Nhdn xdt: BN thd can khi phgm vj ddp ung didu trj tdt lion thd ty vj hu hdn: 57,14% so vd'i 24% b0nh nhdn cua thd ty vj hu hdn, s y khdc bi0t cd •y nghta thdng kd vdi p <0,65. Cd 2 BN khdng ddp u'ng didu trj thuOcthdtyvi hu hdn, chldm 5,13%
BAN LUAN.
Thudc D-08 ed tdc dyng ki0n ty (Cam thdo, Mdm xdi, Sa nhdn), seo gd luong huydt, mdm xdi cd tde dyng hogt huydt ndn ehi thdng; Bgch thuoc cd tdc dyng so can; Sa nhdn ed tde dyng didu trung hda v j ; d tde cdt cd tdc dyng thdng huydt mgeh, khu hdn thdp; Dinh Idng ed tde dyng bdi bo an thdn; Nha dam tU', Sa nhdn ed tde dyng uc chd vi khudn, Tdc dyng giam dau thud'ng vj a thd can khi phgm vj Id 78,57%, thd ty V! hu hdn Id 76% sy khde bi0t khdng cd •^ nghTa thdng kd. Ty Id hdt vi0m d- thd can khi phgm vj Id 33,33%, thd ty vi hu hdn Id 45,45% sy khdc bi0t vd didu tri giO'a hai thd khdng cd y nghTa thdng kd (p>0,05). So sdnh vd'i nghidn cuu cua Trdn Thj Bleh Hing ket qua cua ehung tdi thdp hon, cd thd do ehung tdi ed thdi gian didu tri ngdn hon.
Ddnh gid hi0u qua didu tn. chung tdi thdy ed 57.14% bdnh nhdn thd can khi pham vi cd kdt qua dieu trj tdt. ty Id ndy a thd ty vj hu hdn Id 24%, su khde tiidt cd ^ nghTa thdng ke vdi p<0.05. Nhu vdy the can khi pham vj didu tri ed hi0u qua cao hon
Thuoe D-08 (Sdu trj vd'i lieu cua nghien euu dd khdng thay anh hudng den mot so ehi tieu eo quan tgo mdu, edc ehi sd sinh hda mdu the hien chuc ndng gan, than, dudng mdu trudc vd sau didu tn.
K^T LUAN.
Bdi thudc D-08 cd tdc dyng didu trj vdi 2 thd b0nh theo y hpe cd truydn Id can khf phgm vj vd tJ vj hi hdn. Qua ndi soi dg ddy td trdng t f 10 hdt vidm, phD nd dgt 41,18%; giam vi0m 52,94% ; khdng giam vifim 5,88%. Kdt qud ffidu trj dgt hi0u qua tdt 35,9%, c6 hi0u qud 58,9%. Trong dd thd tjf v\ h u hdn dgt hi^u qud tdt 24%, ed hl0u qua 68%; thd can khf phgm vj hidu qud tdt 57,14%, cd hi0u qud 42,86%.
TAI LI^U THAM KHAO.
1. Ngd Quyet Chien (2007), Bidn chwng^ iuAn trj mgf sd bdnh ndi khoa - Vi quAn thdng. Y hpc cd truyen bi^n chung ludn trj, thudc nam cham cuu chua bgnh. Nha xudt ban Qudn ddi nhdn ddn 508-510
2 Nguyin Quang Chung, Tg Long vd Trjnh TuSn DQng (2008), Biin ddi vi n0i soi vd md b^nh hpc ciia vidm da ddy man sau dieu tq didt trir Helicobacter pylori.
Tgp chi khoa hpc tidu hda Vi0t Nam Sd ddc bi0t Hgi ngh] lieu hda Odng nam A lan thu 7.
3. Phgm Thj Thu Hd (2004), Chin dodn vA dieu trj bdnh lodt da day, hanh ta trdng - B0nh hpc n0l khoa, t$p 2 Nha xuat ban Y hpc. Hd Npi, 2004.
4. Axon A T R (2007), Relationship between Helicobacter pylon gastritis, gastric cancer and gastric acid secretion. Advances in medical Sciences 2007. Vol 52 55-59
5. Hu L, Hu X, Yang M, Xie H, Xiang Y(2008).
Clinical effects of the method for warming the middle-jiao and strengthening the spleen on gastric mucosa repairin chronic gastritis patients J Tradit Chin Med 200B Sep,28(3) 189-92
TAG DUNG lie CHE VAN DONG VA ANH Hl/ONG HUYET DONG CUA MAGNESIUM SULPHATE TRUYEN TINH MACH TRONG GAY TE TUY SONG
BANG BUPIVACAIN VA FENTANYL PHOI HOP CHO MO CHI U\JtS\
TOM T A T :
/Muc tieu: dAnh gid tdc dung wc chi v$n ddng va dnh hwdng trdn ho hap vdi huyit ddng cua gay td tuy sdng bing bupivacain vd fentanyl kit hp'p magnesium sulphate tmyen T!/l trong md chi dw&i.
Doi (uwig vd phuang phAp nghidn cdu. thir nghiem lam sdng, tiin ciru, ngiu nhidn, mil dan, ddi chirng, can thidp lam sdng c6 so sAnh. Thi/c hi$n tai Bdnh vidn Vi$t Dire tir thAng 3/2012 din thAng 9/2012: gdm 60 bdnh nhdn ASA I, ASA II, phiu thuAt chi dw&i dwac phdn chia ngiu nhidn Idm 2 nhdm. Kit qui vA ban luAn: 60 bdnh nhdn ASA l-ll, phiu thudt chi dw&i, tudi tir 18 din 68, cao 150 - 176 cm, cdn nAng 45 din 65 kg, nam 90%,, nir 10 %,, Khong cd sw khAc nhau vS thdi gian khdi phAt Hit vdn dong vA th&i gian phuc hdi vdn ddng a mirc M, cua hai nhdm (p>0,05). Sw thay ddi vd hd hip (tin so th&, SpO^, vA huyit dong (tan sd tim, HADMTB) khAc bidt giira hai nhdm khong cd y nghTa thong kd vdi p> 0,05 Khong gSp cAc tdc dung phu khAc nhw dau, td bi, di
TRAN THI KIEM - Bdnh vidn Bach Mai wng. Kit luAn: gAy td tuy sdng bing bupivacain vA fentanyl kit'hap truyin MgSO^ Iiiu 50mg/kg tmyk TM lam tAng hidu qua giam dau sau phiu thuAt chi dw&i mA khdng gAy wc chi vAn ddng, khdng lam inti hw&ng trdn hd hip, huyit dong vA khdng cd cdc tic dijng phij khAc.
TO" khda: bupivacain, fentanyl, magnesium sulphate, md chi dw&i
SUMARY:
Objectives: evaluate the motor inhibition, mspimtory and haemodynamic effects of Magne sulfats IV in spinal anaesthesia by Bupivacain combinate Fentanyl for lower under limbs. Material and method, clinical trials, pmspective, mndomized, single - blind, coltrol clinical intervention compared.
Result and discussion: 60 patients divided in two groups, ASA I - II, m spinal anaesthesie ifi Bupivacain combinate Fentanyl for lower underlimbs, 18-68 olds, high: 150 - 176 cm, heigh: 45 - 65 kg.
f^aie is 90%, Female is 10%,. No difference in time ot
Y HOC imSC HANH (865) ^8^4^13
onset of motor paralys and motor recovery time. The chance of respiratry (Frequence respiratory, SpQ2, Hemodynamic (PC, blood press) of fwo gmup were not statistis with p > 0.05. It has'nt the unwanted effectives: pain, numbered, allergic. Concfussion:
Spinal Anasthesia in the combined Intravenous MgS04 increase the effectiveness of pain after lower limb interwentlon without inhibiting movement, no effect on mspiration, blood cimulation and has no effect other side.
Keywords: Fentanyl, lower underlimbs DAT V A N Bt
Gdy td tuy sdng (GTTS) bling bupivacain phdi hp'p vOi fentanyl dd vd edm trpng md vd kdt hp'p gidm dau sau md bang PCA morphin cho phdu thudt ehi dudi dang duoe dp dyng khd phd bidn d V10t Nam, song edn cd nhung mdt hgn chd. Ngodi tde dgng giam dau, nd cdn cd cdc tde dyng khde nhu ue e h i vdn ddng, ha huydt dp trong md. Magnesium sulphate (MgS04) Id thudc dd dup'c bidt ddn nhu dCing didu tri tidn sdn gidt, chdng logn nhjp vd didu trj cdc tnj'dng hpp thidu hyt ion Mg*... Hi0n nay, trdn thd gidi dd cd edc nghidn cuu su* dyng MgSO^ tidm vdo khoang dud'i nh0n hay truydn tTnh mgeh dd gidm'dgu sau phdu thudt, tuy nhidn hi0u qud cua nd edn cdn nghidn ei>u. C/ Vi0t Nam chua cd nghidn cdu ndo vd SU' dyng MgS04 dd gidm dau sau md trdn bdnh nhdn phdu thudt ehi dudi. VI vdy, ehung tdi tien hdnh nghidn cu'u de tdi, "Ddnh gid tdc dyng dc chd vdn ddng vd dnh hud'ng huydt ddng ciia gdy td tuy sdng b i n g bupivacain vd fentanyl phdi hop vOi magnesium sulphate truydn tTnh mgch trong md chi dudi" vdi hai myc tidu:
1, DAnh giA tAc dung tAc dung ire chi v$n ddng cua gAy t§ tiy sdng bing bupivacain vA fentanyl kit hp'p magnesium sulphate tmyin Tf\A tmng md chi dwdi.
2, Anh hwdng trdn hd hip vA huyit ddng cua phwang phAp nAy.
D d i TU'grNG VA PHU'aNG P H A P NGHIEN CU'U 1. P h u c n g phdp nghien c u u : thu nghi0m ldm sdng, tidn cuu, ngSu nhidn, mu don, ddi chi>ng, can thidp ldm sdng cd so sdnh. Thyc hi0n tgi B0nh vi0n Vi0t Oil'c t u thdng 3/2012 den thdng 9/2012; gdm 60 b0nh nhdn ASA I, ASA II, p h l u thudt chi dud'i dupe ehia ngdu nhidn ldm 2 nhdm: Nhdm 1 (nhdm nghlAn cdu): gay td tuy sdng bdng marcain 0,5% 7mg + fentanyl 50meg kdt hp'p tnjydn TM MgSO^ hdu 50mg/kg/gid' duy tri trong md, giam dau sau md bing bom tidm didn (PCA) morphin; Nhdm 2 (nhdm chOvg): gAy td tuy sdng b^ng marcain 0,5% 7mg + fentanyl 50mcg, gidm dau sau md bdng bom ti0m (S0n (PCA) morphin.
2. Ddnh gid tdc dyng IPC chd v0n d^ng: d* ede mLPC thd'i gian id IOc bom thude t0 vdo khoang dud'i nh0n den khi Ii0t v$n d0ng chi dudi theo thang didm cCia Bromage[7]: ddnh gid Ii0t vdn d0ng muc M, /khdng nhdc chdn dudi thing Idn khdi mdt bdn), vi /sau dd b0nh nhdn dd dup'c sdt tri^ng vd trdi sdng dd
md. Thdi gian phyc hdi v$n ddng mO'c M, (phut) Id thdi gian b i t ddu xudt hi0n i>e chd v0n ddng <^ mCpc Mi cho td'l khi vdn ddng trd- Igi tuong O'ng vdi mi>c ndy.
3. Anh hvd'ng ddn tudn hodn: tdn sd tim (TST).
theo ddi tdn sd tim d cde thdi didm trud'c md 1 ngdy ICic khdm tidn md gpi Id T ndn (k;^ hi0u TO), d trdn bdn m i trud'c khi GTTS vd sau GTTS 1 phut, 5 phCit, 10 phiit, 20 philL., ddn khi md xcng vd sau md theo edc thdi didm quy ud-e d" trdn. Huydt dp (HA): theo ddi HATT, HATTr vd huydt dp trung blnh (HATB) eOng d cdc thdi didm nhu trdn; ndu HATT hodc HATB gidm
>20% so vd'i huydt dp trude khi ady t0 s0 xu tri bdng thudc CO mgch fephddnn, tdng toe dd vd tdng lup'ng djchtnjydn[1].
4. Anh hud'ng Idn hd h i p : theo ddi trdn mdn hinh monitoring tdn sd thd" vd Sp02. Bilu hi0n suy hd hdp khi tdn sd thd' < 10 nhjp/phut vd SpO2<90%, tiiy tu'ng mue dd cd thd x u tri b i n g thfr oxy, naloxon, up mask, bdp bdng hodc ddt dng ndi khi qudn thd mdy ndu cdn. Theo ddi cdc tdc dyng phy khde ndu cd,
5. Xi> ly sd Ii0u nghidn cu'u: phdn mdm SPSS 16.0
6. Ogo ddc trong nghidn cu>u: Nghidn ci>u ndy dupe sy eho phdp eua Hdi ddng khoa hpc Trudng Dgi hpc y Hd Ndi vd Ban Gidm dde B0nh vi0n Vi0t Di>e.
K £ T QUA NGHIEN CLTU
1. Ddc didm ehung: gdm 60 b0nh nhdn ASA 1 - II, phdu thudt ehi dudi, tudi tO' 18 ddn 68, cao 150 - 176 cm, edn ndng 45 ddn 65 kg, nam 90%, nu 10%, khdc bi0t khdng cd y nghTa thdng kd giua hai nhdm nghidn ci>u vdi p>0,05.
Bang 1 Thdi gian phdu thudt Th6nq s6
Mm - Max X±SD
Nhdm 1 (n=30) 40-120 64,2±19,8
Nh6m li (n=30) 30-100 66,0±19,5
G\A tri P p>0,05 Nhdn xdt: Khdng cd sy khde nhau vd thdi gian phlu thudt cua 2 nhdmnghien cuu (p>0,05)
2. Tdc dung uc chd vdn d^ng d- muc Mi (phut) Bang 2. Thdi gian khdi phdt I10t vdn ddng d" muc Ml (phut)
Thdnq s6 X±SD Mm - Max
Nh6m 1 (n=30}
4,37±0.51 3,5-5.5
Nh6m 11 (n=30) 4,35±0,54
3,5-5,5 Gi^ trj p
p>0.05 Nhdn xdt' Khdng ed sy khdc nhau ve thdi gian khd'i phdt li0t vdn ddng d muc Mi cua hai nhdm (p>0,05)
Bang 3.
(phut) Thflnq s6
X±SD Mm - lulax
Tii^i gian pliyc h6i v§n asng Nh6m 1 (n=30)
94,8±23,5 60-170
Nli6m li (n=30) 87,2±15,2
65-120
a mu'c Ml Gi^ in p p>0,05 Nhdn xdt: Khdng cd sy khde nhau vd thdi gian phyc hdi vdn ddng 6' mu-e Mi cua hai nhdm (p>0,05),
3. Tdc dv>ng Idn tudn hodn
Y HOC THU'C HANH (865) - s 6 4/2013
B d n g 4 . T h a y d d i v d t d n s d t i m giO'a h a i n h d m Thi/i gian
TO Tl T2 T3 T4 T6 T6 T™
HO HI H3 H6 H12 H24 H36 H48
Ntiem 1 (n=30) X ± S D 83,60±6,98 82,67±6,26 81,25±6,78 79.90±5,2e 78,7017,39 76,93±6,62 74,4717,32 75,4317,32 84,4014,32 80,4314,31 77,0614,90 75,0015.25 74,6315,39 76,3615,07 75.7315,80 75.8015.79
Nii6m il (n=30) X l S D
84,9018,00 83,2714,46 81,1715,68 80,4314,31 79,9315,30 76,2317,31 75,0318.52 76,0316,43 85,1717.30 81,1615.67 77,8314,44 76.101522 76,0015,42 77,3816,48 77.8315,10 76.4016,50
GiS tri p p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 p>0.05 _p>0.05 p>0.05 Nhdn x0t: Sy thay ddi vd tdn sd tim giya hai nhdm theo cdc mdc thd'i gian khdng cd s y khde bi0t vd'i p>0,05.
Bang 5. Thay ddi vd huydt dp trung binh giua hai nhdm theo nidc thd'i gian
Thdi gian TO Tl T2 T3 T4 T5 T6 T™
HO HI H3 H6 H12 H24 H36 H48
Nh6m 1 (n=30) X±SD 90,01 ±6,22 89,64±5,94 82.45±4.92 83,60±6,11 85,37±6,17 84,25±6,08 85.36±6,16 88,51±6,22 92.03±5,75 89,64±5,94 88,20±5,05 88,96±5,27 86.2614,77 85,10±3,78 84,93±4,68 86.70±4,05
Nhdm II (n=30) X ± S D 89.73±5,81 88,37±5,76 81,25±6,78 84,43±5,14 86,17±5,71 85,25±5,58 86,50±5,37 89,73±5,81 92,23±4,20 90.10±4,78 89,42±5,12 89,70±4,93 87,40±4,85 86,36±4,78 85,10±5,94 87,40±4,85
Gid tn p p>0.05 p>0,05 p>0,05 p>0,05 p>0,05 p>0,05 p>0,05 p>0,05 p>0,05 p>0.05 p>0.05 p>0,05 p>0,05 p>0.05 p>0,05 p>0,05 Nhdn xdt, Sy thay ddi ve huydt dp trung binh giua hai nhdm theo ede mdc thdi gian khdng ed sy khdc bidt vdi p>0,05
4. Lup'ng djch, mdu edn truydn, lup'ng thudc vdn maeh dung trong md Lup'ng djch t u 1000 - 2000 ml, lupng mdu t u 250- 500 ml, Khdng cd sy khdc nhau v0 lupng atropin vd lupng dphddrin cdn sir dyng cua hai nhdm vd'i p>0,05.
5. Anh hud'ng \6n hd hdp
Bang 6. Thay ddi v0 SpOj giua hai nhdm theo mdc thdi gian
Thdi gjan TO Tl T2 T3 T4 T5
Nhdm 1 (n=30) X ± S D 99,8710.33 99,85±0,42 99,90±0,34 100,0±0,00 100,0±0,00 100,0±0,00
Nh6m 11 {n=30) X ± S D 100,010,00 100,010,00 99,7510,54 100,010,00 100,010,00 100,010,00
Gi3 tn p p>0,05 p>0,05 p>0,C5 p>0,05 p>0,05 p>0,05
T6 T„, HO H1 H3 H6 H12 H24 H36 H48
100,010,00 99,9710,36 97,3310,50 97,2010,71 97,1710,23 97,7010,46 97,6310,76 97,0310,61 97,4310,51 97,5610,67
100.010.00 99.8510,45 97,6610,63 97,6010.63 97,6610,47 97,4310,60 97,1610,49 97,4910,48 97,0710,62 97,1710,59
P>0,05 P>0,05 P>0,05 P>0,05 P>0,05 P>0,05 p>0.05 P>0.0S P'0,05 _P>0,05 111 iipi I A d . ^.fy iiioy uvi v^ «^|.fv./2 a'uQ Mai IIILUm t h e o c d c m d c t h d ' i g i a n k h d n g c d s y k h d c bi0t viS p > 0 , 0 5 .
B d n g 7 . T h a y d d i v d t ^ n s d t h d ' giO'a 2 n h d m theo Tiifri gian
TO Tl T2 T3 T4 T5 T6 Tn,.
HO HI H3 H6 H12 H24 H36 H48
Niiam 1 (n=30) X l S D 21,0410,90 20,2710,87 18,2010,75 17,1010,85 16,2610,99 16,1310,66 17,1710,99 17,5010,91 20,0310.96 18,0310,57 17,03100,93 17,6010,81 16,2010,73 16,3010,78 16,1010,73 17,2710,80
Nii6m il (n=30}
X l S D 21,5010,64 20,6010.77 18.6310,86 17,6810,84 16,6710,93 16,4010,77 18,1010,96 17,2311,01 20,5110,81 19.0110.98 17.6310.85 17,1210.89 16,6010.70 16,7310.91 16,5910.82 17.7110,71
Gid tri p p>0,05 p>0,05 p>0,05 p>0,05 p>0,05 p>0,05 p>0,05 p>0,05 p>0,OS p>0,05 p>0,05 p>0.05 p>0.05 p>0.05 JD>0.05 p>0.05 N h d n x d t . S y t h a y d o t v d t d n s d t h o giO'a hai n h d m t h e o c d c m d c t h d i g i a n k h d n g c d s y k h d c b i ^ vd'i p > 0 , 0 5 .
6 . C d c t d c d u n g k h d n g m o n g m u d n : chung tOi k h d n g g d p t r u d ' n g h o p n d o n h i d m k h u d n v u n g chpc k i m , rdi l o g n v d n d d n g - c a m g i d c , d a u t d b l chdn, di ung,
BAN LUAN
1. Ddc didm ehung cua nhdm nghidn cuu Trong nghifen euu ndy, ty 10 b0nh nhdn ngm {90%) eao hon nu' (10%) Ty 10 phdn bd nam nhidu hon rp d ed hai nhdm do hdu hdt sd b0nh nhdn dupe phSu thudt chi dudi sau chdn thuong do tai ngn lao ddng hode tai ngn giao thdng, Nghidn euu ndy ed ty 10 rtarr gidi cao hon kdt qua nghidn cu'u eua Ddng Ttii Chdm[1] vd Vd Thj Tuydt Nga[5] Id 70%. Thdi gian phdu thudt eua nhdm 1 Id 64,2±19,8 phCit, nhdm 2 Id 60,0±19,5 phut; sy khde nhau khdng cd if ngtiTa thdng k0 {p>0,05). Kdt qua ndy tuong dieang vdi k^
qud cua Ddng Thj Chdm[1] Id 68,97 phut, nhung th^p hon thdi gian phdu thudt eua Vd Thj Tuydt Nga[51 eOng trdn b0nh nhdn phdu thudt chi dud'i.
2. Hi0u qud <rc chd v$n d0ng
- Thdi gian khdi phAt ll^t v$n ddng d mirc Ki ( b a n g 2 ) : thd'i g i a n k h d i p h d t liet v d n d d n g d mO'c Mi ( t h a n g c h i a d 0 Ii0t v d n d p n g c u a B r o m a g e ) cOa hai n h d m k h d n g c d s y k h d c b i 0 t ( p > 0 . 0 5 ) . N h d m 1 c6 thd'i g i a n k h d i p h d t li0t v d n d d n g 6 mi>c Mi IS
Y HOC THlTC HANH (865) - SO 4/2013
4,37±0,51 phCit, nhdm 2 Id 4,35±0,42 phiiL Kdt qua eua chOng tdi tuong duong vd'i nghidn cQ'u dung bupivacain - fentanyl cua Phgm Minh Di>e Id 4,24±1,08 ph0t[2] vd D 6 v a n Lpi Id 4,3±0,88 phCit[4].
- Thdi gian phyc hdi v$n d^ng d mOv Af, (bdng 3): thdi gian phgc hdi vdn ddng d muc Mi cua 2 nhdm khdc nhau khdng ed nghla thdng k0 (p>0,05). Trong nghidn cO-u ndy, thd'i gian phye hdi v$n ddng d mirc Mi Id 94,8i23,5 phut, tuong duong kdt qud nghidn cuu eCia Nguyin Ngpc Khoa[3] d nhdm dung bupivacain - fentanyl Id 95,6±30,01 phut. Nghidn cuu cua Hwang.
JY[101 thdy tnjydn MgS04 kdt hpp GTTS khdng dnh hudng ddn qud trinh phyc hdi vdn ddng cua b0nh nhdn.
Nhu vdy, tajyen MgSO^ tTnh mgch trong md kdt hpp GTTS khdng anh hudng tdi qud trinh phyc hdi vdn ddng cua b0nh nhdn trong^vd sau md.
3. Tdc dgng cua thudc I0n tudn hodn - Anh hipdng Idn tin so tim (bang 4): tdn sd tim (TST) trung binh tgi thd'i didm trudc gdy td cua nhdm nghidn cO-u Id 83,60±6,98 Idn/phCit vd cCia nhdm chO'ng Id 84,9±8,0 idn/phOt; s y khde bi0t khdng ed ^ nghTa thdng kd vd'i p>0,05. Sau gdy td TST cua hai nhdm giam ddn trong khoang 10 phiit ddu, nhung sy thay ddi TST sau td d' hai nhdm khdng ed sy khde biet, Trong qud trinh phdu thu0t. TST d' hai nhdm thay ddi nhung khdng cd su khdc bi0t (p>0,05), Sau md, tgi thdi diem HO (VAS >4), TST cua hai nhdm deu cao hon thdi didm tarde gdy td nhung khdng ed s u khdc bi0t (p>0,05), Theo chOng tdi, ed le do b0nh nhan dau ndn TST tdng, tuy nhidn sy tdng TST khdng cd sy khde bi0t giiJ'a hai nhdm (p>0,05).
- Huyit Ap trung binh (bang 5): tuong ty nhu TST, HATB cOng khdng cd sy khdc bi0t giua hai nhdm d tdt ea ede thdi diem nghidn eiiu (p>0,05), Sau gdy td, HATB eCia hai nhdm giam ddn trong khoang 10 phut ddu, nhung sy thay ddi o hai nhdm khdng cd sy khdc bi0t. Sau md, tgi thdi didm HO (VAS 54), HATB eua hai nhdm deu eao hon thdi diem trudc gdy te (p>0,05), ed le do bdnh nhdn dau nen HATB tdng, tuy nhidn sy thay ddi HATB khdng cd sy khdc bi0t giO'a hai nhdm (p>0,05). So sdnh sy bien ddi HATB theo cdc mdc thdi gian sau md eua hai nhdm khdng ed sy khac bi0t (p>0,05) Nhu vdy, truydn MgSO^ trong md khdng dnh hudng tdi TST vd HATB. Kdt qua ndy tuong t y kdt qua cua Hwang JY[9], vide tmyen MgSO^ khdng anh hud'ng ddn tdn sd tim vd huyet dp cua b0nh nhdn,
4. Tdc dMng cua thudc ien hd hdp (bang 6) - Anh huvng Idn tin so th&. tdn sd thd cua hai nhdm trude GTTS khde nhau nhung khdng ed y nghTa thdng ke (p>0,05). Sau GTTS vd truyen MgSO^, tdn so thd- giam ddn vd dn ^ n h trong sudt qud trinh phdu thudt; s y thay ddi tdn sd thd' eua hai nhdm khdc nhau khdng cd 9 nghTa thdng kd (p>0,05), Trong nghidn cii'u ndy, tdn sd thd trung binh cua hai nhdm tgi cde thdi didm trudc khi diing thude giam dau tuong duong nhau (p>0,05), thdp nhdt Id 15 Ian/phut, cao nhdt Id 24 idn/phut vd khdng ed tn/dng hop ndo bidu hi0n suy hd hdp (tdn sd thd' dudi 12
Idn/phOt). Kdt qud ndy tuong t y cde nghidn euu eua Apan,A[6], Cheol Lee[8].
- Thay doi SpOj. tgi ede thdi didm nghidn euu, Sp02 cug nhdm truydn MgSO^ ddu dgt t u 95-100%, Sp02 trudc, sau GTTS vd truydn MgS04 eua hai nhdm khdc nhau khdng cd y nghta thdng kd {p>0,05)- MgS04 khdng gdy u-c chd hd hdp.
S. Tdc dgng gidm dau sau md vd lidu lup-ng MgS04
Mdt sd nghidn cuu thyc nghi0m trdn cdc phdu thudt cd muc d0 dau eao hon thdy MgSO^ cd tde dyng gidm dau sau md rd r0t: Ozcan PE [10] su dyng lidu 30mg/kg tidm TM ngay sau md ngyc, sau dd truydn duy tri lidu 10mg/kg/gid trong 48 gid' sau md, sau md, lupng morphin tidu thy 48 gid d nhdm truydn MgSOa (34,8mg) thdp hon nhdm chO'ng (40,2mg) cd y nghTa thdng kd. Hwang, JY[9] dung MgSO^ dd gidm dau sau md thay khdp hdng vdi lidu 50mg/kg tiem TM ngay sau GTTS, sau dd truydn duy tri lidu 15mg/kg/gid eho tdi khi kdt thuc phdu thudt, lupng morphin-ketorolge tidu thy 48 gid sau md d nhdm truyen MgS04 It hon so vdi nhdm khdng truyen vd didm dau VAS thdp hon ed y nghTa thdng kd vdi p<0,05.
K E T LUAN:
1. Mgs64 lidu SOmg/kq truydn TM trong md kdt hp'p PCA morphin sau md Idm tdng hieu qud giam dau sau p h l u thudt chi d u 6 i md khdng gay ue c h d v ^ n dong.
- Thdi gian khdi ddng li0t vdn ddng cua hai nhdm Id nhu nhau,
- Thdi gian phyc hdi vdn ddng d nhdm tnjydn MgS04 kdo ddi hon so vdi nhdm khdng truydn MgS04, tuy nhidn su khdc bi0t khdng cd y nghTa thdng kd.
2. Tdc dung eOa MgSOi I0n tudn hodn, ho hdp vd cde tdc dung khdng mong mudn khdc.
- MgS04 khdng gdy bidn ddi tdn sd tim, huyet dp dpng mgch, tdn so hd hdp vd dd bdo hda oxy cua hai nhdm khdng cd sy khdc bidt vd su thay ddi v i n a trong gidi hgn btnh thudng,
- MgS04 ldm tdng tdc dung giam dau cua gay te tuy sdng vd khdng gdy ra tdc dyng phu khde nhu rdi logn v0n ddng - cam gidc, td bi ehdn hay di ung,
T A I L I E U THAM K H A O
1. Odng Thj Chdm (2005), "Danh gia tac dyng giam dau sau md cCia nefopam trong phiu thugt chan thuang chinh hinh chi dudi", Luan van thac sTy hpc Trudng Dgi hpc y Ha Npi,
2 Phgm Minh Dice (2003), "Nghien cuu si> dyng bupivacain ket hpp fentanyl g§y te tuy sdng trong phiu thudt cdt tu cung", Ludn van thac siy khoa. Trudng Dai hpc y Ha Npi.
3. Nguyen Ngpc Khoa (2008), "Danh gia hi0u qua vd cam cua gdy te tuy song bdng hon hpp bupivacain- fentanyl so vdi bupivacain-sufenlanil de phau thugt vung byng dudi va ehi dudi", Lu$n van thac siy hpc Truang Dgihpcy Hd Npi.
4. Do Van Lpi (2007), "Nghien cuu phot ho;:
bupivacain vdi morphin hogc fentanyl trong gay le .
Y HOC THUC HANH (865) - SO 4/2013
sdng dd md idy thai vd giam dau sau md", Ludn vSn thac sty hoc. Trudng Dgi hpc y Hd Ndi.
5. VO Thj Tuydt Nga (2003), "Ddnh gid hi0u qud giam dau sau md cua meloxicam trong phiu thudt ehdn thuong ehinh hinh ehi dudi", Ludn v5n thac sT y hpc.
Trud'ng Dgi hpc y Hd Ndi.
6. Apan A, Buyukkocak U, Ozean S, et al (2004),
"Postoperative magnesium sulphate infusion reduces analgesic requirements in spinal anaesthesia", Eur J Anaesthesiol, Oct; 21(10)-766-9.
7. Bromage PR (1978). "Mechanism of action epidural analgesia', Philadelphia, WB saunders, pp.142- 147.
8. Cheol Lee, M.D., Mi Soon Jang, M.D., Yppn Kang Song, M.D., et al (2008), "The effect of magnesium sulphate on postoperative pain in patients undergoing major abdominal surgery under remifentanil-based anesthesia", Korean J Anesthesiol, Sep; 55(3):286-290.
9. Hwang JY. Na HS, jeon YT. Ro YJ. et al (2009),
"I.V, Infusion of magnesium sulphate during spinal anaesthesia improves postoperative analgesia', BriSsli Joumal of Anaesthesia, page 1 of 5.
10. Ozcan PE, Tugml S. Senturk NM, et al (2007), • Role of magnesium sulphate in postoperative pain management for patients undergoing thoracotomy, J Cardiothorac Vase Anesth, 21:827-31.
NGHIEN Cl)U D I I N BIEN VA KET QUA DIEU TRI CUA S6C DIEN TIEN ME TREN M O T SO B £ N H TAM THAN
T6M TAT
Nghidn ciru trdn 205 bdnh nhdn tdm thin dwqc diiu tri bing sdc didn (107 binh nhAn dung sdc diin tiin md bing haloperidol+ pipolphen*seduxen vd 98 dung sdc di$n cd diin. chung tdi riJt ra mdt sd kit ludn sau:
- Sdc didn tiin md Ap dung diiu tri dw&c cho cAc bdnh tdm thin nhw sdc didn cd diin (TAm thin phAn lidt thi cAng trwang luc, trim cAm tw chdi An udng, bdnh nhAn c6 y dmh vA hdnh vi fy sAt...).
- Thdi gian tw sau tidm din luc Idm sdc didn: 2 phut.
- sd lin lAm sdc didn- Da sd bdnh nhdn lAm sdc dien 6-7 lin (68,23%,).
- Do ddi tmng binh can co gidt IA 12,26 giAy (th&i gian chd IA 2 phut).
- Can CO cwng chi gAp d 33,64% trwdng hp'p vA kdo dAi 2-4 giAy. Can co giAt gdp & tit cA cAc tnrdng hQp kdo dAi 8 - 10 giAy
- Can CO gidt toAn thi gAp d 33,64%o b$nh nhAn, cdn tai 66,36% binh nhAn ch! c6 can co gi$t ci^c bd.
- Dau diu Id tdc dung khdng mong mudn hay gAp nhit chiem 68,22%.
- Chi 36,45%, sd bdnh nhAn cdn lo Idng nhe.
Tip khda: sdc didn SUMMARY
Studying 205 patients, who have mental dirsorder, 107 patients had been used new method of E.C.T (haloperidol+pipolphen+seduxen before of making E. C. T), and 98 patients had been used classic E. C T, we have following conclusions:
- New method of E. C. T and classic E.CT have the same indication.
- inten/al of 2 minutes between making I. V dmgs (haloperidol+pipolphen +seduxen) and making new E.C.T is the best.
- Percent of patients, who get 6-7 times of new
BUI QUANG HUY, N G U Y I N THj V A N Khoa TAm thin - B^nh vi^n 103 E.C.T, am 68.23%.
- Everage time of convuisival period in new E CT is 12.26 seconds.
- Tonic period appear on 33 64% of patient anti pmlonged 2-4 seconds, clonic period appear on all patient, who had been used new E.C.T, and pmlonged 8-10 seconds.
- 36 64%> of patients, who had been used new E.C T have genemlized tonic-clonic. 66.36% d patients have complex pariial.
- Headache is the most unwanted effect (68.22%) on the new E.C.T.
- Only 36.45% of patients, who had been new E. C T are mild worry about new E. C. T.
Keyword: E.C.T DAT V A N D E
Theo Sadoek B, J. (2007). mdc dO ngdnh tam thdn dd ed rdt nhieu thudc an thdn, chdng trdm c^m vd ehinh khi sde, nhung sdc di0n vdn Id Ii0u phSp didu trj khdng thd thay thd trong mdt sd trudng hep (ty sdt, to chdi dn, cdng truang lye, khdng thudc).
Theo Kaplan H. 1. (1994), sdc di0n tuy cd hi0u qua didu trj rdt cao vdi mdt sd cdc b0nh tdm thdn trSn, nhung trong qud trinh phdng di0n qua ndo eCia liSu phdp sdc di0n, cd m0t tde dyng khdng mong mudn IS gdy ra eon eo gidt kidu ddng kinh. Chinh cdc eon co gidt kidu ddng kinh do sdc di0n gdy ndn dd tao ra nhidu tde dyng khdng mong mudn eua sde didn nhir gdy xuong, sai khd'p, dau ddu, budn ndn, giam tri nhd,,. vd ddc bi0t Id gdy ra tdm ly lo l^ng sp ldm soc (S0n eho ca b0nh nhdn vd ngud'i nhd hp.
Theo Gelder M. (1988), dk hgn chd con co giSt, ngud'i ta dung sdc didn ed gdy m0 tTnh mgch bang thiopental vd thudc gidn co cura. Phuong phdp nSy ddi hdi cde trang bi ky thudt phCrc tgp hon, khd ISm hon vd tdn kdm hon nhidu so vd'i sdc (S0n cd dien.
Chung tdi dd xdy dyng phuong phdp sdc di0n m
Y HOC THU'C HANH (865) - s 6 4^3
