B GIO DC V O TO B Y T TRNG I HC Y H NI THEPNALY XAYSIDA NGHIấN CU BIN C TC THè LIấN QUAN N TH THUT T NG NI KH QUN CP CU TR EM TI BNH VIấN NHI TRUNG NG LUN VN THC S Y HC H NI-2016 B GIO DC V O TO B Y T TRNG I HC Y H NI THEPNALY XAYSIDA NGHIÊN CứU BIếN Cố TứC THì LIÊN QUAN ĐếN THủ THUậT ĐặT ốNG NộI KHí QUảN CấP CứU TRẻ EM TạI BệNH VIÊN NHI TRUNG ƯƠNG Chuyờn ngnh: Nhi khoa Mó s: 60720135 LUN VN THC S Y HC Ngi hng dn khoa hc: PGS.TS Trõn Minh iờn TS Phan Hu Phỳc H NI-2016 LI CM N hon thnh lun ny, tụi xin c by t lũng bit n ti: Ban Giỏm hiu, Phũng o to sau i hc, cỏc phũng ban chc nng ca trng i hc Y H Ni ó giỳp v to iu kin thun li cho tụi quỏ trỡnh hc v nghiờn cu Cỏc thy cụ B mụn Nhi ó úng gúp nhiu cụng sc ging dy, o to tụi sut quỏ trỡnh hc cng nh hon thnh lun ny Cỏc thy cụ Hi ng thụng qua cng ó a nhng gúp ý vụ cựng giỏ tr giỳp tụi cú iu chnh hon thnh lun ny c tt hn Ban giỏm c, Phũng K hoch tng hp Bnh vin Nhi Trung ng ó nhit tỡnh giỳp chỳng tụi quỏ trỡnh hon thnh lun vn.Tp th khoa iu tr tớch cc Bnh vin Nhi Trung ng ó to iu kin thun li nht tụi cú th hon thnh lun ny PGS.TS Trn Minh in v TS Phan Hu Phỳc, Ngi Thy ht sc tõm huyt, tm gng nhit tỡnh ging dy, o to, ó tn tỡnh ch bo tụi trờn ng nghiờn cu khoa hc, l ngi trc tip hng dn tụi hon thnh lun ny Tụi xin chõn thnh cm n tt c bn bố thõn thit ó ng viờn, c v v giỳp tụi c cuc sng v s nghip nghiờn cu ca mỡnh Cui cựng tụi xin chõn thnh cm n: Gia ỡnh: B, M, chng, l ngun ng viờn ln ó chia s mi khú khn, vui bun, sỏt cỏnh v theo dừi tng bc i ca tụi s nghip hc v phn u ca mỡnh H Ni, ngy 20 thỏng 12 nm 2016 Thepnaly XAYSIDA LI CAM OAN Tụi l Thepnaly XAYSIDA, hc viờn cao hc khúa 23, Trng i hc Y H Ni, chuyờn ngnh Nhi khoa, xin cam oan: õy l lun bn thõn tụi trc tip thc hin di s hng dn ca PGS.TS Trõn Minh iờn v TS Phan Hu Phỳc Cụng trỡnh ny khụng trựng lp vi bt k nghiờn cu no khỏc ó c cụng b ti Vit Nam Cỏc s liu v thụng tin nghiờn cu l hon ton chớnh xỏc, trung thc v khỏch quan, ó c xỏc nhn v chp thun ca c s nghiờn cu Tụi xin hon ton chu trỏch nhim trc phỏp lut v nhng cam kt ny H Ni, ngy 20 thỏng 12 nm 2016 Hcviờn Thepnaly XAYSIDA CC CH VIT TT NKQ Ni khớ qun SHH Suy hụ hp SHHC Suy hụ hp cp HSCC Hi sc cp cu NC Nghiờn cu BS Bỏc s T VN Th thut t ng ni khớ qun (NKQ) l mt th thut rt quan trng kim soỏt ng th hi sc cp cu Chớnh s i ca ca th thut ny ó cu sng rt nhiu bnh nhõn thi gian va qua v c ỏp dng thng xuyờn ti cỏc khoa Gõy mờ hi sc, nhng n v hi sc tớch cc nhng trng hp cp cu, cn kim soỏt ng hụ hp Mc dự th thut mang li rt nhiu li ớch cho hi sc bnh nhõn nhng khụng th trỏnh c nhng bin chng cú th xy Trong ú cú th gp bin chng tc thỡnh: chn thng, thiu oxy, chm nhp tim, ngng tim [1],[2], hay bin chng lõu di nh: phự n, khn ting, au hng, hp khớ qun,thm cú th gõy hoi t lp di niờm mc khớ qun, thng sn khớ qun, gõy nhim trựng, hp khớ qun[3],[4],[5].Cỏc mc tai bin v bin chng khỏc t cỏc tn thng t rt nh n tn thng trm trng Nghiờn cu cỏc bin chng tc thỡ t NKQ, Jaber v cng s cho thy cú ti28% bnh nhõn xut hin ớt nht mt bin chng nng nguy him nh ngng tim, sc, suy hụ hp nng[6] cỏc khoa hi sc cp cu nhi, cỏc bin chng ca t ng NKQ cng xut hin vi tn sut cao ti 24%[7], cũn t l t vong th thut gõy thỡ rt ớt ch 0,4%[1] Cỏc bin chng ny cú th nh hng n vic iu tr, thi gian nm vin, chi phớ v cuc sng sau ny ca bnh nhõn gim cỏc bin chng ca th thut cn cú s tham gia ca tt c cỏc thnh phn liờn quan t khõu chun bdng c,nhõn lc, chun b bnh nhõn, cỏch chn li ốn, lachn cỏc phngphỏp vụ cm thớch hp trc t ng NKQ, hn na liu lng ca thuc cng phi phự hp vi tỡnh trng ca bnh nhõn khụng gõy tn thng hoc hn ch bin chng c nhiu nht v mt iu khụng th thiu l k nng ca bỏc s lm cng phi tt Trong ú nhiu nghiờn cu thy rng s thnh cụng ca th thut cũn ph thuc nhiu vo kinh nghim ca bỏc s[8],[9] Trờn th gii, ó cú nhiu nghiờn cu v th thut t ng NKQ cp cu v nhng tai bin ca th thut tr em [1],[2],[4],[5],[6] Vit Nam, t NKQ l mt th thut cp cu rt ph bin, nhng vic la chn cỏc k thut, sdng cỏc thuc an thn, gión c trc lm th thut, cng nh nhng tai bin ca t NKQ cũn cha c cp ti Nhn xet quỏ trỡnh chun b th thut t ng ni khớ qun, cỏc bc tin hnh th thut, quỏ trỡnh theo dừi v sau th thut, v xỏc nh cỏc bin chng tc thỡ ca th thut l rt quan trng, giỳp cho an ton ngi bnh v ngi thy thuc tớch ly kinh nghim chuyờn mụn Do vy chỳng tụi thc hin ti:Bin c tc thỡ liờn quan n th thut t ng ni khớ qun cp cu tr em ti Bnh vin Nhi Trung ng, nhm hai mc tiờu: Xỏc nh t l cỏc bin c tc thỡ ca th thut t ng ni khớ qun cp cu tr em Phõn tớch mt s yu t liờn quan n bin c tc thỡ ca th thut t ng ni khớ qun cp cu tr em CHNG TNG QUAN 1.1 Suy hụ hp tr em Suy hụ hp(SHH) l mt hi chng hay gp nhiu nguyờn nhõn gõy nờn v rt nguy him n tớnh mng ca bnh nhõn nu khụng phỏt hin v iu tr kp thi SHH cp l tỡnh trng c quan hụ hp t nhiờn khụng bo m c chc nng trao i khớ, gõy thiu oxy mỏu, cú hoc khụng cú kốm theo tng cacbonic (CO2) mỏu, c biu hin qua kt qu o khớ mỏu ng mch, vi PaO2 < 60 mmHg, PaCO2>50 mmHg th viFiO2 = 21%[10],[11] SHH tr em c bit tr s sinh cú rt nhiu yu t gúp phn vo lm cho tr b suy hụ hp nng lờn v nhanh vỡ c im cu to ng th ca tr cng cú nhiu im khỏc vi ngi ln vỡ cu to cng cha hon thin nh: ng dn khớ nh hn, nhu cu trao i cht li cao m kh nng d tr li thp v c ch bự tr thp hn so vi ngi ln nờn lm cho tr nhanh chúng b SHH v nng,c bit tr s sinh non nguy c ny cng tng lờn cao v nng n 1.1.1 Nguyờn nhõn ca suy hụ hp SHH cú th nhiu nguyờn nhõn khỏc rt phc tp, nhng cú th túm tt thnh nhúm nguyờn nhõn chớnh: - SHH tn thng h hụ hp, lm ri lon quỏ trỡnh trao i khớ phi nh: viờm phi, vim tiu ph qun, hen ph qun, trn dch mng phi, trn khớ mng phi, viờm khớ ph qun, d vt ng th, phự phi, ui nc,[11] - SHH cỏc bnh tim mch v bnh mỏu lm ri lon quỏ trỡnh chuyn O2 c th nh bnh thp tim h hp van lỏ, tim bm sinh, suy tim, thiu mỏu nng, sc,[11] - SHH cỏc bnh h thn kinh lm c ch v ri lon trung tõm hụ hp, nh hng n cỏc c hụ hp, nh viờm nóo- mng nóo, viờm ty, xuthuyt nóo, chn thng ty, bi lit, nhc c, ng c, chn thng u nng,[11] Cỏc nguyờn nhõn gõy t vong hng u tr em di nm tui vo nm 2015 l bin chng v sinh non thỏng, viờm phi, bin chng liờn quan lỳc chuyn d, tiờu chy v nhng bt thng bm sinh T vong s sinh chim 45% tr di tui mt nghiờn cu nm 2015[12] Biu 1.1: Nguyờn nhõn t vong tr di tui nm 2015 theo s liu ca T chc Y t th gii Theo s liu thng kờ nm 2000 cú khong1,9 triu tr t vong vỡ bnh lý nhim trựng hụ hp cp, 70% s ú Chõu Phi v ụng Nam [13] Viờm phi l nguyờn nhõn lõy nhim ln nht gõy cht ca tr em trờn ton th gii, c tớnh 920136 tr em di tui t vong viờm phi nm 2015 v chim 16% cỏc ca t vong ca tr em di tui[14] 1.1.2 Phõn loi suy hụ hp cp [8] Suy hụ hp cp(SHHC) l tỡnh trng bnh lý cp cu thng gp nht hi sc cp cu tr em[15] Cú nhiu cỏch phõn loi SHHC: theo nguyờn nhõn, theo bnh sinh, theo lõm sng 1.1.2.1 Phõn loi theo nguyờn nhõn 10 - SHHC nhng nguyờn nhõn ti h hụ hp: Cỏc ri lon ti ng dn khớ: bnh lý tc nghn ng th (bch hu, d vt ng th, viờm qun, hp qun, hen ph qun, viờm tiu ph qun.) Cỏc tn thng ph nang v mụ k phi: gõy ri lon trao i khớ nhu mụ phi nh viờm phi, phự phi cp, ARDS, ngt nc, ng dp phi, viờm phi k, trn dch hoc trn khớ mng phi Cỏc bt thng ti mao mch phi: tc mch phi Trong ú theo nguyờn cu thỡ t l t vong tn thng ti phi/SHHC cũn cao dao ng khong 22%-35% [16],[17] - SHHC cỏc nguyờn nhõn ngoi c quan hụ hp: Tn thng trung tõm hụ hp: tai bin mch nóo, chn thng s nóo, ng c thuc, hụn mờ chuyn húa Ri lon dn truyn thn kinh - c: bnh nhc c, hi chng GuillainBarre, chn thng ct sng - ty sng, Bt thng v lng ngc: di chng cũi xng, gự vo ct sng, góy xng sn, bnh c chuyn hoỏ, dựng thuc dón c, 1.1.2.2 Phõn loi theo bnh sinh[18] Theo c ch bnh sinh, SHHC c c trng bi s gim oxy v tng cacbonic mỏu, th hin qua kt qu khớ mỏu ng mch Cú th chia thnh loi SHH: - SHH gim oxy - SHH tng cacbonic SHH gim oxy mỏu (Type 1): xy cú bt thng quỏ trỡnh trao i khớ c gi l SHH th gim oxy PaO2< 60 mmHg ( ln(OR: 2,0; 95%CI: 1,1-3,9) - Bin c gim oxy liờn quan n nguyờn nhõn suy hụ hp ti phi, bỏc s HSCC, ln n lc t (p < 0,05), phõn tớch a bin cũn li yu t nguyờn nhõn suy hụ hp ti phi (OR: 2,7; 95%CI: 1,1 6,7) v hc viờn t ng(OR: 2,3; 95%CI: 1,1-5,3) 70 KIN NGH Giỏm sỏt cht ch quỏ trỡnh t ng ni khớ qun cho cỏc bnh nhõn suy hụ hp, c bit nhúm suy hụ hp nguyờn nhõn ti phi, cung cp ụ xy liu cao trc t nhm gim bt nguy c gim oxy Cn cú trang thit b y c s lng v cht lng Cn o to cho cỏc bỏc s tham gia cụng tỏc cp cu, hi sc nhi khoa cỏc chng trỡnh cp cu c bn, cp cu nhi khoa nõng cao Chỳ trng k nng kim soỏt ng th, ú th thut t ng ni khớ qun l tiờu quan trng Cỏc bỏc s l hc viờn cn c thc hnh trờn mụ hỡnh k trc thc hin trờn ngi bnh Cn cú s giỏm sỏt, tr giỳp ca bỏc s cú kinh nghim cho cỏc bỏc s hc viờn lm th thut t NKQ cho bnh nhõn MC LC DANH MC BNG DANH MC BIU DANH MC HèNH TI LIU THAM KHO NelioS., Carvalho, Brunow W (2009) Complications of tracheal intubation in pediatrics.Revista Da Associacao Medica Brasileira - Journals 55 (6), 646-65 Akira N, David A, Calvin A, et al (2013) A national emergency airway registry for children Landscape of tracheal intubation in 15 PICUs Critical Care Medicine.41 (3), 874-885 Trn Trung Kiờn (2000), Nghiờn cu bin chng ca t ng ni khớ qun ng ming hi sc cp cu, Lun tt nghip thc s y hc, Trng i hc Y H Ni Divatia J V, Bhowmick K (2005) Complication of endotracheal intubation and other airway management procedures Indian Journal of Anaesthesia 49 (4), 308 318 Colice GL, Stukel TA, Dain B (1989) Laryngeal complications of prolonged intubation Chest 96(4),877-884 Jaber S, Amraoui J, Lefrant JY, et al (2006) Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple center study Critical Care Medicine 34 (9),23552361 Rivera R, Tibballs J (1992) Complications of endotracheal intubation and mechanical ventilation in infants and children CriticalCare 10 11 12 13 Medicine 20(2), 193-199 Leone TA., Rich W., Finer NN (2005) Neonatal intubation: success of pediatric trainees Journal of Pediatrics 146(5), 638641 Ronald C Sanders,Jr, MD, MS, John S.,et al (2013) Level of trainee and tracheal intubation outcomes Pediatrics, 131(3), 821-828 Nelson Textbook of Pediatrics (2008) 18th edition GS.TSKH Lờ Nam Tr (2013) Bi ging nhi khoa, Trng i hc Y H Ni, Nh xut bn Y Hc H Ni, tp1, tr420-434 WHO database.Availablefrom: http://www.who.int/gho/child_health/mortality/causes/en/ Williams B G., Gouws E., Boschi-Pinto C., et al (2002) Estimates of World wide Distribution of Child Deaths from Acute Respiratory Infections Lancet Infectious Diseases 2(1),2532 14 WHO database Available from: http://www.who.int/mediacentre/factsheets/fs331/en/ 15 Lờ Nam Tr (2013) Bi ging nhi khoa, Trng i hc Y H Ni, Nh xut bn Y Hc H Ni tp2, tr 300-306 16 Erickson S, Schibler A, Numa A, et al (2007) Acute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study Pediatric Critical Care Medicine; 8(4), 317323 17 Flori HR, Glidden EV, Rutherford GW, et al (2005) Pediatric acute lung injury: Prospective evaluation of risk factors associated with mortality America Journal Respiratory Critical Care Medicine 171(9), 9951001 18 Database Available from: http://emedicine.medscape.com/article/167981-overview 19 Nguyn c Hinh, Ths Lờ Chu Hũa (2013) Bi ging k nng y khoa,Trng i hc Y H Ni, Nh xut bn Y Hc H Ni, tr 181-187 20 Lờ Nam Tr (2013).Bi ging nhi khoa 1, Trng i hc Y H Ni, Nh xut bn Y Hc H Ni, 1, tr 390-396 21 Comroe JH, Botelho S (1947) The unreliability of cyanosis in the recognition of arterial anoxemia.American Journal of Medical Sciences.214(1), 1-5 22 Database Available from: http://emedicine.medscape.com/article/303533-overview 23 Water RM., Roventine EA., Guedel AE (1933) Endotracheal anaesthesia and historical development Anesthesia Analgesia,12 (5) 196 24 Andrew J Davey and Ali Diba (2012).Wards Anaesthetic Equipment, Sixth edition, 158-159 25 Anesthesia History Association (2013), 31 26 History of Anaesthesia Timeline- By DrRegCammack- September 2015 27 Murphy P (1967) A fibre-optic endoscope used for nasal intubation Anaesthesia.22(3), 489-491 28 Benumof and Hagberg, Airway management, Edition Page 479 29 Robertson J,and Shilkofski, N(2008)The Harriet Lane Hanbook 18 edition,1 30 King BR, Baker MD, Braitman LE, et al (1993) Endotracheal tube selection in children: a comparison of four methodos Annals of Emergency Medicine 22(3), 530-534 31 Van der Berg AA, Mphanza T (1997) Choice of tracheal tube size for children: finger size or age-related formula? Anaesthesia.52(7), 701-703 32 Davis D, Barbee L, Ririe D (1998) Pediatric endotracheal tube selection: a comparison of age- based and height-based criteria.The Journal ofthe American Association of Nurse Anesthetists 66(3), 299-303 33 Shiroyama K, Izumi H, Kubo T, et al (2001) A formula based on body lenght for determining the size of an uncuffed endotracheal tube for pediatric cardiac anesthesia Hiroshima Journal of Medical Sciences 50(4), 97-99 34 Takita K, Morimoto Y, Okamura A, et al (2001) Do age-based formulae predict the appropriate endotracheal tube sizes in Japanese children? Journalof Anesthesia.15(3), 145-148 35 Gerardi M, Sacchetti A, Cantor R, et al (1996) Rapid sequence intubation of the pediatric patient.Annals of Emergency Medicine 28(1), 55-74 36 Francisco M.P-R (2012) Rapid sequence intubation Emergencias.24 , 397- 409 37 Seyedeh F K, Pouya P,Shahin B, (2011) Common Complications of Endotracheal Intubation in Newborns.Iranian Journal of Neonatology.2(2), Page 12-17 38 LippinCott Williams (2003) Practice guidelines for management of difficult airway, Anesthesiology 98(5), 1269-1277 39 Cros AM, Bougain J.L, Francon D, et al (2005) Intubation dificile Les Essentiel 389-401 40 Savva D (1994) Predicting difficult intubation British Journal of Anaesthesia.73(2), 149-153 41 D.keith Rose, Morsha M Cohen (2000) The Airway: Problems and predictions in 18,500 patients.Canadian Journal of Anaesthesia.41(5):373-383 42 Mallampati S (1996) Recognition of the difficult airway.Airway management principals and practice.126-156 43 SeoS.H, Lee J.G, Yu S.B, et al (2012).Predictors of difficult intubation defined by the intubation difficulty scale (IDS): predictive value of airway assessment factors.Korean Journal Anesthesiology.63(6): 491 497 44 Nguyn Ton Thng (2003).Nghiờn cu cỏc yu t tiờn lng t ng ni khớ qun khú gõy mờ.Lun tt nghip ni trỳ bnh vin 45 Schwartz DE, Matthay MA, Cohen NH (1995).Death and other complications of emergency airway management in critically ill adults.Anesthesiology.82(2),367-376 46 Weber S (2002) Traumatic complications of airway management.AnesthesiologyClinics of North America 20(3), 503-512 47 Loh KS, Irish JC (2002) Traumatic complications of intubation and otherairway management procedures Anesthesiology Clinics of North America.20(4),953-969 48 Shiima Y, Berg RA, Bogner HR, et al (2016).Cardiac Arrests Associated With Tracheal Intubations in PICUs:A multicenter cohort study.Critical Care Medicine.44(9):1675-82 49 Thomas C Mort (2004) The incidence and risk factors for cardiac arrest during emergency tracheal intubation: A justification for incorporating the ASA Guidelines in the remote location Journal of Clinical Anesthesia.16(7), 508516 50 Domino KB, Postner KL, Caplan RA, et al (1999) Airway injury during anesthesia.Anesthesiology.91(6), 1703-1711 51 Atoni J-B Manuel P, Elaback.JM (1998) A prospective study of unplanned endotracheal extubation in intensive care unit patiens.Critical Care Medicine 26(7), 1180-1186 52 Robert D, Brands L, Imran T, et al (1991) Self extubation Chest 99(5):1319-1320 53 Vassal T, Anh ND, Gabillet JM, et al (1993) A prospective study of unplanned endotracheal extubation in intensive care unit.Intensive Care Medicine.340-342 54 Chevron V, Menard JF, Richard JC, et al (1998) Unplannedextubation: Risk factor of development and predictive criteria for reintubation Critical Care Medicine 26(6):1049-1052 55 Tarik P, Sami E, Fatih S, et al (2013) A new treatment modality for unilateral athelectasis: Recruitment maneuver with endobronchialblocker Indian Journal Critical Care Medicine 17(4), 240242 56 Epstein SK, Ciubotaru RL (1998) Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation American Journal of Respiratory Critical Care Medicine 158 (2), 489-493 57 Colice GL, Stukel TA, Dain B (1989) Laryngeal complications of prolonged intubation Chest 96(4), 877-884 58 Graciano AL, Tamburro R, Thompson AE, et al.(2014) Incidence and associated factors of difficult tracheal intubations in pediatric ICUs.Intensive Care Medicine.40(11):1659-69 59 Lee JH, Turner DA, Kamat P et al (2016) The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational.BMC Pediatrics 29;16:58 60.Varghese E, Kundu R (2014) Does the Miller blade truly provide a better laryngoscopic view and intubating conditions than the Macintosh blade in small children?Paediatric Anaesthesia.24(8):825-9 61.Y Passi et al (2014) Comparison of the laryngoscopy views with the size Miller and Macintosh laryngoscope blades lifting the epiglottis or the base of the tongue in infants and children British Journal of Anaesthesia.113 (5), 869-874 62 M Weiss, A Dullenkopf1, S Bửttcher2, et al (2006) Clinical evaluation of cuff and tube tip position in a newly designed paediatric preformed oral cuffed tracheal tube British Journal of Anaesthesia 97(5), 695700 63 Litman RS, Maxwell LG (2013).Cuffed versus uncuffed endotracheal tubes in pediatric anesthesia: The debate should finally end 64 Anesthesiology.118(3), 500-1 Whyte S, Birrell G, Wyllie J (2000).Premedication before intubation in 65 UK neonatal units Archdis child fetal neonatal 82(1), 38-41 Kumar P, Denson SE, Mancuso TJ.et al (2010) Premedication for nonemergency endotracheal intubation in the neonate Pediatrics 66 125(3), 608615 K Shore, S Walker, L Palozzi,(2015) Complications of intubation in an academic medical-surgical ICU Intensive Care Medicine 67 Experimental.3(1): A431 Lane B, Finer N, Rich W (2004) Duration of intubation attempts during 68 neonatal resuscitation Journal of Pediatrics.145(1), 67-70 Roux D, Reignier J, Thiery G, et al.(2014).Acquiring procedural skills in ICUs: a prospective multicenter study* Critical Care Medicine 42(4), 886-95 69.Stauffer JL, Olson DE, Petty TL (1981) Complications and consequences of endotracheal intubation and tracheotomy A prospective study of 150 critically ill adult patients The American 70 Journal of Medicine 70(1), 65-76 Carbajal R, Eble B, Anand KJ (2007).Premedication for tracheal intubation in neonates: confusion or controversy? Seminars in 71 Perinatology; 31(5), 309-317 Ghanta S, Abdol-latif M, Lui K, et al (2007) Propofol compared with the morphine, atropine, and suxamethonium regimen as induction agents for neonatal endotracheal intubation: A randomized, control trial Pediatrics.119(6): 1248-1255 11,13,14,18,20,34-43 3-10,12,15-17,19,21-33,44- ... HC Y H NI THEPNALY XAYSIDA NGHIÊN CứU BIếN Cố TứC THì LIÊN QUAN ĐếN THủ THUậT ĐặT ốNG NộI KHí QUảN CấP CứU TRẻ EM TạI BệNH VIÊN NHI TRUNG ƯƠNG Chuyờn ngnh: Nhi khoa Mó s: 60720135 LUN VN THC... khớ qun cp cu tr em Phõn tớch mt s yu t liờn quan n bin c tc thỡ ca th thut t ng ni khớ qun cp cu tr em 8 CHNG TNG QUAN 1.1 Suy hụ hp tr em Suy hụ hp(SHH) l mt hi chng hay gp nhiu nguyờn nhõn... rt quan trng, giỳp cho an ton ngi bnh v ngi thy thuc tớch ly kinh nghim chuyờn mụn Do vy chỳng tụi thc hin ti:Bin c tc thỡ liờn quan n th thut t ng ni khớ qun cp cu tr em ti Bnh vin Nhi Trung