1. l ien me
- C h o n g non', c h o t h u oc c h o n g non va b u o n n on t r o ng m o noi soi la rat la rat c o y nghTa vi ty le b e nh n h a n non va b uo n n on sau m d c a o , theo Bailey, ti le n a y c h i e m 6 2 % c o n c h u n g toi ga p 3 2 % . Sir d u n g a t r op i n s u n f a t t ro n g tiSn m e da han c h e non va b ud n non sau md. N eu sau m o vdn c o n b u o n non, n on thi c h o tiep a t ropi n sulfat t iem du di d a (co the g i a m 5 0 % ) . N h u n g c o the’ lam k h o m o m , n h i n kho. N eu vdn n o n k e o dai c an n g h i e n c u u c o the thiing d u d n g tieu hod.
- C h o n g to an: vdi n h u n g b e nh n ha n m d co c h u a n bi thi van dS n a y it q u a n t r on g h o n b e nh n h a n m d c a p ciifu, c h u n g ta co the c h o natri ci tra t 0 , 3 M ket h o p vdi c i m e t i d i n h oa c r a nitidin de d u p h o n g hoi c h u n g M e n d e l s o n . M a r c h i va c o n g sir d a c h u n g m i n h sir c h o n g to an t ru d c khi k h d i m e se lam t a n g pH c u a di ch vi m o t c a c h c h a c c h a n va k eo dai.
2. G a v te v u n g
Chu yeu t h uc hi en t ro n g noi soi c h a n d o a n va phdu t hu a t d u d n g tieu hod. M o t so c o n g trinh n g h i e n c uu da ggi y mc> noi soi c o thS d u g c t h u c h i e n dudi g ay te vung. K y t hu at n ay lam c h o b e n h n h a n k h o c h i u do C 0 2 g a y da u
kich thfch c a h o a n h va ret run t r ong mo. V a lai su p h o n g be' d o g a y te n g oa i m a n g c u n g c a o (T2 - T4) c o the ga y urc c he tim va lam n a n g t h e m sir g i a m m a u tinh m a c h tro v<§ do ta ng hieu lire c u a 1 so tac d u n g k h o n g tot khi b o m C 0 2 vao k h o a n g b u n g . T u y n h i e n C i o f o l o va c o n g sir k h o n g tim t h a y sir thay doi ho hap co y n ghla dudi gay te ngoai ma n g c u ng trong phau thuat phu khoa. Te vu ng co the lam c h o tinh t ra n g b en h n h a n sau m d t hu an lgi h a n , t ra n h d ug c nhurng hau q u a v6 ho ha p m a t r ong gay m e toan the t h u o n g gap.
3. (Jay me t oa n the
3.1. Mot so van de can hcu y
- Vdi gay m e m o noi soi, c h o t h u o c m e phai du de t ra n h c ac k i c h thich gay p ha n xa k h o n g c o lgi
- T r o ng ga y m e phai dat o n g noi khi q u a n va ho h a p dieu k h i e n b a n g c a c h c ho t huoc d an c a d ay du. T r o n g m o noi soi phu k h o a va tieu h o a tang th o ng khi do t a n g the tich khi luu t h o n g de d u p h o n g t a n g C 0 2.
F l et c he r va J o n s o n c h u n g m i n h r ang the tich khf luu t h o n g ldn se t h u a n lgi c h o sir k h u y e c h tan o x y hon la the tfch nho. C ac chi so k h a c n h u tan so ho ha p va ti le hit v a o / t h d ra (I/E) phai d u g c dieu c h i n h c5n than de t r a n h t an g q u a mure ap luc d u d n g thd, co the ga y c h a n t h u o n g do e p va k h o n g tot c h o h u y et d o ng . Vi tri o n g noi khi q u a n phai d u g c k i e m tra moi khi t h a y ddi tu the b en h n ha n va sau b a m C 0 2 d b un g.
Ne n dat on g hut da d a y sau khi dat o n g noi khi q u a n va t r u d c khi c h o c trocart de d u p h o n g c h o c t h u n g da d a y c a n g d o di ch ur d o n g va khi ho h a p bdng mat na luc khdi me. D e tranh ho h a p b a n g mat na c o the c h o t h d o x y 100% hit sau 5 lan t rudc khi tiem t h u o c me.
- D at o n g t h o n g b a n g q u a n g c h o nhurng phdu t hua t t r o ng tieu k h u n g v a m d lau.
- D a t b e nh n h a n d tu the T r e n d e l e n b u r g c h o m d v u n g tieu k h u n g
- M d noi soi " N g u y e n tac 15 - 15" d u g c ton t r on g (ap luc o b u n g 15 m m H g ; tu the dau thap 15°)
3.2. Cdc loai thuoc me, ddn co, giam dau dung cho gay me
T h u o c m e
- T h u o c d u g c Ua d u n g n h a t hien n a y la p r o p o f o l ( D i p r i v a n ) t h u o c n a y c o tac d u n g tot, tinh n h a n h va khi tinh thi h o a n t o a n thoai m a i ne n n o la t h uo c me ly t u d n g c h o n g o ai k h o a noi c h u n g va m d noi soi noi r ie ng. - T h u o c me hoi n h o m h a l o g e n c u n g h a y d u g c s u d u n g n h u h a l o t h a n ,
is oflura n...
H a l o t h a n co tac d u n g d u y tri m e t h u a n lgi, m e m c a va ha h u y e t ap. N h u n g no lam loan n h i p tim khi c o t a n g C 0 2. N g u y c a k h u y e c h t an m a n g phdi ha y t r un g that c u a C 0 2 va tac m a c h , yeu c au t h e o ddi c a n t ha n khi d u n g vdi N 20 t r on g noi soi
N h u n g n g h i e n c uu thuc n g h i e m d sue vat da so s anh s u tac m a c h do C 0 2 t rong khi th on g khi vdi hon h op 0 2/ N 20 va 0 2/ khf da c h u n g m i n h r i n g sir d u n g N 20 lam n a n g them n h u n g hau q u a tim m a c h ho hap. Khi nghT d e n tac m a c h do khf c an n g u n g n g ay N 20 va c h o o x y 100% >
Cac thuoc ddn ccf
T h u o c da n c o c h o dat noi khi q u a n t h u d n g d u n g la s u x a m e t h o n i u m , d a n c o duy tri sau dat noi khi q u a n t h u d n g d u o c d u n g la a t r a c r i u m ( t r a c r i u m ) n goa i ra co the d u n g p a n c u r o n i u m (P a vu lo n) h oa c v e c u r o n i u m ( N o r c u r o n ) . . .
Cdc thuoc giam dau: Cac thuoc ho morp hi n hay duoc d un g nhu: Pethidin, fentanyl, alfentanil. Hien nay c hu ng toi t hudng su d ung pethidin va fentanyl. T r o n g duy tri me, c an su d u n g t huoc me, g i a m dau, da n c o du lieu tra nh be nh nh an thuc tinh t r on g q u a trinh phau thuat.
4. T h o i ky sau mo
4.1. S u tinh tluidc (thodt me)
- Da t be nh n h a n trd lai tu the n i m n g u a t h a n g b a ng roi t h a o d an C 0 2 t rong o b u n g m o t c a c h tu tu.
- Can me du sau c h o de n khi tha o C 0 2 o bung .
- Doi khi c an d u y tri o n g noi khi q u a n va t h o n g khf t ro ng p h o n g hoi tinh de’ d§ p h o n g g i a m 0 2 va tang C 0 2.
- T r uy tim m a c h va bat t h u d n g ve than kinh co the la dau hieu c u a tdc m a c h do C 0 2 bieu hien m u o n ( m o n i t o r ) tim m a c h va ho h ap phai d u o c d u y tri c h o de n khi b e nh nh an tinh tao hoa n toan.
- Su n g u n g t h d phai nghi de n t i c m a c h khi, tran khi m a n g phdi , tran khi t rung that bieu hi en m u o n .
4.2. IIau qu a va hien chung sau mo:
Buon non, non:
N g o a i c a c ye u to n g u y c o vdi tat ca c a c phau thuat (tudi, nu, b e o be u, me t moi, lo lang, liet da day, loai ph au t huat ....) ne u de o n g hut da d a y se lam tang n g u y co' n on , b u o n non, co the d u p h o n g b i n g c h o t h u o c c h o n g non t rong tien me , c a c h g a y m e va d i l u tri sau mo.
Chi'nh s u d u n g t h u o c p r o po f ol han c he d u o c non, b u o n n o n sau m 6 n g a y c a khi sir d u n g ket h o p N 20 , sir d u n g p r op of ol t r ong g a y m e ket h o p vdi t h u o c g i a m dau phi s t er oi d ( AI NS ) sau m o da han c h e m o t c a c h d a n g ke n o n va b uo n n o n sau m d. E p h e d r i n 0,5 m c g / k g tiem tinh m a c h t r o ng m 6 da c o hieu q u a c h o n g n o n sau m d va k h o n g co tac d u n g phu. Sir k e o dai c u a n o n va b u o n n o n sau m d c u n g c an tim ton t h u o n g da day, ruot, ne u c a n thiet phai c an thiep n g oa i k ho a.
Dau: sau mo, b e nh n h a n c o dau 6 bung, vai, ba vai do C 0 2 kfch thi'ch p h u c mac, be nh n h a n da u n hi eu hon d vai trai do C 0 2 len cao. D a u sau 6 c o q u a n md, dau it hon d d i e m c h o c .
Can phai c h o b e nh n h an t h u o c g ia m dau dac biet ho m o r p h i n ( f e n t a n y l . Pethidin, alfe nt ani l ...) rat c o y nghTa t rong m o noi soi. M ot so n g h i e n cuu thay dau co the g i a m sau m d neu c h o trudc va sau m d c a c A I N S n h u d i c lo fe n ac , i n d o m e t h a c i n , n a p r o x e n . T u y n h i e n sir d u n g c a c A I N S thi ft t ho a m a n t rong m d phu k ho a, c h o t h uo c me tai c h o lam g i a m mo t c a c h c o y nghia nhu cau g i a m da u sau md.
Haii qua ho hap:
Nhieu tac gia k h u y e n c h o g i a m dau s dm va thich h o p sau m d n h a m lam gia m n g u y c o ve ho h ap va b e nh tac m a c h , nh at la n h u n g n g u d i be o beu.
5. Ich loi c ua m o noi soi
- Sau mo noi soi, benh nhan ft dau hon so vdi md thong thudng do seo be. - La p h u o n g p h a p m d m a n g tinh t h a m m y do seo be.
- Ty le dfnh, tac ruot sau m o rat thap, c h o p h e p b en h n h a n an u o n g trd lai sdm.
- So n ga y n a m vien g ia m so vdi p h u o n g p h a p m o cd dien. - Hoa t d o n g n g h e n g h i e p s dm trd lai.
N h u n g tien loi n a y dac biet d n gu di c o thai, beo beu.