, Tgp chl Tai MQi Hpng Viet Nam - Volume (57-10). N°4 - July. 2012
GOP PHAN NGHIEN CCtJ T R A N KHI DlTdl DA VUNG C 6 NG^TC VA TRUNG THAT T^I KHOA TAI MUI HQNG - BV. CHgf R A Y
Tr^n Minh Trudng"
T6M TAT
Trdn khi dudi da viing cd ng^ vd trung thdt Id mQt b^nh ly thdng gdp do khi bi tfch lit lgi dudi da gdy nen, nhiiu nguyen nhdn gdy ra nhu sau chdn thucmg, nhiim triing, suyin...
thdm chi khdng ro n^en nhdn. Afftc tiiu: tim hiiu nguyen nhdn, ldm sdng. xu ly vd kit qud dieu tri benh. Boi tufrng vd phuomg phdp nghien cuu: nhimg ca cd trdn khi dudi da vitng cd mdt ndm diiu trf tgi khoa tmh hodc nhOng khoa khdc nhung cd s\r tham gia chdn dodn vd diiu tri cua chuyin khoa tai mSi hpng, phuomg phdp nghiSn ciiu: mo td hdng logt ca vdi nghien cuu hdi cuu - tiin cuu. Ket qud: 31 ca ghi nhdn trong thdi gian tie 1/20 10 den 3/2012. sd^ ca trdn khi dudi da dem thudn Id 12 ca, sd ca cd kem them trdn khi trung thdt, mdng phdi Id 19 ca. khdng cdn can thi$p 9 ca, 22 ca cdn can thi^p trong diiu tri. Ket lu^n: trdn khi dudi da viing cd n^c trun^ thdt thudng khong tdi muc nguy hiim chit n^tedi, nd cd the du^ gidi quyet tdt vai phdn ddng gdp hay khong ciia y ti. tuy nhiin mdt sd ca cd the tien trien thdnh tinh trgng nguy hiim, gdy suy hd hdp md thdy thudc cdn phdi biet vd xd tri kip thdi.
ABSTRACT
RESEARCH OF SUBCUTANEOUS EMPHYSEMA: NECK, CHEST AND MEDIASTINAL AREA AT ENT DEPARTMENT - CHO RAY HOSPITAL Tran Minh Truong Subcutaneous emphysema ofchest and neck region is a result by air or gas trapped beneath the cutis of the skill, pneumomediastinum is a complication and it has manh causes, such as: trauma, infections, asthma... and spontanous cases ven. Purpose: to be aware ofthe causes, clinical, treatment approach and results.
Subjects and methods for study: Subject: the patients having subcutaneous emphysema of the face and neck area are treated at ent department or at other departments here the diagnosis and treatment are involved by ent specialist. Method:
cases description with retrospective andprospective stutfy. Results: Total of 31 cases recorded in the period from Jan 2010 to mar 2012. in which, 12 cases are recorded for subcutaneous empf^sema only and 19 cases accompanied by pneumomediastinum, pneumothorax, self healing is 9 cases, 22 cases need the medical intervention. Conclusion:
Air in subcutaneous tissue does noi a lethal threat, it can be resolved with or without medical intervention. However, in several cases, the said disease will become more dangerous and severe once accompanying with the pneumomediastinum. Thus, the doctors should be identified andproactively treat in time.
Key words: Subcutaneous emphysema
1 DAT VAN DE ^^ ®^P khdng chi linh vuc chuy6n khoa
^ ngoai l^ng nguc hay hd hap md cdc bdc si Trdn khi dudi da vung CO ngvc Id bfnh ^^^ ^ ^ ^,^^^^ ^ ^ ^^ ^ ^ ^^^
• Khoa TMH BV. Ch? Riy
Tap chl Tai MOI Hpng Vidt Nam - Volume (57-10). N"4 - July. 2012
phdi tiiudng xuyen dli mdt. mdt khdc, trdn khi dudi da c6 nhChig mli lifn quan djc bift v6i trdn khi 6 phii - trung tiilt, vi v$y vifc nghifn ciiu vIn dl mOt cdch hf thing, cIn fli$n Id mOt vifc ldm rit thii vj vd d6i h6i kinh nghif m cda cdc bdc si tiiuf c nhihig ITnh vvc chuyf n khoa khdc nhau.
Sau khi nghifn cilu 31 hi so bfnh dn hong d6 c6 nhilu bfnh nhdn chiing t6i trvc tilp tham gia h$i chin vd diiu hj tit thdng 1/2010 din tiidng 3/2012 chiing tdi ting kit sl lifu, xem l?i mft sl bfnh ly ddc bift vd so sdnh kit qud diiu tr) ciia minh vdi kinh nghifm vdi cdc tdc gid nude ngodi nhdm cd m§t phdc dl chan dodn bfnh nhanh chinh xdc va hif u qud.
2. D 6 I TirONG VA PHl/CJNG P H A P NGHIEN CtJtJ
31 tifnh nhdn Id nhiing hdng hgrp cd tran khi dudi da don thudn hodc cd kem theo tran khi trung that, mdng phoi dd duqrc khdm, dieu trj t^ khoa tai miii hgng ho$c dieu tri tai cdc khoa khdc (sdn sdc ddc bift, phii, ling ng\rc...) cua bfnh vifn Chg Riy va can s^ tham gia chdn dodn vd diiu tri cda chuyf n khoa tai mui hpng. thdi gian tir tiidng 1/2010 din tiidng 3/2012
Phuong phdp nghiln ciru:
- Ld phuong p h ^ hIi cihi - tiln ciiu md td - Nghien cihi ho so nhiing bfnh nhdn d- ugc chdn dodn hdn khi dudi da vCmg co nguc do bdt ch nguyen nhan gi ndm t^
khoa tai miii hgng hay dugc mdi tham dvr chin dodn vd diiu trj (bfnh nhan cd till cd kem theo cdc bfnh ly khdc nhu trdn khi
trung thIt, byng ngo^ khoa, gdy xuong...) Ghi n h ^ cdc nguyfn nhdn, trifu chiing Idm sdng.
- Chin dodn c$n ldm sdng:
+ X quang tu till phii thdng, nghifng.
cl thdng, nghifng
+ CT scan bymg ng\rc, CT scan todn thdn (nlu cIn tiiilt)
+ MRI
+ Nf i soi khi phi qudn + Nfi soi thirc qudn
- Cdc bif n phdp vd kit qud diiu trj.
3. K £ T Q U A NGHlfeN CtltJ Bdng : Tull vd gidi bdnh nhdn gidl
nam nO
20 hjii <
2 0
20-30 hllK 7 6
30-40 hlii<
5 5
40talAi hdldn 4 2
Nhdm BN da so trong khodng tuoi tir 20 din 40, hau hit Id BN chuyln din tit cdc tinh vd nhd nhit Id 8 hili vd ldn nhit Id 63 tali, s l BN nam nhilu hon sl BN na.
Nguyin nhdn
+ Sau phlu thu$t cdt amidan: 2 ca -I- Chin thuong vihig m$t, xoang: 2 ca + Chin thuong thanh khi qudn : 11 ca + Sau n$i soi th\ic qudn : 2 ca + Thung thuc qudn co: 3 ca + Nhiim trtag: 6 ca + Sau md khi qudn: S ca Tri^u chdcng l&m sdng ghi nhpi
- Dau rdt hgng: 4 ca -IChdtiid:10ca - S l t > 3 8 d 0 : 6 c a
- Cdng phing dudi da viing cl ng\rc : 31 ca
54
Tap chl Tai MOI Hgng Vidt Nam - Volume (57-10). N°4 - July, 2012
- Sd lep bdp dudi da: 25 ca - Cdm gidc khd thd: 20 ca - Co hmh dnh hdn khi hf n x quang, CT scan: 27 ca
Bdng: Tridu chiing muQn Cdng
phing, Lan tda 2
Sung dd
4 8 3
Trdn khi tdi phdt 2
Chdn d p - suy hd
hdp 5
Hinh anh X quang vd CT: ti&n cdc phim CT Scan vd X quang deu cho thdy hinh anh cua t^ khi dudi da, m^t s6 ca cd hinh dnh cua khi trong trung thit.
Bdng: cdc can thifp da thuc hi§n - Md khi qudn : 8 ca
- Md c^nh CO dan luu dp xe: 8 ca - Md nguc dan luu dp xe va khau tdi
t^o: 4ca
- Cdm kim din luu khi: 7 ca - Dan luu mang phdi: 5 ca Kit qua dieu tr]
Thdi gian ndm vi^n it nhit 3 ngay, thdi gian ndm vi?n ddi nhat 36 ngay, so ngay ndm vi$n trui^ binh 7,5 ngdy.
4 ca van cdn mang canule khi ra v i ^ 1 ca tu vong do nhiim trung huyet.
4. BAN L U ^
Tidn khi dudi da xudt hifin khi hcri hodc khi bi tdc nghan ii lai d Idp dudi da, thdng thudng khi cd ngudn goc tu long ngvrc vdi tri^u chihig rat ddc trung Id Igo x^o, lep b ^ khi sd vdo vung c6 ng\rc.
trudng h^p tran khi dudi da diu tifin du^c ghi nhgn vdo ndm 1950 d mpt ngudi b^nh sau khi bi mdt con ho dii doi. ndm 1900 ca trdn khi dudi da t\r sinh xdy ra trSn d m^t
ngudi Hnh th6i kdn thu$c hdi qudn sau khi anh ta nh6 rdng, khi thoi k6n fhowi dd di qua lo thung d chan rdng vd gdy phii mdt, nguySn nhdn c&a trdn khi dudi da t^ sinh dugc Idm rd vdo nhihig ndm 1939 - 1944 bdi macklin, ngudi dd cd nhftng nghien cihi ve sinh I^ b?nh cila b$nh ndy.[4,5,8]
Tran khi d phoi trung thit (pneumomediastinum) dugc Lacnnee ghi nh$n tren b?nh nhdn sau chin thucmg vdo ndm 1819. Bien chiing ndy cd rit nhieu nguydn nhdn vd da dugc bdc sT Louis Hamman ndm 1939 md td ky d mot phu nii sau khi sanh d benh vien Johns Hopkins, trdn khi trung thit ddi khi dugc ggi la hgi chiing Hamman, cac nha phSu thudt Idng nguc vd chuyen khoa ph6i ggi hgi chiing Macklin [5].
Hgi chiing Hamman Id khi cd tran khi dudi da viing cd nguc kem theo cd tran khi d phdi trung thdt (pneumomediastinum).
Nguyen nhan gSy trdn khi Trdn khi dudi da vung cd ng\rc cd the gap d b^nh nhdn cac chuyen khoa nOi ngogi sdn hay nhi vd do rdt nhieu nguyen nhdn khac nhau gay nen. Cd nhung nguyen nhan thugc liiih v\rc tai mGi hgng (sau cdt amidan, rdch niSm mac thanh - thyc quan, nhiem triing...[6],[7], do chan thuang (hda khi hay bgch khi, gay xuong sudn...), sau mgt so can thi^p y Idioa nhu gay m€, phSu thu|lt l^ng ng\ic, phau thu|it h byng, md khi qudn...
Do cd s\r thdng thucmg tr\rc tilp tir trung thit (hay sau phiic mgc) tdi cac md mem va dudi da cd nguc nen khi cd &g di
Tgp chl Tai MQi Hgng Vi$t Nam - Volume (57-10). N°4 - July, 2012
chuyln tr\rc tilp tir trung thit din dudi da (t6n thuang cda ph6i hay dudng khi) theo cdc cdn mgc.
Trdn khi dudi da t\r phdt dugc cho Id h^u qud tdng dp l\rc trong ph6i gdy nfin vd cdc phi nang. Trong trudng hgp ndy khf di tir cdc phi nang bi vd vdo khodng md kS vd dgc theo cdc mgch mdu ciia ph6i din trung thit vd tir dd theo cdc cdn din dudi da vimg ci ng\rc. Th\ic ti niu khf cd nguin gic xuit phdt til c i sS it phdt triin hudng vdo trung thit nhung ngugc lgi, khi cd nguin gic tir phoi s£f thudng di theo bao ciia mgch mdu vdo trung thit vd lan ra vimg dudi da ci mdt. Ca che tren ddy gidi thich mii quan h^
tudng chimg nhu thugc ve nhihig Iinh v\rc chuyen khoa rat khdc nhau giGa nguyfin nhdn vd bieu hi^n Idm sdng nhung thvrc chit Id rat phu hgp va Idgic ciia nhieu tinh hudng lam sdng [2],[3],[10].
Ve lam sang, chiing tdi sit dyng cdch phdn chia hay theo vi tri hdng rdo bdo v? co the bi tdn thucmg:
- Phd vd hang rdo bdo vg da.
- Phd vd hdng rdo bdo vg niem mgc.
- Chdn thuang dp l\rc vd phi nang.
- Nhiem trimg.
Cdch phan chia ndy don gidn, cd h§
thing giiip cho chiing tdi nhanh chdng tim dugc nguyen nhdn vd cd hudng xii tri thich hgp trudc mgt ca bgnh.
Trong nghidn cixu cua chiing tdi cho thiy chin thuang (tin thuong hdng rdo bdo vg da vd niem mac) chiem phin ldn nguySn nhan gdy trdn khi (25/31 ca).
Nguyen nhdn nhiem triing Id 6/31 ca. M^t
si nguydn nhdn ddng chii ^ md chiing tdi trinh bdy gim:
a. V& th^ qudn: Niu trdn khi dudi da d I ngudi b|nh trong tinh trgng suy ki^ vd sit sau khi di miia nhiiu, tiip theo Id dau ngvic b3n trdi cin ggi <[ nhiiu din hdi chimg boerhavee Id vd viing xa ciia th\ic qudn, cd thi nguy hiim tinh mgng ngudi b$nh. Xdc djnh chin dodn bdng hlnh dnh hgc, nOi soi vd nhanh chdng diiu ti} phlu thu4t khdu ch3 thung.
b. Rdch thifc qudn do bieu dien nuot kiim (3 ca): Diln vi6n vgi vdng cdc thao tdc sS Idm rdch ni€m mgc th\rc qudn gay trdn khi k^m theo nhiem trung n$ng lan rgng. Chiing tdi de xuit cdc dan vj chiic ndng qudn ly vdn hda nen cim biiu dien trd ndy.
c. Sau chin thucmg thanh khf qudn:
mgt so ca v i ^ tim ra v) tri rdch ciia ni€m mgc Id rit khd cho dO cd nOi soi ho$c cdc xet nghi$m chin dodn hinh anh khdc.
Chin dodn Ifim sdng
Cdc diu hi^u vd trigu chiing cda bin khi dudi da vung ci ng\ic thudng cd ddu higu Idm sdng dien hinh:
- Da vi^g ci ng^c phong l£ii, sung vd viem tiy dd, sd cd cdm gidc 16p b6p, Igo xgo. Bdng khf thudng it dau vd giing nhihig nit nhd. Niu trdn khi si lugng ldn m$t sS sung nhiiu, trdn khi quanh vijo^ cd sS ldm ngudi b$nh cd cdm gidc nghgn gigng ndi tliay dii, vd tii§m chi cd the dnh hudng din hd hip. Nghe phdi cd thi thiy dm phi bdo thay dii.
56
Tgp chl Tai MQi Hgng Vi$t Nam - Volume (57-10). N°4 - July, 2012
Hlnh: ^dn khi dudi da (a: do chdn thuong; b do nhiSm trOng)
- Trdn khi cd thi Ian r^ng den cdc vimg khdc ciia co the nhu byng, cdc chi, mdng, biu hay tdi diu cdc chi dudi. diiu ndy cho thiy su thdng thuong li€n tuc cda khodng dudi da.
Trdn khi cd the kem theo rat hgng, dau, khd nudt. mgt sd trudng hgp khd thd, thd rit tham chi suy hd hdp. Can than trgng khi trieu chiing tren xdy ra d nhih^ benh nhan sau khi ngi soi hay cd can thiSp d dudi^ khi thuc qudn.
Cdc trigu chiing va diu hi^u lam sang ciia trdn khi tuong ddi don gidn. Tuy nhien, vi6c tim ra nguyen nhan hodc theo ddi d6 phdt hien nhihig diln tiln bat thudng de dga tinh mang ngudi b^nh mdi that s\r Id quan trgng. nhihig trieu chiing dugc chiing tdi cho ring nguy hiim Id:
- Tran khi tdi phdt vd Ian r^ng nhanh.
- Rii logn thdng khi.
- Thay dii vi diu hifu sinh tin (mgch, hd h ^ , nhigt dO)
- Cd din hieu chen ^ tun hay trung thit (tinh mgch cd ndi, sit..)
- Khi thiing mdng phii cd diu higu chen ep cac co quan lan c|n.
Vai trd cda hinh dnh hgc
Hinh dnh hgc cd vai trd trong vigc khdng djnh chin dodn. Vin dl d$t ra Id chi dinh sd dving cdc phuong tign chin dodn sao cho kinh tl vd dat hi^u qud cao.
X quang phoi thing cho thiy hlnh dnh khi dudi dgng nhihig ddi sgc dgc theo ca nguc Idn, tuy nhien hinh dnh cd thi lin vdi m$t trudng hgp khi d phoi. Mgt sd tdc gid cho rdng vin cd thi bd sdt tdn thuong vi cd thi cd tdi 50% si ca trdn khi trung that ma khdng xdc dinh dugc tr6n phim tu thi thing [2],[3]. Chiing tdi cho rang chyp X quang cd gid tri khdng chi trong chan doan ma cdn cd tdc dung trong vigc theo vi cd the chup moi 1-2 ngay 1 ldn tham chi trong ngdy cGng cd the chyp nhieu lan niu cd chi dinh.
Phim X quang phdi thang cung se cho phep thiy hinh dnh cua trdn khi trung that (diu hieu hamman) rit hay gdp trong sdn khoa. Hgi chiing hamman hay xdy ra d nhihig san phy sinh con Idn ddu, khoang tii 3 thdng giiia thai ky, phim phdi thdng cho thiy hinh dnh khi d trung that vien dgc tiheo bdng tim vd cung dgng mach chd [8]
Cd tdc gid [2],[4] cho rdng chyp X quang thyc qudn hgng cd uong cdn quang cd gid tri trong chin dodn nhiing ton thuang d hgng thuc qudn, th$m chi mgt sd kip phlu thugt khdng can CT Scan md chi dua vdo chup thuc qudn cdn quang vd ndi soi thyc qudn de quylt djnh cho vigc phlu thudt.
Tap chl Tai MOi Hpng VIQt Nam - Volume (57-10). N°4 - July, 2012
Hlnh: ddu hl$u hamman Chyp CT Scan ng\rc byng rit cd hi^u qud hong vi^c khu tni noi t6n thuang vd xuit phdt ciia khi nhu tit 6 gdy cCia xuong sudn, xuong ddn... ngodi ra cdn cho ph6p phdt hien nhiing t6n thuong kin ddo khdc nhu thung cdc tang trong 6 byng. Chiing tdi cd 2 trudng hgp khd khdn trong ch4n dodn nen tiln hdnh chup CT Scan toan thdn, ket qua chiing toi da phat hi^n dugc trdn khi tir mpt ca tir 6 gay cua xuong ddn vd mpt ca tir d gay xuong sudn sd 1 gay thung dinh phoi. Chiing tdi de xuat nhihig trudng hpp benh nhan hi da clidn thuong hodc trdn khi vdi dien tien bat thudng thi n^n chi djnh chup CT Scan mpt cdch hp thong.
Hlnh: hlnh anh trdn khi vOng cd hdn CT Ndi soi 6ng mdm dd thong nhat chi dupe th\rc hipn khi dd cd chl djnh c ^ can
thi^p phlu thu$t vl hong khi ldm thii thuat cihi phdi bom hoi vdo thvc quan vd nhu vdy cd khd ndng djch trong dudng ti£u hda sB thodt ra vd di vdo trung thit, n$i soi bdng 6ng Cling cd th^ cho phdp thiy t6n thuong d&ng thdi. Qua n^i soi chiing tdi dd xdc djnh chinh xdc dugc 12 ca cd t6n thuong d dudng khi - th^rc qudn. n$i soi cd thi tiln hdnh dudi gdy ti t^i chS nhtmg t6t nhit Id ndn ldm dudi gdy mi.
Diiu trj
Vdi m0t hudng hpp trdn khi dudi da cb ngvic Uf phdt nlu khdng cd cdc diln tiln bit thudng thi khdng can cdc b i ^ phdp diiu tri gi d^c bi^t:
- Ngudi bpnh nen nghi thodi mdi dudi syr theo ddi cda y te, trdn khi dugc theo doi bdng cdch dung biit mdu vi bd cua khu v\rc trdn khi vd so sdnh theo tCmg khodng thdi gian...
Trdnh cdc d^ng tdc xi mOi manh, gdng siic trong khi thanh mdn dang ddng (tdo bdn), nlu lo^ hodn todn khd nang rdch tbvic qudn thi ngudi b|nh cd the dn uong dudng mipng, chl d$ dn nin dung cdc chit Idng.
Thuoc gidm dau, thu6c ho c6 thi sii dyng trong mOt so trudng hgp. Cho ngudi bpnh thd th€m oxy s€ giiip cho co thi hap thu khi nhanh hon.
- Khdng sinh dvi phdng cdn nhilu tranh Iu|n vl cd khd ndng Idm che lip cac trieu chiing ciia m$t tinh tr^oig nhiim triing, nlu cd chi dinh thi chiing tdi thudng dung lo^
khdng sinh cd ho^t phd rdng vd trong thdi gian thich hgp. Nlu cd ton thuong cda
58
Tgp chl Tai MQi Hgng Vi$t Nam - Volume (57-10). N°4 - July, 2012
niem mac dudng tieu hda (thiing hgng, thiing thyc qudn) thi cin phdi su dyng cdc khdng sinh mgnh phi r^ng (c^phalosin, quinolone vd phii hgp vdi metronidasone).
Thyc tl cho thay nlu chi Id mgt si lugng nhd trdn khi dudi da thi co thi sg cd khd nang hip thu hit sau 3-7 ngdy [5],[5],[9].
Trudng hgp bgnh cd nhChig dien tiln bit thudng nh khi dudi da tdng Ign ho^c tdi phdt sau khi dd din luu sS din din nguy co chen ep dudng hd hip, sung phd mi, gidm mdu ve cdc phi nang gdy thieu mau d phoi, d tiiih mgch viing xuong ciing, xuang chdy nen din den khd nang hogi tir d cdc bd phdn ndy, liic dd can nhanh chdng can thiep dan luu khi.
- Dan lim khi cd the thyc hien bang.
- Dung kim chich ghim dudi da.
- Dat dng din lu dudi da vd cd hiit Ii€n tuc.
- Rach l i tren bl mgt da.
- NIU khi thiing mdng phdi thi can din luu mdng phdi.
- Md khi quan trong m^t sd trdng hgp cd kem theo suy hd hap.
- Viec ghim cac kim chich dudi da de din luu khi hay rach cdc lo trgn bl mgt da cdn nhilu y kiln trdi ngugc [2],[8],[9]
nhur^ chiing tdi vIn thudng xuySn sat trimg da sau dd ghim cac kim chich cho ket qud dan luru khi rit tit, chiing tdi khdng rach da W ly do thlm my va nguy co nhiim triing.
NIU trdn khi dudi da sau md khi quan thi phai xem lgi si ciia canule s* dyng thich
hgp ho$c nlu khdu da bl m$t ch$t qud thi cd thi cdt bdt vdi mii chi cho khi thodt ra.
5. K £ T LUAN
Trdn khi dudi da vdng cd nguc thudng dugc bieu hign bang cac dau hieu tuong doi rd rang khi tich tu dudi da do rat nhilu nguyen nhdn gay nen, bgnh thudng ty het sau vdi ngdy md khdng cin nhung diiu tri dac biet. Tuy nhien, khi cd kem theo cdc trieu chiing nhu dau nguc hay khd thd, khd nudt... thi thay thudc can nhanh chdng nhgn biit, hdi kf b$nh sd ciia ngudi bSnh vd tham khdm ting quat xac dinh nguyen nhdn vd tien trien cua benh. nguyen nhan quan trgng nhat Id tran khi dudi da vimg ci trung that do rdch khi qudn hay thyc qudn. Chyp phim X quang vd CT Scan co nguc la can thilt vd cd gid tri trong vigc chin dodn b^nh Cling nhu xdc dinh chinh xdc vi tri cdc thuang ton. Diiu tri bdo ton bang cdch dimg thuoc khdng viSm, gidm dau, bii djch, khdng sinh, can thiSp y khoa cd the la dan luu khi, md khi quan... nhung quan trgng nhit Id cd bi^n phdp theo ddi dl phat hi^n kip thdi nhthig biln chiing vd cd hudng xir tri kip thdi
Tap chl Tai MOI Hpng Vidt Nam - Volume (57-10). N°4 • July, 2012
TAI L i f u THAM K H A O
1 Trin Minh Trudng, Trin Anh Bich (2007), nhiim triing cl sdu h6n b^nh nhdn ddi thdo dudng: So sdnh hlnh dnh ldm sdng vd kit qud diiu tr) vdi b^nh nhdn khdng ddi thdo dudng til 1/2005- 9/2006, Y hpc TP. H6 Chi Minh sA 11 phy bdn 1,0-. 32-35.
2. Nguyin Cdng Minh (2005), Chin thuong ngyc, tr. 134-147.
3. Bodenez C; Houliat TH: Traisac L, emphyseme cervical spontane: a proposse 1 cas. Revue de Laryngol Otol Rhinol 2003: 124,3: 139-143.
4. Miman MC; Ozturan O; Durmus M (2001), Cervical subcutaneous emphysema: Ananual complication of adenotonsilectomy, Pediafr Anesth 2001 Jul; 11(4); 491-493.
5. Raymond L.W (2000), Emphysema of the face, neck and mediastinum from compressed gas barotrauma to the ear, American Journal of emergency raedecine, 18(7): 841-842.
6. Green RJ. Dafoe DC, RafBn TA., Necrotizing fascittis. Chest 1996;
110:219-92.
7. Evelopp SE; Donat WE; Aisenberg R;
Braman SS, Pneumatic Chest Wall Compression. A Cause of Respiiatoiy Fairlure from massive subcutaneous emphysema, C chest 1991 Apr; 99(4):
1021-3.
8. Maunder RJ; Pierson DJ; Hudson LD:
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