{"id":34362,"date":"2023-06-20T17:30:29","date_gmt":"2023-06-20T10:30:29","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=34362"},"modified":"2023-06-20T17:55:43","modified_gmt":"2023-06-20T10:55:43","slug":"ky-thuat-gay-te-can-chop-gay-te-tren-mang-xuong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/06\/20\/ky-thuat-gay-te-can-chop-gay-te-tren-mang-xuong\/","title":{"rendered":"K\u1ef9 thu\u1eadt g\u00e2y t\u00ea c\u1eadn ch\u00f3p (g\u00e2y t\u00ea tr\u00ean m\u00e0ng x\u01b0\u01a1ng)"},"content":{"rendered":"<h5>\u0110i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 nha khoa nh\u01b0 l\u1ea5y nh\u1ed5 r\u0103ng, s\u1eeda ch\u1eefa r\u0103ng v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 n\u01b0\u1edbu th\u01b0\u1eddng l\u00e0m cho b\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y \u0111au \u0111\u1edbn v\u00e0 kh\u00f3 ch\u1ecbu. \u0110\u1ec3 gi\u1ea3i quy\u1ebft v\u1ea5n \u0111\u1ec1 n\u00e0y, c\u00e1c nha s\u0129 th\u01b0\u1eddng s\u1eed d\u1ee5ng c\u00e1c k\u1ef9 thu\u1eadt g\u00e2y t\u00ea \u0111\u1ec3 gi\u1ea3m \u0111au v\u00e0 c\u1ea3m gi\u00e1c kh\u00f3 ch\u1ecbu cho b\u1ec7nh nh\u00e2n. Trong \u0111\u00f3, para-apical supraperiosteal anesthesia (P-ASA)- g\u00e2y t\u00ea tr\u00ean m\u00e0ng x\u01b0\u01a1ng c\u1eadn ch\u00f3p r\u0103ng l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt g\u00e2y t\u00ea \u0111\u01a1n gi\u1ea3n v\u00e0 hi\u1ec7u qu\u1ea3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn trong nha khoa. B\u00e0i vi\u1ebft n\u00e0y s\u1ebd gi\u1edbi thi\u1ec7u v\u1ec1 k\u1ef9 thu\u1eadt P-ASA, c\u00e1c b\u01b0\u1edbc th\u1ef1c hi\u1ec7n v\u00e0 l\u1ee3i \u00edch c\u1ee7a n\u00f3 trong \u0111i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 nha khoa, c\u00f9ng v\u1edbi c\u00e1c khuy\u1ebfn c\u00e1o v\u1ec1 c\u00e1ch ch\u0103m s\u00f3c r\u0103ng mi\u1ec7ng sau qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/h5>\n<h4>1. T\u1ed5ng quan:<\/h4>\n<p>Para-apical supraperiosteal anesthesia (P-ASA) &#8211; g\u00e2y t\u00ea c\u1eadn ch\u00f3p hay g\u00e2y t\u00ea tr\u00ean m\u00e0ng x\u01b0\u01a1ng l\u00e0 m\u1ed9t <a href=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/lua-chon-kieu-gay-te-tai-cho-kiem-soat-dau-truoc-dieu-tri-noi-nha\/\">k\u1ef9 thu\u1eadt g\u00e2y t\u00ea t\u1ea1i ch\u1ed7<\/a> trong nha khoa, \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m \u0111au v\u00e0 c\u1ea3m gi\u00e1c kh\u00f3 ch\u1ecbu cho b\u1ec7nh nh\u00e2n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 nha khoa nh\u01b0 nh\u1ed5 r\u0103ng, s\u1eeda ch\u1eefa r\u0103ng v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 n\u01b0\u1edbu. K\u1ef9 thu\u1eadt P-ASA \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch ti\u00eam m\u1ed9t lo\u1ea1i thu\u1ed1c g\u00e2y t\u00ea v\u00e0o v\u00f9ng n\u01b0\u1edbu xung quanh r\u0103ng b\u1ecb \u1ea3nh h\u01b0\u1edfng, gi\u00fap gi\u1ea3m \u0111au v\u00e0 c\u1ea3m gi\u00e1c kh\u00f3 ch\u1ecbu trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>Thu\u1ed1c g\u00e2y t\u00ea \u0111\u01b0\u1ee3c ti\u00eam ti\u1ebfp x\u00fac v\u1edbi m\u00e0ng x\u01b0\u01a1ng khu\u1ebfch t\u00e1n t\u1edbi m\u00f4 x\u01b0\u01a1ng b\u00ean d\u01b0\u1edbi qua \u00f4ng Haver \u0111\u1ebfn n\u01a1i \u0111\u00e1m r\u1ed1i d\u00e2y th\u1ea7n kinh v\u00e0 m\u1ea1ch m\u00e1u ch\u1ee7 y\u1ebfu c\u1ee7a r\u0103ng \u0111\u01b0\u1ee3c t\u1eadp trung. Khi thu\u1ed1c g\u00e2y t\u00ea \u0111\u01b0\u1ee3c ti\u00eam v\u00e0o v\u00f9ng n\u00e0y, c\u00e1c s\u1ee3i d\u00e2y th\u1ea7n kinh v\u00e0 m\u1ea1ch m\u00e1u s\u1ebd b\u1ecb t\u00ea ho\u00e0n to\u00e0n, gi\u00fap gi\u1ea3m \u0111au v\u00e0 c\u1ea3m gi\u00e1c kh\u00f3 ch\u1ecbu cho b\u1ec7nh nh\u00e2n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n<figure style=\"width: 365px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/www.intechopen.com\/media\/chapter\/47578\/media\/image6.jpeg\" alt=\"G\u00e2y t\u00ea c\u1eadn ch\u00f3p\" width=\"365\" height=\"274\" \/><figcaption class=\"wp-caption-text\">G\u00e2y t\u00ea c\u1eadn ch\u00f3p<\/figcaption><\/figure>\n<h4>2. C\u00e1c b\u01b0\u1edbc k\u0129 thu\u1eadt g\u00e2y t\u00ea apical supraperiosteal anesthesia (P-ASA):<\/h4>\n<ul>\n<li>Ti\u1ec1n x\u1eed l\u00fd: \u0110\u1ea7u ti\u00ean, nha s\u0129 s\u1ebd s\u00e1t khu\u1ea9n v\u00e0 l\u00e0m kh\u00f4 v\u00f9ng ti\u00eam \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 nhi\u1ec5m tr\u00f9ng.<\/li>\n<li>Ti\u00eam thu\u1ed1c g\u00e2y t\u00ea: Sau khi v\u00f9ng ti\u00eam \u0111\u00e3 \u0111\u01b0\u1ee3c s\u00e1t khu\u1ea9n v\u00e0 l\u00e0m kh\u00f4, nha s\u0129 s\u1ebd ti\u00eam thu\u1ed1c \u0111\u1eb7t \u0111i\u1ec3m chu\u1ea9n l\u00e0 ng\u00e1ch ti\u1ec1n \u0111\u00ecnh &#8211; n\u01a1i ti\u1ebfp gi\u00e1p gi\u1eefa ni\u00eam m\u1ea1c di \u0111\u1ed9ng v\u00e0 c\u1ed1 \u0111\u1ecbnh. Tr\u1ee5c kim ti\u00eam song song tr\u1ee5c r\u0103ng, h\u01b0\u1edbng 45 \u0111\u1ed9 so v\u1edbi b\u1ec1 m\u1eb7t l\u1ee3i, v\u00e1t kim quay v\u1ec1 ph\u00eda l\u1ee3i. Kh\u00f4ng n\u00ean \u0111\u00e2m qua m\u00e0ng x\u01b0\u01a1ng g\u00e2y r\u00e1ch, \u0111au v\u00e0 t\u1ee5 m\u00e1u.<\/li>\n<li>B\u01a1m thu\u1ed1c t\u00ea: Gi\u1eef ch\u1eafc tay, b\u01a1m ch\u1eadm 1-1,5 ml. H\u1ea1n ch\u1ebf t\u0103ng s\u1ed1 l\u1ea7n ti\u00eam, t\u0103ng li\u1ec1u thu\u1ed1c t\u00ea v\u00ec s\u1ebd t\u0103ng nguy c\u01a1 g\u00e2y ng\u1ed9 \u0111\u1ed9c thu\u1ed1c t\u00ea.<\/li>\n<li>Ch\u1edd \u0111\u1ee3i: Sau khi ti\u00eam thu\u1ed1c g\u00e2y t\u00ea, nha s\u0129 s\u1ebd ch\u1edd \u0111\u1ee3i kho\u1ea3ng 5-10 ph\u00fat \u0111\u1ec3 \u0111\u1ee3i thu\u1ed1c g\u00e2y t\u00ea ph\u00e1t huy t\u00e1c d\u1ee5ng, thu\u1ed1c t\u00ea c\u00f3 th\u1ec3 k\u00e9o d\u00e0i 45-60 ph\u00fat. Trong th\u1eddi gian ch\u1edd \u0111\u1ee3i, b\u1ec7nh nh\u00e2n s\u1ebd c\u1ea3m th\u1ea5y v\u00f9ng n\u01b0\u1edbu v\u00e0 r\u0103ng b\u1ecb t\u00ea ho\u00e0n to\u00e0n.<\/li>\n<li>Th\u1ef1c hi\u1ec7n \u0111i\u1ec1u tr\u1ecb: Sau khi thu\u1ed1c g\u00e2y t\u00ea \u0111\u00e3 ph\u00e1t huy t\u00e1c d\u1ee5ng, nha s\u0129 s\u1ebd th\u1ef1c hi\u1ec7n c\u00e1c th\u1ee7 t\u1ee5c \u0111i\u1ec1u tr\u1ecb nh\u01b0 nh\u1ed5 r\u0103ng, ch\u1eefa t\u1ee7y r\u0103ng ho\u1eb7c \u0111i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 nha khoa kh\u00e1c.<\/li>\n<li>Theo d\u00f5i v\u00e0 ch\u0103m s\u00f3c sau \u0111i\u1ec1u tr\u1ecb: Sau khi \u0111i\u1ec1u tr\u1ecb xong, nha s\u0129 s\u1ebd theo d\u00f5i v\u00e0 ch\u0103m s\u00f3c v\u00f9ng ti\u00eam \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 x\u1ea3y ra v\u00e0 h\u01b0\u1edbng d\u1eabn b\u1ec7nh nh\u00e2n v\u1ec1 c\u00e1ch ch\u0103m s\u00f3c r\u0103ng mi\u1ec7ng sau qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/li>\n<\/ul>\n<h4>3. Ch\u1ec9 \u0111\u1ecbnh v\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh k\u1ef9 thu\u1eadt apical supraperiosteal anesthesia (P-ASA):<\/h4>\n<h5>3.1. Ch\u1ec9 \u0111\u1ecbnh:<\/h5>\n<ul>\n<li>G\u00e2y t\u00ea \u0111i\u1ec1u tr\u1ecb nh\u1ed5 r\u0103ng, \u0111i\u1ec1u tr\u1ecb t\u1ee7y, \u0111i\u1ec1u tr\u1ecb nha chu<\/li>\n<\/ul>\n<h5>3.2. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/h5>\n<ul>\n<li>Nhi\u1ec5m tr\u00f9ng, vi\u00eam c\u1ea5p t\u00ednh<\/li>\n<li>L\u1edbp x\u01b0\u01a1ng ph\u1ee7 ch\u00f3p r\u0103ng d\u00e0y s\u1ebd d\u1ec5 th\u1ea5t b\u1ea1i<\/li>\n<li>Qu\u00e1 m\u1eabn v\u1edbi thu\u1ed1c g\u00e2y t\u00ea<\/li>\n<li>Ph\u1ee5 n\u1eef c\u00f3 thai \u0111\u1eb7c bi\u1ec7t trong 3 th\u00e1ng \u0111\u1ea7u thai k\u00ec<\/li>\n<\/ul>\n<h4>4. L\u1ee3i \u00edch c\u1ee7a k\u1ef9 thu\u1eadt para-apical supraperiosteal anesthesia:<\/h4>\n<ul>\n<li>T\u1ec9 l\u1ec7 th\u00e0nh c\u00f4ng cao, \u00edt ch\u1ea5n th\u01b0\u01a1ng, \u00edt ng\u1ed9 \u0111\u1ed9c thu\u1ed1c t\u00ea.<\/li>\n<li>Gi\u1ea3m c\u1ea3m gi\u00e1c \u0111au v\u00e0 kh\u00f3 ch\u1ecbu cho b\u1ec7nh nh\u00e2n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb nha khoa: P-ASA gi\u00fap gi\u1ea3m \u0111au v\u00e0 c\u1ea3m gi\u00e1c kh\u00f3 ch\u1ecbu cho b\u1ec7nh nh\u00e2n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/li>\n<li>\u0110\u01a1n gi\u1ea3n v\u00e0 nhanh, kh\u00f4ng c\u1ea7n s\u1eed d\u1ee5ng m\u00e1y m\u00f3c hay thi\u1ebft b\u1ecb \u0111\u1eb7c bi\u1ec7t: P-ASA l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt \u0111\u01a1n gi\u1ea3n v\u00e0 nhanh, kh\u00f4ng c\u1ea7n s\u1eed d\u1ee5ng m\u00e1y m\u00f3c hay thi\u1ebft b\u1ecb \u0111\u1eb7c bi\u1ec7t. Nha s\u0129 s\u1ebd s\u1eed d\u1ee5ng kim ti\u00eam nh\u1ecf \u0111\u1ec3 ti\u00eam thu\u1ed1c g\u00e2y t\u00ea, v\u00e0 th\u01b0\u1eddng s\u1ebd ti\u00eam m\u1ed9t l\u01b0\u1ee3ng nh\u1ecf thu\u1ed1c g\u00e2y t\u00ea t\u1eebng ch\u00fat m\u1ed9t \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o t\u00ednh ch\u00ednh x\u00e1c c\u1ee7a k\u1ef9 thu\u1eadt.<\/li>\n<li>\u00cdt g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 so v\u1edbi c\u00e1c k\u1ef9 thu\u1eadt g\u00e2y t\u00ea kh\u00e1c: P-ASA \u00edt g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 so v\u1edbi c\u00e1c k\u1ef9 thu\u1eadt g\u00e2y t\u00ea kh\u00e1c nh\u01b0 g\u00e2y t\u00ea v\u00f9ng . Th\u1eadm ch\u00ed, sau khi k\u1ebft th\u00fac \u0111i\u1ec1u tr\u1ecb, t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c g\u00e2y t\u00ea s\u1ebd l\u1eafng xu\u1ed1ng nhanh ch\u00f3ng v\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 tr\u1edf l\u1ea1i ho\u1ea1t \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng ngay sau \u0111\u00f3.<\/li>\n<\/ul>\n<h4>5. K\u1ebft lu\u1eadn:<\/h4>\n<p>Para-apical supraperiosteal anesthesia (P-ASA) l\u00e0 m\u1ed9t k\u1ef9 thu\u1eadt g\u00e2y t\u00ea \u0111\u01a1n gi\u1ea3n v\u00e0 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb nha khoa. K\u1ef9 thu\u1eadt n\u00e0y \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m \u0111au v\u00e0 c\u1ea3m gi\u00e1c kh\u00f3 ch\u1ecbu cho b\u1ec7nh nh\u00e2n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 nha khoa nh\u01b0 l\u1ea5y nh\u1ed5 r\u0103ng, s\u1eeda ch\u1eefa r\u0103ng v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 n\u01b0\u1edbu.<\/p>\n<p>P-ASA \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1eb1ng c\u00e1ch ti\u00eam thu\u1ed1c g\u00e2y t\u00ea v\u00e0o v\u00f9ng para-apical supraperiosteal, n\u01a1i m\u00e0 c\u00e1c s\u1ee3i d\u00e2y th\u1ea7n kinh v\u00e0 m\u1ea1ch m\u00e1u ch\u1ee7 y\u1ebfu c\u1ee7a r\u0103ng \u0111\u01b0\u1ee3c t\u1eadp trung. K\u1ef9 thu\u1eadt n\u00e0y \u0111\u01a1n gi\u1ea3n v\u00e0 nhanh, kh\u00f4ng c\u1ea7n s\u1eed d\u1ee5ng m\u00e1y m\u00f3c hay thi\u1ebft b\u1ecb \u0111\u1eb7c bi\u1ec7t, v\u00e0 \u00edt g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 so v\u1edbi c\u00e1c k\u1ef9 thu\u1eadt g\u00e2y t\u00ea kh\u00e1c.<\/p>\n<p>Tuy nhi\u00ean, P-ASA c\u0169ng c\u00f3 m\u1ed9t s\u1ed1 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 b\u1ec7nh nh\u00e2n c\u1ea7n tu\u00e2n th\u1ee7 c\u00e1c khuy\u1ebfn c\u00e1o v\u00e0 ch\u1ec9 d\u1eabn c\u1ee7a nha s\u0129 \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. Nh\u00e0 s\u0129 c\u1ea7n ph\u1ea3i \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 x\u00e1c \u0111\u1ecbnh li\u1ec7u k\u1ef9 thu\u1eadt n\u00e0y c\u00f3 ph\u00f9 h\u1ee3p v\u1edbi tr\u01b0\u1eddng h\u1ee3p c\u1ee7a b\u1ec7nh nh\u00e2n hay kh\u00f4ng. B\u1ec7nh nh\u00e2n c\u0169ng c\u1ea7n th\u00f4ng b\u00e1o cho nha s\u0129 v\u1ec1 b\u1ea5t k\u1ef3 v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe ho\u1eb7c thu\u1ed1c \u0111ang s\u1eed d\u1ee5ng \u0111\u1ec3 nha s\u0129 c\u00f3 th\u1ec3 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111\u00fang \u0111\u1eafn trong vi\u1ec7c s\u1eed d\u1ee5ng P-ASA.<\/p>\n<p><em>Ngu\u1ed3n tham kh\u1ea3o: S\u00e1ch Ph\u1eabu thu\u1eadt trong mi\u1ec7ng &#8211; Gi\u00e1o tr\u00ecnh tr\u01b0\u1eddng \u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i &#8211; Nguy\u1ec5n M\u1ea1nh H\u00e0<\/em><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0110i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 nha khoa nh\u01b0 l\u1ea5y nh\u1ed5 r\u0103ng, s\u1eeda ch\u1eefa r\u0103ng v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 n\u01b0\u1edbu th\u01b0\u1eddng l\u00e0m cho b\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y \u0111au \u0111\u1edbn v\u00e0 kh\u00f3 ch\u1ecbu. \u0110\u1ec3 gi\u1ea3i quy\u1ebft v\u1ea5n \u0111\u1ec1 n\u00e0y, c\u00e1c nha s\u0129 th\u01b0\u1eddng s\u1eed d\u1ee5ng c\u00e1c k\u1ef9 thu\u1eadt g\u00e2y t\u00ea \u0111\u1ec3 gi\u1ea3m \u0111au v\u00e0 [&hellip;]<\/p>\n","protected":false},"author":29,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[28,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - 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