Vai trò của hồi sức sau mổ nhân một trường hợp mổ tắc ruột trên bệnh nhân covid nặng, suy tim, già yếu, suy kiệt

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Tác giả: Nguyễn An Lê, Quang Chính Nguyễn, Sơn Hà Nguyễn, Toàn Thắng Nguyễn, Văn Thường Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại: 613.65 Personal health and safety

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2022

Mô tả vật lý: 314-321

Bộ sưu tập: Metadata

ID: 498973

Thêm vào giỏ

Describe the clinical, subclinical characteristics and results of post-operative resuscitation treatment of an elderly, frail, exhausted, heart failure patient with severe lung lesions related to Covid-19 infection undergoing late bowel obstruction surgery. Method: Report on a clinical case of Covid-19 after bowel obstruction surgery and resuscitation treatment at the Anesthesia and Resuscitation Department of Duc Giang General Hospital from March 15, 2022. Results: A 98-year-old female patient, exhausted (P~29kg), has not been vaccinated, has symptoms of fever, cough, abdominal pain for 5 days
nausea, vomiting, and can't pass gas, constipation. PCR Covid CT-17, chest X-ray with scattered opacities lesions, abdominal computed tomography scan diagnosis: intestinal obstruction due to obturator hernia. Emergency surgical consultation to remove intestinal adhesions, and suture the obturator hole. After surgery, the treatment was given to: (1) resuscitate good surgical problems, exhanced recovery efter surgery (ERAS), and (2) actively treat severe lung damage caused by Covid. The patient's results were stable after the surgery, eating, drinking, and defecation remained normal, the Covid-19 rapid test was negative, the chest X-ray was stable before discharge, and the patient was discharged after 15 days of treatment. Conclusion: Treatment strategies set out before, during, and after surgery on elderly, weak, and severely damaged lungs due to Covid-19 are extremely important. The patient not only had a bowel obstruction for many days but also had severe Covid-19 lung damage, along with senility, exhaustion and heart failure. After ensuring the safety of surgery and solving the surgical problem thoroughly, the doctors need to predict the patient's postoperative course and provide reasonable treatment. Resuscitation and post-operative care have a key role, requiring the participation and consultation of many specialties in the hospital, especially for patients who are old, weak, exhausted, and with serious underlying medical conditions accompanied by severe lung damage due to Covid -19 as the clinical case that we describe.Mô tả đặc điểm lâm sàng, cận lâm sàng và kết quả điều trị hồi sức sau mổ của một bệnh nhân già yếu, suy kiệt, suy tim có tổn thương Covid nặng phẫu thuật tắc ruột muộn. Phương pháp: Báo cáo ca lâm sàng Covid-19 sau mổ tắc ruột điều trị hồi sức tại khoa Gây mê hồi sức bệnh viện đa khoa Đức Giang từ ngày 15/3/2022. Kết quả: Bệnh nhân nữ 98 tuổi, thể trạng suy kiệt (P~ 29kg), chưa tiêm vaccine, có triệu chứng sốt, ho, đau bụng 5 ngày, buồn nôn, nôn nhiều, bí trung đại tiện. PCR Covid CT-17, Xquang phổi có tổn thương kính mờ rải rác, chụp cắt lớp vi tính ổ bụng chẩn đoán: Tắc ruột do thoát vị lỗ bịt. Hội chẩn mổ cấp cứu gỡ dính ruột, khâu lỗ bịt. Sau mổ, điều trị đảm bảo hai mục tiêu: một là hồi sức vấn đề ngoại khoa tốt, tăng cường phục hồi sớm sau mổ, hai là điều trị tích cực tình trạng tổn thương phổi nặng do Covid. Kết quả bệnh nhân ổn định về mặt ngoại khoa, ăn uống, trung đại tiện bình thường, test nhanh Covid âm tính, Xquang phổi trước ra viện ổn định, bệnh nhân ra viện sau 15 ngày điều trị. Kết luận: Chiến lược đặt ra trước mổ, trong mổ, sau mổ trên những bệnh nhân già, yếu, phổi tổn thương do Covid-19 nặng là vô cùng quan trọng. Bệnh nhân không chỉ tắc ruột nhiều ngày mà còn phổi tổn thương Covid nặng kèm theo suy kiệt, suy tim. Sau khi đảm bảo an toàn trong mổ, giải quyết được vấn đề ngoại khoa triệt để thì tiên lượng diễn biến sau mổ của bệnh nhân, đưa ra hướng điều trị hợp lý, hồi sức, chăm sóc sau mổ có vai trò mấu chốt, cần sự vào cuộc, hội chẩn của nhiều chuyên khoa trong bệnh viện, đặc biệt trên những bệnh nhân già yếu, suy kiệt, bệnh lý nền nặng kèm theo tổn thương phổi nặng nề do Covid-19 như trường hợp lâm sàng chúng tôi mô tả.

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