TJBLP CHl NGHIEN CU'U Y HQC
DANH GIA K^T QUA DAN LU'U TRAN MAU, TRAN KHJ KHOANG MANG P H 6 | TRONG BENH C A N H DA C H A N T H U ' Q N G
TAI BENH VIEN DA KHOA TRUNG U-QNG T H A I NGUYEN, GIAI DOAN 2010 DEN 2014
A u Van T h a o \ Lo Quang Nhat^
^Trung tam y te huyen Cho t^&i, Bac Kan, ^Tru&ng Dai hpc Y Duoc Thii Nguyen Nghiin cuv nhim danh gia kit qua phiu thuat diiu tq tran miu. tran khi khoang mang phdi trong binh canh da chin thuang. Ddi tuang gdm 82 binh nhan cd Iran mau khoang mang phoi. Iran khi khoang mang phoi hay ca tran mau - tran khi khoang ming phdi. o mdt hoac cS hai ben phdi tmng binh canh da chin thuong dupc diiu trj tai binh vi$n Da khoa Tmng uong Thii Nguyin trong thai gian 4 nam tir thing 3/2010 din 3/2014. Kit qua cho thiy tuoi tmng binh la 39.4 ± 1.5 tuoi; ty 1$ nam/nu-: 9.2/1. Nguyin nhin tai nan giao thong cd 44 binh nhan chiem 53,7%, tai nan sinh hoat chiim 26.8%; cac tmong hop den viin cd tinh trang sdc (65.9%), dan luu khoang mang phoi toi thiiu mdt bin chiim 98,8%, din luu khoang ming phdi tdi thieu 2 ben la 1.2%. Mo nguc sau dan luv 4 tnrong hc^ (4,9%). Kit qua tdt dat 78%. trung binh dat 17.1%.
kem dat 4.9%. Dan luu khoang ming phoi tdi thiiu la phiu thuat chu yiu de diiu tn trin miu. tran khi khoang ming phdi trong binh canh da chin thuong
Tip khoa: tran mau mang phoi, tran khi mang phoi, da ch^n thu'O'ng
I. DAT
V A N D £Ngay nay vdi s u phat trien cua xd hdi, s u gia tang nhanh ehdng cua cac phuang tien giao thdng, trong khi dd eac dudng xa, co s d ha t i n g ehua d u a c dau t u kip thdi. y thuc tham gia giao thdng cua ngudi ngudi dan cdn hgn c h i ndn cdc trudng hop tai nan giao thdng ngay cang nhidu [1]. Do vdy, nhung nam g i n day so trudng hap nan nhan ed tran mau ttdn khi khoang mang phoi ngdy cdng nhiiu vd t h u d n g ton t h u o n g phoi hap vdi cac c h i n t h u a n g khde gay ndn bdnh canh da c h i n t h u o n g r i t ngng, n h i i u trudng hop t u vong hay d i lai eac di ehung nang n i v i sau, tao ndn ganh nang cho gia dinh va xa hdi
Dia chl lien he- Au Vin Thio, Tmng tim y te Cho m&i, BSc Kan
Email- auvanthao2010@gmail com Ngiynh$n 25/1/2015 Ngiy duoc chip lhu$n. 18/5/2015
Chan doan cdc trudng hpp tran mau - tran khi khoang mdng phoi thudng dua vao cac d i u hidu ldm sang va ehup X - quang l i n g nguc thdng t h u d n g [1 - 4]. Didu tri ede trudng hpp tran mau, tran khi khoang mang phoi muc dd n h i i u t h u d n g phai dat d i n luu khoang mang phoi t i i thieu va dem lai k i t qua tdt [2, 5]. Khoa Tim maeh Long ngue cua Bgnh vign Da khoa Trung uong Thai Nguyen da tiep nhan va dieu trj nhiiu trudng hop tran mdu - trdn khf khoang mang phoi trong bdnh eanh da c h i n thuang. Tuy nhidn, cdc nghidn cuu v i de tdi nay cdn it, ehua hd t h i n g , vi vdy, de ddnh gid k i t qua p h i u thuat d i i u tn trdn mau, tran khi khoang mang phoi bdng d i n luu mdng p h i i t i t thieu trong bdnh eanh da c h i n thuang tai bdnh vidn Da khoa Taing uong Thdi Nguyen, chCing tdi tidn hdnh nghien euu de tdi vdi muc tidu. Ddnh gia k i t qua p h i u thudt dieu trj trdn mau, trdn khf khoang mdng phoi trong bgnh eanh da c h i n thuang.
TCNCYH 93 (1) - 2015
TAP CHi NGHIEN CU'U Y HQC
II. D 6 1 TU'gNG VA PHU'aNG PHAP
1. Ddi t u v n g
Doi tupng nghidn edu bae g i m 82 bgnh nhan cd trdn mau khoang mdng phoi. trdn khi khoang mang phoi hay ea tran mdu - ttdn khi khoang mdng p h i i , d mpt hodc ca hai ben phoi ttong bdnh canh da c h i n thuong d u p c d i i u ttj tai bdnh vien Da khoa Tmng u o n g Thai Nguydn trong thdi gian 4 ndm t d thdng 3/2010 d i n 3/2014.
2. PhiFong phap: Nghien edu dupe t i n hanh theo phuang phdp md ta c i t ngang.
Cdc chi tieu nghidn cdu: tuoi, gidi, nguyen nhdn c h i n thuang, chan doan ton thuong, sd luong djch d i n luu, s6 ngay ddn luu, k i t qua phdu thudt ddn luu
Danh gia l(et qua sau phiu thuat
+ K i t qua t i t : Bdnh nhan h i t dau ng\rc hp^c cdn dau nhg, h i t khd thd, ri rdo phe nang binh t h u d n g h i t djch, h i t khi hay hinh anh phim x-quang cdn m d nhg gdc sirdn hodnh ben t i n t h u o n g
+ K i t qua trung binh: ri rdo p h i nang phoi giam rd d mdt hay hai bdn p h i i Phai xoay chlnh lai ddn luu hpde chpc hut mdng phoi tn sung do cdn dtch cdn khi, sau khi x u tri dat ket qua tot, phai m d n g y c l i y mdu cyc.
+ K i t qua kdm- vidm mu mdng phra, hay t u vong.
E)ao di>c n g h i e n CLPU: Thdng tin rieng cua bdnh nhdn v i bdnh tdt d u o c bao mdt va chi d u p c s u dung cho mue dich nghien cdu, D u o c s u d i n g y cua bdnh nhdn va gia dinh khi p h i u thugt
II.
K £ TQUA
B a n g 1 . Phan bd benh nhan theo n h o m t u i i , gidn t i n h
Nhom t u 6 i DifAi 20 tuoi TO' 20 - 40 tuoi 71/41 - 6 0 tuoi Tren 60 tuoi Tong cong
Nam 6 28 37 3 74
NLF 1 4 2 1 8
%
8,5 39 47,6 4,9 100
Ty 16 nam gSp nhi^u hcyn nO- {nam ctii^m 90,2%, nu" chi^m 9,8%). Ty le nam/ni>: 9,2/1; ntiom tu6i gap ntii^u ntiat la ntiom tuoi tir 41 - 60 tuoi (chiem 47,6%), tiep den nh6m tuoi tu- 20 - 40 tuoi c h i i m 39% vS nh(5m tuoi trSn 60 g j p it nhat 4,9%. Ty \i nam/n& [i 9,25/1, tuoi tmng blnh 13 39,4 ± 1 , 5 tuoi.
TCNCYH 93 (1) - 2015
• T A P CHi NGHIEN C O T J Y H p C Bang 2. Nguyen nhan c h i n thu'O'ng
Nguyen nhan Tai nan giao thong Tai nan smh hoat Tai nan lao dOng Tong cong
n 44 22 16 82
%
53,7 26,8 19,3 100,0
Nguyen nhan tai nan giao thdng cd 44 bdnh nhdn chiem 53,7%, tai nan sinh hoat ehiem 26,8%, tai ngn lao dpng gap it n h i t chiem 19,3%. Tinh ttang benh nhan khi ddn vi$n: Khdng s i c gap 28 bgnh nhdn c h i i m 3 4 , 1 % , s i c nhe 41 bdnh nhdn (50%) vd 13 b§nh nhdn cd s i c vua chiem 65,9%, khdng gap trudng hpp ndp s i c ndng.
Cdc ttudng h p p tran mau, trdn khi khpang mdng p h i i trpng bdnh canh da c h i n thuang, thudng gdp kem ttieo ton I h u o n g phoi hop d mdt c o quan cd 71 ttudng hpp, chiem 86,6%. Ten thuang t d phdi h o p t u 2 c o quan t r d ldn it gdp hon cd 11 tn/dng hpp, c h i i m ty Id 13,4%.
Bang 3. C h i n doan tru'dc p h l u t h u a t ChSn doan
Tr^n mau, tran i<hi l<hoang mang phoi hai ben Tr^n khi khoang mang phoi
Tran m^u khoang mang phoi
TrSn mau. tran khi khoang mang phoi mot ben Tong so
n 1 2 22 57 82
%
1,2 2,4 26,8 69,5 100,0
22 t r u d n g hgp trdn mdu khoang mang phoi mdt ben c h i i m 26,8%, ed 57 trudng hop ed ttan mdu va tran khi khoang mdng phoi c h i i m 69,5%. 2 trudng hpp trdn khi khoang mang phoi mdt ben hay ttdn mau, ttdn khi 2 ben gap it hon.
- D i n luu khoang mang phoi mdt ben c h i i m 98,8% (trong do cd 3 ttudng hpp dd ddn luu a ttjyen d u d i (huy$n), nhung khi vdo vidn phai dan luu lai). D i n luu ca 2 bdn chi cd 1 trudng hpp (1,2%).
- M d nguc: C d 4 benh nhdn phai m d ngyc sau ddn luu khpang mdng p h i i dp mdu cue khoang mdng phoi c h i i m 4,9%.
TCNCYH 93 (1) - 2015
TAP CHI NGHIEN CU'U Y HQC •
Bang 4. Sd lu'p'ng djch qua sonde trong dcrt d i i u trj
So Iu'O'ng dich Du'6'i 500 ml 5 0 0 - 1 0 0 0 ml Tren 1000-1600 ml Tren 1500 ml Tong cpng
n 54 23 5 0 82
%
65,9 28 6.1 0 100
So lifong d|ch difdi 500ml CO 54 tru'dng h^p, chiem 65,9%. S6 lu'ong dich tCr 500 - 1000ml c6 23 tru'dng hop, c h i i m 28%. Co 18 tnjdng hop c h i i m 22% d i n luu trong thdi gian 48 d i n 72 gicf.
64 benh nhan nJt d i n luu tren 72 gid c h i i m 78%
Bang 5. K§t qua d i i u trj p h l u thuat
K i t qua T i t Trung binh Kem Tong cong
n 64 14 4 82
%
78,0 17,1 4.9 100,0
D i i u tn dat k i t qua t i t ed 64 trudng hop c h i i m 78%, dgt trung binh cd 14 ttvdng hpp chiim 17,1%, dat k i t qua kem cd 4 trudng hpp chiem 4,9%. Cdc b i i n chdng sau ddn luu: xep phii 14 benh nhan (17,1%); 4 bdnh nhdn mdu cue mang phoi (4,9%); khdng cd bien chung 64 benh nhdn (78%).
IV. BAN LUAN
K i t qua nghidn edu d cho t h i y trdn mdu, Iran khi do da c h i n thuang ed the gdp d moi Ida t u i i (6 t u i i d i n 77 tuoi), trong do t / le gdp d nhdm t u i i t d 20 - 60 r i t cao (86,6%), day la t u i i lao ddng chinh Phan b i tuoi trong nghien cuu nay cao hon so vdi cae nghien cuu eua tae gia Pham Ngpc Sdm cd ty le Id 74% [1].
Theo Nguydn Huu U'dc nam 2004 - 2006 [2]
thi t u i i trung binh la 34,9 + 15,3. Theo Nguydn Huy Son thi tuoi trung binh trong nhdm t i i n cuu tai bdnh vidn Vidt D d c Id 34,8 ± 13,2 tuoi
[3]. Theo nghidn cdu cua Nguydn Trudng Giang (2006) cd ty Id 77,4% [6].
Ty Id nam/nu Id (9,25/1) (bang 1), cdn theo tap gia Pham Ngpc Sam ty Id ndy x i p xl 4/1, theo tac gia Nguydn H d u U'dc [2] Id 6,4/1 va Ngd Gia Khdnh [4] Id 5,5/1. Thep chung toi, nguyen nhdn gdy s y chdnh l$eh gtdi tinh nay la do nam gidi tham gia giao thdng n h i i u hon so vdi n u gidi
Theo nghidn edu ndy, nguydn nhdn chin thuang do tai nan giao thdng c h i i m 53,7%
(bang 2) Theo Ngd Gia Khdnh ty Id ndy la
90 TCNCYH 93 (1) - 2015
71,15% [4], theo tae gia Vi Hong Due la 78%
[7] N h u vdy, tai nan giao thdng vdn la ydu to chinh gay nen da c h i n t h u o n g cd trdn mdu, tran khi khoang mang p h i i .
K i t qua nghidn c d u cho t h i y hau h i t cdc trudng hap da c h i n t h u a n g cd trdn mau, tran khi khoang mang phoi d i n vien trong tinh trang s i c nhe vd soc v d a , c h i i m 65,9%.
Khdng co t r u d n g hop ndo sde ndng, ty Id ndy theo k i t qua nghien c d u cua Phgm Ngoc Sdm la 2 2 % [1] Ngd Gia Khanh thay ty Id bdnh nhdn nhap vi#n trong tinh trang s i c chi ehiem 11,54% [4].
Dp benh nhdn trong bdnh canh da chan thuang ed b i i u hidn trdn mau, tran khi khoang mdng phoi phoi hop vdi cae ton thuong khac, tai mpt eo quan c h i i m 86,6%, hai C P quan trd len CP 11 trudng hop, c h i i m 13,4%
Trong nghidn euu nay, tran mau tran trdn khi khcang mdng phoi mpt bdn ed 57 trudng hpp, c h i i m 69,5% (bang 3). Theo nghien edu cua Phgm Ngpc Xdm ehdn thuang ngue kin cd ttdn mau. trdn khi khoang mang phot hai bdn don t h u i n Id 26%, the da c h i n thuong la 74%
[1]. Theo tdc gia Nguydn Trudng Giang [6], trong nhdm bdnh da chan t h u a n g cd chan thuong ngyc thi cd d i n 2 5 % Id trdn mau trdn khi khcang mang phoi hai bdn. Ddn luu khoang mdng phoi toi t h i i u mpt bdn, c h i i m 98,8% Ddn luu mang p h i i t i i thieu Id ky thuat CO ban d u p c chi djnh cho cde trudng hop trdn mdu, tran khi khoang mdng phoi, s u dyng ong cd kich t h u d c to (28 - 32Fr) d khpang lidn s u d n 5 hp^c 6 d u d n g nach giua. M d ngyc sau d i n luu khoang mdng phoi la 4 tt^rdng hpp. Theo Phgm Ngpc Sdm ty l§ phai p h i u thuat dgt ddn luu lai Id 21/68 trudng hpp [1].
So luang djch d u d i 500 ml, c h i i m 65,9%
(bang 4) d i i u ndy eho b i i t hau h i t trong da c h i n t h u o n g ed trdn mau, tran khi khoang mang phoi deu cd b i i u hidn t h i i u mdu, ndn
TAP CHi NGHIEN CCPU Y HQC trong qud trinh dieu trj can ehu y truyen bii lupng dieh, mdu eung nhdm.
Thdi gian d i i n g d i n luu thudng phai trdn 72 gid (ba ngdy), c h i i m 78%, thdi gian luu sonde d u d i 48 gid khdng g^p trudng hpp ndo. D i i u ndy hoan todn phu hpp vdi d i i n b i i n lam sdng cua b$nh nhdn da c h i n thuang, bdnh nhdn ed nhieu ton thuang kdm theo nhu c h i n thuong cdt s i n g , gdy xuong dilji.. Ddy la ly dc chlnh bdnh nhan khd ngoi day 6e tap thd, thoi bdng sau ddn luu khoang mdng phoi Ndn trong 82 trudng hop khdng cd trudng hop ndo riit sonde ddn luu d u d i 48 gid Thdi gian nit d i n luu sau 72 gid c h i i m 78%. K i t qua ndy phCi hpp vdi k i t qua nghidn cuu cua Pham Ngpc Sdm [1] va cOng phu hpp vdi k i l qua nghien c u u cua Nguydn Huy Son tgi bdnh vidn Viet Due t u 1999 d i n 2000 [3].
Ddn luu trdn mdu, trdn khi mdng p h i i dung ky thudt trong bdnh eanh da chan thuong thudng dem lai k i t qua t i t , it d i Igi bien chdng tai p h i i . Qua nghien cdu, chung tdi t h i y cd 78% cac trudng hpp dgt k i t qua tot, nghidn cdu cua N g u y i n Hi>u U'dc vd cpng s u , ty Id tdt dgt 89,9% [2], ehi edn 14 trudng hpp dat k i t qua trung binh vd 4 trudng hap dat k i t qua kem Vi trong da c h i n thuong, t h u d n g Id c h i n thuang manh CO ton t h u a n g phdi hpp tai l i n g ngyc nhu gay n h i i u xuong s u a n , dap phoi, kem theo cd gdy xuong dDi, c h i n t h u a n g cdt s i n g , v d tgng i bung, do vay bdnh nhan khdng t y ngoi ddy, khdng t y tap t h d dupc... Ndn p h i i n d kdm, djch mdu u dpng trong khpang mdng p h i i , can phai hd trp thdm cac cdc thu thuat xoay chlnh i n g d i n luu, chpc hut tham chi phai m d ngyc lay l i y mau tu mdng phoi.
Trong nghidn cdu ndy gdp 04 trudng hop cd bieu hien mau cue mdng phoi, dieu dd ehung td e i n cd kinh nghidm ttong x d tri, theo ddi d i n luu tran mau, tran khi khoang mang phoi.
TCNCYH 93(1)-2015 91
TAP CHi NGHIEN CCFU Y HQC
V . K t T L U A N
Qua nghidn edu 82 t r u d n g hpp d i n luu tran mdu, trdn khi khoang mdng phoi trong bgnh canh v i mdt s i dac d i i m ldm sang, c^n Idm sdng vd danh gia k i t qua dieu tri chung toi ed mdt so k i t luan sau:
- Bdnh nhan da chan thuang cd tran mau, tran khi khoang mdng p h i i g^p d t i t ca eac dp t u i i (6 - 77 t u i i ) nhieu nhat nhdm t u i i lap ddng 20 - 60 t u i i (86,6%), chu y i u Id nam gtdi (90,2%), nguydn nhan ehu y i u dp tai ngn giao thdng
H i u h i t cac trudng hop d i n vign deu cd tinh trgng s i c (65,9%), d i u cd cdc t i n thuong p h i l hap. nang d nhieu eo quan de dpa tinh mang bdnh nhdn
Trong bgnh eanh da chdn thuong chu yeu cd trdn mau, trdn khi khoang mdng p h i i p h i i hpp (69,5%), chi ttdn khi khoang mang phoi it gap (2,4%).
Dieu ttj dan luu khcang mdng p h i i toi t h i i u Id phdu thudt chij y i u de dieu tri ttan mdu, tran khi khoang mang phoi. Ket qua tot dat 78%, tnjng binh dgt 17,1%, kdm dgt 4,9%.
Lo'i c a m c n
Nhdm tdc gia xin chdn thdnh cam on khoa Ngogi Tim mach - Long nguc, khoa Gay me H i i sde benh vien Da khoa Trung uong Thdi Nguydn dd giCtp d d tdi hoan thdnh nghien cdu ndy Chung tdt xin cam k i t khdng xung ddt lpi ich t d k i t qua nghidn edu.
TAI LIEU THAM KHAO
1. Pham Ngpc Sam (2010). Nghien ci>u dac d i i m ldm sdng, cdn Idm sdng vd k i t qua dieu ttj ttan mdu, ttdn khi khcang mang phoi ttpng Chan ttiuang ngyc kfn ttong 3 nSm (2007 - 2010) tai bdnh vidn Viet O d e LM$n vSn Thac sp, Trwijng Dai hgc YHd Ndi.
2. Nguyin HCFU U'dc (2006). Danh gid tinh hinh c i p cuu c h i n thuong long nguc tat bdnh vien Vidt D d c giai doan 2004 - 2006.
Tap chly hgc VietNam. 3 2 8 , 4 0 2 - 4 1 3 . 3. Nguyin Huy S o n (2001). Nghien cinj diku tri ttdn mau mdng phoi do chan thuong nguc bdng ddn luu mdng phoi. Luan vSn tit nghipp ddc sT chuyen khoa 2. Truong Dai hoc YHi Ndi.
4. N g d Gia K h a n h (2008). Nhdn xet dac d i i m Idm sdng vd X - quang ngyc cua bdnh nhdn c h i n t h u o n g n g y c kin. Kh6a luan tdt nghiSp bac sy y khoa. Truing Bai hoc Y Ha Npi.
5 oang Hanh De (1985). C h i n thuang nguc. Chuyen khoa ngpai. Nha xudt ban Y hoc Ha Npi, 169
5. NguylnTru'dng Giang, Nghiem Oinh P h i n , N g u y i n Van S o n , Dang Ngoc Hung (2005). Ddc ^ i m ton thuang va chiin thuat x u tri c h i n thuang ngyc ttong da ehin thuong. Ngoai khoa. 7. 12 - 1 7 .
7. Vi Hdng Dire (2007). Nghidn cuu dac d i i m lam sdng, c§n Idm sdng eua cae chin thuong ngyc d u o c dieu trj b i n g m d nguc tai benh vien Viet Ode. Lu$n vSn thac sy y khoa, Truing Dai hoc Y Hd Npi
TCNCYH 93 (1) - 2015
•^ TAP CHi NGHIEN CO'U Y HpC
Summary
TREATMENT OF HAEMOTHORAX, PNEUMOTHORAX IN MULTIPLE TRAUMA
Thoracic trauma is a common cause of significant morbidity and mortality. This study evaluate the results of treatment of haemothorax, pneumothorax in multiple trauma. From 3/2010 to 3/2014, there are 82 patients with heamothorax, pneumothorax or heamopneumothorax in multitrauma of Thainguyen natipnal general hospital The results shown that the mean age was 39.4 ± 1 5 years old. The ratio of male/female was 9.2/1; 44 patients was from motor vehicle acci- dents representing 53.7%; accidents activities in 26.8% Patients admitted with shocks represented 65,9%; unilateral chest drainage was performed in 98.8% of all cases, bilateral chest drainage in 1.2% cases; thoracotomy in 4 eases. Optimum result was achieved in 78% of all cases, average result in 17.1%. In conclusion, chest tube placement is the first step in the man- agement of traumatic haemothorax, pneumothorax in multitrauma.
Keys word: haemothorax, pneumothorax, multitrauma
TCNCYH 93 (1) - 2015
