nhanh thong qua vi$c phat trien toi da can ngo?i vl. Lam giam den mdc toi thieu rdi loan phat trien xddng sau gay xu'dng. N h d vay, dinh Metaizeau thdc s d la mdt phu'dng phap, mot phu'dng tien ngay cang dddc iJng dung trong dieu W gay xu'dng diai tre em.
V. KET LUAN 1 . Qui I r i n h k^^ t h u ^ t
Day la mgt qui trinh ky thuat dieu tri gay ki'n than xudng diJi tre em co do an toan cao, de iitig dung d nhutig cd sd y te cd dieu kien ve phuWng tien nhu" man tang sang, ban mo chinh hinh.
2. l/u nhu'dC di€m cua qui trinh ky t h u a t
* l?u diem: Qui trinh ky thuat ddn gian, de hieu, de lihg dung d nhthig c d s d y t e co dieu kien ve phu'dng tien n h d man tang sang, ban k6o nan chinh hinh.
* Nhu'dC d i e m : Chi ap dung cho gay kin than xu'dng dijt tre e m . Ky thuat nay doi hdi nhiitig phu'dng tien va dung cu chuyen dung di kem nhd; man lang sang, ban chinh hinii, kim khda, tay cam chUT. Neu thieu dung cu thi thu'c hien ky thuat se gap kho khan.
VIETNAM MEDICAL JOURNAL m - JANUARY • 2017
TAI LIEU T H A M KHAO s 1. Nguyin Tifn L3m, Vu Huyen Trinh, Phan Dijfe
Minh Man, (2007^, "Dieu tri gay than xudng dui ti^
em tjang dinh no! tiiy Rush dudi man tang sang^K hoc thanh phdHS ChfMmh, 11(1), tr. 472-476.
2. Pham Kim Thien Long (2000), "Dieu tri gay thSn xdOng dui d tre &n bang dinh na tuy Rush diifli man tang sang " Thdi si/ Ydddc hoc, tr. 119 -120.
i . Nguyen Thai Sdn ( 2 0 0 3 ) , "Dinh Metaizeau v L cac kha nang uYig dung tren lam sang'; Hgi ngm khoa hoc hoi Chan thu'dng chinh hinh toin gum
lan thiTIIl/tr. 66-67. ^ 4. Vu Huyen Trinh (2007), "Phan tich nguyen n i i i L
thanh cong va that bai trong 1^ thuat dong dinjl Rush than xu'dng diji tre em dddi man tang sangli
£^ tai nghiin ahr khoa hoc dfp cd sd. Binh i ^ l ciiin thifdng diinh hinh TP. Ho 0}iMinh. M 5. Diete H.G e t ai ( 1 9 9 7 ) , 'Titanium ElasUc nail
system technique guide'; Synthes - Origina^<
instruments and implants of the assodation for the study of internal fixation - AO/ASIF.
6. Metaizeau 3.D, Pien« Lascombes (2010), "Fentoal fracture, • Rexible intramedullary nailing in diildren"
^n^-Veriag Bmlin htekMi&g,^. 197-230.
t. David L.S John M.F ( 2 0 1 0 ) , "Femoral shaft fractures. Fractures in childrens", Rockwood and\
Wilkins Fractures in Children^, p. 798-838.
SIEU AM DO K H O A N G CACH TU" DA DEN M 6 M NGANG - M A N G P H O I V A C H I E U D A I T H y C TE KIM TUOHY
TRONG GAY TE CANH COT SONG NGU'C
T O M TAT
Myc tieu: So sinh khOcing each tii da den mom ngang, la thanh mang phS tren sieu am vdi do dai thu'c te cua kim Tuohy den mom ngang va khoang canh cot song ngu'c (CCSN) khi gay te CCSN. B&
tltdng vS phuVng phap nghiSn cuU: thu* nhiem lam sang trSn 35 mo than, nieu quan tai khoa gay me B|nh vien Bach Mai, tCr tiling 10/2014 di'n 5/2015.
Sieu §m do dp sau tiJ* da den mom ngang, la thanh mSng phoi va chieu dai thdc te cua kim Tuohy den mom ngang va khoang CCSN tai Tg-Tg. Ketgua:Juoi
* Binh Win Bach Mai
** Benh wit i/iet Diit
Chju tradi nhiem chinh: Nguyin Hong Thuy Email: [email protected] Ngay nhan bai: 3.10.2016 I^gay phan bien khoa hpc: 20.12.2016 Ngay duyet b^i: 30.12,2016
Nguyin H6ng Thfly*, Nguyen Quoc Aah*,' Nguyin Qu6c Kinh**, Nguyin XuSn Hien*
trung binh dis BN la 50±i3,22 tu6i, chi so BMI tnjng binh la 20,8±2,65 kg/m^. l<hoang each tij' da den mom ngang theo m i t cat ngang ciia sieu am la 2,25±0,6W cm va chieu d^i thi/c te kim Tuohy la 2,66±0,63 c n r ^ hai khoang each nay co moi tu'dng quan chSt vdi h f ^ f tu'dng quan r=0,979 (p<0,05). Khoang each tuT da d ^ la thanh mang phoi (3,62±0,682em) va chieu d^i ^ te klm Tuohy den khoang CCSN (4,10±0,703 cm) cung CO mcfi tudng quan chat v6i r=0,937 (p<0,05). 1^
tri chpc kim tai Tg chiem ty le cao nhat (54,1%), tilf choc thanh cong ngay lan dau la 94,3% va thanh congj.
cua gay te la 100%. Khong c6 trdcing hop nao xay r l tai bien thung mang phoi, ty ie chpc vao mach mau | , 2,8%. Kei luan: Siiu am khoang canh c6t song n j ^ theo mat cat ngang cung cap die chi so dang tin ^m giup fch cho vi?c thdc hien g§y te CCSN thanh c6m^
cao va an toan cho Benh nhan, tranh ddpc nguy co^
dam thung mang phfii va tran khi mang phoi.
Tu'khoa: Sieu am, Khoang canh cot song ngiiC,, Phau thuat thein-nieu quan.
22
TAP CHi Y HOC VIET NAM TAP 450 - THAHG 1 - SO 2 - 2017
I M M A R Y
ULTRASOUND MEASURE THE DISTANCE FROM M O M T O H O R I Z O N T A L DA - PLEURAL K I M A N D ACTUAL LENGTH rUOHY C O M P E T I T I O N I N ANAESTHESIA
THORACIC S P I N E
Objective: To compare the distance from the n to the transverse process, to the parietal pleural ultrasound with the actual depth of the needle ohy to the t^nsverse process and and to ravertebral space in thoracic paravertebral block.
tbjects and Methods, clinical trial on 35 patients Iddney-ureter surgery in anesthesia recovery room Bach Mai Hospital from 10/2014 to 5/2015.
jasound to measure depth from skin to transverse Dffiss, to parietal pleural and the actoal depth of the edie Tuohy at Te-Tg to transverse process and to raverisbral space. Results. The mean age of tients was 50±13,22 years, BMI was average at i,8±2,65 kg/m^. Distance from the skin to transverse Dcess of 2,25±0,604cm on ultrasound and actoal ipth of the needle Tuohy was 2,66±0,63cm and they s correlated with correlation coefficient r=0,979
<0,05). Distance from the skin to parietal pleural ,62±Qj682qni) and the actual depth of Tuohy needle paravertebral space (4,10±0,703cm) also correlated th r=0,937 Cp<0^05). The insert:ion point located at e level dlF Tg is high percentage (54,1%); and the te of successful first attempt is 94,3% and the the iccess of anesthesia was 100%. There is no cases of eural puncture in the study, the rate of vascular incture was 2,8%. Conclusion: Ultrasound imaging thoracic paravertebral space with transverse snsducer position to provide reliable indicators useful r performing anesthesia highly successful and safe r the patient, help avoid inadvertent pleural jncture and pneumothorax.
Key words: Ulhasound, Thoracic paravertebral lace. Kidney-ureter surgery.
DiOkTVANDE
Gay te canh cot song la mot trong nhuYig
^lu'dng phap lau ddi nhat cua gay te viJng dddc iTdung each day hdn mot the ky. Hugo Sellheim Leipzig (1905) la ngu'cfi di tien phong Irong ITnh / c gay. Sau khi cong bo ban dau, ky thuat gay
; nay da bi quen lang cho den tan nam 1979, ill Eason va Wyatt nhin lai ky thuat gay te CCSN 3 tai hien laj tinh hap dan "ldi fch mdi tiy l<y
"luat cu" bang each mo ta mot ky thuat dat atheter vao khoang CCSN. Ket qua cua gay te CSN la lam phong be than kinh van dong, cam iac va than Idnh giao cam giao d 1 ben cd the.
ieu qua giam dau cua te CCSN ^ii<ic danh gia I tu'dng tddng vdi giam dau ngoai mang cdng hdng co du diem ve ky thuat la de lam hdn, ty
! thanh cong cao va it tac dung phu hdn. Hieu ua giam dau va tfnh an toan cua no con phu luoc vao ky thuat gay te va kinh nghiem ciia
ngu'di lam gay t e [ 1 ] , [ 2 ] . Ky thuat^vao^ khoang CCSN bao gom cac phu'dng phap co dien mang tmh bddc ngoat n h d ky thuat mat su'c can, kich thfch than kinii. Cac phu'dng phap nay gap kho trong viec xac djnh khoang each tii da den cac moc giai phau la rat khac nhau va ky thuat mlft su'c can doi khi kho cam nhan dddc. Gay te CCSN dddi hu'dng dan sieu am co nhieu du diem vuWt trpi Iam i s n g t y le thanh cong va tfnh an toan cua ky thuat gay t^ nay do nhin ro cac mdc giai phau, du'dng di cua kim va s d lan truyen ciia thuoc te [ 3 ] , [ 4 ] . Tai Benh vien Bach Mai, chung toi ap dung sieu am khoang CCSN theo mat c3t ngang tru'dc khi tien hanh gay te vdi myc tieu:
"So sanh khoang each t i i ' da den mom ngang, den la thanh mang phoi tren sieu am vdi dp dai thdc te cua kim Tuohy den mom ngang va khoang CCSN", tii 66 lam tien de cho nhffng nghien cu^i sau hdn va mang lai s i / an toan cho Benh nhan.
II. €)6l TUCnsiG VA PHU'ONG PHAP NGHIEN CUOJ 1 . D o i tu'dng nghien cu'u; 35 BN dddc gay te CCSN dddi hu'dng dan sieu am de giam dau sau mo than - nieu quan tai Khoa Gay me Hoi sjjfc Benh vien Bach Mai t i r thang 10/2014 den a 5 / 2 0 i 5 .
1.1. Tieu chuau iy^ chgn ijenh nhan
• BN 6\S<3c mo phien than va nieu quan mfit ben vdi dudng mo sddn Idng, t r l n g ben, dudi sudn.
• Tuoi tren 16, khong phan biet gic^ tfnh, dong y hdp tac nghien cihj
• The trang toan than ASA I - I I va do suy than < 2.
^ • Gay me NKQ va d d kien rut NKQ tai phong mo hoac phong hoi tfnh
• khong CO chong chi dmh cua gay te canh cot song ngdc va thuoc t e
1.2. TiSu chuan lo^i tru'ijinh nhan
• Benh nhan khong dong y tham gia nghien cufU
• Benh nhan mo than, nieu quan hai ben
• Benh nhan co tien sir va hien tai co mac cac benh than kinh hay tam than.
• Tinh trang su'c khoe tru'dc mfi' nang (ASA i n , IV), CO cac benh Iy kem theo n h d benh tim phoi nang, suy gan nang, suy than do 3, 4.
• Co tien sir nghien hoac phu thupc opioid va cd chong chi dinh cua gay t e canh cfit song ngdc
2. Phu'dng phap nghien cu'u:
21. Tftfl^AfflgftftaffoftA'thir nghiem lam sang.
2.2. Cac bWdc tien hanh:
- Cach thdc chpn BN: 35 BN co chf dmh mo tiian-nieu quan va dii tieu chuan dddc chpn ngau nhien theo phan doi tddng nghien ciTu.
VIETNAM MEDIcai JOURHAL N'2 • MMUARY - 2017
- Tien hanh giam tau sau mo: sau l<hi BN tinh va aa rut ong NKQ, diem VAS>4. _ ,
* £ & chi so ttieo doi danh gia tmng nghien cuV f Cac chi tieu chung: tuoi, gidi, chieu cao, can nang, BMI.
^ Lien quan tdi gay te:
- Bo Ichoang each tu' da den mom ngang tren sieu am
- Bo do dai thi/c te tir da den mom ngang cua kim Tuohy
- Bo idioang each tir da den ia thanh mang phoi tren sieu am.
- Oo dp dai thirc te tiJ' da dgn Ichoang CCSN ciia i<im Tuohy.
- Vj tri choc i<im, ben gay te, so lan thay M huclng kim, so lan choc.
f Hieu qua gay te.
f C&c tac tai bien sau gay te: choc vao madi mau, thiing mang phoi, dau vet chpc, nhien, triing khoang CCSN...
2.3. Phan tich sdiieu: Sir dung phan mem SPSS 19.0.
KET QUA
1, eac diem ciia doi tu'dng nghien cii'u
Bang 1: Bac diem chung cua dSi iifdng nahlen ctfu Pac diem
Tuoi BN (nam) Can nang (kg) Chieu cao (cm) BMI (kq/mT~
X ± SD 50 ± 13,22 52 ± 8,89 157 ± 5,78 20,8 ± 2,65
147 - 170 15,56 - 27,31
NhanxetAm trung binh la 50 (17-70 tuoi), chi so can nang csS th§trung binh la 20,8 (15,5 -27,5).
2. khoang each tir da den mom ngang, la thanh mang phoi tren sieu am va chieu dai thu'c te ciia Icim Tuohy dSn mom ngang va den IcHoang CCSN,
• Bang 2: Khoang. each tif da den mdm ngang, la thanh mang phoi tren sleu am va chieu, dai thdc tecua kim Tuohv dSh mdm ngang va din khoang CCSN (cm).
X ± SD Khoang each da- mom ngang tren sieu am (cm)
Chieu dai thifc te ciia kim Tuohy da - mom ngang (cm) 2,25 ± 0,604
2,66 ± 0,63 1,5 - 3,5 Khoang each da-la thanh manq phoi tren sieu am (cm) 3,62 ± 0,682 Chieu dai thiTctE ciia kim Tuohy da-khoanqCCSN(cm) I 4,10 ± 0,75?
2,4 2,8
-4,8
-5,5 0,937 <0,05.
Nhan xei: Chieu dai thu'c te eiia kim Tuohy den mom ngang dai hdn khoang each tif da den mom ngang tren sieu am va hai khoang each nay eo moi tu'dng quan chat vdi he so tu'dng quan r=0,979 (p<0,05). Chieu dai thifc tS ciia kim Tuohy den khoang CCSN Idn hdn khoang each da - ia thanh mang phoi tren sieu am va hai khoang each nay co moi tu'dng quan chat vdi he so tu'dng quan r=0,937 vdi p<0,05.
3. Mpt so van S& iiSn quan tdi gay te canh cot song ngu'c Bang 3; Mot sd vSn de lien quan den gay te canh cgt sdng ngu'c
t Tan so (n) TV le (%)
Vitri choc kim Ts
T, T»
T,
1 7 18
9
2,9%
20,0%
51,4%
25,7%
Ben pay te Ben phai
Ben trai
So lan thay doi Oian
l i a n
20 15
57,1%
42,9%
du'dnq kim 31
4
88,6%
11,4%
Sd lan choc kim l i a n
2 ian
33 2
94,3%
5,7%
Hieu qua qay te Thanh conq
That bai
35 0
100%
0%
TAPCHiYHOCVIETNAMTAP450-THANG1-so 2-2017
Nhan xet: Vi tn gay te chu yeu tai Ta chiem ty le 51,4%. Ty Ie gay te thanh cong khi gay te lan iu chiem ty le kha cao la 94,3%.
4. Cac tai bien lien quan tdi gay te canh cot song ngu'c
Choc vao mach mau gap 01 BN, chiem t^ le 2,85%. Cac bien chuTig khac ciia gay te CCSN khong ip trong nghien ciru nay.
1. BAN LUAN
1. C ^ tu'dng nghidn cu'u
Trong nghien ciru cua chiing toi, BN co tuoi 10 nhat la 17 tuoi, I6n nhat la 70 tu6i, do tuoi ung binh la 50±13,2. Trong nghien cirtj ciia cac ic gia nddc ngoai co do tuoi cao hdn nhd Pusch tren 22 phu nLr phau thuat mot ben vu, tuoi ung binh 57,7 (46 -75) [5];' tac gia Marhofer P, ay te CCSN dddi hu'dng dan d 22 BN mo ung Id vu cd dp tuoi trung binh la 58 (41-74) [6];
3i Stephane L tren 48 BN ddt song cao tan khoi than cd tuoi trung binh la 69 (56-81) [7]. Luyet tren BN mo npi soi long ngdc co tuoi trung inh la 55 (21-77). Chi so can nang ed the trong ghien cihi ciJa ehung toi trung binh la 20^
g/m^ (15,5 -27,5); thap hdn cac gia nddc ngoai hd Marhofer P, chl so can nang cd the trung inh ta 24,8 (18,4-36,3) [6]. Ttieo Naja MZ, BMI
•ung binh la 27,8±5,8 kg/m^ va chi sd can nang d the CO anh hu'dng den dp sau ciia kim den hoang CCSN.
2. LiSn quan tdi gay te canh cot song iguTc du'di hu'dng dSn siSu am
Zl. Klwang each tCf da d&i mom ngang rens^am va dinkitl^i thut tecua Idm Tuohy
Trong nghien ciru ciia chung toi, khoang ach tfr da den mom ngang do tren sieu am tai i tri tiJ" T6-T9 trung binh la 2,25±0,604 cm, hoang each nay thap nhat la 1 cm va cao nhat 3 3,2 cm. Theo nghien ciid cua Pusch F tien ianh gay te CCSN tren 22 phu nff mo mpt ben u. Sieu am theo true cat ngang vdi d3u do hang cd t i n so 7,5 MHz tai T4. Khoang each tCr la den mdm ngang do tren sieu am Ia 2,1 cm 0,9-3,4 cm) [5]. Theo tac gia Hara K gay te :CSN dddi hu'dng dan sieu am tren 25 BN phau huat vii 1 ben. Sieu am theo true quet doc vdi lau do thang co tan so 3-11 MHz tai Ti va T4, iioang canh tir da den mom ngang tren sieu am ai Ti la 2,7 cm (1,8 - 4,1) va tai T4 la 2 cm (1,2 2,8 cm). Chieu dai thdc te ciia kim tir da vao ten mdm ngang da dddc mot sd tac gia nghien :uli tren lam sang. Khi thdc hien gay te CCSN ren BN mo than- nieu quan, chiing toi tien hanh lo khoang caeh thdc te tir da den mom ngang ren kim Tuohy. Ket qua chieu dai ciia kim tir da
den mdm ngang tai vj tri tir T5-T9 trung binh la 2,66±0,63 cm; khoang each naythap nhat la 1,5 cm va cao nhat la 3,5 cm. Ket qua cua chiing toi phil hdp vdi nghien cu'u ciia Pusch F, chieu dai cua kim tir da den mom ngang tai T4 la 2,5 cm (l|,5-3,8 em) [5]. Theo tae gia Hara K, chieu dai cua kim tu* da den mom ngang tai Ti sau hdn, trting binh la 3,2 cm (2-4,5 cm) va tai T4 la 2,3 cm (1,5-3 cm). Khi so sanh hai khoang each (tir da den mom ngang tren sieu am va chieu dai thdc te cua kim Tuohy den mom ngang), chiing toi nhan thay khoang each do tren sieu am luon thap hdn chieu dai thdc te cua kim va hai khoang each nay co moi tu'dng quan chat vdi h$
so tu'dng quan r=0,979. Ket qua nay phii hdp vdi ket qua ciia Pusch F: khoang each tir da den mom ngang tren sieu am thap hdn chieu dai thdc te ciia kim Tuohy trung binh la 4 mm (1- 7mm) va hai khoang each nay eo mdi tu'dng quan chat vdi r=0,974 [5].
2.2. Khoang cadt tu' da dSh mang phoi tren siiu am va chieu dai cua kim Tuohy den khoang CCSN.
Trong nghien cu'u ciia chung toi, khoang each tu* da den la thanh mang phoi do tren sieu am tai vj tri tir Tg-Tg trung binh la 3,62±0,682 cm; khoang each nay thap nhat la 2,4 em va cao nhat ta 4,8 em. Tae gia Marhofer P gay te CCSN dddi hu'dng dan sieu am d 22 BN mo ung thd vu.
Sieu am true quet ngang vdi dau do thang co tan so 6-15 MHz tai hai diem T3 va Tg, khoang each tir da den la thanh mang phoi tai T3 la 3,1 cm (2,4-4,6 cm) va Tg la 3,2 cm (2,4-4,9 cm) [6].
Theo tac gia Hara K, khoang each tir da den la thanh mang phoi tai T4 la 3,1 em (2,3-4,1 cm).
Op sau eiia kim gay te tir da vao den khoang CCSN da dddc mpt s6 tac gia nghien cu'u tren lam sang. Cf dot ong ngdc, khoang each nay trung binh la 4-6 cm. Trong nghien diu ciia Chung toi tren BN mo than- nieu quan, chung toi tien hanh do khoang each thde te tir da vao den khoang CCSN tren kim Tuohy. Sau khi hoan tat viec luon catheter vao khoang CCSN, chung toi danh dau vi tri tiep xiic vdi da eiia kim Tuohy, sau khi rut kim ra tien hanh do vdi thddc cd vach chia centimet. Ket qua chieu dai thde te ciia kim Tuohy tai Tg-Tg trung binh la 4,lb±0,703 cm,
VIETNAM MEDICAL JOURHAL M°2 • JANUARY - 2 0 1 7
ngan nhat la 2,8 cm va dai nhat la 5,5 cm. Ket qua cua chung toi tu'dng du'dng vdi tac gia Pusch F, thirc hien gay te tai v| trf T4, chieu dai thiTc te cua kim la 4 em (2,4-5,6 em) [5]. Tac gia Hara K thu'c hien gay te CCSN tren BN mo vu cho thay chleu dai l<lm thye tS tai Ti sau hdn, trung binh la 4,6 cm (2,8-6 cm) va tai T4 nong hdn, trung binh la 3,6 cm (2,5-4,5 em). Ket qua nay sau hdn so vdi Marhofer P, chieu dai eua kim gay te tfr da vao den khoang CCSN tai T3 la 3 cm (2,3- 4,1 cm) va Ts la 3 cm (2,3-4,8 cm) [6]. Ket qua dp saU cua klm trong nghien cihi eua chiing toi nong hdn so vdi mpt so tae gia nu'dc ngoai khac.
Tac gia Stephane L tren 48 BN dot song cao tan khoi u than khoang each nay sau hdn, tai T9 la 4,9 em (3,9-6,1 cm) va T u la 5,2 cm (4,4-6,2 cm), nhutig khong cd sir khac nhau giii'a ve do sau giii'a hai vi tri gay te (p>0,05) [7]. 0 tre eni cd the u'dc tfnh chieu dai eua kim den khoang CCSN theo cong thii'c: [21,2 + 0,53x P (kg)] mm [1],[6]. i<hi so sanh hai khoang each tir da den la thanh mang phoi tren sieu am va chleu dai tht/c te ciia kim Tuohy den khoang CCSN, ehiing toi nh$n thay khoang each tir da den la thjnh mang phoi tren sieu am luon thap hdn ehieu dai thirc te ciia kim den khoang CCSN va hai khoang each nay cd moi tifdng quan chat vdi r=0,937. Theo nghien cihi Pusch F, khoang each tir da den la thanh mang phoi tren sieu am thap hdn chleu dai thiTc te ciia kim Tuohy den khoang CCSN trung binh ia 4 mm (1-7 mm) va hai khoang each nay cd moi tu'dng quan ehat vdi r=0,959 [5].
2.3. Mgi sd van dS khac llSn guan tdi giy ii canh cot sdng ngifc
Hieu qua gay te thanh eong 100% (35/35) tipng nghien cihi ciia ehiing toi, dap iing tot nhu cau giam dau sau mo eho BN. Ket qua cua chiing toi phil hdp vdi kit qua ciia Hara K, gay te CCSN du'di hu'dng dan sieu am tren 25 BN mo vii, hieu qua thanh cflng la 100% va eiia Pusch F, hiSu qua thanh cong 95,4% tren 22 BN md vu [5].
Trang nghien cu'u eua ehiing toi cd 33 tru'dng hdp gay te thanh eong trong ^n choc kim dau tien, chiem ty le 94,3%; cd 2 tru'dng hop rut kim ra khoi da va tien hanh choc lai kim ian 2 (5,7%). V| tri gay te CCSN trong nghien cu'u eua Chung toi du'de thiTc hien tai cac vi trf tir Tg den T9, da so cac tru'dng hdp gay tg d vi tri dot song ngirc Ta, chiem ty ie 51,4%. Trong nghien cihi cua Chung toi, viec gay te ian dau chfnh xac ma khong thay doi hu'dng kim la 31 tru'dng hdp (chiem 88,6%), trong khi ed 4 trudng hdp phai 26
doi hu'dng kim mpt ian (chiem 11,4%). Ve ben gay te, chiing tfli thiTc hien te CCSN ben phai2fl tru'dng hdp (57,1%) va ben trai 15 tru'cfng help (42,9%), giiJa hai ben khong cd sir khae nhau ve do sau cua kim Tuohy den khoang CCSN vdi p>0,05.
3. Tai bien gay te
Trong ket qua nghien cihi, chiing toi gap 01 tru'dng hdp choc vao mach mau (2,85%) nhutig khong de lai di chu'ng va eac tai bien khae chuji^
gap trong nghien cuu nay (thiing mang phSij- tran khf m^ng phoi, tu mau...). Oieu nay thSt sir?
cd y nghTa khi tien hanh sieu am xac dinh v| tii' gay te, eung nhy Men doan khoang each ttr da vao den cac moc giai phau eiia khoang CCSN nhir mdm ngang, la thanh mang phoi se giiip cho ngu'di thirc hien thii thuat an toan va tranh dUde nguy ed thiing mang phoi va tran khi mang^
phoi. Tac gia Hara K gay te CCSN du'di hu'dng*
dan sieu am tren 25 benh nhan mo vii 1 bin, ong nhan thay khong cd tai bien thung mang phoi hay cac bien chihig khac lien quan tn/c tiep den viee gay te khi sir dung sieu am ho trd gayl, te CCSN. Theo Naja Z nghien cihi cac bien e'hihigf sau khi gay te CCSN va that lutig d 682 BN vdi"
ky thuat khong phai sieu am (640 ngu'di Idn, 42 tre em) va quan sat thay cae bien chii'ng cd tan suat sau: ly le that bai 6,1%, chpc vao madi mau 6,8%, ty mau tai diem choc 2,4%, dau't?l v! trf choc 1,3%, thiing mang phoi 0,8%; tran kill mang phoi 0,5%, lan vao khoang dydi nheni hoac vao khoang ngoai mang cihig 1% [2].
V. KET LUAN
Qua nghien cihi sieu am khoang CCSN tren, 35 BN mo than-nl|u quan, ehung tdi nhan thaf vi|c danh gia bang sieu am khoang CCSN theo niat cat ngang da cung cap thflng tin dang tin cay, giup eho viec tien hanh gay te CCSN eo ty le thanh cong cao va an tuan, tao cam giac thoai mai eho Benh nhan. Cd mot moi lien quan cliat che giii^ khoang each ty da den mdm ngarig tren sieu am va ehieu dai thyc te eua klm Tuoli®
den mdm ngang, cDng nhy moi lien quan chS gWfa khoang each t y da den mang phoi vdi chleu daj thyc te cua kim Tuohy den khoang CCSN."
Sieu am giup xac djnh chinh xac vi tri choc klm, hydng xuyen klm va u'dc lydng khoang each tif da den mom ngang, den la thanh mang phoi, tif do CO the yde lydng khoang each tir da den khoang CCSN va chieu sau toi da ciia kim Tuohy khi thyc hien gay te, dieu dd gdp phan tranh lal
TAP CHi Y HOC VlgT NAM TAP 450 - THANG 1 • SO 2 • 2017 :n dam thiing mang phoi va han che nguy cd
m khi mang phoi. Ngay nay, gay te vimg dddc dung nhieu de giam dau sau mo, dac biet khi sd ho trd ciia sieu am va sieu am lam tang
;u qua, tang tinh an toan cho gay te vimg.
U UEU THAM KHAO
Karmakar M (2001). Thoracic Paravertebral Block. Anesthe^iogy, 95, 771 - 780.
Andreas Vogt (2013). Paravertebral block. A new standard for perioperative analgesia. Trends in Anaesthesia and Ciitical Carer, 3 , 3 3 1 - 335.
Andreas Vogt (2011). Review about ultrasounds in paravertebral blocks. European Joumai of Pain Supplements, 5, 489-494.
Karmakar Manoj Kumar (2011). Ultrasound- Guided Thoradc Paravertebral Block. Adas of
Ultrasound-Guided Procedures in Interventional Pain Management, 134-147.
5. Pusch F, Wildling E, Klimscha W, WeinstabI C (2000). Sonographic measurement of needle insertion deplii in paravertebral blocks in women.
BrJAnaesdr, 85, 841-843.
6. Marhofer. P, Kettner. SC, Hajbok. L, Dubsky.
P and Fleischmann. E (2010). lateral ultrasound-guided paravertebral blockade: an anatomical-based description of a new technique.
Bntish Journal of Anae^esia-, 105(4), 526-532.
7. Stephanie Lieutaud (2014). Comparaison de ta diffusion dinique et tomodensitometrique du bloc paravertebral au a)urs du traitement thermo- ablatif percutane des tumeurs renaies. These pour Ie dipI6me d'etat de docteur en medecine, Faculte de medecine Toulouse-Purpan.
[GHIEN CITU MO HINH BENH KY SINH TRUNG TAI KHOA NHI VA KHOA NHIEM C O A B E N H VIEN DA KHOA TINH T R A VINH N A M 2 0 1 2 - 2 0 1 4
3 M T A T
Qua nghien cuVi 5101 ho sd binh an cua benh ian vao dieu tri tai khoa Nhiem va khoa Nhi tai Benh In da khoa tinh Tra Vinh trong 3 nam tCr 2012 den i l 4 , chiing toi tiiu dUdc ket qua:
- Ty l | benh nhan dieu tri npi tm benh k/ sinh jng tai benti vien da Idioa tinh Tra Vinh nam 2013 la i,74%, t9 Ie benh nhan dieu trj noi, tru benh ky sinh Ling tai b§nh vien Irong nam 2012 la 31,58 %va Dng nam 2014 la 24,68%.
- CSc benh thudng g3p chi^m ty Ie cao tir nam )12 den 2014 la: Nhiem virus 6 vi tri Wiong xac dinh 16,75% - 68,79% - 50,83%), Tay Chan Mieng do
;25,51% -38,87% - 23,99%).
Tu'khoa: b^nh ky sinh triing (KST), Benh vien da loa tinh Tra Vinh (BVDK)
U M M A R Y
RESEARCH DISEASE MODELS PARASITES [NFECTION I N THE FACULTY OF SCIENCE ND CHILDREN HOSPITAL I N 3 YEARS TRA
V I N H PROVINCE ( F R O M 2 0 1 2 TO 2 0 1 4 ) Through the study of 5101 medical records of stients in treatment at the Department of Infection Khoa YDupc, Tru'dng £^i hoc Tra Vinh Iliu trach nhiem chinh; Pham The Hfen nail:; [email protected] gay nhan bail 1.11.2016 gay phan bien khoa hpc: 20.12.2016 gay duyet b^i: 29.12.2016
Pham The Hien*
and pediatrics at the Hospital in Tra Vlnh province from 2012 to 2014 three years, we obtained results:
-The proportion of inpatient patients parasitic diseases in general hospitals Tra Vinh province is 43.74% in 2013, the proportion of inpatient patients parasitic diseases at the hospital In 2012 was 31, 58%
and in 2014 is 24.68%.
- The common diseases high percentage from 2012 to 2014 are: Viral infections in unspedfied locations (36.75% - 68.79% - 50.83%), hand foot and mouth level 1 (25.51 % -38.87% - 23.99%).
Keywords: parasitic diseases. Hospital Tra Vinh Province
I. DAT V A N DE
Viec xac djnh mo hinh benh ky sinh trung giup eho benh vien xay dutig ke hoach cham sde sire khoe cho nfian dan va cho nlian vien y t e mpt each toan dien, dau t d cho cong tac phong chong benh cd ehieu sau va trong diem, tirng bddc ha thap ty ie t i r vong cho epng dong, nang cao cham soc su'c khde nhan dan.
Dap iing nhu cau phuc vu va djnh hu'dng phat trien benh vien mot each ben vEJng can co nhffng thong tin ve tinh hinh benh ky sinh trimg cung vdi ket qua dieu t r i ciia nhuYig benh nhan.
Xuat phat t i r thu'c tien do, de tai nghien ciTu cua ehung toi da dddc thdc hien vdi 3 muc tieu sau:
- Danh gia thde trang benh ky sinh trimg tai Benh vien da khoa tinh Tra Vinh trong 3 nam (2012 - 2014).