CHUYEN DE: PHAU THUAT TIM MACH VA LONG NGUC VIET NAM
deu theo hudng dan (68,8%o), kh6ng kham lai thuong xuyen (62,5%o).
TAI UEU THAM KHAO
1. Do Kim Que. Danh gia ket qua som va trung han phau thuat thay van hai la voi van co hoc tai benh vien Thong Nhat.Y hoc Viet Nam (2008) 356: 42-48
2. Nguyen Van Phan: Tong quan dieu tri benh ly van tim. Y hoc Viet Nam (2008) 356: 49-55.
3. Lam Trieu Phat. Danh gia ket qua so'm phau thuat thay van hai la co' hoc trong benh ly hep van hai la. Luan van tot nghiep thac sy y khoa 2006.
4. Dang Hanh Son. Bien chung va that trai sau thay van hai la. Y hoc Viet Nam (2006) 328:
132-139.
5. Nguyin Lan Viet. Thuc hanh benh tim mach 2007. 374-392
6. Kirklin JW. Posoperative care. In Cardiac surgen.'2"". 1993. p 195-247
7. Gerard P Aurigemma. Complication of prosthetic heart valves. Uptodate 2008
8. Gerard P Aurigemma. Antithrombotic therapy in patients with prothetic heart valves. Uptodate.com 2007.
9. John E Hefner. Pleural efusions following cardiac surgery. Uptodate 2006.
10. Frank E Silvestry. Overview of the postoperative management of patients undergoing cardiac surgery. Uptodate.2007.
Birorc DAU DANH GIA KET QUA PHAU THUAT T I M TAI BENH VIEN OA KHOA KIEN GIANG
Danh Trung, Huynh Hai Dang^
Tran Van Thanh, Pham Van D6Tn(*)
TOM TAT
Muc tieu: Danh gia ket qua sdm phau thuat tim tai BVOK Kien giang.
Doi tu'dng va phu'dng phap nghien cu'u:
Nhii'ng benh nhan dUdc phau thuat tim tai Benh vien Da khoa dnh Kien giang td thang 5/2009 den thang 8/ 2010. Hdi cii'u mo ta.
Ket qua: Td thang 5/2009 den thang 8/2010 chung toi da phiu thuat dUdc 121 trUdng hgp, trong do: nam: 52, nii': 69. Tudi tir 1 - 81 tuoi, con dng dgng mach: 16, thong lien nhT: 16, thong lien that: 45, hep dgng mach phdi: 4, benh van 2 la: 24, benh van dgng mach chii va van 2 la: 10, benh dgng mach chii ngUc boc tach; 2, u nhay nhT phai: 1, benh mach vanh: 3. Ty le thanh
cdng: 99,2%. Bien chii'ng gap nhieu nhat la: loan nhjp tim.
Ke't luan: Chung toi da phau thuat dUdc cho 121 trUdng hdp vdi ty le thanh cong la 99,2%. Phan loai benh phau thuat nhieu nhat la thong lien that va benh ly van 2 la. Phau thuat tim la chuyen khoa sau nhUng c6 the trien khai dugc d cac benh vien tuyen tinh.
ABSTRACT
PRIMARY EVALUATION OF THE HEART SURGERY IN KIEN GIANG GENERAL HOSPITAL.
Objectives: To evaluate the results early heart surgery in Kien Giang general hospital.
* Benh vien da klioa tmh Kien Giang 116
Y HOC VIET NAM SO DAC BIET - THANG 11/2010
Patients and method of research: The heart surgery patients in Kien Giang general hospital from May 2009 to August 2010.
Retrospective study..
Results: From May 2009 to August 2010, we have been 121 surgical cases, including:
Male: 52, Female: 69. Age from 1- 81 years old.
Patent ductus arteriosus (PDA): 16, atrial septal defect (ASD): 16, ventricular septal defect (VSD):
45, pulmonary artery stenosis: 4, Mitral valve disease: 24, aortic valve and mitral valve disease:
10, aortic dissection: 2, myxoma right atrium: 1, coronary artery disease: 3. Success rate: 99.2%.
Most disease common complications are: heart arrhythmia.
Conclusion: we have been 121 surgical cases with a success rate is 99.2%. Most surgical patients are ventricular septal defect and mitral valve disease. Heart surgery is a specialist deep but can be applied at the provincial hospital.
I. OAT VAN OE
Hien nay, Benh Iy tim mach co khuynh hudng ngay cang gia tang. Nhu cau de chan doan va dieu tri benh tim mach doi hoi chi phi y te ngay cang cao. Dac biet, doi vdi nhirng benh tim can phau thuat thi doi hoi phai CO nguon nhan lire chuyen sau, trang
thiet bi hien dai va rit t6n kem. Hang nam, Benh vien Da khoa tinh Kien Giang phai chuy6n hon 100 benh nhan len cac benh vien d TPHCM d6 phlu thuat tim. Uoe tinh, hien nay so lugng benh nhan cSn dugc phau thuat tim khoang han 400. Tir nhu c4u thuc t6 do, tir nam 2005 Benh vien Da khoa tinh Kien Giang da chuan bi nguon nhan luc va cac trang thiet bi cin thi6t d6 phuc vu cho phau thuat tim. Tir thang 5/ 2009, dugc sir ho trg cua Benh vien Chg Ray TPHCM, Benh vien Da khoa tinh Kien Giang da bit diu tri6n khai ky thuat phau thuat tim va d8n nay da dat dugc nhung ket qua rit dang khich le.
Qua thdi gian dau trien khai chung tdi t6ng ket lai nham muc dich:
Danh gia ket qua som phiu thuat tim tai Benh vien Da khoa Kien Giang.
II. o6l Tl/pNG VA PHI/ONG PHAP N G H I I N CLfU 1. Doi Tuotig Nghien Cuu:
NhUng benh nhan dugc phau thuat tim tai Benh vien Da khoa tinh Kien Giang tir thang 5/2009 d6n thang 8/2010.
2. Phuong Phap Nghien Cihi: hoi cuu mo ta.
KET QUA
Tir thang 5/2009 den thang 8/2010 chimg toi da phau thuat dugc 121 truong hgp bao gdm:
L Tuoi, Gioi tinh, Can nang:
- Tuoi trung binh: 20,6. nhd nhat: 1 tuoi, Idn nhat: 81 tudi - Gidi tinh: nam: 52, nir: 69.
- Can nang: nho nhat: 10 kg, nang nhat: 65 kg.
2. Phan loai benh:
PHAN LOAI BENH Sd lu'dng Tyle
Benh tim bam sinh 81 66,9%
Con dng dgng mach Thong lien nhT Thdng lien that Hep dong mach phdi
16 16 45 4
13,2%
13,2%
37,2%
3,3%
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CHUYEN OE: PHAU THUAT TIM MACH VA LONG NGLTC VIET NAM
Benh tim mac phai Benh 2 la ddn thuan
Benh van dgng mach chii va van 2 la.
U nhay nhT phai Benh mach vanh
Benh mach vanh va van 2 la.
Phinh boc tach dgng mach chu ngUc TONG SO
40 24 10 1 2 1 2 121
33,1%
19,8%
8,3%
0,8%
1,6%
0,8%
1,6%
100%
3. Thoi gian nam d phong hoi sue:
Trung binh la: 3,4 ngay. It nhat la: 1 ngay, nhieu nhat la: 33 ngay.
4. Thoi gian nam vien: Tnmg birih: 16,5 ngay. It nhat: 7 ngay, nliieu nhat: 40 ngay.
5. Ket qua sum:
Bien chirng trong mo: khong.
Bien chirng sau mo:
- Cha}' mau. mo lai cam mau: 1 (0,8%).
- Tran khi mang phoi: 1(0,8%).
- Tran dich mang phoi: 2 (1,6%)).
- Tran dich mang ngoai tim: 4 (3,3%i).
- Loan nhip tim: 10(8,3%).
- Nhiem trimg vet mo: 5(4,1%)).
- Tir vong: 0.
Chuy6n benh vien Chg Ray: 2 (1,6%)). 1 ca benh nang xin ve. 1 ca tiep tuc dieu tri ngi va cho xuat vien.
KStquasom: 120/ 121 (99,2%).
IV. BAN LUAN
Trong thai gian dau trien khai phau thuat tim, chiing toi chgn lgc nhiJng benh thong lien nhl, con ong dgng mach, thong lien that chua CO bien chiing. benh ly khong phirc tap, can nang it nhat la 10 kg. Tu6i nho nhat phau thuat la 1 tuoi, chan doan: con ong dgng mach. Tuoi lon nhat la 81 tuoi, chin doan la hep nhieu nhanh mach vanh. Benh thuong hay gap la thong lien thit (37,2%) va benh ly van 2 la (19,8%).
Trong 121 tru'dng hgp, co 3 truong hgp chimg toi phau thuat cap ciai. 1 benh nhan nam, 58 tuoi, chan doan: phinh boc tach dgng mach chu nguc doan quai va doan xuong, xir tri: thay quai dgng mach chu, tai tao lai dgng mach canli chung trai va than tay dau. 1 benh nhan nam, 22 tuoi, chan doan: phinh hoc tach dgng mach chu ngirc/ hgi chung Marfan, xir tri: phau thuat Bental. 1 benh nhan nir, 38 tuoi, chan doan: u nhay nhT phai, xir tri: cat u nhay, va lai vach lien nhT. Ca 3 truong hgp nay deu on dinh va xuat vien.
Co 2 trudng hgp benh mach vanh chiing toi chuyen benh vien Chg Ray: 1 benh nhan dugc dieu tri ngi, xuat vien. 1 benh nhan nang, xin ve vdi chan doan: viem phoi dong dac, suy than, suy gan/ hau phau bac cau noi chil - vanh.
Nhin chung, qua thdi gian dau trien khai phau thuat tim chiing toi dat dugc ty le thanh cong la: 99,2%. Tuy nhien, chiing toi cting gap 1 so bien chirng, thuang gap nhit la loan nhip tim (8,3%)) d nhtrng benh nhan bj benh ly van 2 la. Co 1 trudng hgp phai mo lai vi chay mau mat sau xuong iic. Trong 4 truang hgp tran dich mang ngoai tim, co 2 ca dan luu khoang mang tim, 2 ca chgc hut dich.
Nhtrng bien chung nay deu dtrgc chung toi xir ly kip thdi va cho ket qua tot.
Thdi gian nam hoi sire va thdi gian nim vien trong nghien cuu cua chung toi tuang doi dai do trong thai gian dau chung toi cin
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Y HOC VIET NAM SO DAC BIET - THANG 11/2010
than va giu benh nhan d phong hdi sue de thuan tien theo doi. Sau nay thdi gian tren da dugc rut ngan nhieu.
Triln vgng trong thai gian tai, chiing toi se phau thuat cho nhung truong hgp benh da dang va phirc tap ban.
V. KET LUAN
Qua thdi gian 16 thang trien khai phau thuat tim tai Benh vien Da khoa Kien Giang voi su ho trg cua Benh vien Chg Ray, chiing toi da phau thuat dugc cho 121 truong hgp vdi ty le thanh cong la 99,2%). Phan loai benh phau thuat nhieu nhat la thong lien that va benh ly van 2 la.
Phau thuat tim la chuyen khoa sau nhung co the trien khai dugc d cac benh vien tuyen tinh.
TAI LIEU THAM KHAO
1. Dao Hu'u Trung (2006), " Thong lien thit".
Benh hpc tim mach, tap 2, 389 - 397.
2. Elliot M. Antman, MD (2007), "Surgen, for valvular heart disease". Cardio\ascular therapeutics. 815-841.
3. Kirlin/ Barratt - Boyes (2003), "Ventricular septal defect". Cardiac surgery, third edition, 850-909,
4. Kirlin/ Barratt - Boyes (2003), 'Patent ductus arteriosus". Cardiac surgery, third edition, 928-945.
5. Nguyen Van Phan (2008). "DiSu fri phiu thuat benh van tim". DiSu tri hoc ngoai khoa 16ng ngu'c. 248 - 264
6. Phan Kim Phirang (2008). ' Bidu trj cac benh tim bam sinh thirong gap". Di^u tri hoc ngoai khoa I6ng ngirc. 265- 282.
7. Phan Nguyin Vinh (2006), " Hep van 2 la".
Benh hpc tim mach, tap 2, 15 - 26.
8. Robert M. Bojar (2005), "Early postoperative care". Manual of perioperative care in alduh cardiac surgery. 237 - 258.
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