Bước đầu đánh giá hiệu quả phòng ngừa hội chứng Xi măng xương với Adrenalin 1/500.000 súc ống tủy xương đùi ở bệnh nhân thay khớp háng
Authors: Trương Phước 
Published: May 2023

Đặt vấn đề: Thay khớp háng là phẫu thuật hay gặp ở người cao tuổi. Cho đến nay việc dùng xi măng trong loại phẫu thuật này vẫn còn khá phổ biến. Hội chứng xi măng xương có thể xảy ra làm tăng tỷ lệ tử vong và bệnh tật ở người cao tuổi trong và sau mổ. Đề tài này nhằm đánh giá hiệu quả ngăn ngừa hội chứng xi măng xương của dung dịch Epinephrine 1/500.000 ở bệnh nhân thay khớp háng có xi măng; Khảo sát tác dụng không mong muốn của dung dịch Epinephrine 1/500.000 lên huyết động khi súc rửa ống tủy xương đùi.

Đối tượng, phương pháp: Phương pháp nghiên cứu: Mô tả cắt ngang. Đối tượng: 38 bệnh nhân lớn tuổi có chỉ định mổ thay khớp háng có sử dụng xi măng theo chương trình. Trước khi đổ xi măng, tất cả bệnh nhân đều được súc rửa ống tủy xương đùi bằng dung dịch Adrenaline 1/500.000 (hoà trong NaCl 0,9%). Ghi nhận sự biến đổi sinh hiệu trước và sau khi súc rửa ống tủy xương đùi với Adreanaline 1/500.000. Theo dõi các chỉ số: Tri giác, HA tâm thu, HA tâm trương, HA trung bình, Mạch, SpO2 ở các thời điểm trước và 1, 2, 3, 4, 5, 6, 7, 8, 9 và 10 phút sau khi đổ xi măng. Ghi nhận sự thay đổi các chỉ số, phát hiện sớm và xử lý hội chứng xi măng xương.

Kết quả: Các chỉ số theo dõi không có sự khác biệt có ý nghĩ thống kê ở 2 thời điểm trước và sau khi súc rửa ống tủy xương đùi với Adreanaline 1/500.000. Tỷ lệ xảy ra hội chứng xi măng xương độ 1: 2/38 ca (5,26%), độ 2: 2/38 ca (5,26%), độ 3: 0/38 ca (0%).

Kết luận: Adrenaline 1/500.000 súc rửa ống tủy xương đùi trước bơm xi măng không ảnh hưởng tới huyết động ở bệnh nhân thay khớp háng. Adrenaline 1/500.000 súc ống tủy xương đùi trước bơm xi măng làm giảm tỷ lệ xảy ra hội chứng xi măng xương.

ABSTRACT INITIAL EVALUATION THE EFFICACY IN PREVENTING OF BONE CEMENT IMPLANTATION SYNDROME WITH ADRENALINE 1/500,000 IRRIGATION FEMORAL CANAL IN HIP REPLACEMENT PATIENTS

Backgroud: Hip replacement is a common surgery in the elderly. Until now, the cementation for this type of surgery is still quite popular. Bone cement immplantation syndrome could occur and increase mortality and morbidity in the elderly during and after surgery. This study aims to evaluate of the efficacy of Adrenaline 1/500.000 solution in preventing of bone cement implantation syndrome in patients with cemented hip replacement; and investigate the undesirable effects ofAdrenaline1/500.000 solution on hemodynamics when it has been rinsing to the femoral canal.

Methods: A cross - sectional descriptive study was carried out on 38 elderly patients had been indicated for hip replacement selective surgery with cementation. All patients were flushed the femoral canal with Adrenaline 1/500.000 solution (dissolved in 0.9% NaCl) before cementing. Recording the changes in vital signs before and after rinsing the femoral canal with adrenaline 1/500.000 solution. Monitoring the indicators: consciousness, systolic BP, diastolic BP, mean BP, pulse, SpO2 at the time points before and 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 minutes after cementation. Notting the changes in indicators, early detection and treatment of bone cement implantation syndrome.

Results: There was no statistically significant difference in the monitoring indicators before and after flushing the femoral canal with Adrenaline 1/500.000. Rate of bone cement implantation syndrome grade 1: 2/38 cases (5.26%), grade 2; 2/38 cases (5.26%), Grade 3: 0/38 cases (0%).

Conclusions: Flushing the femoral canal with Adrenaline 1/500,000 before cemenation had no effect on vital signs. Adrenaline 1/500,000 rinsing the femoral canal before cementation can reduces the incidence of bone cement implantation syndrome.