电外科安全操作推荐指南.pptVIP

火灾危险因素 判断手术部位是否处于潜在富氧环境中 头颈部 口腔 胸腔 腹腔 (未灌洗过的肠道) 判断手术部位是否用过含易燃物质的 准备液 酒精 含酒精的准备液 当前第62页\共有66页\编于星期三\7点 在微创手术中导致的损伤 电容耦合 绝缘层破坏 电容耦合造成的损伤 微创手术电外科损伤 直接耦合 绝缘层破坏 电容耦合 如何避免微创手术中的电外科风险 保证绝缘层完整，任何破损必须更换 使用尽可能低的功率设置 使用低电压波形 (腔镜模式) 短时间的间断工作替代持续工作 工作电极的通道不可使用混合系统 当前第63页\共有66页\编于星期三\7点 目前医护人员的处境… 刷手护士 巡回护士 麻醉医生 手术医生 律 师 当前第64页\共有66页\编于星期三\7点 ？ 当前第65页\共有66页\编于星期三\7点 谢 谢 当前第66页\共有66页\编于星期三\7点 * * * * * Many electrosurgical units have two modes of functioning: monopolar (also called unipolar) and bipolar. This slide shows a monopolar circuit. In the monopolar mode, only the active electrode is in the operative wound. The return electrode is placed at some other location on the patient’s body. Current flows through the patient’s body, between the active electrode and the return electrode. Monopolar electrosurgery is used for tissue cutting, fulguration, and desiccation. Monopolar electrosurgery uses high voltage with voltage between 3000 volts and 9000 volts in coag and 1350 volts and 4000 volts in cut. * With the bipolar mode there are still two electrodes, an active and a return electrode. They are both incorporated into the same instrument. In this example, the current flows between the tips (simplistically, one is the active and the other is the return) of the bipolar forceps that are grasping tissue. Because the current flows from one tip (electrode), through tissue, to the other tip (electrode) the circuit is completed without current traveling through any other part of the patient’s body. A return electrode (pad) is not needed for a bipolar procedure. The tissue effect of bipolar electrosurgery, when forceps are used, is desiccation, because the tines of the forceps are in direct contact with the tissue. Other instrumentation is available that allows cutting during bipolar procedures. A benefit of bipolar electrosurgery is the use of lower voltage to push the current through the tissue. Because the forceps grasp only a small amount of tissue,