Hemostatic: incazelo kanye nokubuyekeza

omfisha Hemostatic zisetshenziselwa ukunqanda ukopha ngabo uyathunjwa, futhi kokucindezelwa yesikhashana wesikebhe ukopha noma isiqu bomkhumbi elinqunywe. Ububanzi osayizi yalawo mathuluzi has nedlanzana ezimbalwa. Lokhu kungefani ngenxa yokuba khona imithambo ezinobukhulu obuhlukahlukene kusukela 1 kuya ku-20 mm, futhi usebenzisa ezihlukahlukene amasu hemostasis. izitsha ezincane elinqunywe ngesikhatsi kokuhlinzwa, isango ngocingo bese clamping ligated ngenhla (sutured) isiqu ngentambo.

Hemostatic, ezisetshenziswa phusha izitsha okwesikhashana kukhona ukungezwani phakathi kwakho. Vikela yakhelwe nigweme ukusaphaza izitsha ezincane igazi, kungaba ona ukuphela bomkhumbi. Njengomthetho, it is ezenziwe ngezinto eqinile. Izibopho, lapho zibizwa nangokuthi semithambo, eyenziwe impahla nokunwebeka, ngenxa yalezi zici yendlela aklanywe ngayo. Amagama la mathuluzi okuhambisana ngokugcwele ngokusebenzisa kwabo ehlosiwe. Esimeni esiphuthumayo, angasetshenziswa for nenkanuko edlulele ka napkins.

Nokho, kufanele sikhumbule ukuthi Ukugunda hemostatic, okungenani kanye isicelo nenkanuko edlulele ka napkins noma ukotini amabhola kanye gauze, asisakwazi usetshenziselwe inhloso yazo. Lokhu kungenxa ukusonteka wengxenye ukusebenza kanye nokulahlekelwa umsebenzi. Esikhathini esizayo, kufanele ukumaka futhi isetshenziswe kuphela ukulungisa amabhola kanye napkins.

Izimfuneko ezikhumulweni

Hemostatic kumele bahlangabezane nalezi zidingo ezilandelayo:

• nenkanuko edlulele Esinokwethenjelwa on ekupheleni isitsha ngeke slippage kuvumelekile.
• Ngekusetjentiswa okuphindiwe impahla yabo kufanele ilahleke.
• Ithuluzi kumelwe kube lula ukuxhumanisa futhi livulwe ngaphansi kwethonya kwezandla likadokotela ohlinzayo.
• Mshini ukukhiya kumele kube ngokuphephile silungise emihlathini, ekuvimbeleni ukuvulwa nolwazi. Ukuze wenze lokhu, isibonelo, isamba ofanele ngesimo Racks.
  Lapho kwehla kusuka ukuphakama 1 imitha ithuluzi akumelwe angesabi ukuvula ebusweni umsebenzi, futhi ngokuphindaphindiwe ukuvala nokuvulwa nemihlathi akufanele kusenze uziqondise.
• Kufanele uhambisane nemithetho Ergonomics.
• Ukudlala, ngaphandle lacerations ukuthi kungenzeka isisindo omfisha, onikezwe emaphethelweni isilonda.
• Kufanele avumele ukusetshenziswa electrocoagulator.
• Ubukhulu bayo hhayi ukuvimba Uhlolojikelele yasendle kuhlinzwa.
• Igcina ithuluzi kumele luhambisane ububanzi nezitsha.

Ukwahlukaniswa izibopho

Hemostatic ihlukaniswe subgroups eziningana:

1. Ukugunda Hemostatic ukuhlinzeka clamping ezitsheni yesikhashana ngaphambi Ligation noma abeke ukubambelela electrocoagulation (ohlehliswe isiqeshana hemostatic).

2. Umhlinzi izibopho, ephumula okwesikhashana ukugeleza kwegazi futhi sivumele ukubuyisela ubuqotho isitsha (angiorrhaphy).

3. kwasani izibopho ekhuthaza ukwakheka thrombus e mafutha anciphisa isikhala esingaphakathi umkhumbi ngemva kokufaka isiqeshana.

umklamo Izici

omfisha Hemostatic yakhiwa izingxenye abalwe ngezansi:

• Jaws (emihlathini).
• Luphatha izindandatho.
• castle eziwisekayo noma abayizithulu.
• Racks.

Ifomu emihlathini (emihlathini)

1. Ongunxantathu side, isib, Halstead neurosurgical izibopho.
2. Trapezoid wakhomba, isib, Billroth ngocingo.
3. Ngamazinyo trapezoid, isibonelo, ngocingo Kocher.
4. Okusaqanda, isibonelo, Pean Esebenzisa.

Isiqophi ungaba emihlathini iqonde futhi lwalugobile. Namantombazane Laphezu emhlathini avunyelwe kokubili transverse futhi etshekile. esebenzisa Hemostatic, agobile isetshenziswa kaningi.

ngocingo Kocher

ngocingo Kocher sinamazinyo ekupheleni. Basuke bawagxilise ekupheleni isitsha njengokuhle ngesikhathi sokuvalwa omunye ingxenye yayo ye imvume izinyo phakathi ezinye ezimbili.

Ngaphambi kokuba ahlinzwe, udokotela ohlinzayo kufanele uqobo hlola isimo Ukugunda hemostatic (toothed, iqonde, engonxantathu - akunandaba), ngoba:

• umonakalo emazinyweni kungabangela Racks ithuluzi samorazmykanie, okuyinto iyingozi kakhulu ngesikhathi yethula clamping wesikebhe ezinkulu.
• etshekile izingxenye zokusebenza ngeke sivumele ukuyeka ngempumelelo ukopha.

Izibopho emihlathini kuhluke ukuma, iphrofayili ukusebenza kwamanzi, injongo kanye nosayizi kwezinsimbi zomculo.

izinhlobo izibopho

Lezi zinhlobo ezilandelayo Ukugunda:

1. hemostatic igiya ngqo kanye nobude 15 kuya ku-20 cm, noma has a releasable ukukhiya isikulufa, nge notch etshekile Laphezu zokusebenza imihlathi. Imikhawulo nemihlathi zinamazinyo ngakolunye uhlangothi, kweyodwa begodu nakwezimbili ngakolunye uhlangothi. Ngesikhathi sokuvalwa enqabeni omunye namazinyo awe phakathi ezinye ezimbili.

2. notch transverse, bona ayafana ohlehliswe, kodwa ebusweni zokusebenza has a cutting transverse. Ezenziwe ngensimbi engagqwali, amaqabunga apholishiwe a bukhanye. Ubude kusuka 16 kuya ku-20 cm, kungaba ngokuqondile noma lwalugobile.

3. Neurosurgical hemostat "omiyane", engasindi, ubude 15.5 cm, has a isikulufa ukukhiya. Izipanji sesigabeni longitudinal esime a Isigaxa ufushanisiwe, surface yabo ukusebenza kuyinto notching mncane transverse. Iyatholakala agobile noma iqonde thwi kanye nendawo. Ikakhulu esetshenziselwa hemostasis emincane phakathi nezinqubo neurosurgical.

4. Izingane "omiyane" isakhiwo afana wangaphambilini, kodwa abe emihlathini ohlabayo. Ubude 12.5 cm, futhi iqonde futhi lwalugobile. Njengoba iklanyelwe i-angioplasty umuntu ingqondo arachnoid ekuhlinzeni ezingane, i ukusebenza kwezitho parenchymal.

5. besisu Deep, senzelwe hemostasis futhi Ligation semithambo e amanxeba ajulile. Ubude wabo 26 cm, izipanji abe ukuma aqonde, noma lwalugobile kanye nobude iDemo.

Isiqophi we "Mosquito" athwale amagama Halstead Ukugunda. Ezahlukene zokusebenza ebusweni esihle. изогнутый используется для новорожденных. Isiqeshana "Mosquito" izimisele esetshenziswa izinsana. небольших сосудов в процессе нейрохирургических операций. Nokobana hemostasis izitsha ezincane phakathi nokuhlinzwa neurosurgical.

Ngocingo Billroth ithumba futhi ekucindezela imithambo yegazi. Wayelethwa ukusebenza emihlathini engalibaleki futhi imbobo encane, futhi surface tapered ngaphandle. emihlathini Ejabulisayo ifakwe sebeziqhumbuza, okuholela izicubu ngaphansi abalimala.

Ngocingo Popper kuyinto ngocingo eside iqonde kuhlinzwa, okuyinto esetshenziswa operation nenyongo sesinye.

Njengoba isiqeshana sisetshenziswa?

Ngaphambi ukusebenza udokotela ohlinzayo kufanele uqobo hlola ekusebenzeni izibopho. Lokhu kuyiqiniso ikakhulu uma ekhipha ezinkulu. Ngokwesibonelo, ezedlulayo umsipha phrenic-esiswini, kunalokho, wenabisela kwesobunxele esiswini umthambo ngocingo okuyinto onesici, igcwele yokuphunyuka ekupheleni isitsha, okungaholela ukopha okubi kakhulu.

Indlela nakradyvat Ukugunda?

Ububanzi ingxenye mesentery (umsipha) ngezitsha yahlolwa therein kufanele kube inhlukanozigaba ukuba Uhlonze lwalo.

Khumbula lokhu okulandelayo:

- isiqu asele ka usayizi esikhulu nekrozirovat ukuthi kungabangela ubovu ukuvuvukala;

- okuvela elikhulu surface area deserozirovannoy kungaholela isifo ingcina;

- ligature, okuyinto esikhulu amafutha ngobuningi, kungenziwa iphazamiseke nganoma yisiphi isikhathi.

Ngezinye izigaba ezibucayi kakhulu nemisipha (the mesentery), yibo ngeke kususwe, ligatures neziqeshana kufanele abeke udokotela ohlinzayo ku izingxenye esikhiphekayo we mesentery abeke umsizi wabo.

Excision we umsipha noma we mesentery phakathi izibopho senziwa eduze kwendawo ukuthi uhlala. Umthamo isiqu asele kungcono ukwenza okuncane okwengeziwe, isebenze njengofakazi sokuthi ukuwohloka ngeke kwenzeke ligatures.

Izibopho futhi ligatures ku emisipheni Kunconywa ukusebenzisa engela kancane, njengoba lokhu kwandisa umthamo esiphunzini, futhi lokhu kusenza sibe esiqinile.BREAK nenkanuko edlulele ligatures.

Kukhona imithetho elandelayo, okumele ilandelwe:

1. Ukuze kube semikhawulweni ligatures, singakwazi ukudonsa. Ngakho bangakwazi Dabula ukuphela bomkhumbi.

2. Kufanele Sigubhe engela 40-50 degrees phakathi indiza ye sikelo izindwani buhlanjululwe Cooper kanye lokuluhlaza.

3. blade engezansi sikelo kuyadingeka ukuze aphumule inhlangano.

4. Ukuphela cut the ligature kumele singeqi 1-2 mm.

Hemostats for izilonda imikhawulo

Ukuhlukanisa isilonda kusukela isikhumba, ngokuvamile besebenzisa onenkotho hemostatic isiqeshana umugqa (1160 mm eside).

Amanxeba engajulile ezifanele ukusebenzisa ngqo. Kodwa ukubanjwa gauze amafutha ongama maningi efanelekayo hemostats agobile.

Lokugcina amathuluzi okuhlinza

Amathuluzi egcinwe endaweni evuthayo ezomile ezingeni lokushisa 15-20 ° C. Kumelwe kungabi egumbini elilodwa nabo izinto pair okuyinto ingadala ukugqwala of izinsimbi (formalin, i-iodine bleach).

Amathuluzi eyenzelwe lokhu ukusetshenziswa zibekwe amakhabethe, kanye ukuhlunga kubo ngohlobo futhi uya khona. Lezo ezenziwa carbon steel, ngesikhathi ezokuthutha okuqhubekayo noma isitoreji kusetshenzwe Vaseline hlangothi noma upharafini simboziwe. Kuze kube yimanje ongahluziwe jelly Incibilikile lokushisa 60-70 ° C, egxilile ke amathuluzi bese zihambisana ephepheni elenziwe bushelelezi.

Igrisi amathuluzi awekho ngaphansi kwezinto ezinelungelo ezilandelayo: insimbi engagqwali, aluminium, zethusi, ithusi. Ukulungiselela amathuluzi gcoba: degrease futhi Bilisa amanzi nge soda ngensipho namanzi, omisiwe, zihlolwe for nokugqwala, nokugqwala isuswe ngu wokucwebezelisa ekhona. Icubungula amathuluzi kuphela amagilavu kufanele sigcwaliswe, njengoba potozhirovye iminonjana kungaholela nokugqwala kumiswa.

Sixoxe ngokuningiliziwe yezokwelapha hemostatic isiqeshana, izinhlobo zayo, imithetho yokusetshenziswa futhi isitoreji.