T^P CHi Y HOC VIET NAM TAP 459 - THANG 10 - SO 1 - 2017
TAI LI^U THAM KHAO
1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease update 2016.
2. Madani A, Keyzer C, Gevenois P.A. "Quantitative computed tomography assessment of lung sbucture and ftjnction in pulmonary emphysema". EurRespirJ.
2001 OCT, 18(4): 720-730.
3. Fujimoto K, Kitaguchi Y, Kubo K, Honda T (2006). "Clinical analysis of chronic obstructive pulmonary disease phenotypes classified using high-resolution computed tomography".
Respirology 2006;11: 731^0.
4. Schroeder J.D.,McKenzieA.S.,Zach 3JV.va cong SI/ (2013). Relationships Between Airflow Obstruction
and Quantitative CT Measurements of Emphysema, k Trapping, and Ainways in Subjects With and WUhpu Chranic Obsbuctive Pulmonary Disease. iUR Atn}
Roentgenol, 201(3), VI/460-W470.
5. Akira M., Toyokawa K., Inoue Y. va cong sir, (2009). Quantitative CT in chronic ob'stnicSw pulmonary disease: inspiratory and ecpjrgtciy assessment. AJR Am J Roentgenol, 192(1), 267-272, 6. WashkoG.R.,Crinra-GJ.,Mohsenif^rZ.vac6ngar
(2008). Ganputed tOTiographie based quantificatKr of emphysema and oonelation to pulmonary fijndion and mechanics. COFV, 5(3), 177-186.
7. Lalita Fernandes et al (2015), "Quantification of Emphysema in Chrome Obstructive Pulmonary Disease by Volumetric Comnuted Tomoaraohv of Lung", Lung India 2016 NoV'Dec, 33(6): 646-S2
DANH GIA CAC TAC DUNG KHONG MONG MUON KHI GAY ME BANG SEVOFLURAN TRONG NOI SOI PHE Q U A N 6* TRfe EM
T O M TAT
Muc tieu: Danh gia cac tac dung khong mong muon khi gay mebSng thuoc me sevofluran trong npi soi ho hap 6 b-e em. Ooi tift^ng, phu'dng phap nghien cihi: nghien culi mo ta hoi cifu tren 64 benh nhan tir 0 - 90 thang tuoi du'dc noi soi ho hap_^ tai Benh vien Nhi trung Udng, fiUdc vo cam bang sevofluran va gay te tai cho bang xjt lidocain, khi dp an than van chu'a dii thi du'dc bo xung bang propofol 0,5 mg/kg/lan. Ket qua: Bien chu'ng khi noi soi ho hap gap phai la: xanh ti'm (14,06%), chay mau (3,13%),^dpa nguVig bm (1,56%, cap cuU kip thcfi, khong de iai di ehuYig gi). Tae dung khong mong muon d berih nhan la: quay khoe sau khi noi soi ho hap (12,5%), dau hong sau khi npi soi (4,59%). Tac dung khong mong muon tren nhan vien y te trong phdng mo la: buon ngii (7,81%)^ ngiil thay miii thuoc me sevofluran trong phong npi soi (26,6%). Ket Iu3n: Gay me bang sevofluran trong npi soi ho hap d tre em la phu'dng phap vo cam tu'dng doi an toan, it bien chiilig va tac dung khong mong muon tren benh nhan, tuy nhien, van co mot lUdng khi me sevofluran thoat ra moi trUcing nen can c6 lie thong thong khi phong noi soi tot de tranh bi phcJi nhiem cho nhan vien y te.
Tdkhoa: noi soi ho hap, gay me tre em, sevofluran SUMMARY
EVALUATION THE SIDE EFFECTSOF ANESTHESIA W I T H SEVOFLURANE FOR
BRONCHOSCOPY I N CHILDREN
*Tru&ng Dai hgc y Ha Ngi
**Benh vien fJhi trung uffng
Chju trach nhiem chfnh: Pham Thi Hien Hoa Email: [email protected] Ngay nhan bai: 10.6.2017 Ngay phan bien khoa hoc: 30.8.2017 Ngay duyet bai: 5.9.2017
Nguyen Due Lam*, Pham Thj Hiln Hoa**
Objective: To evaluate the side effects of anesthesia for children's bronchoscopy uagg sevoflurane. Patients and Methods: A retrospect descriptive study of 64 patients from 0 to 90 months of age who received bronchoscopy at the National Hospital of Paediatrics, sedated with sevoflurane and local anesthetic by lidocaine, when sedation is not sufficient, it is supplemented with propofol O.Smg/kg, Results: Complications during bronchoscopy weiK cyanosis (14.06%), bleeding (3.13%), menace cardiac arrest (1.56%, successful treatment, no sequdae), Side effects in patients are: crying after bronciioscopy (12.5%), sore throat after bronchoscopy (4.69%). Tjie side effects on the medical staff in the endoso^
room were: sleepiness (7.81%), smell of Sevofluran In the environment(26.6%). Conclusion: Sevoflurane anesthesia In pediatric endoscopy is a relatively safe, minimally invasive and side effects of anesltirt'c method in patients, however, there is still a high level of sevoflurane in the environment should be wd ventilated to avoid exposure medical staif.
Keywords: respiratory endoscopy, pediatiic anesthesia, sevoflurane
I. OAT V ^ N DE
Gay me cho npl sol ho hap d tre em la van de kho khan vi phai ehia se du'dng th6 vdi cac dgng cu npi soi. Thuoc me thu'dng du'dc sir dung clio thii thuat nay t la sevofluran, tuy nhien,Jrorg qua trinh noi sol ho hap, mot lu'dng thuoc me nay bi thoat ra ngoai nen eo the anh hu^dng den mu'e dp vo cam va gay 6 nhiem moi tru'dng. Vay viec sir dung gay me bang sevofluran trong nj«
soi ho hap vdi cac phu'dng tien ho trd ho hap mdi hien nay co dam bao dirde tfnh an toan trong gay me hoi su'c va eo the gap cac tac dung khong mong muon gi doi vdi benh nhan frong va
106
TAP CHi Y HOC VigT NAM T ^ P 459 - T H A N G 10 - SO 1 - 2 0 1 7
3U thii thuat, doi vdi nhan vien y te trong phong 10 hay khong? Oe tra ldi cau hdl tren, ehiing toi en hanh de tai nay nham myc tieu: Danh gia cae ac dung khong mong muon khi gay me bang luoe me sevofluran trong npi soi ho hap d tre em.
. €)6l TU'pWG VA PHU'ONG PHAP NGHIEN CUU 2.1 D O I tu'dng nghien cihi: Cac benh nhan 'u'dc ehi djnh npi sol ho hap tai phong Npi soi ho ap can thiep eiia Benh vien Nhi trung u'dng tir fiang 6/2016 den thang 12/2016.
• Tieu chuan li/a chon: tuoi tir 0 - 90 thang, 10 me benh nhan dong y eho con tham gia ighien ciTu.
• Tieu chuan loai trd: Cae tru'dng hdp chong hi djnh gay me toan than: da day d^y, di tat loac ton thu'dng nang vung ham mat ma khong 6 giai phap thong khf.
2.2 Phu'cfng phap nghien cij\i: Nghien ciTu fi6 ta, tien eiru.
• C3 mau: 64 benh nhantheo phu'dng phap ay mau thuan tien.
2.3 Cach thii'c tien hanh
• Chuan bi benh nhan: kham lam sang benh ihan va xem eae ket qua xet nghiem.
• Phac do vo cam: theo doi lien tuc cae thong so: mach, huyet ap, Sp02, EtCOj. Thd oxy 3lit/phiit. Gay te lo mui ben djnh dat ong npl sol bang nho miii 1 - 1,5ml thuoc te lidocain 2%.
Khdl me bang each up mask vdi sevofluran 6%
trong oxy lu\j lu'dng 51it/phiit. Duy tri me bang sevofluran 1 % trong oxy lu'u lu'dng 2 - 3 lit/phut.
Khi ong soi mem vao qua thanti mon va chae ba khf quan, xjt l,5mi lidocain 2% de gay te tai eho.
Khi tre day dua hoac eo that: tiem them propofol 0,5mg/kg/lan va thong khf ap ii/e du'dng.
• Khi npl soi ong mem thanh cong, neu eo ehi dinh npi soi phe quan ong ciTng thi tang lieu sevofluran len 5% trong oxy Slit/phut, sau do duy tri me bang sevofluran nong dp 1-2%, gay te niem mac bang xit lidocain. Neu dp me chu'a dil thi tiem them propofol 0,5mg/kg/lin den khi dil dp me. Sau thii thuat, tre du'dc theo doi tai phdng Hoi tinh cho den di tinh hoan toan. Cac chi tieu nghien culi: eae dac diem chung cua benh nhan, cac bien chirng trong qua trinh npl soi ho hap, cac tac, dung khong mong muon tren benh nhan sau thii thuat, cac tac dung khong mong muon tren nhan vien y te trong phong mo..
II. KET QUA
Bang 3.1. Dae didm chung eua ddi tu'dng nghiSn cdd Thong so
Nhom tuoi: Sd sinh 1,5 thang - 1 tuoi
1 - 3 tuoi
> 3 tuoi
So Itftfng BN (n = 6 4 ) Ty le %
9
25 25 5
Gidl tmh:14% •
• 39,1%
39,1%
7,8"
Nam Nff
Phan loai su'c khoe theo ASA: Do I
06 II 06 III Do IV
42 22
65,6%
34_,4%
21 26 16 1
Phu'dng phapjioi soi ho hap: Ong memOng mem+ong eirng
32,8%
40,6%
25%
l,f
:hi djnh noi soi: Mep du'dng thd D| vat du'dng thd Viem nhiem du'dng h6 hap
Di tat thanh quan Di tat ho hap khac
64
16 100%
25%
Frieu chu'ng lam sang tru'dc soi: Thd rit, co keo Ran am
Chay mau phoj Xep 1 thiiy phoi Thd'cd cir dang hen Khong eo trieu ehifng
15 11 17 6 15
23,44%
17,19%
26,56%
9,36%
23,44%
26 13 2 5 4 6
40,63%
20,31%
3,13%
7,81%
6,25%
9,38%
Bang 3.2. Cae biSh ehdng trong khi noi soi ho hip d tre em Bien chu'ng Noi soi ong mem
• ( n , % )
Phu'dng phap noi soi suf dung Noi soi ong n;'em + ong cu'ng
( n , % )
Tong (n, % )
Chay mau
1 (1,56%) 1 (1,56%) 2 (3,13%)
VIETNAM MEDICAL JOURNAL N°1 - OCTOBER - 2017
D o a nquTiq t i m 0 (0%)
1 (1,56%) ra56%£3
5 (7,81%) 1 (6,25%) 9 (14,06%!^
Khong bien chu'ng
42 (65,63%) 10 (15,63%)
KiipsU;
Bang 3.3. Cac tac dung khdng mong mudn tren benh nhan glal doan sau ndi sol hST^
Tac dung khong mong muon Tre quay khoe khi tinh
Tre keu dau hong
4,69%
Khonq
82,81%
Bang 3.4. Cac tae dung khdng mong mudn tren nhan vien y te trong phdng ndi soi Tac dung khong mong muon
Nhan vien y te buon ngu Nqijl thay mui Sevofiuran
Khonq
n 5 17 42
7,81%
%
26,6%
65,63%
IV. BAN LUAN
Ket qua nghien edu trong bang 3.1. cho thay:
dp tuoi ciia benh nhan trong nghien ciTu ciia ciiung toi deu d lira tuoi tir 0 den 8 tuoi, trong do t / le du'di 1 tuoi la 54,69%, do nghien cii'u du'dc thu'c hien d Benh vien Nhi trung u'dng nen chung toi gap rat nhieu tre du'dc chuyen tir tuyen du'di len do mac cae benh ly bam sinh gay bat thu'dng d du'dng ho hap nen can phai npi soi de chan doan va can thiep sdm, co tru'dng hdp phai npi soi cho tre ngay sau khi sinh. Gay me eho doi tu'dng tre nhd tuo'i nay thu'dng kho khan hdn do tre rat nhay cam vdi tinh trang thieu oxy [2], [3]. Trong nghien ciTu ciia chiing toi, ty le t)enh nhan trong tinh trang nang, phan loai su'c klioe ASA dp 3, dp 4 chiem ty le 27%, day cung la mot thach thii'c vdi bac sy gay me hoi sire vi gay me de npi soi ho hap eho cae benh nhan nay se CO rat nhieu nguy cd. Cac trieu chii'ng lam sang eiia eac benh nhan tru'dc klil npi sol phe quan ta: kho thd, ran am, ran rit, thd co keo...
Dae biet, ed 13 tre da du'dc dat npi khf quan (20,31%), 3 tre da du'dc dat canyl khf quan (4,68%), do khi noi soi ho hap nhieu khi phai rut ong npi khi quan de tien hanh npi soi hoac bo canyl de nong cho khf quan hep nen thu'c SLT rat kho khan d nhu'ng tre dang cd ong npi khf quan hoac cd canyl khf quan.
Trong^nghien ciili nay, ty le benh nhan bi viem nhiem du'dng ho hap chiem ty le 26,5%
(chu yeu la benh ly viem phoi keo dai, xep phoi sau thd may, di vat du'dng thd gay viem phoi...), benh ly hep thanh khf phe quan chiem 23,4%, mot so benh ly hep thanh khf phe quan cd the du'dc dieu tri tot bang npi soi ho hap can thiep.
Ket qua d bang 3.2 eho thay: ed eac tai bien nguy hiem gap phai trong thdi gian nghien eiru dd la: doa ngiTng tim, chay mau va xanh tim. Cd gap 1 tru'dng hdp doa ngiTng tim: benh nhan 3 tuoi, bj hep ha thanh mon do mang ngan, da du'dc md khi quan, thii thuat npl sol can thiep
nong eho hep bang npl sol ong cu'ng kho khan, benh nhan xuat hien nhip tim cham, tan so tim du'di 30 lan/phiit. Benh nhan da du'dc ep tim ho trd va cap cu'u kip thdi, sau do nhjp tim trd lai binh thu'dng, khong ed dl chirng ve than kinh sau do. Ty le chay mau vimg niem mac du'dng ho hap khi npi soi h6 hap la 3,13%, ehiing toi phai cam mau bang each tiem 1,5 ml dung dich adrenalin 1/100 000 vao vi trf chay mau di cam mau. Mii'e dp chay mau kh6ng dang ke va benh nhan on djnli ngay sau khi sol. Ty le benh nlian bj xanh tim chiem 14,06% trong nghien eiru cua Chung toi. Xanh tim la do thieu oxy hoac do co that phe quan trong qua trinh npi soi. Ty le xanh tim ciia chiing toi cao hdn so vdi eiia J de Bile (<
6%), cd the do tae gia nay ehi siy dung ong sol mem, trong khi chimg toi cd sir dung ca ong soi cimg cho mot so tru'dng hdp [1]. Tuy nhien, ty le benh nhan bj xanh tim cua chung toi thap hdn so vdi ciia Soudabeh Haddadi (18,6%), ed the do tac gia nay tien hanh noi soi phe quan de lay di vat bang ong soi eirng nen ty le xanh tim cao hdn [4].
Cac tac dung khong mong muon tren benh nhan giai doan sau khi npi soi la: tre quay khoe sau khi soi (12,5%) va dau hong sau khi sol (4,69%). Do dac diem doi tu'dng nghien culi cua chung toi la tre em, da so nhd tuoi (<3 tuoi), nen khd hdi du'dc ve trieu chu'ng dau hong htfn so vdi benh nhan la ngu'di ldn hoac tre ldn. Do dd, can theo doi va cho thuoc giam dau sau^ngi soi ho hap d tre em, dac biet tre qua nho khong danh gia du'dc ve dau. Co the b/ le tre quay khoe sau mo cung lien quan den tac dung khong mong muon nay.
Trong gay me bang thuoc me ho hap sevofluran cho npl sol ho hap d tre em, cm quan tam den cac tac dung khong mong muon n6i nhan vien y te trong phdng npi spi do thuoc ipe thoat ra moi tru'dng ben ngoai. Trong nghien dfu
TfyP CHi Y Hpcyi|TNAMTAP459 - THANG 10 - s 6 1 - 2017 cua Chung toi, cd tdi 26% so tru'dng hdp ndi soi
ho hap CO ghi nhan phan nan ve mui thuoc sevofluran trong phdng soi va 7% eac tru'dng hdp npi soi cd ghi nhan nhan vien y te trong phdng npl soi thay buon ngii do hit thuoc me sevofiuran hd ra moi tru'dng. Cd the do gay me vdi lull ludng ddng khi mdi cao va sir khong can ddi giula dung cu npi soi va dudng thd nen lam khi me thoat ra moi tru'dng phong npi soi kha nhieu.
Can phai co he thong thdng khf tot trong phdng npi soi de giam thieu phdi nhiim ciia nhan vien y t^
vdi khi me gay 6 nhiim phdng thii thuat.
V. KET L U A N
Sir dung sevofluran vdi nong dp khi khdi me la 6% lu'u lu'dng oxy la 5 liVphut va duy tri me nong dp 1 % vdi lu\i lu'dng oxy 2 - 3 lit/phiit, ket hdp vdi gay te tai cho bang xjt dung djch lidocain la phu'dng phap vo cam tu'dng doi an toan eho thii thuat npl sol hd hap d tre em, ft gay bien
chii'ng va tae dung khdng mong muon tren benh nhan, tuy nhien, van cd mot lu'dng khi me sevofluran thoat ra m6i tru'dng nen can eo he thong thong khi phdng noi soi tot de tranh bj phdi nhiem cho nhan vien y te.
TAI UEU T H A M KHAO
1. J.de Blic, V.Marchac va P.Scheinmann (2002), "Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures", EurRespirJ, 20, tr. 1271-1276.
2. K.Z. Chen, M. Ye, C.-B. Hu va X. Shen (2014),
"Dexmedetomidine vs remifentanil intravenous anaesthesia and spontaneous ventilation for airway foreign body removal in children", British Journal of Anaesthesia, 112(5), tr. 892-7.
3. Selma Maria de A.S et al (2012), "Pediatric bronchoscopy". Global perspective on Bronchoscopy, 111-1^^.
4. Soudabeh Haddadi, Shideh Marzban et al (2015), "Tracheobronchial forei-bodies in children:
a 7 year retrospective study", Iranian Journal of Otorhinoiaryngoiogy, 27(5).
NGHIEN CU'U THITC TRANG HO TRCT CUA GIA DINH TRONG PHUC HOI CHU'C NANG CHO NGUCTI KHUYET TAT TAI XA QUE NHAM,
HUYEN T A N YEN, TINH BAC GIANG
Nguyin Thi Thdi', Nguyin Phuong Sinh^
TbiVI TAT
SU ho trd cua gia dinh trong phuc hoi chufc nang eho ngu'di khuyet tat la rat quan trpng giup ngUdi khuyet tat nhanh ehdng hoa nhap xa hgi, dong thdi nang cao chat lu'dng cuoc song. Muc tieu: Mo ta thi/e trang ho trd cua gia dinh trong phuc hoi chuTc nang tai niia cho ngu'di khuyet tat tai xa Que Nham, huyen Tan Yen, tinh Bac Giang nam 2016. Phu'dng phap nghien cuti: Dieu tra mo ta eat ngang dUde thi/c hien tren 247 ngu'di khuyet tat va ngUcfi ho trd chinli trong phuc hoi chirc nSng cho ngu'di^ khuyet tat, sir dung bp eau hdl nh§m tim hieu viec ho trd eua gia dinh trong phuc hoi chirc nang cho ngu'di khuyet tat. Ket qua: Ty le ngUifi khuygt tat dUde ho trd ciia gia dinh trong phuc hoi chirc nSng chi^m' 72,1%, trong do ho trp phuc hoi chii'c ning hoa nhap x5 hpi chiem t / le cao nhat 91%, hS trd phuc hoi chirc nang sinh hoat hang ngay chiem 45,3%, ho trd phuc hoi chirc nang van dong va di chuyen chlem 54,7'%, ho trd phyc hoi chiTe nang giao tiep va ngon nqd chiem ty le thap nhat 45,3%.
Tdkhoa: Phuc hoi chdc nang, ngu'di khuyet tat 'Benh vien Phuc hoi chut nang Bac Giang
^frddng Dai hgc Y-Dddc Thai Nguyen Chju trach nhiem ehinh: Nguyen Phu'dng Sinh Email: [email protected]
Ngay nhSn bai: 11.7.2017 Ngay phan bien khoa hpc: 5.9.2017 Ngay duyet bai: 14.9.2017
SUMIVIARY
RESEARCH ON THE REAL SmJATEON OF FAMILY SUPPORT I N REHABILTTA'nON FOR D I S A B I L i n E S I N QUE NHAN COMMUNE, TAN YEN DISTRICT, BAC GIANG PROVINCE It is important to help people with disabilities to have social integration and improve their quality of life is the family support in rehabilitation. Objectives: To describe the status of family support in home rehabilitation for the people with disabilities in Que Nham commune. Tan Yen district, Bac Giang province in 2016. Research methodology: The investigation was conducted on 247 people with disabilities and primary supporters in the process of rehabilitation.
Using questionnaires to explore family support in rehabilitation for the disabilites, Results: The percentage of people with disability received the family support in home rehabilitation is 72.1%, including the support of social integration was the highest, accounting for 91%, the support for rehabilitation of daily activities made up 45.3%, the support of mobility rehabilitation accounted for 54.7%. In contrast, The support of communication and language rehabilitation was the lowest, constituting at 45.3%.
I.OjBkTV^NBE
Ngu'di khuyet tat la mot doi tu'dng can du'dc sy" quan tam va ho trd dac biet ciia ngu'di than, gia dinh va xa hpi, chiem khoang 6% dan so ca
