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PGS.TS. Ngo Quy Chau va cong su


MOI SOI PHE QIJM


NHA XUAT BAN Y HOC
HA NOI - 2007


Chu bien:


PGS.TS. Ngo Quy Chau


Tham gia bien soan:

PGS.TS. Ngo Quy Chau


TS. Chu Thj Hanh


ThS. Nguyln Thanh Hoi


TS. Do Quyet
TS. Hoang Hong Thai


Pho Giam doc Benh vien Bach Mai

Trirdng khoa Ho hap Benh vien
Bach Mai.

Pho trirdng bo mon Noi tong hop
trirdng Dai hoc Y Ha Noi. Chii tjch
Hoi Ho hap Ha Noi.


Pho Giam dd'c Benh vien Bach Mai

Trirdng khoa Ho hap Benh vien
Bach Mai.

Chti tjch Hoi Ho hap Ha Noi.

Khoa Ho hap Benh vien Bach Mai

Oy vien Ban chap hanh Hoi Ho hap
Ha Noi

Khoa Ho hap Benh vien Bach Mai

Oy vien thirdng vu Ban chap hanh
Hoi Ho hap Ha Noi, Thir ky Hoi Ho
hap Ha Noi

Trirdng khoa Lao va Benh phoi
Vien Trung irong Quan doi 103

Bo mon Noi Tong hop - Trirdng Dai
hoc Y Ha Noi.

Uy vien Ban chap hanh Hoi Ho hap
Ha Noi


Thir ky bien soan:

ThS. Nguydn Thanh Hoi


LOI GIOI THIEU


Ky thuat noi soi phe quan da ditde biet den tCr the ky XIX,
ban dau la noi soi phe quan ong ciing. Su xuat hien cua noi soi
phe quan ong mem mang lai cuoc each mang trong chin doan
va trong dieu tri nhieu benh ly ve ho hap. O niidc ta, ky thuat
dude trien khai ngay mot nhieu d nhiing trung tarn y te 16n,
vdi nhutng ky thuat lav benh pham de chan doan cac benh ho
hap cung nlni cho phep can thiep dieu tri. Vdi tien bo cua khoa
hoc ky thuat, thu thuat nay ngay cang ditdc chi dinh rong rai
trong cac chuyen nganh Ho hap, Hoi sdc cap ctiu, Ngoai khoa,
Gay me hoi sdc.v.v...

Nhoni tac gia gom nhiing can bo nhieu kinh nghiem ve noi
soi phe quan trong chan doan va dieu tri cac benh ly ho hap
thuoc tnidng Dai hoc Y Ha Noi, Benh vien Bach Mai, Benh vien
trung lidng quan doi 103 da cung tham gia bien soan cuon sach
nav kha cong phu. Cuon sach la sit ket hdp nhuan nhuyen giiia
nhiing kien thiic cd ban, kinh nghiem cua cac tac gia vdi nhiing
kien thiic cap nhat trong llnh viic noi soi phe quan Iren the gidi.
Day la tai lieu rat liiiu ich cho ca nhiing ngiidi mdi bit diu cung
nhit nhiing ngu'di da lam noi soi phe quan.

Nhii cac tac gia da noi do thdi gian cd han nen cuon sach cd
the van con mot so" khiem khuyet, rat mong ban doc xa gan dong
gop y kien de lan xuat ban sau sach se diidc hoan thien hdn.

Xin tran trong gidi thieu cung ban doc


HIEU TRJCING
TRadNG OAI HOC Y HA NOI



GS.TS. Nguyen Lan Viet


3


4




LOI NOI DAU


Tut dau the ky XIX, ky thuat noi soi phe quan ong cting da
dan diidc cac bac si biet den. Dac biet la sau khi IKEDA khai
sinh ra ong soi phe quan mem nam 1964, ky thuat nay ngay
cang co vai tro quan trong trong thiic hanh ho hap. Vdi sii ting
dung cac tien bo khoa hoc ky thuat cong nghe, he thong may noi
soi phe quan mem ngay cang diidc hoan thien cho phep tham do
ngay mot xa hOn, vdi nhieu ky thuat lay benh pham de chan
doan cac benh ho hap cung nhit cho phep can thiep dieu tri ngay
mot nhieu hOn, thuan tien hOn. 0 nhieu ntfdc tren the gidi, ky
thuat nay co chi dinh rat rong rai, dvfOc cac bac si chuyen nganh
Ho hap cung nhu cac chuyen nganh khac nhit Hoi scfc cap ctiu,
Ngoai khoa, Gay me hoi sflc si dung hang ngay.

0 Viet Nam soi phe quan ong cting da ditqc thUc hien bdi
cac nha phoi hoc ti nhing nam 80 cua the ky trade. Soi phe
quan ong mem bat dau tut nhutng nam 90. Day la mot ky thuat
tUOng dol an toan, dem lai Ich lqi cho chan doan va dieu tri nen
co chi dinh tren nhieu benh nhan. Tuy nhien hien nay ky
thuat nay cung mdi chi dOOc thiic hien d nhutng cd sd y te ldn,
chuyen sau va so bac si lam thanh thao ky thuat nay chita cd
nhieu do doi hoi ngitdi lam phai nam vutng nhutng ky nang cd
ban, thuc hien thanh thao mdi dat ket qua va tranh daqc cac
tai bien cd luc nguy hiem.

Chinh vi vay chung toi gom cac thay thuoc lam viec trong
nganh Ho hap da manh dan bien soan cuon sach nay nhdm
giup cac ban dong nghiep nhanh chong nam bat dddc cac ky
nang can thiet cho soi phe quan, chia se cac kinh nghiem tlch
luy dUOc qua hdn hai mddi nam thiic hanh ky thuat nay, gop
phan nhanh chong phat trien rong ky thuat noi soi phe quan d
Viet Nam.


5


i


Chung toi xin bay to long biet on toi cac thay co. cac the he
dan anh trong va ngoai nude da dong vien chung toi. dac biet
la GS. J-P. Derenne, trudng khoa Phoi. Benh vien Pitie -
Salpetriere. Paris. GS. Yves Martinet, trUOng khoa Phoi trung
tam Vien trudng Nancy. Vi thdi gian co han. kinh nghiem chua
nhieu nen chac chan cuon sach con nhieu khiem khuyet. Kinh
mong cac bac thay va cac ban dong nghiep. dong gop y kien de
l4n tai ban sau cuon sach dupe hoan thien hon. Xin tran trong
cam On.


Ha noi ngay 2810812007

Thay mat cac tac gia

Chu bien




PGS.TS. Sgo Quy Chau


6



MUC LUC


1. Ldi gicii thieu 3

2. Ldi noi diu 5

3. KhOt khudn va bao quan ong noi soi 9

4. Giai phlu cay khi phe quan 25

5. Gay te trong noi soi phe quan 37

6. Chi dinh va chong chi dinh cua noi soi phe quan ong 45
mem

7. Noi soi phe quan ong cdng 69

8. Noi soi phe quan ong mem 77

9. Sinh thiet phoi qua noi soi phe quan 91

10. Riia phe quan phe nang 104

11. Ky thuat sinh thiet hut bang kim xuyen thanh khi 114
phe quan

12. Noi soi phe quan ong mem trong chan doan mot so' 128
benh ly d phoi

13. Dot khoi u sui hoac seo hep khi quan qua noi soi phe 152
quan

14. Mot so diem m6i trong noi soi phe quan 171

15. Dat khung gia do khi phe quan (Stent) 182

16. Gap di vat qua noi soi phe quan 205

17. Xijf tri ho ra mau 216


7


8




KHtT KHUAN VA BAO QUAN ONG NOI SOI


1. MOT SO DUNG DjCH Slf DUNG CHO KHLf KHUAN ONG NOI SOI

1.1. Dung djch tay rura

Sd dung dung dich tay rda co l't bot, do pH trung ti'nh va
tuan theo chii dan ve lieu litdng va nhiet do cua nha san xuat
ong noi soi.

Khong sd dung lai dung dich tay rda.

Sd dung qua nhieu dung dich tay rda hoac dung dich
khong phu hdp (vi du: xa phong bot) co the lam tac cac ditdng
ong ben trong may.

1.2. Dung dich tiet trung

Nhin chung, mot dung dich vdi hoat chat 2,0% - 3,3%
glutaraldehvde tUdng thich vdi ong noi soi phe quan mem. Can
lien he vdi cac nha san xuat de dUdc cung cap ten va nong do
cac dung dich tiet trung da qua thd nghiem.

Chu y: con (alcohol) khong phai la dung dich tiet trung.

1.3. Nirdc tiet trung

Khi ong noi soi lay ra khoi dung dich tiet trung, phai dUdc
rda sach bang ntfdc tiet trung (natriclorua 0,9%). Trong trUdng
hdp khong co nitdc tiet trung, ta co the sd dung nddc may hoac
niidc da dUdc xd ly (vi du: dung phin loc).

Trong tritdng hdp sd dung nude khong tiet trung: sau khi
lay ong noi soi ra khoi dung dich tiet trung, lau ong noi soi va
bdm rda cac ditdng ong bang ethyl alcohol 70% hoac isopropyl
alcohol 70%, sau do lam kho cac dddng ong.


9


Khong sii dung lai nude tiet trung.

1.4. Li/u y ve gel bdi trdn dau ong soi

Khong sU dung vaseline de boi trdn ddu ong soi. Thu
nghiem cho thay rang viec sU dung gel nay se lam bien dang
phan cao su d dau ong soi. Viec nay gay kho khan cho qua
trinh dUa ong va gay hu hong cho ong soi.

2. PHl/ONG PHAP VE SINH VA TIET TRUNG ONG NOI SOI PHE
QUAN MEM

Chung toi trinh bay quy trinh ve sinh va tiet trung ong noi
soi phe quan mem cua Hang Olympus. Cac ong noi soi cua
Hang khac cung co quy trinh tUdng dUdng. Can tham khao
Hudng ddn cu th§ cua tfitng Hang.

2.1. Chuan bj trang thiet bj cho qua trinh ve sinh va tiet trung

TrUdc khi thUc hien viec ve sinh va tiet trung may noi soi
ta can chuan bi cac trang thiet bi cho qua trinh khu khuan
nhU sau (Hinh 1):

Chu y:

Su dung bon co ki'ch thude phai ldn hdn 40x40cm va du
sau de co the ngam hoan toan may noi soi.

Khong cuon ong soi va day dan sang vdi dUdng ki'nh nho
hdn 40cm. May noi soi co the hu hong neu bi cuon qua chat.

Vai tro cua mot so phu kien ve sinh may noi soi mem
(Olympus)

- Nap day (MH-553) (chi dung cho may videoscope): dude
gjin vao dau noi tiep xuc dien cua ong soi de ngan khong cho
nude vao may trong qua trinh ve sinh va khi tien hanh kiem
tra ro ri.

- Ndp day van (MH-944): de dong kin cac 6 van hut. van
khi'/nUdc va 6 van dung cu trong qua trinh rUa may.


10



<

/

; u

#

saO—

i

Nap day
MH - 553

Nap day van
MH - 994

Ong bdm
NH - 946

Ong rCra Van tang cuong

kenh hut - MH-856 MH - 948

o

\ .

\u.


0*


Con 70

Gang sach

-

Chau ntroc
sach

Van sinh thief
MB-358

Chau ddng
dung djeh tiet trung






'51


Choi BW-20T Choi Bom 30ml p un 9 cu Ch ^ t ^. teS ‘

MH - 507 tluf test ro khi ro khi


Dung dich Dung dich

tay rifa tiet trung





Ban chai mem Vai Nirdc cat

khong xo, bong Nguon sang


Hinh 1 . Cac trang bj dung cho khur khuan ong NSPQ

- Ong bdm (MH-946): bdm dung dich tay rvia, dung dich
tiet trung niidc cat, khong khi vao trong cac diidng ong ben
trong de khii trung, riia va lam kho.

- Van tang eddng (MH-948): khi gan vao o van khi/nUdc,
giup bdm khong khi qua ca hai dddng ong khi va niidc. Con khi
an van nay, niidc se dddc bdm qua ca hai ditdng ong. Do do,
tang hieu qua riia kenh khi va niidc cung nhd dau phun
khi/niidc.

- Choi ilia (BW-20T): de chai riia he thong dtfdng ong
trong may noi soi.


11










- Ban chai (MH-507): de chai ilia dau chop duoi ong soi. o
van hut va 6 van dung cu.

- Ong rila kenh hut (MH-856): de bcfm dung dich tay riia
qua ditdng kenh dung cu.

2.2. Ve sinh va tiet trung may noi soi

2.2.1. Sado ve sinh va tiet trung may noi soi



12



















Van hut


2.2.2. Lam sach ngay sau khi dung


ThUc hien ve sinh ong soi
ngay sau khi rut ra khoi benh
nhan.

(1) Chuan bi san 500ml
dung dich tay nia.

(2) Lau sach toan bo
phan than ong soi dtfa vao
benh nhan bang vai mem vdi
dung dich tay nia.

(3) Hut dung dich tay nia
qua ong soi khoang 30 giay.

+ Dat dau ong soi vao
dung dich tay nia va hut trong
khoang 30 giay (hinh 2).



Hinh 2. Lam sach ong ngay sau
khi rut ra khoi benh nhan


+ Nhac dau ciia ong soi ra khoi dung dich tay nia va hut
khong khi trong khoang 10 giay.

(4) Bdm midc va khi bang van tang cUdng MH-948 (hinh 3, 4).



Hinh 3. Thao van khi, ni/6c va Hinh 4. Bom ni/dc va khong khi
gan van tang ci/dng


13








Chii y: de tranh cho ong soi khong bj tac hdi/mide. phai
luon dung van tang citdng MH-948 ve sinh ditdng khi/nuor >au
mni lan sdi.

- Tat may hut va ngunn sang.

- Thau van hdi/nifdc ra khoi 6ng sni, va dat chung vao
trung bon dung dich tay riia (hinh 3).

- Gan van tang citdng MH-948 vao 6ng sui (hinh 3).

- Bat ngunn sang. Chun che do cap khi tren ngunn sang d
mdc can nhat.

- Nhan van tang citdng bdm nifdc ra khni vni phun
khnang 30 giay. Sau dn, tha van tang citdng de bdm khnng khi
trnng 10 giay (hinh 4).

(5) Bdm dung dich t4y riia va khnng khi van kenh niidc
phu (chi danh chn nhQng 6ng sei c6 kenh nitdc phu).

- Gan eng riia kenh nitdc phu van 6ng sni.

- Dung bdm tiem 30ml bdm dung dich tay riia van kenh
nitdc phu.

- Dung bdm tiem 30ml bdm nude sach van kenh ntfdc phu.

- Dung bdm tiem 30ml bdm kheng khi van kenh nitdc phu
de d&y het nude ra ngcai.

(6) Tit nguen sang. Tat bn xd ly hinh an’n (neu ce).

(7) Than van tang citdng, van hut, van sinh thiet ra khni
eng sni va dat chung van trnng ben dung dich tay nta. Sau de
tien hanh viec ve sinh va tiet trung may thee nhu muc 2.2.4 -
2 . 2 . 6 .

(8) Than dUdng eng cua binh nitdc noi vdi ong soi va dat
vao vi tri cu cua binh.

(9) Than ditdng ong hut noi giCta may hut va ong soi.


14


(10) Thao day noi giufa ong soi va bo xvi ly hinh anh.

- Videoscope: thao day noi videoscope va gan nap day
MH-553.

- Firberscope: thao dau camera ra khoi mat nhin.

(11) Thao ong soi ra khoi nguon sang va dem den khu vtfc
ve sinh may.

2.2.3. Kiem tra ro ri

1) Do day nu'dc vao bon. Dung bon co kich thtfdc toi thieu
ben trong la 40x40cm va chieu sau cho phep du de ngam toan
bo ong soi vao trong mtdc.

2) Dung dung cu kiem tra ro ri MB-155 de kiem tra ong
soi theo quy trinh sau. (hinh 5, hinh 6)



Hinh 5. Bo thur test ro ri cho may Hinh 6. Bo thfr test ro ri cho

noi soi phe quan ong mem ong noi soi phe quan video

- Lap dung cu kiem tra ro ri MB-155 vao nguon sang. Bat
nguon sang va chon che do cung cap khi cua nguon sang d vi
tri cao nhat (m\ic H f GH hoac 3).

- Kiem tra dung cu thu ro ri co thoat hdi ra hay khong bang
each nhan nhe vao cai chau ben trong cua dung cu thvi ro ri.


15








- Lap dau noi cua dung cu thii ro ri vao phan noi thong
khi d ong soi.

- Vdi dung cu kiem tra ro ri da dude noi, ngam ong soi
vao trong node. Xoay bo phan dieu khien cua ong soi va quan
sat trong khoang 30 giay. Xac nhan rdng khong co vi trf nao
cua ong soi co xuat hien nhutng hot khi lien tuc.

- Trong suot qua trinh kiem tra ro ri neu phat hien thav hot
khi noi len lien tuc tut bat ky vi tri nao cua ong soi chung to rang
ong soi da bi ro ri. Neu ban da xac dinh dutOc vi tri ro ri, lay ong
soi ra khoi nifdc, tiep tuc thtlc hien cac biidc con lai viec ve sinh
va tiet trung. Sau do lien lac ngay vdi van phong Olympus.

Chu y

+ Xoay dau noi cua dung cu kiem tra ro ri cho tdi khi no
d£(ng lai tai mot cho. Neu viec gan va xoay khong thitc hien
chinh xac thi ap suat khi ben trong ong soi se khong du va viec
kiem tra ro ri ong se khong con chinh xac.

+ De ngan ngha ong soi bj hit hong khong nen ngam
chung ong soi vdi cac vat khac ngoai trvt cac phu kien ve sinh
ong soi.

+ Khong duoc thao dau noi cua dung cu kiem tra ro ri
vdi ong soi trong khi ngam. Nude se vao ben trong va lam hong
ong soi.

+ Trong qua trinh kiem tra ro ri, do tac dung cua ap
suat khong khi ben trong ong soi nen phan cao su dau ong soi
se cang len. Do la dieu binh thudng.

3) Lay ong soi va dung cu kiem tra ro ri ra khoi bon nude.

• , - Tsiit nguon sang.

- Thao dung cu kiem tra ra khoi nguon sang.

- Ddi trong khoang 30 giay hoac cho tdi khi ldp cao su boc
phia ngoai cua dau uon cong trd ve trang thai ban dau. Thdo
dung cu kiem tra ro ri ra khoi ong soi.


16


- Lau kho hoan toan dung cu kiem tra ro ri.

Chu y: luon thao dau noi cua dung cu kiem tra ro ri ra
khoi nguon sang trUdc va ddi trong khoang 30 giay hoac cho tdi
khi 16p cao su boc phia ngoai cua dau uon cong trd ve trang
thai ban ddu roi sau do mdi dUdc thao diu con lai cua dung cu
kiem tra ro ri ra. Neu thao dau noi givia dung cu kiem tra ro ri
vdi ong soi ra triidc trong khi dung cu kiem tra ro ri vSn noi
vdi nguon sang thi ap suat ben trong cua ong soi se khong
thoat ra ditdc va lam hit hong may.

2.2.4. Ve sinh ong soi

(1) ChuSn bi

- Do day nude tfa dung dich tay rota vao bon vdi nhiet do
va nong do dUdc quy dinh bdi nha san xuat ong noi soi. Dung
bon co ki'ch thude tdi thidu ben trong la 40 x 40cm va chieu sau
cho phep du de ngam toan bo ong soi vao trong nude.

- Ngam ong soi va toan bo cac van hut, van khi/nude, van
sinh thiet vao trong bon.

(2) Ve sinh be mat ben ngoai

- Vdi ong soi da dUdc ngam vao trong bon dung mot ban
chai mem hoac vai mem khong xd hoac bong de chai hoac chui
phia ngoai be mat cua ong soi. Dac biet chu y tdi khe hd cua
vdi phun khi/nUdc va phai chac chan rdng tat ca be mat cua
chop duoi ong soi hoan toan sach.

(3) Chai cac dudng ong

Chai dudng ong hut, dudng dung
trinh sau day.

a) De thang phan than cua ong soi.

b) Cam chat ban chai ve sinh dudng ong BW-20T khoang
3 cm tit phia long cting.



17






c) Dtfa ban chai vao o van hut nghieng mot goc 45 do.

d) Daiy nhe nhang ban chai vao ben trong dtfdng ong cho
tdi khi dau ban chai loi ra d chop duoi cua ong soi. Lam sach
dau ban chai bdng dau ngon tay. Can than khi rut ban chai ra
khoi dtfdng ong. Lam sach dau ban chai mot lan niia. Neu chat
ban van con giut lai sau khi chai, chai lai nhieu lan cho tdi khi
chat ban da dtfdc day ra ngoai.

e) Dtfa ban chai rtf a ong vao trtfc tiep d van hut (goc 90 do).

f) Day nhe nhang ban chai vao ben trong dtfdng ong cho
tdi khi dau ban chai ra khoi dau nbi hut. Lam sach dau ban
chai bdng dau ngon tay. Can than khi rut ban chai ra khoi
dtfdng ong. Lam sach dau ban chai mot lan ntfa. Neu chat ban
van con giii lai sau khi chai, chai lai nhieu lan cho tdi khi chat
ban da dtfdc day ra ngoai.

g) Dut ban chai ngan MH-507 vao o van hut cho tdi khi
mot nOfa chieu dai cua ban chai da ndm phia trong cua o van.
Xoay ban chai mot vong va sau do rut ra. Lam sach long ban
chai. Lap lai cho den khi chai sach chat ban.

h) Dut ban chai ngdn MH-507 vao 6 van dung cu cho tdi
khi no dijfng lai. Xoay ban chai mot vong va sau do rut ra. Lam
sach long ban chai. Ldp lai cho den khi chai sach chat ban.

Chu y: khi cho ban chai lam sach MH-507 vao o van hut.
Neu hdn mot mia chieu dai cua ban chai da dtfdc dtfa vao thi
se co the rat kho khi rut ban chai ra khoi 6 van hut.

(4) Ngam BW-20T va MH-507 vao dung dich tav rtfa sau
do tien hanh ve sinh.

Bdm dung dich tay rvta vao ditdng ong khi/nude va
dabng ong hut


18


An th^ng xuong het mire


Nut hinh tru


Nap van
sinh thiet



Hinh 7. Gan nap day 6 van MH-944, ong bdm MH-946 vao ong soi

- Dung nut cam dtfdng ong MH-944, bo phan rda ong
MH-946 va bdm tiem 30ml de bdm dung dich tay riia vao ben
trong dtfdng ong khi/nitdc va dadng ong hut.

+ Gan nap day 6 van MH-944, ong bdm MH-946 vao ong soi.

+ Ngam dau hut cua MH-946 vao trong dung dich tay rUa.

+ Gdn bdm tiem 30ml vao kenh khi/nUdc cua MH-946.

+ Bdm 90ml (bdm 3 lan) dung dich tdy rUa vao trong
diidng ong khi'/nddc.

+ Gdn bdm tiem 30ml vao kenh hut cua MH-946.

+ Bdm 90ml (bdm 3 lan) dung dich tay rUa vao trong
dUdng hut.

+ Thao MH-946 va MH-944 ra khoi ong soi va de tat ca
lai trong dung dich tay rUa.

Ngam trong dung dich tay rita

- V6i ong soi van dtfdc ngam trong dung dich tay rUa,
dung gac mem hoac vai mem (khong co bong/xd) de chui tat ca
chat ban bam be mat ngoai cua ong soi.


19




- Ngam ong soi, MH-944 va MH-946 trong mot khoang
thdi gian va nhiet do quy dinh bdi nha san xuat tay rUa.

Lay ong soi va phu kien ra khoi dung dich tay rvta

Mang ong soi va tat ca phu kien ra khoi dung djch tay rita
va dat vao trong mtdc sach.

Day dung dich tay rvCa ra khoi cac ditdng ong

- Dung MH-944, MH-946 va bdm tiem 30ml bdm ntfdc
sach day toan bo dung dich tay rUa ra khoi dildng ong.

+ Gan MH-944 va MH-946 vao ong soi. Dat d4u hut cua
MH-946 vao trong nude.

+ Gan bdm tiem 30ml vao kenh khi/ntfdc cua MH-946 va
bdm 60ml nude sach vao trong ditdng ong khi/niidc.

+ Gan bdm tiem 30ml vao kenh hut cua MH-946 va bdm
90ml nude sach vao trong ditdng ong hut.

+ Lay ong soi cung cac phu kien MH-946 va MH-944 ra
khoi nitdc.

+ Dung bdm tiem 30ml bdm 90ml khong khi vao kenh
hut cua MH-946.

+ Dung bdm tiem 30ml bdm 90ml khong khi vao kenh
khi/nitdc cua MH-946.

+ Thao MH-944 va MH-946 ra khoi ong soi.

Lam kho cac be mat ben ngoai

- Dung mot tarn vai mem sach lau kho toan bo be mat
phia ngoai cua ong soi va cac phu kien.

- Kiem tra ong soi lai mot lan nfla xem chat ban con bam
trd lai ong soi hay khong. Neu co phai ve sinh lai cho sach se.


20


2.2.5. Tiet trung

Tat ca cac bade tiet trung phai diidc thUc hien trong dieu
kien ong soi va cac phu kien ngam hoan toan trong dung dich
tiet trung. Neu may soi va cac phu kien dtfdc lap hoac thao ra
trong khi khong ngam vao dung dich tiet trung se lam cho be
mat cua may soi va phu kien tiep xuc khong tot vdi dung dich.
Do do se lam giam hieu qua cua tac dung tiet trung.

Chuan bi

Do day dung dich tiet trung vao trong bon vdi nhiet do va
nong do theo nhii hitdng din cua nha san xuat. Dung mot cai
bon co ki'ch thude tdi thieu ben trong la 40x40cm va chieu sau
cho phep du de ngam toan bo ong soi vao trong nufdc.

Btim dung dich tiet trung vao tat ca cac ditdng ong

- Gin MH-944 va MH-946 vao ong soi va ngam hoan toan
vao trong dung dich tiet trung.

- Vdi dau hut cua MH-946 dat trong dung dich tiet
trung, dung bdm tiem 30ml bdm vao ditdng ong khi/ntfdc
60ml dung dich tiet trung va vao ditdng ong hut 90ml dung
dich tiet trung hoac cho tdi khi toan bo khong khi ben trong
da bi day ra ngoai.

- Thao MH-944, MH-946 ra khoi ong soi va d§ lai trong
bon dung dich tiet trung.

- Dung vai mem de tach cac bot khong khi bam tren be
mat cua ong soi.

- Day bon diing dung dich tiet trung bang mot nap day
kin de tranh hdi cua dung dich thoat ra ngoai.

Ngam toan bo may noi soi va phu kien trong dung dich
tiet trung mot thdi gian theo nhit quy dinh cua nha san xuat
dung dich tiet trung.


21


2.2.6. Rita sach sau khi tiet trung

Khi dtfdc lay ra khoi dung dich tiet trung, may noi soi can
phai dvtdc nia sach bang nutdc tiet trung. Neu khong co nitdc
tiet trung, co the sui dung dung dich con 70% (ethyl alcohol)
hoac isopropyl alcohol 70% de chui rUa be mat ngoai ong va
bdm rvia cac dtfdng ong ben trong.

Co hai quy trinh dtfdc mo ta nh\i ditch day.

Rita lai bang ntfdc tiet trung:

(1) SVk dung MH-944 va MH-946 de day dung dich tiet
trung ra khoi ong.soi.

- Tnldc khi lay may noi soi ra khoi dung dich tiet trung,
gdn MH-944 va MH-946 vao ong soi.

- Dat dau hut cua MH-946 ra ngoai khong khi.

- Dung bdm tiem 30ml bdm 90ml khong khi vao kenh hut
cua MH-946.

- Dung bdm tiem 30ml bdm 90ml khong khi vao kenh
khi/nvfdc cua MH-946.

(2 )Thao tat ca cac phu kien ra khoi ong soi.

(3) Ngam ong soi va toan bo phu kien ve sinh vao trong
nifdc cat. Dung vai mem de chui nia phia mat ngoai cua ong
soi va tat ca phu kien.

(4) Noi MH-944 va MH-946 vao lai ong soi. Bdm 90ml nifdc
tiet trung vao cac diidng ong khi/nUdc va dUdng ong hut.

(5) Lay toan bo ong soi va phu kien ve sinh ra khoi nude cat.

(6) Dung bdm tiem 30ml cung v6i MH-944 va MH-946 de
day niidc ra khoi dutdng ong khi/niidc va diidng o'ng hut.

(7) Thao tat ca cac phu kien ra khoi ong soi.

(8) Dung vai tiet trung lau kho toan bo may soi.


22


(9) Noi MH-944 va MH-946 vao lai may va dung bdm tiem
30ml bdm l&n lifdt 90ml khong khi vao difdng ong khi/nifdc va
dUdng o'ng hut.

(10) Noi may noi soi vdi may hut bang mot ong hut sach va
hut khong khi trong 15 giay.

Rika lai bang nitdc khong tiet trung:

(1) Bdm nifdc khong tiet trung va khong khi vao ong soi
nhif phan "Rika lai bang nifdc tiet trung"

(2) Nhung dau hut cua bo MH-946 vao trong con 70% (ethyl
alcohol) hoac isopropyl alcohol 70%. Dung bdm tiem 30ml, bdm
60ml va 90ml con 70% (ethyl alcohol) hoac isopropyl alcohol 70%
vao cac difdng ong khi/nUdc va dUdng ong hut.

(3) Lay dau hut cua bo MH-946 ra khoi alcohol. Bdm 60ml
khi vao cac dufdng ong khi/nUdc va difdng ong hut.

(4) Sik dung tam gac tarn con 70%

(ethyl alcohol) hoac isopropyl alcohol
70% lau chui may noi soi, o van
khi/nUdc, van hut va cac phu kien.

2.2.7. Bao quart may noi soi

- Tu dung may noi soi phai sach,
kho, thong thoang va bao quan tai
nhiet do phong. Bao quan may noi soi
dvfdi anh sang mat trdi, nhiet do cao,
do &m cao hoac difdi tia X co the lam
hong may noi soi.

- Lay tat ca cac phu kien ra
khoi may noi soi. Rut van khi/nifcfc,
van hut va van biopsy ra khoi may se
lam thong thoang va kho may soi.



Hinh 8. Tu bao quan
ong noi soi phe qu£n


23



- Khong bao quan may noi soi trong hop. Hop chi dung
khi van chuyen may.

(1) Trifdc khi bao quan may noi soi, phai lau kho toan bo
may (dac biet la cac dtfdng ong, cac o van. dau ong soi, cac mat
kxnh va cac tiep xuc dien) va cac phu kien.

(2) Dung gac t^m con 70% hoac ethyl alcohol 70% lau can
than mat kinh d dau ong soi, mat nhin va d dau noi vao
nguon sang.

(3) Van cac khoa d bo phan dieu khien ve vi trx ’F4" (Free).

(4) Treo may.trong tu vdi dau ong soi tu do. Dam bao rang
dau ong soi cang thang cang tot.


TAI LIEU THAM KHAO

1. Spach H.D (1995). "Infection control". Text book of
bronchoscopy. Williams & Wilkins. 109-119.

2. Oho K, Amemiya R (1984). "Cleaning and sterilization".
Practical fiberoptic bronchoscopy. 2 nd , 16-17.

3. Culver D.A, Minai O.A, Gordon S.M, Mehta A.C (2004).
"Infection control and radiation safety in the
bronchoscopy suite". Flexible bronchoscopy. Blackwell
science, 2 nd , 9-25.


24


GIAI PHAU CAY KHI PHE QUAN


I. GIAI PHAU KHI PHE QUAN

Stf hieu biet can ke giai phliu khi' phe quan het stic quan
trong doi vdi thu thuat noi soi phe quan dac biet vdi noi soi phe
quan can thiep.

1. Duong thd tren

Gom mui, hau, thanh quan.


DSy cha^g giap-mcng -
Sun !hor


Cu sun ch6m
Cu sun sung
Nep ti6r. dirh


Nep thanh am


Tuy6n giap



Sun thanh thifct

—- - Sung Ion xuong mong


Tien dinh thanh quan
f*- SUng tren (sung mong)

Co l*6n pheu ngang
- Co Ii6n oheu cheo

Non chjn
Co nh5r*ph&u sau
Sung duoi sun giap


Khi quan


Hinh 9. Mat trong thanh quan va cac bo phan lien quan
(cat ngang giijra)


25




Than xt/ong m6ng

Day chang mong-thanh thiet
DSy chang giap-mong

Khdi m3 cua thanh quSn
Day chang giap-thanh thiat

Day thanh am



Sun thanh thiet
Mang giap-mong

Si/ng tr6n sun giap manh


Sun ph£u


Ban (manh) sun nhln


Sun khi quar


HinhIO. Mat trong thanh quan va cac bo phan lien quan
(cat doc giOra)


w

*


y ;:,v

■ 'V.X

•C &

I





Nap thanh mon


Day thanh am




Sun pheu Ho le


Hinh 11. Cac thanh phan sat tren day thanh am


26




















2. Khi quan, phe quan va cac thanh phan lien quan



PQ thuy !r*n

PO Oxjy day


PO {rung gian


Trdi


PO 96c tr&i


PQ gtc p*iai


Hinh 12. Cay khi phe quan


2.1. Khi quart

Khi quan hinh tru, mat sau khong co sun, dai khoang 13-
15 cm. Chay chech ra sau va sang phai.


27










2.2. Khi quart vung co

Tet sun nhan den bd tren
xUdng lie, hoac bd tren dot
song lung 2. Mat trUdc la
tuyen giap, eo tuyen giap
n&m tren sun 2, 3 va 4 cua
khi quan. Thuy ben, tiep giap
vdi mat ben cua khi quan.

Tinh mach tuyen giap n&m d
phan dudi, do mau vao tinh
mach vo danh ben trai, nhin
chung cac tinh mach d xa
thanh khi quan va khong
nguy hiem vdi cac thu thuat
noi soi. Tinh mach vo danh
trai cung khong nguy hiem vi

n^m xa thanh khi quan, ngay sau can xUdng etc. NgUdc lai, ndi
phan chia cua dong mach than canh tay ddu lai tiep xuc sat
vdi khi quan d vung nen co va dong mach canh chung ben trai
nam bat cheo d mat trude cua khi quan [1],


Hinh 13. Khi quan doan
sat tren carina


Mat sau, khi quan vung co tiep giap vdi thUc quan. ThUc
quan nam hdi chech sang trai khi quan. Day than kinh quat
ngUdc ben phai gap lai khi quan d mete sun thii 6 va chay song
song d mat sau cua khi quan. Day quat ngUdc trai, tet dudi
quai dong mach chu, chay doc theo bd sau cua khi quan, trUdc
thUc quan.


Mat ben, ngoai lien quan vdi tuyen giap, khi quan co con
lien quan vdi cac cau true mach mau - than kinh vung co
(dong mach canh chung, tinh mach canh trong, va day than
kinh X), cac cau true nay, chay chech len tren va ra sau, vi
vay chi tiep xuc vdi khi quan d phan nen cua co. Thue te, chi
co dong mach canh chung la tiep giap gdn vdi bd ngoai cua
khi quan.


28




1. Dong mach phoi trai

2. Phe quan goc trai

3. Day than kinh X

4. Dong mach chu

5. Day than kinh quat ngi/dc

6. Thifc quan

7. Khi' quan

8. T7nh mach chu tren

9. Dong mach phoi phai

10. Phe quan goc phai


Hinh 14: Khi quan d mat cat qua quai
dong mach chu



1. Thuy di/di trai

2. Thuy tren trai

3. Dong mach phoi trai

4. Day than kinh X

5. Thi/c quan

6. Phe quan goc trai

7. Dong mach phoi

8. Dong mach chu

9. T7nh mach chu tren

10. Phe quan goc phai


Hinh 15: Lat cat di/6i Carina

2.3. Khi quan vung ngut

Khi quan ngxic dai hdn khi quan co, nam d 1/3 tren cua
long ngiic va lien quan rat chat che vdi cac mach mau cua


29


trung that. Day la vung co nguy cd bi thung va chay raau ldn
khi soi phe quan va thuc hien cac ky thuat can thiep (2],[3].

Lien quan cua mat tnidc

Cac tinh mach d ngoai va khong tiep xuc trtfc tiep vdi khi
quan. Tinh mach vo danh ben trai ttf bd tren quai dong mach
chu chay chech xuong dudi va sang phai, roi hoi tu vdi tinh
mach vo danh ben phai tao thanh tinh mach chu tren nam ben
phai cua khi quan. Tinh mach chu tren di xuong doc theo bd
tritdc ben cua khi quan. O dridi, tinh mach chu tren nhan them
tinh mach azygos [2].


Khicuan


D3y than kinh phd-i


TTnh nach don (ldn)


Ddrig mach pW5i phai


Ph^i ph&
Thi/c quin doan rgjc


Day thif) Kmh qu3t nguoc trai
Thi/c quan

mach dJO don */ai
than lunh ph£-vi trai
$uon tnj!
lan k nh Im


Quai ddcg mach ch j



Day ching dong mach
Dtag mach phoi trai
Thin ddng mach ch j
C^c tinh mach ph£
trai trtn va difdi


Day thin lunh
ph6-vj*ai

DOng rrach chu ngtrc
y (BM chu *u6ng)


Hinh 16. Lien quan cua khi quan, carina va cac thanh
phan trung that (da cat bo tim)

Cac dong mach nkd phia trong, tiep xuc tnlc tiep hdn
vdi khi quan. Quai dong mach chu, chay chech tir trude ra sau,
tCr phai sang trai, sat vdi bd trai cua khi quan. Quai dong mach


30















chii tiep xuc rat sat vdi khi quan, tao thanh an lorn vao thanh
khi quan va day khi quan hdi lech sang ben phai.


Mat sau\ khi
quan ngiic tiep
giap vdi thiic quan,
cang di xuong thiic
quan cang chech
sang trai.

2.4. Carina

JK

0 tan cung,
khi quan chia
thanh hai phe
quan goic phai va



Than dong mach canh tay dau tach ra tCf quai dong mach
chu, ngay trutdc khi quan, roi chay d bd ben phai khi quan, den
nen co, than dong mach canh tay dau chia thanh dong mach
diidi don phai va dong mach canh chung ben phai. Dong mach
canh chung ben trai, khi mdi xuat phat thi chay ngay ben bd
trai cua khi quan, nhtfng cang len tren vung co cang tach xa
khi quan, khong con nguy hiem vdi cac thu thuat noi soi. Dong
mach diidi don trai chay cheo d trvtdc ngoai cua khi quan
khong tiep xuc true tiep vdi khi quan. Day than kinh X chay
xuong song song vdi dong mach canh chung ben trai, cit ngang
d bd ben trai cua quai dong mach chu va tach ra nhanh quat
ngiidc trai, nhanh
nay chay diidi quai
dong mach chu, roi
chay ngufdc len
tren, nam trong
ranh tao bdi bd
trai cua khi quan
va thUc quan [1].


Hinh 17: Lien quan giura khi phe quan va
cac mach mau Idn


31


trai, phan nho len d giuta hai ndi phan chia goi la carina. Khf
quan va hai phe quan goc tao thanh hinh chut Y Ion ngifdc, goc
giQa hai phe quan goc khoang 70 do.

Lien quan mach mau, than kinh d vung Carina rat quan
trong doi vdi ngifdi lam noi soi phe quan. Cl mat trildc va hdi
chech sang phai, dong mach phoi tach thanh nhanh phai va
trai. Giuta hai ndi phan chia nay (phan chia khi quan va dong
mach) co khoang trong goi la khoang lien phan chia. Mat tritdc
va lech sang phai cua carina la ndi tiep giap giuta tlnh mach
azygos vdi tlnh mach chu tren. Mat tnidc va ben trai, carina
tiep xuc vdi quai dong mach chu, day than kinh quat ngitdc
trai. Day nay di len tCt ditdi quai dong mach va tiep xuc vdi
carina d mute nay. Mat sau la thutc quan [4].


3. Lien quan cua cay khi quan phai


3.1. Phe quan goc phai


Phe quan goc
ben phai tao vdi
true cua khf quan
goc 20-30 do. 6
ngtfdi ldn, phe quan
goc phai dai khoang PQ tr6n
2,5 cm, khau kfnh
1,5cm

Lien quan chfnh
cua phe quan goc
ben phai la vdi dong
mach phoi phai.

Dong mach nay cat
ngang phfa trtfdc
dong mach chu len
va tlnh mach chu


ph6i phai —OM ph6i tfeii



PQ g6c ph4i v£ UA\

Hinh 18: Cac phe quan goc va
dong mach phoi


32


tren. Dong mach nay tiep giap sat vdi phe quan d ndi phe quan
goc phai tach ra phe quan thuy tren. Tai day, dong mach phoi
tach ra hai nhanh: nhanh chfnh cung cap mau cho vung dinh
va vung triidc va nhanh xuong cap mau cho thuy sau. Sau do
dong mach phoi phai tiep tuc di xuong va ra sau.

Tlnh mach phoi, nam phfa dtfdi dong mach, hai than tlnh
mach nhan mau cua thuy tren, hdp vdi tlnh mach cua thuy
gifia tao thanh tlnh mach phoi tren ben phai. Cac mach rpau
nay khong tiep xuc true tiep vdi khf quan.

Phe quan gob ben phai co khau kmh 16n hdn va hitdng di
gan trung vdi true cua khf quan. SiJ phan bo" cua cac mach
mau theo kieu chong len cac phe quan va chay song song vdi
chung. Nhin chung cac tlnh mach n&m xa phe quan, trti doc
theo bd trong cua thuy giuta va thuy dutdi gay nguy hiem cho
cac thii thuat dac biet trong benh ly ac tfnh [2],

3.2. Phe quan thuy tren - phai

Phe quan thuy tren tach vuong goc ra ti( phe quan goc
phai, each ndi phan chia cua khf quan khoang 2,5 cm. Phe
quan thuy tren ngan, khoang 10-15cm, chay chech len tren va
ra ngoai. Chia thanh 3 phe quan phan thuy: tren, sau, trutfe.
Mat sau cua phe quan thuy tren khong co lien quan nao vdi
mach mau, trong khi do, mat trifdc tren difdc ap sat bdi dong
mach thuy tren. Tinh mach thuy tren d thap khong lien quan
trilc tiep vdi phe quan.

3.3. Thuy giCfa va dtfdi

Thuy gida tach ra tu: mat trifdc cua phe quan trung gian,
each ndi tach ra cua phe quan thuy tren khoang 2,5cm, chay
chech xuong difdi va ra ngoai. Dong mach phoi phai tach ra cac
nhanh cho tvfng phan thuy cua thuy gida va thuy difdi, nhin
chung, cac nhanh dong mach nay chay d bd ngoai cua phe


33


quan, tuy nhien co rat nhieu cac bat thUdng ve phan bo mach
mau doi vdi cac phe quan nay.

Cac tlnh mach cua thuy giuta nam d trUdc trong cua phe
quan, chung hdp vdi tlnh mach phoi thuy tren de tao thanh tinh
mach phoi tren nam sat bd trong cua phe quan trung gian.

Cac tlnh mach thuy dudi n§m phia sau cac phe quan, tiep
xuc vdi bd sau trong cua cac phe quan phan thuy day cua thuy

dudi [1J.

4. Lien quan cua cay phe quan trai
4.1. Phe quart goc trai

Phe quan goc trai chay ngang hdn so vdi phe quan goc
phai, tao vdi dudng true cua khi quan goc 40-50 do, dai hdn
(5cm) nhitng nho hdn (11mm) phe quan goc ben phai. Phe
quan thuy tren trai tach ra tit bd tritdc ngoai cua phe quan goc
phai, roi di chech len tren va ra ngoai. Phe quan goc trai con
lai doi thanh phe quan thuy diidi di xuong ditdi va phan chia
thanh cac phe quan dudi phan thuy.

Ngay d ndi tach ra phe quan goc trai lien quan vdi quai
dong mach chu, dong mach phoi trai, va thuc quan. Quai dong
mach chu v^t d mat tren, vong ra sau phe quan goc trai, con
mat trtfdc giufa phe quan goc trai vdi dong mach chu la than
dong mach phoi. Dong mach phoi trai ngSn (2,5cm), chay
chech len tren va ra sau, luc ddu chay d trUdc, sau do d tren
phe quan goc trai, roi d mat sau cua phe quan thuy tren trai,
tao thanh hinh chd S vong quanh phe quan goc trai va phe
quan thuy tren trai.

Cac tinh mach chay triidc phe quan, nhung d dudi dong
mach. Tinh mach phoi tren ben trai chay ngang qua phe quan
goc trai d ndi phan chia ra phe quan thuy tren trai. va tiep xuc
true tiep vdi bd trUdc dudi cua phe quan nay.


34


C) mat sau, thuc quan co mot phan, khoang 2cm, dinh sat
vao phe quan goc ben trai.

Nhin chung, so vdi ben phai, cac ky thuat can thiep noi soi
d phe quan goc trai nguy hiem hdn rat nhieu, vi cac ly do: Phe
quan goc trai nho hdn va di chech hdn. Cac mach mau nhtf
quai dong mach chu, dong tinh mach phoi trai va thtfc quan
bao boc xung quanh phe quan goc trai. Cac dieu tri can thiep
doi vdi phe quan thuy tren cung rat kho, vi no diidc tach ra
gan nhut vuong goc vdi phe quan goc, va dong mach phoi trai
gan nhif om xung quanh phe quan nay. 0 thuy dvfdi, dong
mach chay song song vdi cac phe quan [4],[5].

4.2. Phe quan thuy tren - trai

Phe quan thuy tren trai rat ngan, no phan chia ngay
thanh hai phe quan la: phe quan vung dinh va phe quan ludi.

Dong mach phoi trai la diem litu y chu yeu, vong quanh
phe quan thuy tren ngay d goc cua phe quan thuy tren. Tren
dudng di dong mach nay tach nhieu nhanh: khi den bd tren
cua phe quan thuy tren, tach ra nhanh dong mach nuoi thuy
dinh, sau do khi den mat sau cua phe quan nay lai tach ra hai
hoac ba nhanh cung cap mau cho thuy lvfdi

Cac tinh mach nam d trtfdc phe quan thuy tren va tiep xuc
tnJc tiep vdi phe quan thuy tren va phe quan goc trai

4.3. Phe quan thuy dirdi trai

Phe quan thuy dtfdi trai rat ngan, va cac lien quan giong
nhit phe quan ben phai.

Than dong mach phoi d ben ngoai cua phe" quan thuy diidi,
tach ra nhanh nuoi phan thuy dinh cua thuy dtfdi, sau do la
cac nhanh cua phe quan phan thuy day.

Cac tinh mach d phia sau cua phe quan. Tinh mach phoi dudi
nam ngay phia sau ndi phan chia cac phe quan phan thuy day.


35


TAI LIEU THAM KHAO

1. Ifrim M. Ifrim C.F, Maghiar A. Maghiar T, Niculescu
A.G. (1999). "Phan noi tang". Atlat giai phau ngtfdi.
Nha xiiat ban Y hoc.

2. Kitamura S; Kobayashi J. (1995). "Atlas and basic
technique". Textbook of Bronchoscopy. Williams &
Wilokins. 31-48.

3. Kavuru M.S; Mehta A.C. (2004). "Applied anatomy of
the airway". Flexible bronchoscopy. Blackwell science.
2 nd . 36-38.

4. Oho K, Amemiya R. (1984). "Anatomy of the
bronchus". Practical fiberoptic Bronchoscopy. Igaku-
Shoin. 1 st . 27-65.

5. Shigeto Ikeda. (1974). "Atlas of flexible bronchoscopy".
Igaku Shooin Ltd.


36


GAY TE TRONG NOI SOI PHE QUAN

■


1. DAI Cl/ONG

Gay te trong noi soi phe quan la mot giai doan quan trong
bao trum toan bo thu thuat va di theo suot qua trinh soi phe
quan. Ky thuat co thiic hien hoan hao thi cuoc soi mdi dat ket
qua tot va tranh nhutng tai bien dang tiec.

Gay te trong noi soi phe quan co nhQng dac diem hoan
toan khac vdi gay te trong cac thu thuat khac do dac diem ve
sinh ly ho hap.

2. MUC TIEU CUA GAY TE: giup cho ngxibi benh

- Khong ho trong suot qua trinh soi.

- Khong vat va kich thich.

- Khong con cam giac dau.

- Khong co trieu cluing non hay buon non.

- Khong co cac phan ting phu cua thuoc.

Ngoai cac muc tieu neu tren, gay te con phai bao dam
tranh ditdc cac phien phitc khac nhit:

- Khong anh hitdng nhieu den ho hap cua ngtfdi benh.

- Khong lam thay doi nhip tim cua ngvfdi benh.

- Khong anh hiidng den cac thong so" ve khi mau cua
ngUdi benh (Pa0 2 , PC0 2 , pH).

- Khong lam boi nhiem them trong long khi phe quan
ngvfdi benh do hau qua cua thuoc te, each gay te, phvfdng tien
gay te [3],[4].


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3. TRiNH Tl/GAY TE

3.1. Tien te

Muc dich

- Sau khi giai thfch cho ngtfdi benh ve muc dich cua thu
thuat ngtfdi benh yen tam phin nao thi tien te la thu thuat
tiep theo cung co cho ngitdi benh yen tam hdn.

Tien hanh tien te

- Cho ngifdi benh dung thuoc an th&n nhe tritdc khi soi de
ngitdi benh tranh lo ling, hdp tac hdn vdi thiy thuoc:

+ Diazepam (seduxen, mekoluxen) 5mg /vien x 1 vien
uong toi hom trvtdc khi soi. Chong chi dinh dung thuoc an than
vdi nhutng benh nhan

. FEV1< 50%.

• Co suy ho hap man tmh:

Pa0 2 < 60mmHg; PaC0 2 > 45mmHg.

• Benh nhan co hep khi
quan phe quan, tang tiet ddm
dai nhieu.

+ Atropin 1/4 mgxl ong,
tiem bap hoac dudi da 30 phut
trildc khi soi de tranh tang tiet d
mieng va phe quan, de phong
phan xa cua than kinh X.

Co tac gia khuyen dung chong non:

Metoclopramid (Primperan) 10 mg x 1 ohg, tiem bip.

Neu noi soi dtf kie'n keo dai nguoi ta co the chi dinh:

- Hydroxyzin, khang histamin co tac dung an than tot.



Hinh 19. Tiem bap seduxen
va atropin


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- Ngoai ra co the cho Midazolam vdi lieu 0,05 mg/kg the
trong hay Fantanyl lieu 2 microgam /kg thl trong. Thuoc
khong anh hifdng den nhip tim, an than, chong lo lang cho
ngtfdi benh. Thdi gian tac dung cua thuoc 30-60 phut, thdi gian
ban huy cua thuoc vao khoang tijf 2- 4 gid. Chong chi dinh doi
vdi nhulng benh nhan bi suy ho hap man tinh [1].

3.2. Gay te

Gay te tai cho

Muc dxch

Nhit tren da neu, yeu cau cua cong doan gay te phai bao
dam cho ngitdi benh khong co cam giac dau ddn khi dvfa ong
soi vao va ca khi thilc hien cac thu thuat lay benh pham (sinh
thiet, chai, rc(a phe quan).

Co hai hinh thUtc gay t
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