Trn dch mng phi d bt k l loi dch g, hay do nguyn nhn g, cng cn phi chc ht chn on v iu tr. 1.

. Ch nh v chng ch nh. 1.1. Ch nh: - chn on xc nh c trn dch mng phi. Ngy nay nh siu m c th pht hin rt nhy trn dch mng phi mc rt t 5 ml tr ln; cho ln vic chc thm d mng phi khng cn l bin php duy nht na. Bao gi cng siu m ri mi chc d mng phi. Tuy nhin tuyn trc cn phi cn c vo cc triu chng lm sng ca trn dch mng phi v sau chc thm d. - chn on nguyn nhn: ngi ta c th cn c vo tnh cht dch c ht ra v lm cc xt nghim: sinh ho , t bo, vi trng, th mt s trng hp c th chn on c nguyn nhn ca trn dch mng phi. Tuy nhin mun chn on xc nh nguyn nhn trn dch mng phi vn phi da vo xt nghim m bnh v vi sinh vt. - iu tr: + Ht tho dch gii phng s chn p phi. + i vi mt s trng hp trn dch mng phi mn tnh, sau khi chc tho ht dch, ngi ta bm cht gy dnh mng phi chng trn dch mng phi ti lp. + i vi m mng phi, chc tho dch mng phi kt hp ra mng phi. 1.2. Chng ch nh: Khng c chng ch nh tuyt i, cn ch cn nhc trong mt s trng hp sau: - Bnh nhn qu yu, suy th, suy kit nng - Ri lon chy mu v ng mu. - Nhi mu c tim. 2. Chun b cho chc ht dch mng phi. 2.1. Chun b bnh nhn: - Cn phi gii thch ng vin bnh nhn yn tm v khng bnh nhn qu i khi lm th thut. - o mch, nhit , huyt p, nhp th v cho bnh nhn i v sinh trc khi chc ht dch mng phi. -Bnh nhn phi c chp phi, siu m, xt nghim mu c chn on xc nh trc khi lm tiu th thut. - Tim tin t 15-30 trc khi lm tiu th thut: Atropin 1/4mg 2 ng . Tim bp. Seduxen 5 mg 1 ng. Tim bp. C th khng cn tim tin t, nu tnh trng bnh nhn yn tm cho php. 2.2. Chun b dng c: - Trong khay v trng gm c cc dng c: bm kim tim 5ml v 10 ml, kim chc d chuyn bit c van 3 chiu (nu khng c th thay bng kim tim thng thng loi 16G vi 1 ng cao su v km kocher thay cho van ). Gng tay v trng, bm tim 50 ml hoc100 ml Khn c l v bng gc v trng. - Khay hu trng gm c: km kocher, cn iod 1% v cn 70 0, ng nghim, thuc t: novocain 0,25% 5-10 ml hoc lidocain 2%. Thuc phng khi cp cu: adrenalin, depersolon, coramin - Ngoi ra cn c b hoc khay qu u ng dch, gh ngi, n chiu sng, ti oxy, my ht, l si hoc qut. 3. K thut. - T th bnh nhn v thy thuc: + Cho bnh nhn ngi kiu ci nga trn gh ta, 2 tay khoanh trn vai gh, trn t vo tay lng cong ra sau. C th cho bnh nhn ngi trn ging, tay m mt ci chn bng lng cong ra sau. Trng hp bnh nhn mt, c th nm t th Fowler. + Th thut vin ngi i din vi mn sn nh chc d. Tr th vin ng bn cnh ph. - Khm phi xc nh v tr m kim, thng l gian sn 9 ng nch sau (ni c ti cng mng

phi). Sau st trng v chi sng c l. - Gy t theo lp: t da, t chc di da, c, n mng phi l thnh. - Chc kim ti im gy t, thng gc vi thnh ngc v m lt b trn ca xng sn. Khi kim qua mng phi l thnh s c cm gi st v nh tay hn. Ht th nu thy c dch th ht tip khong 10-20 ml dch xt nghim (cn phi xt nghim ngay t nhng bm tim ht ra u tin). Nhng xt nghim cn lm l: sinh ho, t bo, vi trng. Sau nu l ht tho dch th c th dng my ht hoc bm tim to. Phi ht chm v m bo ht kn bng h thng van 3 chiu. Mi ln ht khng qu 800 ml. Nu cn c th ht li ln II trong ngy, sau 12h. - Khi ngng th thut th rt kim, st trng ri day ti ch 1 lt, ri bng li. Theo di mch huyt p c thc hin trc v sau khi lm th thut. 4. Tai bin v cch phng trnh. - Chy mu v au ti ch: do chc phi b mch thn kinh gian sn. Mun trnh, cn phi chc kim lt ln b trn xng sn. - Chong ngt do lo s: y l tai bin thng gp, do bnh nhn qu s hi hoc lm th thut lc bnh nhn ang i. Ch cn cho ung nc ng nng, mt lc l khi. - Tru tim mch do sc mng phi: tai bin ny xy ra khi ht dch qu nhanh v qu nhiu. Cn phi tun theo ng cc thao tc k thut. - Khi tai bin xy ra, vic trc tin phi xoa bp tim ngoi lng ngc, tim trng adrenalin 1 0/00 vo tnh mch, cho th oxy, sau cp cu ging nh ngng tun hon. - Trn kh mng phi: thng do kh b ht vo qua kim, do khng m bo ht kn. Cng c th do chc vo phi gy v bng kh thng. Ch cn ht ht kh sau khi ht dch. - Ph phi cp: cng c th xy ra khi ht dch qu nhanh v nhiu. - Chc nhm ph tng: vo phi, vo tim, gan , rut, lch v d dy. Cn nm vng v tr gii phu v lm thn trng, trnh th bo. - Nhim trng: c th gy ra m mng phi. Cn phi tun th ng qui tc v trng trong th thut. - C th cn gp: khi huyt, tc kh mch, d ng thuc, gy kim - Rc ri c th gp: trong khi ang ht, khng thy dch ra na. C th l ht dch, nhng cng c th kim tin vo qu n nhu m phi hoc do kim tri ra n thnh ngc, hoc c th do tc kim. Cn phi kim tra cc tnh hung ny iu chnh kim.