Thuoc gay te me Con dao hai luoi

Tags: tac dung gay te, thuoc gay me, dao hai luoi, co tac dung, tac dung phu, co the, tai bien, con dao, su dung, cam giac, tuc la, dung, tiem, lieu, toan


Co the noi su dung thuoc gay te, me la mot tien bo vuot bac cua nganh y nham gop phan thuc hien muc tieu nang cao chat luong cuoc song cua con nguoi. Tuy nhien su dung thuoc loai nay giong nhu viec su dung con dao hai luoi ma luoi nao cung that sac.
Thuoc dua den tac dung gay te, me rat tot nhung dong thoi cung co the gay tai bien chet nguoi. Khong hiem xay ra truong hop nguoi benh chi moi duoc tiem mot lieu thuoc gay te nho lai bi tu vong vi soc thuoc.
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Gay te cuc bo. 

Thuoc gay te

Thuoc gay te la thuoc co tac dung uc che day than kinh cam giac de lam tam thoi mat cam giac tai noi thuoc tiep xuc. Tuc la thuoc chi gay te, lam mat cam giac dau don tai noi co thuoc chu khong anh huong den y thuc, hoat dong cua co the. Khi nho rang va duoc tiem thuoc te chang han, ta thay vung nuou duoc tiem te cung va khong con cam giac nua nhung y thuc van hoan toan tinh tao, tay chan van hoat dong binh thuong. Thuoc gay te duoc chia lam hai loai: gay te be mat (tetracain, ethyl clorid) dung de boi, dat tren da, niem mac, nho mat; gay te tiem (lidocain, bupivacain). Khi tiem se xuyen tham qua da - niem mac (trong nho rang), gay te ngoai mang cung va gay te tuy song (hien nay mo lay thai chi can gay te tuy song). Mot so thuoc gay te thuong su dung la lidocain, bupivacain, procain... trong do lidocain duoc dung rong rai nhat. Do thoi gian tac dung gay te qua ngan, thuoc thuong duoc them chat co mach adrenalin de keo dai tac dung cuc bo cua thuoc. Bac si dieu tri can than trong khi dung adrenalin phoi hop voi thuoc gay te vi dung qua muc co the gay thieu mau cuc bo. Tac dung phu cua thuoc gay te thuong la ha huyet ap, nhip tim cham. Tac dung tren than kinh nhu gay vat va, suy ho hap va co giat. Dac biet thuoc co the gay di ung, tram trong nhat la gay soc phan ve. Bac si phai danh gia duoc lieu dung an toan cua thuoc gay te thong qua xac dinh tuoi, can nang cua benh nhan, dac diem lam sang, muc do vung mach mau o noi thuoc tiep xuc va thoi gian dung thuoc. Neu dung duong tiem, phai can than theo doi tac dung doc cua thuoc trong 30 phut dau sau khi tiem va can co thuoc cap cuu de xu ly khi bi tai bien.

Thuoc gay me

La thuoc co tac dung uc che he than kinh trung uong de lam mat hoan toan y thuc, phan xa va moi cam giac cua toan than. Tuc la khi duoc gay me nguoi benh se bat dong, ngu say nhu chet, hoan toan khong hay biet khi cuoc phau thuat co khi rat nghiem trong dang dien ra. Thuoc gay me duoc chia lam hai loai:

Thuoc gay me dang hit: la cac thuoc gay me bay hoi o the khi duoc dung qua duong ho hap de duy tri me sau khi khoi me bang thuoc gay me tinh mach. Co cac thuoc: ether me, halothan, dinitrogen oxid (N2O)... De tranh giam oxy huyet phai dung thuoc gay me dang hit phoi hop voi mot nong do oxy thich hop.

Thuoc gay me tinh mach: la cac thuoc dung duong tiem tinh mach chu yeu de khoi me nhanh va sau do duoc duy tri bang thuoc me dang hit thich hop hoac duoc tiem truyen gian doan hay lien tuc. Nguoi ta cung dung thuoc gay me loai don thuan de gay ngu nhe trong cac phau thuat ngan, dac biet duoc tien hanh voi su ho tro cua thuoc gay te. Co cac thuoc: thiopental, ketamin, etomidat...

Hien nay van chua co duoc mot thuoc gay me ly tuong co dac diem: khoi phat tac dung nhanh, em diu; khoang cach an toan (tuc giua lieu dieu tri va lieu doc) rong; khong co tac dung phu o lieu dieu tri. Tuc la cac thuoc gay me duoc dung hien nay deu doc va co the gay tac dung phu. Hau het co the gay suy ho hap, giam huyet ap, suy chuc nang tuan hoan nao. Mot so thuoc co the gay suy gan, suy than. Hien nay nguoi ta khong gay me bang mot thuoc duy nhat ma duoc thay bang “gay me can doi”, tuc la dung phoi hop nhieu thuoc co tac dung khac nhau de tao ra trang thai me can doi. Nhu ben canh thuoc gay me, nguoi ta dung thuoc tien me la thuoc an than, thuoc chong co that, thuoc gian co, thuoc giam dau... Su dung thuoc gay me luon luon co nguy co bi tai bien cho nen phai san co va day du cac phuong tien hoi suc cap cuu doi pho voi truong hop bi tai bien do thuoc va ca cac tai bien khac xay ra trong cuoc phau thuat (nen luu y soc co the do thuoc gay te, me nhung cung co the do phan xa than kinh khi tien hanh mo xe o cac vung nhay cam nhu hau, hong, co, hau mon... va phai co thuoc, phuong tien cap cuu thich hop). Dac biet su dung thuoc gay me chi an toan khi duoc tien hanh boi bac si duoc dao tao mot cach bai ban chuyen khoa gay me hoi suc.

PGS.TS Nguyen Huu Duc

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