1. H thng ht dn lu khoang mng phi ca my Thopaz.

1.1.Gii thiu.

Thopaz l thit b ht dn lu khoang mng phi s dng cng ngh hin i vi

tiu chun mi ca hng Medela (Thy S).

S ra mt ca Thopaz c coi nh l mt bc tin ln ca khoa hc i vi h thng

dn lu khoang mng phi. Thopaz hu nh khc phc c cc khuyt im ca h

thng dn lu khoang mng phi truyn thng ang c s dng ti hu ht cc bnh

vin hin nay, gip cho bnh nhn b trn kh, trn dch mng phi, hoc sau khi phu thut

lng ngc nhanh chng hi phc v tit kim chi ph iu tr.

1.2.Cc kt qu nghin cu kho st.

Phn ny s trnh by kt qu ca mt s kho st nghin cu so snh gia my

Thopaz v h thng c.

1.2.1. So snh v thi gian t ng dn lu, thi gian iu tr ti bnh vin v chi ph

iu tr.

Kho st i vi bnh nhn sau khi phu thut lng ngc phi t dn lu nhm

iu tr trn kh mng phi, so snh 51 bnh nhn iu tr vi my Thopaz v 51 bnh nhn

iu tr vi h thng dn lu truyn thng. Trong c hai nhm, cc bnh nhn c t p

sut ht m -15 cmH2O v ch Gravity mode (Thopaz) hoc ch dng hai bnh dn lu

(bnh cha dch v bnh water seal trong h thng dn lu truyn thng). Ch nh rt ng

dn lu khi tha iu kin sau: h thng dn lu truyn thng yu cu khng c bt kh

bnh water seal trong cc ng tc h hp gng sc ca bnh nhn lin tc, cn my

Thopaz yu cu lu lng dng < 40ml/pht v n nh trn th trong 8 gi. C hai h

thng cng cn mt iu kin na l trn dch (nu c) < 400ml/24 gi.

- Kt qu so snh thi gian t ng dn lu v thi gian iu tr ti bnh vin:

Hnh trn cho ta thy thi gian t ng dn lu (days of drainage) v thi gian iu

tr ti bnh vin (days in hospital) ca nhm bnh nhn dng my Thopaz thp hn so vi

nhm bnh nhn dng h thng dn lu truyn thng.

- Kt qu so snh v chi ph iu tr: nhm bnh nhn s dng Thopaz tit kim c

trung bnh 1012 dollars mi bnh nhn so vi nhm bnh nhn cn li:

T cc kt qu trn cho thy my Thopaz gim c thi gian t ng dn lu, thi

gian iu tr v tit kim chi ph iu tr so vi h thng dn lu truyn thng.

1.2.2. Kho st v nh gi ca bnh nhn v cc bc s, y t v Thopaz.

Sau 2,5 thng s dng Thopaz trn 120 bnh nhn, 15 bc s v y t c lm mt

bng nh gi v Thopaz da trn mc hi lng. Mc c chia nh sau: hon ho

(excellent), rt tt (very good), tt (good), hi lng (satisfactory), cn c ci thin (need

improvement), t hi (poor). Bnh nhn c iu tr bng Thopaz cng c lm bng

kho st v kin ca h.

- Kt qu kho st bc s, y t v mc hi lng ca h:

- Kt qu kho st nh gi v cc tnh nng ni bt ca Thopaz nh ht p lc m

(vacuum setup), o tc dng(air flow rate), th hin th u nhn (graphic

display legibility), h thng cnh bo (alarm system):

Thm vo , phn ng ca cc bnh nhn s dng Thopaz rt tch cc: khi lng

my nh, thit k nh gn, hot ng m i v c th di chuyn mt cch thoi mi.

Vi cc kt qu kho st trn cho thy, Thopaz l mt thit b c cc bc s, y t

v bnh nhn nh gi cao v cht lng, d s dng, thn thin vi ngi dng, hot ng

m i, khi lng nh.

1.3.Nhng tnh nng ni bt ca my Thopaz.

Nh phn trn ta thy c u im ca my Thopaz so vi h thng dn lu

khoang mng phi truyn thng, cng nh s hi lng ca bc s, y t, bnh nhn khi s

dng my. Trong phn ny ta s i vo cc tnh nng ni bt ca my Thopaz.

1.3.1. Thun li cho vic vn ng, i li ca bnh nhn.

Vi khi lng my khong 1kg (khng tnh canister) v thit k nh gn, bm ht,

c th chy bng ngun in hoc pin, bnh nhn c th vn ng nh, i li d dng m

khng phi nm ging lu di nh h thng dn lu truyn thng. iu ny mang li tm

l thoi mi cho bnh nhn, gip th trng ca h ngy cng ci thin v hi phc nhanh

hn. Hn na, iu ny cng gip cho cc y t gim c mt phn cng vic chm sc

bnh nhn ca h, gp phn gim chi ph iu tr.

Hnh so snh kh nng di chuyn ca hai bnh nhn

1.3.2. Thopaz hin th d liu khch quan, lin tc.

Cc thng s nh p lc ht m, lu lng dng trong ng dn lu c hin th

lin tc theo thi gian trn mn hnh LCD di dng th(Graph mode) hoc s(data

mode). iu ny gip cho cc bc s theo di, nh gi tnh trng trn kh mng phi ca

bnh nhn mt cch khoa hc v chnh xc. So vi h thng dn lu truyn thng th h

phi xem lng bt kh thot ra bnh water seal, v ch xem mt thi im nht nh

ch khng th lin tc theo thi gian c. nh gi da vo th gip bc s pht hin

kp thi nhng bin i bt thng ca tnh trng bnh nhn v a ra hng x l thch

hp. ng thi h cng c th chc chn hn trong vic ra quyt nh rt ng dn lu.

c bit, my cn c chc nng phn bit hai trng hp lm lu lng dng chy

trong ng gn bng 0, l do bnh nhn khng cn trn kh hoc trn kh rt t khng

ng k v do ng dn lu b tc:

Nh hnh trn ta thy, khi lu lng dng gim n gn bng 0, ta c th phng to

th xem xt k hn v c hai k hiu trn mn hnh. Mt k hiu cho bit ng ng

dn lu bnh thng (catheter open) v k hiu cn li cho bit ng ng dn lu b tc

(catheter clogged?). Da vo , bc s c th phn bit c v a ra gii php hp l.

Ngoi ra, Thopaz cn c th a d liu ln my tnh qua cp ni USB bc s c

th xem xt v nh gi. Medela cung cp phn mm c d liu t Thopaz, giao din

phn mm hin th y d liu bnh nhn, ngy t ng dn lu, thi gian t ng, p

lc ht, lu lng dng. D liu c th c lu tr, in ra giy hoc gi i xa, phc v cho

vic chn on t xa.

Giao din phn mm theo di bnh nhn trn kh mng phi ca hng Medela

1.3.3. Thopaz c th ty bin p lc ht m ph hp vi bnh nhn.

H thng ng i cho php my c th duy tr p lc m trong khoang mng phi

c bc s ci t nh h thng ng i:

Hnh m t h thng

ng i dn lu ca my

P2=-1kPa

suction tube

P1= -1.6kPa

h=

25

cm

secretion

measuring tube

pressure difference

because of vertical pillar

h=

6cm

Pset= -1kPa

air leak

pleura space

Trn hnh, h thng ng i bao gm ng o p sut khoang mng phi (measuring

tube) v ng dn lu (suction tube). ng o c nhim v o p sut khoang mng phi, t

iu chnh bm ht duy tr p sut . V d nh khi ci t p lc ht l -1 kPa (-

10,2 cmH2O), th bm s ht vi p lc -1,6 kPa nhm m bo p lc khoang mng phi

t gi tr -1 kPa.

Khi my hot ng, c sau 5 pht my s t ng v sinh ng ng dn lu nhm

hn ch tc nghn, ng dch trong ng.

1.3.4. H thng cnh bo.

Thopaz c h thng cnh bo ngi s dng v li trc trc k thut, du hiu bt

thng ca bnh nhn nh trn kh t ngt tng cao. Nu gp li ny, my s bo ng

bng ting chung v mn hnh s hin th l loi li g. Khi ngi s dng bm nt,

ting chung s mt v hng dn x l s xut hin trn mn hnh, hng dn ngi s

dng phi lm nhng g x l n.

Hnh trn l mt v d v cnh bo h thng b tc nghn (system clogged). u

tin mn hnh hin th tn v loi li. Sau , ngi dng bm nt mi tn ln hoc xung

xem hng dn x l li . Trong v d ny th sau khi bm nt, mn hnh s hin

hng dn kim tra ng ng hoc thay bnh canister.

C hai loi li l li m ngi s dng c th x l c (warning v alarm) nh h

thng b tc nghn, r kh, y bnh canister, pin yu, Li th hai l li m ngi s

dng khng th can thip v x l c (internal error), khi gp li ny th u tin ngi

s dng phi khi ng li my, nu vn gp li th phi lin lc dch v chm sc

khch hng ca Medela sa cha.