THO MAY SO SlNH

l. Al CONG THO MAY SO SlNH

1. Moc tico giop tbo:
On dnh um sung vu kh muo o moc lO
2
vu up oc thup nhut.
2. Cac pboong tboc tbo dong cbo trc so sinb:
u. Th! my thng th"ng, Kiem soat ap lc (Pressure Control): dong cho tut
cu bonh y guy soy ho hup o tro so snh. Cho do nuy kom sout dooc up oc,
tho gun ht vuo, tho ru, nhong khong kom sout dooc tho tch kh oo thong
tVt), khong tho to dong thch ong kh do dun pho thuy do. Do do noo
bonh nhun to tho ru vuo gu doun co nhp muy so khong dum buo kh oo
thong vu tung ngoy co do kh.
b. Th may tan so cao (High frequency ventilation (HFV): Co 3 ou:
- Hgh roqooncy postvo prossoro vontuton tHlllV): co tho up dong tu khou.
- Hgh roqooncy ot vontutor tHl): t dong v guy buy kh do tho ru tho dong.
- Hgh roqooncy oscutor tHlO): hon dung dooc ou choong.
HlllV: 1ho muy co hoc o tun so 60 l50 un/phot. Vt= 4m/kg, l/L <
0.3, tho ru tho dong. HlllV co o dom hun cho tnh trung chong muy, gum
nho cuo xo dong thooc un thun
Hl: 1un so l00 600un/phot, tho ru tho dong, do do co tho b o CO
2

HlO: tho muy tun so cuo t = 5 30Hz, t!c 300 l500 un/phot) vo tho
tch kh oo thong bung houc nho hon khoung chot gu phuo t 2 3m/kg), tho
ru cho dong. Koo tho nuy cho phop dong MAl cuo do trunh xop pho nung, to
do cu thon ty o thong kh too muo. HlV co tho dum buo do thong kh mu
vun trunh dooc thuy do tho tch pho nhoo vu trunh dooc ton thoong pho
kom. V vuy, HlV co tho o ch trong kh pho thong mo ko pho vu trun kh
mung pho.
HlV co ch dnh kh thut bu vo cho do tho muy tho ng
thoong, duc bot kh do kh, kh pho tho ng mo ko pho. 1oy
nhon, muy du t ton.
ll. CHl ]NH THO MAY
l. Con ngong tho nung > 20 guy houc kom chum nhp tm, thut bu vo
thooc vu NClAl vo l ! 6 cmH
2
O vu lO
2
> 0.8
2. luO
2
< 50 mmHg kh lO
2
> 0.8 ttro bonh tm bum snh tm).
3. luCO
2
> 60 mmHg kom toun muo koo du.
4. Soy ho hup huo phuo.
lll. THC HANH THO MAY
Kh cu dut tr so up oc ht vuo to du bun duo lll tlll = ll + lLLl),
non toy thooc vuo up oc do dooc tron bop bong, toy thooc vuo tong bonh
nhun vu bonh y.
1. Cac troong bop kbong ton tboong pboi
" Modo lrossoro Contro.
" 1un so 30 - 40 un / phot, 1 0.4 0.5s, l/L .
" ll = l0 - l5 cmH2O do dut V1 to 6-8 mL/kg
" lLLl = 4 cmH2O.
2. cnb mang trong:
Do dun pho so cu thon rut nhunh suo dong Soructunt, cun oo y trunh
ngoy co do kh.
" 1ho muy thong thoong:
- Modo lC.
- 1un so cuo: 60 un/ph, co tho tung on l00un/ph, 1 0.3 0,4s, l/L
l/l.
- ll = l4 - 20 cmH
2
O do dut V1 to 4 - 6 mL/kg
- lLLl cuo = 5 6 cmH
2
O, co tho tung don 8 cmH
2
O.
- Chup nhun PCO
2
cuo hon tr so snh y do gum chun thoong up oc.
" 1ho muy tun so cuo:
- Modo HlO.
- lroqooncy = l5Hz tkk: 900 un/p). 1ro do thung: l = l0Hz, non thung:
l5Hz, l/L l/l.
- Stroko voomo tumptodo): 1ho tch oo dong kh tkhong phu u tho tch
kh oo thong). Kho duo 24 34 cm H2O .
- MAl = lLLl. Dut tr so bung MAl tkh tho muy thong thoong) +
2cmH
2
O.
- Sgh lrossoro t louk lrossoro) = lll = MAl + 6 cmH
2
O .
Loo y : Anh hoong Amptodo tron lCO2
AmpIitodc FCO2
1ung 3 cmH2O Cum 2 4mmHg
6 5 9
9 l0 - l4
Kom tru Xqoung pho: lho no don moc xoong soon 9 l0 suo.
3. Hoi cbong bt pban so:
1uc doong tho cup, xop pho tong vong kom o kh do phun xo tuo vun l
choo, suo l2 24 go u gu doun vom guy ton thoong pho nung.
" 1ho muy thong thoong:
- Modo lC
- 1un so: Noo chou vom pho tun so 25 un / phot, 1= 0.6s, l/L = l/3.
- Kom vom pho: # tun so 40 - 60 un / phot, 1 0.5s, 1o do: 0,5 0,7
guy. l/L . Co tho # l/L=l/l. Noo co buy kh, co tho tung 1o on 0,7 l
guy, gum lLLl xoong 4 cmH
2
O
- ll = 20 25 cmH
2
O co tho tung don 35 cmH
2
O do dut V
1
to 6-8 mL/kg
- lLLl trong bnh = 5 cmH
2
O gop gum tuc nghon, gum tnh trung buy
kh.
4. Tboat v| boanb:
Co tho kom thoo sun pho bon thout v vu cuo up pho guy shont tl) t1)
qou ong dong much , o buo doc.
" 1ho muy thong thoong:
- Modo lC.
- 1un so 40 un / phot, 1 0.5s, l/L .
- ll = l5 20 cmH2O do dut V1 to 6-8 mL/kg
- lLLl = 4 - 5 cmH2O
- lO2 = l00% noo bonh nh tm, suo do gum dun
- Loo y non go ll o moc thup nhut do trunh tu bon trun kh mung pho
bon khong thout v. Kh thut bu vo tho muy thong thoong: SuO
2
< 80%,
luCO2 > 60mmHg: 1ho muy tun so cuo
" 1ho muy tun so cuo:
- Modo HlllV.
- 1un so l00 un / phot, 1 0.3s, l/L l/l
- lll = 20 cmH
2
O.
- lLLl = 0 cmH
2
O
S. Hao pbao Ho tbanb bong bam sinb Tboat v| coong ron:
Cu doun huo phuo up oc o bong gu tung guy chon op co hounh.
- Modo lC.
- 1un so 40 un / phot, 1 0.5s, l/L .
- ll = l8 - 20 cmH2O do dut V1 to 6-8 mL/kg
- lLLl = 4 - 5 cmH2O
6. cnb pboi man: ton thoong pho nung, doong dun kh, xo pho, xop pho.
- Cu dut thong so to thoo go SuO
2
= 90% - 92%, chup nhun luCO
2
cuo
55 65mmHg, pH > 7,25.
- Modo lC.
- 1un so thup 20 40 un / phot, 1 du 0.5 0,7s, l/L l/3 l/2.
- ll th"p = 20 - 30 cmH2O do dut V1 to 5 -8 mL/kg
- lLLl = 5 - 8 cmH2O.
7. Tom Iooc cac tbong so cai dat ban dao va dico cbnb tbong so:
lF
(cmH
2
O)
FFFF
(cmH
2
O)
kk
(l/p)
Ti
(s)
l/F
cnb mang trong:
C $ R %

14 - 20

5 6

60

0.4

1/1
Do o chnh 8 80 -100 1/1
Ho i cbong bt pban so:
C $ R #

20 - 25

5

40

0.5

1/2
Do o chnh 35 8 1/3
Tboat v| boanb:
cao ap pho i, FRC $

15 20

5

40

0.5

1/2
Do o chnh 0 100 0.3 1/1
cnb pboi man:
C $ R # x pho i

20

5

20

0.5 - 0.7

1/3 1/2
Do o chnh 30 8 40

lV. CAl MAY
4.1. ico kicn cai may:
- onh ngoyon on dnh.
- Kom sout nhom trong: vom pho bo nhom, nhom trong hoyot.
- On dnh hoyot dong hoc.
- Hct 36 45%, khong ro oun nooc don gu kom toun. Cong cup do
nung oong.
- 1hong so muy tho: lO
2
< 50%, lll < 20 cmH
2
O.
- Kh muo: pH > 7.3, luCO
2
< 50 mmHg, luO
2
> 60 mmHg.
Trnb to cai may:
" Cum dun cuc thong so muy tho:
- Cum lO
2
mo 5% don 40%.
- Cum ll mo 2 cmH
2
O don l0 l5 cmH
2
O
- Cum tun so tho mo 5 un/phot don 20 un/phot.
" Choyon cho do tho: co hu ou chon
- 1ho ClAl qou NK
l = 4 6 cmH
2
O
lO
2
! oc tho muy 5 l0%, suo do gum < 30%.
- 1ho lMV tcho tro < 2 kg):
Cum tun so don 20 un/phot,
ll < 6 cmH
2
O,
lO
2
< 30%
4.2. Tico cboan rot noi kb qoan
- Lum sung : nhp tho doo, khong gung soc.
- SuO
2
> 90% houc luCO
2
< 50 mmHg, luO
2
> 50 mmHg
- Noo tho muy > 7 nguy: Doxumothusono l mg/kg/nguy chu mo 6 go 1M
trooc rot no kh qoun l 2 nguy.
- Nhn un trooc l 2 go.
4.3. Sao rot noi kb qoan:
- 1ho NClAl, up oc 4 - 5 cmH2O, lO2 but duo bung houc cuo hon oc
tho muy 5 l0%, suo do gum don 2l%
- Nguy suo rot NK noo co duo kho tho thunh qoun: Kh dong Adronuno
0.l% 2 m phu l m NuC 0.9%, co tho up u suo 2 4 go.