Vl l5 ~~l l.1, khf r'h~~iY'l vl.J.lt",; tu xy ,~'ong x 21 % lrj ·"·'~n(T r;10/~ ;.\ UV(.t :.,J_6 ;!::: l , V le a: i-i« ti"'N 1\ 1J.1 U1V $0,09' vao 'v ~ Ao : ;::jA6io fL'O,zt // luqng O2 hoa tan huySt tuang khong nhiSu nhlmg r~t quan trQng vi qua d6 O2 m6i gin kSt ho~c tach rai khoi Hb dS dSn mo 1-16 lui ui br-; ~,;j.Q- Ab ~f f ~ , ;_ _ '1yo,Q1lJ ~~,e8\'~ cf£' lib ~)Do hao._h~~a SaO? : 2t?'~6q.~ P.s:t.Q~ tab·· l\i~ tiO (Sa02): o,,_.}&; tflo ' @l o'l 0) ~ inh tlluOll.g ~a02 khoang 95 - 100% 02_~qi.l=ll?J:t:!Y_tbg9_'2_p_h~nJan_Y_~.Q_ap s_~_L~,~_~_Q _ 2Jr9P.g mau In NCUYEl'TNHAN THIEU OXY Thi€u O2 thi~u ngu8n cung c~p O2 1.1 Thi~H Oxy moi tnl'O'ng o Ap suAt khong a d6ng b~ng 1a 760 mmHg, cang len cao ap su~t l 40% keQ_~l~i co Lhbgay xa hoa sau thuy tinh thb va c:o thb G§Y1TI.1h o SlT dlfng ~y s.p ~\l'ecao co thb gay can Q_Qpg_kiDb o TI1O' Quk~i Mi)t co thb gay ~igiac va lam g!~ khoang l~_~J~_l_1!~~!1launao s6 oQc tillb khac Khi cho thO'Oxy 100% lien t\lC thai gian dai co thb gay: o Tay chan bi dau nhue o Dau kh6'p xuO'ng ~''£i~}~~~ GhID trl;~};GN{aTCB]- Cao ddng-(]Jvj · ·- . . .- - -' p~~~~ '44 , l.iFJ ,'1.w-t;.r.~2iiTk1.;!1 'Wm~,m.~ w.~;mlrn!lilf.1:;~'t~~A.~~~~~''.~'!.!t:'l.f.!!1.·:!n; ~.'ll~;I;:U$'1~'i1""j.m.~~~-r w .:n:.!;."".~1' u"M~!~.w.(f·~~/~'mi'~"f!i:tp'"";i';'1g!'»nm.':;iilS"Ziit'all'~"'i!!,-'C'~"'l;.t!i'!!.;·.:!;; Truong Coo dang 1\ y tf7.U(:l11 te Ii ~~~1iw.~'lli??~'1!i.i~E""li1ilin~-m~$~~G.ii.la~7:!1.~ DV I'mHI lJuy rrie llVt )UL ~iim9»iitJuro~~~Qa~~?ilmr:::~l~MiM:rf,t_)iiO:fiWiW~r~~iiiti:~~,~;i;t~~~v.: ,t_~~i~u 4_~_gi~L o S11 dung thuoc ti~n me, thuoc me dt:mg li~u, dung n6ng dQ o Chon 6ng noi quan thich hop voi benh nhan, kh6ng chon ong qua nho, difit6ng l1Qikhi quan phai ki~111 tra c~n than, tranh dat van mot ben phoi o Trong gay me kh6ng d~ b~nb nhan tbj§u kh6i IUQTIg tu~n hoan, bu mau d~y du o Cung c~p du Oxy cho benh nhan, h6 tra ho hap dung luc r _ o Thuong xuyen thea doi benh nhan suot qua trinh gay me, gay te 'riA.t, Mat!( l' -No"'jIJu' va~ ~ \ b~ ctJ c0? ~ (!1N leo ctau) ,G~ tcO sd f/ '1i2n m~cgJ lco s-cf e- r co JJwtcL ctdM.ho1n ' ~ M dilQC ~ I6N b.'7 t phun ap khoang chung 46 mmHg D?ng hoa tan quan trQng va n6 t?O nen phan ap CO2 a mau (PC02) va la d?ng se t~l,IC tiSp trao d6i a ph6i 1.2 D~ng dlfQ'C Hemoglobin v~n chuy~n -;-ChiSm khoang(jO~! Hemoglobin v~m chuy~n CO2 b&ng cach g~n CO2 vao - -riliOilYN-=:tii tua phah tUJ2~bih-t~o rteh~ca.~'bafh}E~lI~_~(jg!~~!d~(ft~.~~:~~- Day la 1TI9tphan ling thu~n nghich: Hb + CO2 ~ HbC02 1.3 D~ngHCO} ~~~~~'!:-~~~:2E.~~~~~~~~r-e~~\@~:r~.~~~€!l:cr"~~i-~~::;I;,.llil.~~~~~~~i31,\~,?!i~,!,~~~~~~! Giaa trinh GJvIGTCB I- Cao (16ng GJ"v{ Page 51 rU'ung l_.,UU [{ong 1\'y tnuut It: 11 VV ",VI< Ui.4'y t t t « LJ.'_" '.''''''-' ~ii~il "ii:¥:~:i.;Z:F.~iii~'"Ei~~i.i"~~r.f:':-ti.J~;';;;;~~1iii"iam?~Ta:~1M.:t,.mrz;jm'f:;i.l.;:$,i!iaiiiMiit=.i ~;~~~5iffiifiGr~~ ;;r~"-iI7Jruir~::=':::;-~~~'m nhu sau: Kh1 CO2 til t6 chirc di vao huyet t~'~1ghi~i~p tuc di VaGhong c~u Trong " , ~, if ~ , hong diu 2-0% CO2 se ket hgp vai Hb, 75% se ket hgp vai nuoc duoi vic dung cua enzim Carbonic anhydrase (CA) tao nen thC03 , H2C03 phan ly tl 'hclnh' il/Crll/ 4, Trinh bay duoc each v(ln hq!!h may gay me cbl' 'k' IcPu'seJ I DAI ClfONG i!, \/c111 '!lC1~rf) • " '" c,' ,,' , , Cac may gay me la nhirng phuong tien can thiet khong the thieu doi voi '* (?c[i1{ K,el},) ~i