II. CAC TAI BIEN, BIEN CHUTNG
a. Tac mach hoi:
Tdc m a c h hoi la bien c h u n g ft gap, n h u n g lai rat n g u y hi em.
N g u y e n n h a n g ay tac m a c h hoi c o the do k im b o m hoi c h o c vao m a c h m a u , co the C 0 2 vao t h a n h m a c h d t ha nh b u n g khi c h p c h o a c rut t roc ar t. N g a y nay, n g u d i ta c o n noi de n tac m a c h hoi lien q u a n d en viec s u d u n g d a o laser Y A G . D a u d a o laser l uon l uon c o d o n g khi de lam lanh, khi cdt to churc, t h an h m a c h d u g c md, trud c khi c a m m a u , khf c o the di va o l o n g m a c h g ay t i c m a c h .
M u c do t ra m t rg n g va trieu c h u n g c u a tdc m a c h hoi ph u t h u o c v a o k h o i l u g n g C 0 2 d u g c b o m vao l ong m a c h . N g u d i ta c h o r a n g vdi luu l u g n g C 0 2 d u g c b o m va o tinh m a c h tijr 0 , 0 9 - 0 ,1 5 m l / k g / p h u t c o the’ d u g c thai t r u ra n g oa i q u a phdi, vugt q u a luu l u g n g nay, c a c b o n g hoi se di v a o he t h o n g tuan h o a n va g a y ra c a c bien c h u n g tdc m a c h (liet n u a n g u d i , m u ....). C u oi c u n g khoi l u g n g ldn C 0 2 vao c a c b u o n g tim trai se ga y ha u q u a c u c ky n g u y hie m: n g u n g tim.
Cac trieu c h ti ng lam s a ng t r on g the n a n g la: tim tai, tu h u y e t , d o b a o h o a o x y gi am, roi loa n n h i p tim, sau d o la ngirng tim. Hu t tir C a t h e t e r t r u n g t am ra hoi la da u hi£u c hdc c h i n va la b u o c dieu tri da u tien. T r e n p h i m c h u p X q u a n g , c o the nhin t h a y b o n g hoi nSm c h o n g len b o n g tim. M o n i t o r giira vai tro q u a n t ro ng t r o ng c h u d n d o a n . D o p p l e r trudc tim t h u d n g rat n h a y de phat hien ra m a c h hoi n ho. D i e u tri c a p ciru ba o g o m : t h o n g khi vdi o x y n g u y e n c hat , dat b e n h n h a n n g h i e n g trai, hut C 0 2 q u a C a t h e t e r t r u n g ta m, xoa b op tim c o tac d u n g lam n h o c a c b o n g hoi t r on £ long m a c h va d e d a n g loai bd no k hoi tuan h o a n . C a n t h o n g khi phoi vdi lieu p h a p o x y a p luc c a o de g i a m c a c di c h u n g nao.
b. Tran k h i cdc k h o a n g ngoai o bung: - Tr an khi m a n g p hoi la bien c h u n g ft gap.
N g u y e n n ha n: khf tran tir b u n g len m a n g phdi va t ru n g that d o bat t h u d n g ve giai phdu. Tr a n khf m a n g phoi t h u d n g x a y ra tir tir, ft khi g a y k h o t h d va co the ha p thu tu nh ie n.
N g u y e n n h a n thu: hai la lam thiing c o h o a n h khi m o , g a y t ra n k hf m a n g phoi n a n g c a n ddn luu m a n g phoi n g a y lap tire, n g u y e n n h a n n a y k h o n g g ap t rong phdu t hua t noi soi p hu k hoa .
- Tr a n khf d ud i da t h u d n g g a p t ro n g phdu t huat noi soi. T h u d n g g a p t r o n g c a c thi c h o c ha y rut trocart, khi lay b e n h p h a m , n h a t la khi c o r a c h r o n g th e m t h a n h b u n g . K h f co the lan n h a n h de n c a c v u n g k h a c n h u d t h a n h n guc , cd, lung. Bien c h u n g na y h ay gap, t h u d n g k h o n g g a y n g u y h i 6 m gi va hap thu tu nhi en.
- Tr an khf n g o ai p h u c ma c: t h u d n g do d au k i m b o m C 0 2 c h u a q u a p h u c m a c , C 0 2 l am t a ch l a p p h u c m a c o b u n g . Bien churng n a y h a y g a p va ft n g u y hi em, c d the sau c h o c tr oc a rt ddn luu khf la het.
- Tr a n khf d m a c treo, m a c noi ldn, d a y c h d n g r on c u n g d o ky t h u a t c h o c k im b o m hoi k h o n g d u n g k y thuat.