Hiệu quả gây tê tủy sống bằng hỗn hợp bupivacain với sufentanil và morphin trong phẫu thuật thay chỏm xương đùi

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Tác giả: Văn Đăng Trần, Văn Kim Long Vũ

Ngôn ngữ: Vie

Ký hiệu phân loại:

Thông tin xuất bản: Y Dược học Cần Thơ 2021

Mô tả vật lý: 22-28

Bộ sưu tập: Metadata

ID: 406745

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Gây tê tủy sống với bupivacain và morphin trong phẫu thuật thay chỏm xương đùi có thời gian khởi phát chậm, thời gian giảm đau sau mổ kéo dài, liên quan đến nhiều tác dụng phụ, bao gồm buồn nôn và nôn, ngứa, suy hô hấp sau mổ. Việc phối hợp với opioid tan trong mỡ như fentanyl hay sufentanil làm rút ngắn thời gian khởi phát, ảnh hưởng tối thiểu lên huyết động, kéo dài thời gian giảm đau sau mổ, giảm tỷ lệ tác dụng phụ so với morphin đơn thuần, giúp bệnh nhân sớm phục hồi vận động, tránh những tai biến, biến chứng trong và sau mổ. Đối tượng và phương pháp nghiên cứu: chúng tôi nghiên cứu tiến cứu can thiệp không nhóm chứng trên 53 bệnh nhân có ASA I - III được phẫu thuật chương trình thay chỏm xương đùi với gây tê tủy sống bằng hỗn hợp 9 mg bupivacain heavy 0,5% với 5 mcg sufentanil và 100 mcg morphin. Ghi nhận thời gian tiềm phục và thời gian duy trì phong bế cảm giác ở ngực 10, thời gian phục hồi vận động, thời gian giảm đau sau mổ và các tác dụng không mong muốn như mạch chậm, tụt huyết áp, lạnh run, buồn nôn, nôn, ngứa. Kết quả: Hiệu quả giảm đau tốt chiếm 94,3%, thời gian tiềm phục là 5,7 ± 2,3 phút, thời gian duy trì phong bế cảm giác ở ngực 10 là 137,3 ± 17,4 phút, phục hồi vận động hoàn toàn sau 154,2 ± 13 phút, thời gian giảm đau kéo dài 20,9 ± 1,5 giờ. Các tác dụng phụ gồm: 11,3% tụt huyết áp, 1,9% lạnh run, 7,5% buồn nôn, nôn, 9,4% ngứa sau phẫu thuật. Kết luận: gây tê tủy sống bằng hỗn hợp bupivacain với sufentanil và morphin đạt hiệu quả vô cảm tốt, không ảnh hưởng hô hấp, phục hồi vận động sớm, thời gian giảm đau kéo dài, ít tác dụng phụ., Tóm tắt tiếng anh, Spinal anesthesia with bupivacaine and morphine on replacement of the femoral head provides slow onset, excellent postoperative analgesia but may result in many side effects, including postoperative nausea and vomiting, pruritus, respiratory depression after surgery. The coordination more lipophilic opioids such as fentanyl or sufentanil shorten onset time, minimize effect on hemodynamics, prolong postoperative analgesia, and reduce the incidence of side effects compared to morphine alone, early help patients recover movement, with fewer intraoperative accidents and fewer postoperative complications. Materials and method: We studied 53 ASA physical status I-III were scheduled for replacement of the femoral head with spinal anesthesia with 9 mg bupivacaine heavy 0.5% combined 5 mcg sufentanil and 100 mcg morphine. Recognizing the onset time and duration time blocking sensation in the chest 10, motor recovery time, postoperative pain time and the side effects such as bradycardia, hypotension, nausea, vomiting, pruritus. Results: Good pain relief 94.3%
onset time was 5.7 ± 2.3 minutes
duration time was 20.9 ± 1,5 hours. Side effects include: 11.3% hypotension, 7.5% nausea, vomiting
9.4% prutitus after surgery. Conclusions: Intrathecal bupivacaine with sufentanil and morphine has a good result, no effect on respiration, stable hemodynamic with less accident and complications in during ang postoperation.

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