Hinh 6.7. Dtfdng rach can, giai phong khoang d cSng tay (Hargens)
4.4.3. Dieu tri hoi chung Wolkmann
Giai doan sdm (sau 1-2 tuan): gay me, bo bot duoi cd tay va ngon tay ttfng giai doan, ket hdp vdi thuoc giam dau, giam phu ne.
Dieu tri hoi chting W olkmann muon: rat kho khan, doi hoi chuyen khoa sau ve phau thuat chinh hinh. Ty le tan phe cao.
5. HOI CHLfNG CHEN EP KHOANG CANG CHAN
Hay gap sau mot chan thUdng; 80% co gay xtfdng
Vi tri: gay mam chay, gay cao than xtfdng chay (doan co cd bung chan rat ch&c, rat day).
Co 4 khoang c in g chan: khoang trtfdc, khoang ben, khoang sau nong va khoang sau sau (xem hinh 6.1).
5.1. Lam sang
Trtfdc day con dtfdc goi la hoi chtfng bap chan cang
M atsen dtfa ra 5 bieu hien lam sang cua hoi chtfng chen ep khoang c£n g chan nhtf sau:
- Dau qua mtfc thong thtfdng cua mot gay xtfdng, mac du da dtfdc bat dong chi gay.
- Cang ctfng toan bo cang chan
- Te bi va co cam giac "kien bo" d dau ngon, ve sau khong con nhan biet dtfdc cac ngon.
- Dau tang khi van dong thu dong, cang dan cd b&p - Liet van dong cac ngon
5.2. Can lam sang
- Do ap ltfc khoang: neu ap ltfc khoang >30m m H g, c&n rach can ngay d«? giai
phong chen ep.
- X quang: chup X quang thUdng (chan doan gay xtfdng); chup mach mau. chup C.T
- Xet nghiem cong thtic mau, sinh hoa mau, yeu to' dong mau.
5.3. Dieu tri
5.3.1. Theo ddi: khi lam sang chtfa ro ret; ap ltfc khoang khong cao (hinh 6.5)- Cho benh nhan vao vien, keo lien tuc tren khung Braun - Cho benh nhan vao vien, keo lien tuc tren khung Braun
- Cho thuoc giam dau; giam phu ne; khang sinh - Theo doi lien tuc 6 gid
5.3.2. Dieu tn p h iu thuat
Phai md can cap ctiu ngay khi dau hieu lam sang ro rang, ap ltfc khoang tang cao >30mmHg.
- Rach can: rach can 4 khoang bang 2 dtfdng rach: dtfdng rach ngoai (vao khoang ben, khoang trtfdc), dtfdng rach trong (vao khoang sau nong va sau).
- Dtfdng rach: di suot chieu dai cang chan, rach dtft can nong, can sau (can noi cd cua cd dep), lay het mau tu, kiem tra bo mach khoeo va chay sau (xem hinh 6.8)