l . T h a y doi ve ho hap
Khi C 0 2 d u g c b o m va o k h o a n g p h uc ma c 6 b u n g la loai khi k h u y e c h tan rat n h a n h , d u g c h a p thu lai tir p h u c m a c va co the’ g a y ra ta ng C 0 2.
N h u n g n g u g c lai vdi ap luc C 0 2 born vao k h o a n g p h u c m a c o b u n g g ay c an trd p h an n a o tua n h o a n p h u c m a c se lam g i a m sir tai h a p thu C 0 2. Sir e p va g i a m di d o n g ciia c o h o a n g se lam tha y doi chi so t h o n g khi / tudi m a u ( V A / Q ) ddn d e n hi en t u g n g s h u n t d n h u n g v u n g t h a p ciia nhu m o p ho i va hieu irng k h o a n g c h e t d p h a n t ru dc ciia phdi. Hi eu irng k h o a n g c h e t se g o p p h a n lam t a n g ap lire C 0 2 t ro ng m a u d o n g m a c h ( P a C 0 2). C o c h e t a n g na y mot p h a n c o n do tu the T r e n d e l e n b u r g . Su ta ng C 0 2 n a y c o n c o the’ g i a t a n g khi b o m C 0 2 n g oa i p h u c m a c de lay h a c h k h u n g c h a u h o a c khi t h u c h i e n sai ky t huat c h o c troc art q u a t h a n h bung.
2. T h a y doi ve t u a n h o a n
Khi b a m C 0 2 vao k h o a n g p h u c m a c o b u n g , chi so tim g i a m t u a n g urng vai dp luc C 0 2 dirge b a m . Su g i a m chi so tim c o n lien q u a n de n s u g i a m k hoi lu g ng m a u tinh m a c h trd ve tim c u a nira d u a i pha n c a the do s u c h e n e p c dc tinh m a c h Ion t r o ng o b u n g khi b a m C 0 2. Song s o ng vai cdc hien t u g n g neu tren, sire c an m a c h m a u he t h o n g ta ng se lam c h o h uye t dp k h o n g g i a m m a c o n tang len m a c du chi so tim gi am.
Su tang sue c an m a c h m a u d o s u c h e n e p c dc than d o n g m a c h t r o n g o b u n g do tang dp luc khi b a m C 0 2 lam h u y e t dp ta ng va s u ta ng h u y e t dp c o n do su giai p h o n g cdc c h a t c o ma c h .
Tu y nh ie n, tu the T r e n d e l e n b u r g c u n g cai thien p h an n a o sir t r a v ! tim c u a m a u tTnh m a c h va lam ta ng nhe chi so tim c u n g n h u vo'i dp luc d o n g m a c h phdi t rung binh va ap luc t r o ng long ngu c.
3. C a c t h a v doi k h a c
Do ta ng dp luc t r o ng 6 b u n g c u n g vdi tu the T r e n d e l e n b u r g se tao diSu kien t hua n lgi c h o sir trao n g u g c di ch d a d a y vao phdi. N h u n g c o n g trinh n g h i e n c uu ga n d ay d a x ac di nh dieu nay.
Su kfch thich philc m a c do C 0 2 n h a t la a v o m h o a n h se lam d au vai va ba vai trai sau mo.
Ill- KHAM TRIT0C MO VA Ll/A CHON BENH NHAN
Bilan t ru a c m o noi soi ft co van de d ac biet so vai m o t h o n g t h u d n g . Chi c an hoi be nh n h a n ve tien sir va b e nh tat va k i e m tra lam s a n g va 1 so xet n g h i e m c a ba n c o the c h o p h e p d a n h gia cdc n g u y co' d o g a y m e va q u y e t d inh t he m mot so k i e m tra c an thiet .
1. C hi di nh m o noi soi p hu k h o a
N g a y nay do di sau n g h i e n c uu sinh b e n h ly va ky t hu at m o n e n c hi d i n h m d noi soi d u g c m d ro ng . Co rat n h ie u chi di nh m d noi soi vdi m u c dfch c h a n d o a n va diSu tri ( c h u a ng oa i da c o n , diSu tri vo sinh, u b u o n g trurng va u b u o n g t r un g x o a n , v ie m vdi tr un g, lac noi m a c tu c u n g , triet san, sinh san trg giup, cdt tu c u n g ...) T r o n g p h a m vi bai nay, c h u n g toi k h o n g di s au vao cdc chi d in h p ha u t huat noi soi.
2. C h o n g chi d i n h m o noi soi t r o n g phu k h o a
Cdc c h o n g chi di nh c o di en da neu t ron g p h au t hua t noi soi b a o g om : - T a n g dp lire noi soi
- G l a u c o m e
- Ti en sir tran khf m a n g phdi tu n h i e n - K h f p h e t h i i n g
- Sir doi d o n g m a u tarn that - Shunt levine
IIinh 1°: Dung monitoring theo doi ngUoi benh trong noi soi
M ot so tinh t ra n g b e n h ly k h a c, co the’ c h o p h e p m d noi soi n h u n g phai t he o doi het sire th an trong.
- Benh m a c h v a nh h o a c be nh tim: t rong q u a trinh m o phai th eo doi het sire n g h i e m n g a t ve h u ye t d on g. T u y n hi en m d noi soi c u n g c o lo'i vi c h at lu g ng luc tinh va g i a m ty le tac ruot sau m d lam c h o sir d i l u h o a khoi lu gn g tua n h o a n d<§ d a n g hon.
- Suy ho h a p m a n (b e nh ly phe q u a n - phoi tac h o a c h e n phe q u a n tudi gia) c u n g c o the m o noi soi d u g c no ha n c h e a nh h u d n g c h u c n a n g ho hap sau md. T u y n h ie n phai d u g c c h u d n bi ky va t h e o doi da c biet vi d ay la n h u n g b e n h n h a n gia.
T o i s i g n a n t va c o n g sir da c h u n g m i n h c o sir anh h u d n g d e n c h u c n a n g ho ha p sau m d noi soi d n h u n g be nh n ha n tren 50 tudi.
- N h u n g b e n h n h a n q u a be o ( beo b eu ) n g a y ca luc n gh i ngoi c h u c n a n g tim va t u a n h o a n c u n g da bi anh h u d n g . Sir t an g ap lire d u d n g t h d c u n g t h u d n g x u y e n co tren n h u n g b e nh n ha n nay. Vi va y phai g a y m e that tot, ba o d a m that m e m c o mdi gi up c h o pha u t hu at noi soi dat ket q u a tot. - N h u n g phu nir c o thai thi pha u thuat m d noi soi c a n phai ton t r o n g n h u n g