GY T TY SNGThs.Bs.Trn Th Cm Nhung

Mc tiuNu c nh ngha gy TTS.Trinh bay c nhng ch nh v chng ch nh ca gy TTS.Trinh bay c nhng tai bin ca gy TTS v cch x tr.

1. i cngGy TTS hay cn gi gy t di mng nhn hay gy t di mng cnga thuc t vo khoang di nhn, ha thuc vo dung dch no ty, tc dng ln r thn kinh, gy mt cm gic v lit vn ng

2.1. Gii Phu Ct sng

2.1. Ct sngGm 33 t sng: - 7 t sng c, - 12 t sng ngc, - 5 t sng tht lng, - 5 t sng cng, - 4 t sng ct

2.2. Gii Phu Dy chng

2.2 Gii Phu Dy chngT ngoi vo trong gm c:- Da, t chc di da.- Dy chng trn gai- Dy chng lin gai- Dy chng vng- Mng cng v mng nhn st pha trong dy chng vng- Mng nui p st tu sng.

2.3. Cc KhoangKhoang ngoi mng cng: L khoang o, gii hn pha trc l mng cng, pha sau l dy chng vng, cha nhiu t chc lin kt, m, mch muKhoang di nhn: Bao quanh tu sng, nm gia mng nhn v mng nui. Thng vi pha trn qua cc no tht. Trong khoang ny cha r thn kinh, dch no tu

2.4. Dch no ty- Dch no tu c sn xut t m ri mng mch ca no tht IV. - S lng khong 120 140 ml tc khong 2 ml/kg, tr s sinh l 4 ml/kg, trong cc no tht cha khong 25ml.- T trng thay i t 1,003 - 1,009, pH khong 7,39 - 7,5.- Thnh phn: Glucose t 40 80 mg/dl, proteine t 15 45 mg/dl, Na+ t 140 150 mEq/l, K+ 2,8 mEq/l.

2.5. S phn b vng cm gic

2.5. S phn b vng cm gic - Vng vai: m ri thn kinh cnh tay.- C honh: cc nhnh t C4.- Vng hm c bng: N8.- Vng rn: N10- Vng np bn: N12 C 3 loi cm gic:- Cm gic nhn bit khng bao gi mt hon ton - Cm gic nng lnh mt cng mc gim au m.- Cm gic au do kp i khi bnh nhn lm vi cm gic s, do vy khi kp da cn phi hi bnh nhn c au khng.

S phn b thn kinhChi trn: N1- N6, Ngc: N2 N12Bng: N4 TL2Rut non, rut gi, rut tha: N9 N11Chi di: N11 TL2Trc trng, t cung, bng quang: N12 TL2Niu qun: TL1 TL2,

3. Ch nh Chng ch nh3.1. Ch nh:- Phu thut bng di- Cc phu thut sn ph khoa- Cc phu thut chi di- Cc phu thut tit niu- Cc phu thut tng sinh mn trc trng

3. Ch nh Chng ch nh3.2. Chng ch nh: Chng ch nh tuyt i - TK: Bnh nhn t chi, tm thn, tng p lc ni s - TH: Thiu khi lng tun hon, sc, bnh tim nng - Ri lon ng mu - Nhim trng ti ch chc, nhim khun huyt - Bt thng gii phu m khng th chc tu sng c. - D ng thuc t.

3. Ch nh Chng ch nh3.2. Chng ch nh:Chng ch nh tng i- au u v ct sng.- Vim xng khp, ung th di cn vo xng.- Bnh mch vnh, nhi mu c tim.- X mch mu no.- THA nng hoc HA qu thp.- Tr em qu nh kh thc hin.

4. C CH TC DNG CA THUC T Cc yu t nh hng n s lan rng ca thuc t: - V tr t - T th BN- Th tch thuc t - Bn cht thuc t - T trng thuc t: u trong, ng trong, nhc trong

4 . C CH TC DNG CA THUC TDu hiu ca t di mng cng sau 2 3p - Cm gic t gn 2 chn, ln gi v bng - Cm gic nng chn v khng nhc chn ln c - Lit h thng giao cm: rut thu nh, mch chm, HA gim do dn mch ngoi vi.

5. K thut gy t ty sngHi bnh s, tin s v khm lm sng- Truyn dch LR 500 ml- St trng vng da sau lng, tri sn l, xc nh li mc L2 L3, L3 L4, L4 L5.Dng kim t 27G hay 29G: thy dch no ty chy ra v khng c muBm thuc t Bupivacain 0,5% heavy hay Levobupivacain 0,5%, c th pha thm Fentanyl 5 20 mcg hay morphin 100 200 mcg

5. K thut gy t ty sngRt kim v dn vng t - Cho BN nm nga - Cho th oxy qua mt n mt - Theo di HA mi 2,5 - 3p trong vng 10p u

5. K thut gy t ty sng - Duy tr HA mc bnh thng, HA h > 20 mmHg so vi HA ban u th cho Ephedrine 2 6 mg/liu - Nu v cm tht bi, chuyn sang gy m ni kh qun - Theo di cc bin chng trong m: h HA, mch chm, bun nn v nn, lnh run

T TH BNH NHNT th ngiT th nm

Te tuy song that bai : c che, x tr, va phong ngaP.D. Fetters, J.R. Jansson and J.A. Wildsmith Tht bi = 1/100British Journal of Anesthesia 2009

Bt thngNguyn nhnThay thKhng t DD thuc bt thngChch khng ng chChch li ?T khng Mc t trn khng V tr chch qu thpGPH bt thng Tht thot mt phn thucCho nm u thpChch li ?T mt bnDy chng dcNm nghing mt bnT tng mng Liu dng khng Chch khng bnh thng 1 phn ?Thi gian t khng Liu dng khng ng?

C xut hin dch no ty khng phi l bo m thnh cng

CC THUC PHA THM TRONG GY TTS

ThucLiu lngFentanyl 5 20 mcgSufentanil 2 5 mcgMorphin 100 200 mcgClonidine75 mcgMagnesium100 mgMidazolam1 - 2 mgS - Ketamin0,05 mg/kg

7. Cc loi kim t ty sngBn l chuyn gia ca nhng cy kimBan thc hien te xuyen thanh bung 2 ben ngay ca khi benh nhan ate tuy song vi 0,1 mg morphin?

6. Cc tai bin - bin chng khi t6.1. Khi gy t ty sng:Tht biChc vo cc r thn kinhChc vo mch mu

6. Cc tai bin - bin chng khi t6.2. Sau gy t: - Tt HA v mch chm - Bun nn v nn - Nhc u - B tiu - au vng lng ch t - Cc bin chng thn kinh

KT LUNNgi lm cng tc GMHS phi d kin c nhng tnh hung thun li v bt li c bin php d phng thch hp v x tr kp thi v ng n.

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