JOURNAL OF 108 - CLINICAL MEDICINE A N D PHARMACY Vol 9 - N°2/2014
Nhan xet giam dau va phuc h6i sau mo khi gay me TCI bang propofol kit hop vol gay te ngoai mang cung trong phau thuat ung thir phoi
Remarks on Reduction of Pain After Surgery Recovery by TCI-Propofol Anesthesia Combined with Epidural Anesthesia in Lung Cancer Surgery
Nguyin Thi Le My*, *Bmh vien Thanh Nhin Nguyin Tiln Diic**, ""Benh vien K Trung uang.
Cong Quylt Thing*** "•*Benh v,en HihiNghi
Muc tieu: ddnh gia mdc dp gidm dau sau md vd su hdi phuc d benh nhan phau thuat ung thU phoi bdng TCI-propofol ket hap vco te ngoai mdng eUng. Ddi tUpng va phUOng phap nghien cUu: 31 benh nhdn dupc chan doan ung t h u phdi, cd ehi dinh phau thuat tai Khoa gay me, Benh vien K Trung uong. Nghien eUu tien eUu, can thiep lam sang. Kef pud: thdi gian ho khac dUpc la 10,07 ± 1,60 gid, ngdi day 15,65±l,61gid, di lai duac37,02±l,90gid, rut sonde dan luu la 66,97+6,4 gid. E)iem VAS luc nghi tU sau 2 g i d tiem thuoc trddi deu cd mUc gidm dau kha va tdt. Oiem VAS luc van ddng tU sau 8h den 48h thi mUc dp giam dau la kha va trung binh. TU sau 48h trd di cd mUc dp dau khd va tdt. Ket ludn: gay me bang TCI-propofol ket hop vdi te ngoai mang cUng sau phau thudt giup cho benh nhan gidm dau dUpc tot, rut ngan thdi gian hoi phuc va han che cae bien ehUng khdng mong muon trong phau thuat ung t h u phdi.
Tdkhoa: gidm dau sau md, hdi phuc, phau thudt ung t h u phdi, TCI-propofol, te ngoai mang cUng
Summary:
Objecyive: To assess postoperative pain and recovery in TCI propofol anesthesia combined with epidural anesthesia in lung cancer surgery. Subjects and methode: The study was conducted on 31 patients diagnosed with lung cancer and was indicated operation to remove the effected tobe in the Department of Anesthesia, K Central Hospital. Prospective study, clinical intervention. Results: Time that patients can cough up' 10.07 ± 1 60 hours, sit up: 15.65±l,61hours and walk around: 37.02±1.90 hours.
Drainage tube withdrawn: 66.97±6,4 hours.VAS scores at rest after injection 2 hours onwards was generaly good or relatively good. VAS scores at mobilization after 8h to 48h was at pain relief level of average or relative good. After 48h onwards, pain relief level was at good or rather g o o d . Conclusion: this method helps patients get good pain relief and shorten recovery time and minimizes complications in lung cancer surgery.
Keywords: analgesia postoperative, Reduction,Lung cancer surgery, TCI-propofol, epidural anesthesia
Phan bien khoa hoc: TS. NGUYEN QUOC T U A N 96
TAP CHl Y DUQC LAM S A N G 108 Tap 9 - S o 2/2014
1. Dat van de
Hien nay, u n g t h u phdi chiem t y le ldn va Id m d t trong nhCrng nguyen nhan t U v o n g hang dau t r o n g ung t h u , phau t h u d t la p h u o n g phap dieu tri hQu ich nhat. Gdy m e hdi sUc ludn d d n g vai t r d rat quan trpng de phau thuat. Nhiem vu eua ngUdi bac sy GMHS Id phdi lUa chpn dUPC p h u a n g phap v d edm tdt nhat de dn d j n h bd hap, tuan hoan, giam thieu lieu thudc me, t h d i gian t h d may, t y le nhiem t r i i n g , xep phdi, nhat la gidm dau sau m d vd sU phuc hdi sau m d . . .
Gay me TCI b a n g P r o p o f o l ket h o p gay te ngoai m d n g cUng de phau t h u a t va g i d m dau trorig ung t h U p h o i la 1 t r o n g nhUng p h u o n g phdp vd edm tdi Uu.
Do phau thuat dnh hudng true tiep len hd hap, tuan hoan, sau md benh nhdn rat dau, lam giam khd nang phuc bdi ngUdi benh. Chinh vi vay chung tdi tien hanh nghien eUu vdi muc tieu la:
Odnh gid su gidm dau vd hdi phuc sau md trong gdy m§ TCI bdng propofol ket h p p gdy te ngodi mang cdng t r o n g phau t h u d t ung t h u phoi.
2. Doi tUtfng va phUPng phap nghien ciiTu 2.1. Doi tuang nghien cdu:
Nghien eUu dUpc tien hdnh tren 31 benh nhdn 6iigc chdn dodn ung t h u phe quan ed chi dinh cdt thuy phdi tai khoa PT-GMHS Benh vien K. Tudi:
(15-65), ASA: {1 - ll), khdng ed chdng ehi dinh gay me.
2.2. Phuang phap nghien cUu:
Nghien cUu tien eUu, can thiep ldm sang.
Cdch thUetien hanh:
-DdteathertervdokhoangNIVlC, v i t r i D5-6 hoac ' D6-7, thude vao khoang NMC (trUdc khdi me 30p):
" 30mgBupivacain-i-0,lmg Fentanyl.
- Tien me: Hypnovel 0,04mg/kg 10 phut sau khdi
^ me bdng Propofol (Diprivan PFS) vdi ky thuat TCI dat (Cp) 4mcg/ml, trong qua trinh khdi me chuan do an than dua
^ tr#n bdng djem OAAS so sanh vdi Ce tU do dieu chinh Ce de dat d^n OAAS = 1, Esmeron 1 m g / k g ddt ndi khi qudn hai ndng.
- Duy tri me: TCI Diprivan PFS, Esmeron dua vao bdng diem ddnh gia do me P i ^ de dieu chinh Ce sao cho dat PRST = 0. NgUng TCI khi ddng ngUe xong.
- G i a m d a u sau mo Cach chgn nong do thudc
Chpn ndng dp thudc gidm dau Bupivacain 0 , 1 % + Fentanyl 2 p g / m l
Cdch tien hanh: Lay 10ml Bupivacain 0,5% -i- 0,1 m g Fentanyl (2ml) ta dupc dung dich hdn hpp Bupivacain va fentanyl (BF), lay 12 ml BF -i- 38ml Natrielorid 0,9% ta 6dgc BF: Bupivacain 0 , 1 % -i- Fentanyl 2 i i g / m i .
Cach thdc giam dau
Ngay sau khi rut dng ndi khi qudn, danh gid neu diem VAS < 4 tien hdnh dat bom tiem dien truyen lien tuc qua catheter NMC d u n g djch BF Sml/gid.
Neu diem VAS > 4 thi tiem qua catheter NMC 5ml d u n g dich BF, Sau d d ddt bam tiem dien truyen lien tyc qua catheter NMC vdi tdc dp 5ml/gid.
Tdc dp truyen phu thudc vao diem VAS, diem an than (SS), tan sd t h d , mach, huyet dp, SpO^. Trong 24h dau sau phau thudt tdc do truyen Id Sml/gid, t r o n g t h d i gian tU 24 - 48h truyen 4 m l / h , tii 48 - 72h sau phau thudt truyen 3ml/gid.
Cdc benh nhdn duae ddnh gia sau md trong 72 gid, bdi edc tieu e h i : diem VAS, ehi sd smh t d n , lieu lupng thude gidm dau, thdi gian phuc hdi sau phau thudt, tde d u n g khdng mong mudn. Rut catheter N M C s a u 7 2 h .
Danh gia:
- Gidm dau sau mo: Ho: t h d i diem bdt dau tien hanh giam dau, H0,25- sau tiem 15 phut, H0,5: sau tiem 30 phut, H I : sau tiem 1 gid, H2, H6, H8, H16, H24,H36, H48,H72.
- Phuc hdi sau phau thuat: Thdi gian benh nhdn ed the ngdi day dUPc, ho khac, di lai.
Cae sd lieu dupc xU ly theo SPSS 16,0
L OF 108 - CLINICAL MEDICINE AND PHARMACY Vol9-N°2/20M
3, Ket qua nghien cuTu
Thdi gian phuc hoi sau phau t h u a t
Bang 3 , 1 , Oanh gia mufc 66 phuc hoi sau p h l u t h u a t
" ^ ^ — — - _ _ Chi tieu,
T/gian ~~~~—-—.____
Ho khac duac (gid) Ngdi day dupe (gid) Di lai dupc (gid)
Thdi gian rut Sonde dan lUu (gid)
( X + S D ) 10,07±1,60 15,65+1,61 37,02+1,90 66,97 ± 6,4
Nhdn xet. t h d i gian ho khac dupc la 10,07 ± 1,60 gid, ngdi day 15,65+1,61gid, di lai dupe 37,02±l,90gid, rut sonde ddn lUu la 66,97±6,4 gid.
66.97
Thoi gian rOt sonde
Bieu do: Ddnh gid mdc do phuc hoi sau phdu thuat
Tac d u n g g i a m d a u : dupe t i n h theo thang diem VAS Diem dau VAS
^"~---^^^ Thong so
Th6igian ^^"^^^
Ho Ho,:5 H.,, H, H, Hj H.
H,6
H„
H„
H48 H,,
B o a a u V A S Luc nghi
( X + SD) 3,16±0,61 2,62±0,65 1,88±1,04 1,81 ±0,87 1,79±0,52 1,70±0,71 1,61 ±0,68 1,59+0,71 1,57±0,55 1,58±0,67 1,49±0,65 0,96+0,34
Luc van dgng ( X ± S D ) 4,16±0,61 3,52+0,65 2,79±1,04 2,71+0,87 2,69+0,52 2,65+0,71 2,51+0,68 2,48+0,71 2,47+0,55 2,41+0,67 2,36+0,65 1,85+0,34
TAP CHi Y DU'O'C L A M S A N G 108 Tap 9 - S o 2/2014
Whdn xef;
- Oiem VAS luc n g h i t U sau 2 g i d t i e m thudc t r d di deu cd mUe gidm dau khd va t d t .
- Oiem VAS luc van d p n g t U sau 8b den 48h thi mUe dp gidm dau la kha va t r u n g binh. TU sau 48h trd di cd mUc dp dau khd va t d t .
4. Ban luan
Thdi gian phuc hdi sau m o cd lien q u a n t d i mUe dp gidm dau sau m d . Viee b e n h nhdn k h d n g dau bode dau nhe t h i khd nang ho khac cijng n h u vdn d d n g se d u a c sdm h o n . Can phdi khuyen khich benh nhan van d d n g , ly lieu p h d p edng sdm edng tdt, day c u n g Id Uu d i e m eua p h u p n g phap gidm dau NMC sau phau t h u a t u n g t h u p h d i . Theo nghien cUu eCia Vigdis Hansdottir, Julia Philip khi so sdnh gidm dau sau m d t i m bdng p h u o n g phdp bupivacain ket h p p fentanyl qua d u d n g NMC va phUPng phdp PCA bdng m o r p h i n t i n h mach cho rdng n h d m benh nhdn d u n g giam dau bang NMC cd thdi gian van d p n g sdm hPn vd t h d i gian nam vien sau md ngdn han so vdi n h o m d u n g m o r p h i n tinh mach qua PCA.
Allan Gottschalk cung eho ket qua tUPng t u . Nhu vdy thdi gian phuc hdi t r o n g nghien cUu eua chung tdi ngdn phu h a p vdi nghien cUu cua tdc gia trong nUdc eung nhU nUdc ngodi.
Trong nghien cUu cua ehung t o i , hieu qua gidm dau sau phau thudt ung t h u phoi Id rat tdt, sau 1 gid tiem thudc t r d di tat ca cdc benh nhdn deu cd mUe dd gidm dau tdt va khd khi nghi. TU gid thU 2 t r d di hau het tat ed cdc benh nhdn deu cd mUe dp gidm dau tdt vd khd khi vdn d d n g . Bdi vdy, khi benh nhan ho 6dgc. van d d n g t d t se trdnh dUpc bien trUng xep phdi. Dung p h u a n g phdp CEl truyen lien tue hdn hop bupivacain 0 , 1 % - fentanyl 2 ^ g / m i vao khoang NMC dat ket qud gidm dau sau m d rat tdt.
S.Ketlu^n
PhUPng phdp gdy te NMC phdi hpp vdi gdy me TCI bdng propofol Id p h u o n g phdp vd cam phdi h p p
rat Uu viet, ban che rat nhieu nhUng bien ehUng t r o n g phdu t h u d t eung n h u sau phau thudt, cac t h d n g sd tuan hoan , hd hap trude, trong, sau phau thudt t u a n g ddi on djnh. Nhat la sau phau thudt g i u p cho benh nhan giam dau 6dgc tdt, rut ngdn t h d i gian hdi phuc va han che cdc bien ehUng khdng m o n g m u d n t r o n g phdu t h u d t ung t h u phdi.
Tai lieu t h a m khao Tieng Viet
1. Nguyen Qudc Kinh, Gdy me tinh mach todn bd va mdt sd tien bp. Sinh hoat khoa hoc chuyen de Gay me hdi sUc. Nha Trang 2007,
2. Nguyen Thi Kim Bich Lien . Gay me todn than bang dudng tinh mach. Bai giang gay me hdi sUc. NXB y hpcHanpi2002,tr605-610
3 Nguyen HQu Tu (2002)," Bdi gidng gay me hdi sdc".Nhd xuat ban yhgcHd Noi, tr:84' 102 4 SU dung lam sang thudc me tinh mach vdi ky
thuat TCI, Sinh hoat khoa hoc chuyen de. Daklak 2008
5, Cao Thi Anh Bao (2003), "Nghien cUu giam dau sau md bung tren bdng gay te ngoai mang cUng ngUc lien tuc vdi hon hpp bupivacain - morphin".
Luan van thac sy y hpc, Dai hoc y Ha Npi, Ha Ndi.
u. Nguyen Viet NghTa (2004), "Giam dau sau phau thuat long ngUc bang phuang phdp bam lien tuc bupivacain ket hop fentanyl qua catheter ngoai mang eUng". Luan vdn thac sy y hpc, Hpc vien quany. Ha Npi.
Pr Jean Mane Desmonts (2008), " Gdy me cho benh nhan mo ngUc", Tai lieu ddo tao lien tuc sau dai hoc ve gay me hdi sUc, dai hpc y Ha Npi - Oai hpc Pans 7, t r . 93 -116
Tieng nUdc ngoai
1. Grutti I, Quintana B, Olmedilla L, et al. Artenal oxygenation during one-lung ventilation, combined versus general anesthesia, Anesth Analg 1999;88:494-9
2, Beunmof J,L„(1994), "Anesthesia for thoracic surgery". 2"'' End Philadelphia, WB Saunders. 1994
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3. Bigler (2003). "Lung function changes during anesthesia and thoracic surgery", Ugesksleager.
Jam 3; 165 (3): 232-5.
4. Steegers PA, Backs PJ.Propofol and. Alfentanil during one-lung ventilation. J Cardiothorac Anesth 1990;4:194-9.
5. Servin F5. et al. TCI compared with manually controlled infusion of propofol. Anesth 1998 Apr;
53{Suppl 1): 82-86.
6. Mazzarella B.et al.Comparison of manual infusion of propofol and target-controlled infusion:
effectiveness, safety and acceptability. Minerva Anestesiol.l999Oct;65(10):701-9.
7. Rehberg B. Target-controlled versus manually- controlled infusion of propofol. Eur J Anesth. 2007 24/11:920-926,
