I KHOA H O C ]
CONG NGHE - CHUYEN GIAO
UNG DUNG 6XY CAO AP TRONG DIEU TRI BENH GIAM AP 6 THO LAN
• • • •
tai benh vien 175
ThS. BS. LE HONG MINH
Benh vien 175
PGS. TS. KHUC XUYEN
"- Hoi YHLD Viet Nam
Tdm tit: Benh giam ap a thg lan la tai bien thudng gap vdi NLD lam viec trong mdi trudng nudc dudi ap suat cao. Nguyen nhan cua benh la thuyen tac mach mau do cac bdng khi bieu hien bing cac trieu chung nhu liet chi, dau ca, roi loan ca vdng. Neu cap ciru va dieu tn khdng kip thdi cd the gay ton hai nang ne nhu tir vong, bai liet, giam hoac mat sue lao ddng suot ddi cua tha lan. Ap dung dxy cao ap trong dieu tn benh giam ap a tha lan tai benh vien 175 budc dau thu duac mot so ket qua kha quan, giam nhanh cac trieu chung benh, khdi phue van ddng ehi, phuc hoi kha nang lao dong cho ngudi benh.
Abstract: The divers' decompression sickness is a common accident in workers working under high pressure water The cause of this sickness is obstructed vessels due to air bubbles, manifested by symptoms such as paralytic, or lost working ability for the rest of a diver's life if the patient is not be given emergency aid and appropriate treatment. Application of high-pressure oxygen in treatment for diver s decompression sickness at Hospital A/° 175 has gained initial achieve- ments: Decreasing symptoms rapidly rehabilitating limbs' movement, recovering patients' work ability
I. DAT V.AN DE
Benh giam ap d thp lan la tai bien thudng gap vdi NLO lam viec trong mdi trudng nudc dudi ap suit eao. Dac biet hay gap d dpi ngu thp lan khai thae thiiy san do da phin la lan vo, khdng ed PTBVCN, khdng dupe huin luyen cac bien phap an toan. Khdng it eac tai bien lan xay ra vdi hau qua dang tide nhu liet de lai di chUng ea ddi eiia ngudi thp lan. Ap dung dxy cao ap trong dieu tri benh giam ap d thp lan tai benh vien 175 budc d i u thu dupe mdt sd ket qua kha quan, giam nhanh eac trieu chirng benh, khdi phuc van dpng chi, phuc hdi kha nang lao ddng eho ngudi benh. Chiing tdi tien hanh nghien eiru nay vdi mue tieu:
- Tim hieu ve ddi tupng, nguyen nhan va hoan canh xay ra tai nan.
- Danh gia ket qua ap dung dxy eao ap trong dieu trj benh giam ap d thp lan khai thae thiiy san.
II. DOI TirONG VA PHirONG PH.AP NGHIEN
11.1. Odi tUdng nghien cuHi:
Ddi tuang nghien eUu la cae benh nhan bj benh giam ap la thp lan dieu trj lai benh vien 175 tU 2006 - 2008. De tai tien hanh phdng v i n ngudi benh ve tudi ddi, tudi nghe, thdi gian lan, dp sau, phuang phap lan, thai dp xir tri khi ed tai bien, sd lin xay ra tai nan; loai trU tdn thuang ket hpp.
11.2. PhUcrng phap nghien cifu:
- Tien ciru ket hpp hdi eiru benh an cua benh nhan.
- Benh nhan dupe kham lam sang, danh gia tdn thuang.
- Dieu trj:
+ Chay dxy eao ap thdi gian 4h/ngay chia 2 lin trong 7 ngay. May dxy cao ap hieu dLKC-301M NGA , ap lue may 1 - 6 at.
+ Ket hap truyen djeh cao ph§n tur, thude gian mach, thude tang dxy md, tang tuan hoan vi mach, thd dxy, bii djeh dien giai.
, , I T«p chi
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KHOA HOC, CONG NGHE - CHUYEN GIAO
III. KET QV.\ N(iHIEN ClUl (xem cac Bang lU 1 den 9)
Bang 1: Tuoi ddi cua ddi twcfng nghien cifu Bang 7: Cac bien phap dieu tri Tudi doi
20-30 31-40 41-50 Tdng so
So luong 2 7 3 12
Tyle 2/12 7/12 3/12 12/12 Bang 2: Tuoi nghe cua ddi tifdng nghien cihi
Tudi nghe
<10 11-20
>20 Tdng so
So luong 5 4 3 12
Tyle 5/12 4/12 3/12 12/12 Bang 3: Thdi gian lam viec cua thcflan
Thdi gian 2-3h 3-4h
>4h Tdng so
Sd luong 1 5 6 12
Tyle 1/12 5/12 6/12 12/12 Bang 4: Dp sau lam viec cua tha lan
Dp sau 20 - 30m 31-40m
>50m Tdng sd
Sd luong 2 8 2 12
Tyle 2/12 8/12 2/12 12/12 Bang 5: Solan bj tai nan do lan
Sd lan 1 2 3
>3 Tdng sd
Sd luong 0 2 7 3 12
Tyle 0/12 2/12 7/12 3/12 12/12 Bang 6: Trieu chdhg benh
Trieu chirng benh Oauco
Dau bung Oau dau Tebi Liet 2 chi dudi Bi tieu tien Kho thd, dau nguc Giam huyet ap
Sd luong 12
5 9 12 10 8 6 4
Tyle 12/12
5/12 9/12 12/12 10/12 8/12 6/12 4/12
V. BAN LUAN
IV.1. Oac diem ddi tifdng va nguyen nhan:
Viee lan bat hai san la cdng viee vit va, nang ne, NLD phai lan sau va lam viee lien tue 3 - 4h dudi nude nen ddi hdi eao ve sire khde, vi vay thp lan thudng tre tudi va ed the luc tdt. Ngudi lan bit hai sin thudng tap
Bien phap Oxy cao ap
Truyen dich cao phan tir Thuoc gian mach Tang tuan hoan vi mach Bu dich dien giai Cham cUu, ly lieu Giam dau Thd dxy Nang huyet ap
Sd luong 12 12 12 12 12 6 10
3 2
Tyle 12/12 12/12 12/12 12/12 12/12 6/12 10/12 3/12 2/12 Bang 8: Thdi gian lulbenh
Thdi gian
< 5 ngay 6 - 1 0 ngay
>10 Tdng sd
Sd luong 4 6 2 12
Tyle 4/12 6/12 2/12 12/12 Bang 9: Ket qua dieu tri
Ket qua Khdi benh hoan toan Di chung
Bien chung Tir vong
Sd luong 10
2 1 0
Tyle 10/12
2/13 1/12 0/12
trung thanh tUng dpi ed tinh chit gia dinh, xdm gieng; khdng dupe tap huin ve ATLD hay dao tao nghe, thudng la tnjyen nghe theo kinh nghem. Benh nhan bj benh giam ap dupe nghien cUu gdm 12 ngudi, loan bp la nam gidi, cd tudi ddi thip nhit la 25, eao nhat la 45, tudi tmng binh la 35,4 ± 5,6. NLO bien thudng bit diu lam viee tU rit sdm, nhieu trudng hpp bit diu theo gia dinh di lan tu 15 -16 tudi nen tudi nghe thudng eao. Tuy nhien ty le bi nan theo nghien eUu khdng phu thupe vao tudi dd\ cung nhu tudi nghe. Ngudi tre mdi lam, it kinh nghiem, thudng khdng lan viing nude sau, khdng hay lam cd. Trai lai ngudi cd the luc tdt, nhieu kinh nghiem cd kha nang lam viec lau hon cung nhu lan sau hon dd ehii quan gay tai nan. Thdi gian lan cd lien quan tdi ty le tai nan, da sd tn/dng hpp xay ra tai nan khi lam viec keo dai tren 3 gid lien tue, ty le thip hon vdi thdi gian lan dudi 3 gid. Dd sau lam viee ed quan he mat thiet vdi ty le tai bien, ngudi lan sau tren 30m ed ty le tai nan chiem 10/12 tn/dng hop. Qua phdng vin cac thp lan bj tai nan thi lan cang sau, thdi gian lam viee dudi nudc cang dai cang de bj tai nan. Sd tn/dng hpp tai nan den benh vien dieu trj chiem ty le rit nhd so vdi thuc te. Hau het cac tha lan deu cd cac trieu chimg benh giam ap nhieu lin, nhe thi dau co khdp, dau diu; nang hon thi khd thd, bai chi, bit tinh v.v Trong eac tha lan bj tai nan phai dieu trj deu ed it nhat 2 lin bj tai bien trong qua trinh lan. Khi xay ra tai bien da sd cac tn/dng hpp deu duoc ddng nghiep dua trd lai dp sau lam viee thue hien qua trinh tu giam ap. Thdng thudng sau khi tu • giam ap eac trieu chung benh giam dan cd the gay yeu chi, te bi hay dau eo khdp vai ngay. Mdt sd tn/dng hpp nang ed the tir vong ngay,
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eac tn/dng hop phai dua den benh vien la nhi/ng tn/dng hpp nang ne, gay liet, hay de dpa chirc nang sdng. The hien bang lam sang phong phu vdi cac trieu ehUng liet 2 ehi dudi, dau ea, dau diu, te bi, dau bung, rdi loan eo vdng.
Mpt sd tn/dng hpp ed khd thd, giam huyet ap.
1V.2. Bien phap va ket qua dieu tri:
Benh nhan nhap vien duoc dieu tri theo phac dd gdm chay dxy eao ap ap lue 2 - 3 at, thdi gian 4 gid chia lam 2 lin, sd ngay chay la 5 - 1 0 ngay. Tat ea cae trudng hpp dupe ket hpp dieu trj bang truyen djeh cao phan tir, bdi phu nude dien giai, thude gian mach va tang tuin hoan vi mach, nang huyet ap, giam dau, thd dxy. Mdt sd trudng hpp giai doan hdi phuc tiep tue phue hdi chUc nang bing cham cifu, lap vat ly trj lieu.
Oxy cao ap la bien phap sir dung oxy nguyen chit dudi ap luc eao, viec dieu trj nay nhim 2 mue dich, lam giam kich thude ciia cac bdng khi trong Idng mach, lang cung lupng dxy cung cap cho cac md thieu mau. Cirtang ap suit ciia dxy thd vao len 1 at trong dieu kien nhiet dp khdng ddi thi dxy hda lan bd sung khoang 2,3 ml trong 100ml mau. Hd hap bing dxy tinh khiet d ap suit 3 at se din den tang dxy hda tan trong mau khoang 6,65% (6,65ml), gip 22 lan so vdi hd hip dudi ap suit khi quyen. Liic nay lupng dxy hoa tan chinh bing lupng dxy ehenh lech giua mau ddng mach va Unh mach, nghla la lupng dxy cin thiet cho chuyen hoa te bao. Nhu vay dudi ap lue 3 at, dxy cao ap se tao ra 1 ngudn cung cap dxy mdi eho te bao dii de dam bao eho mpi hoat dpng ciia co the, cd the thay the chUe nang Hb eua hdng ciu. Bing thue nghiem ngudi ta da chirng minh co the vin hoat ddng binh thudng khi ta thay mau bing dung djeh Dextran hay Ringer neu co the d trong mdi trudng dxy tinh khiet ap lue 3 at. Dd la eo sd sinh ly de sir dung dxy cao ap trong dieu trj cac tinh trang thieu dxy, dae biet trong tn/dng hpp benh giam ap thp lan.
Mpt sd trudng hpp ehii yeu la den dieu trj sdm dat ket qua nhanh, giam nhanh cae trieu ehUng lam sang, hdi phuc hoan loan trong vdng 5 ngay chiem ty le 4/12; thdng thudng thdi gian dieu trj 6 -10 ngay, chiem 6/12 trudng hpp. Cd 2 trudng hpp phai dieu trj dai ngay do liet. Ket qua dieu trj: Khdi benh hoan loan la 10/12 trudng hpp; ed 2 trudng hpp de lai di ehUng yeu nhe 2 chan dupe hudng d i n lu lap luyen sau ra vien; cd 1 trudng hpp cd bien chirng thung nieu dao trong qua trinh dieu trj.
V. KET LUAN
- Lan bit hai san la viec lam nang nhpc, nguy hiem. Ty le tai bien thuc te cao hon nhieu so vdi eac trudng hpp nhap vien. Tai bien cd the gap d cac nhdm tudi ke ca nhung thp lan nhieu kinh nghiem. Ty le tai bien ed lien quan tdi thdi gian lan va dp sau lam viec ciia thp lan. Da sd cae trudng hpp tai bien xay ra vdi ngudi lan sau tren 30m va thdi gian lam viee tren 3 gid.
- Ap dung dxy eao ap va eac bien phap dieu trj tai benh vien 175 mang lai ket qua dieu trj tdt, giam nhanh cae trieu chirng cua benh, hdi phue cac thuang tdn do thieu dxy md. Ty le khdi benh hoan loan la 10/12 trudng hpp, ed 2 tn/dng hop dii het liet nhung v i n cdn bai nhe 2 chi dudi, anh hudng sire khde lau dai.
Tai lieu tham khao
1. Pham Huy Nang: Ket qua khao sat tai bien do lan a mot so ca quan dia phuang trong diem. Vien Y hoc Hai quan.
2. Le Trung: Benh nghe nghiep. Nha xuat ban Yhoc, 1994.
3. Hyperbasic medicine practice, 1994.U
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NGHIEN Ciru...
(Tiep theo trang 15)
Ipc khae nhau, gia trj COD va dp mau eiia nudc sau xir ly hoan loan dap Ung tieu ehuan thai, TCVN 5945-2005.
V. KET LUAN
- 0 thdi gian xir ly la 90 phiit thi hieu qua qua trinh xir ly la tdi uu khi ndng dp chat d nhiem trong nude cao (COD = 12000mg/
I). Vdi nudc thai cd ndng dp P nhiem thip han (COD < 10000mg/l) cd the chpn thdi gian xd ly tdi uu la 60 phiit, vi hiu nhu sau 60 phiit hieu qua qua trinh dien hda khdng tang dang ke.
- 6 pH = 2,5 - 3,5 tde dp khir COD va dp mau la tdt nhat ddi vdi nude thai chUa diu ed ham lupng d nhidm cao.
- Ham lupng H^O^ tdi uu eho qua trinh dien hda la 9,56g/l. Tuy nhien neu nudc thai cd ndng dp chat d nhiem thip hon (COD <
10.000mg/l), thi khdng nen sir dung HjO^cho qua trinh dien hda vi ban than qua trinh dien hda cung da tao ra gdc 'OH va hieu qua xif ly ciia qua trinh dat 90,54%.
- Ty le Hfi^ va Fe^' tdi uu cho qua trinh la 2,5:1 (tuang duong ham luong Fe^* la 3,8g/l).
- Qua trinh dat hieu qua d mat dp ddng kha nhd (1^ = 0,83 A/dm^; U = 5V), khi tang mat dp ddng thi hieu qua qua trinh hiu nhu khdng tang ma ed xu hudng giam;
- Nudc sau xir ly bing dien hda tiep tuc dupe xif ly bing hap phu, eac ket qua eho thiy sau xir ly bang hap phu chit lupng nude dap irng tdt tieu chuan thai TCVN 5945-2005.
Tai lieu tham khao
1. Tran Hiep Hai: Phan Ung dien hda va Ung dung, Nha xuat ban Giao due, 2005.
2. H. Rueffer, K. H. Rosenwinkel:
Taschenbuch der Industrie-abwasserrein'igung.
Oldenbourg, 1999.
3. K. J. Bock, H. Stache: Surfactants. The Handbook of environmental chemistry, Vol. 3. part B: Anthropogenic compounds. Springer Vertag Berlin.
4. L. Hartiger: Handbuch der Abwasser und Recyclingtechnik. 1999. •
