VI. Zotsatira za intraoperative kuchepetsa kutentha kwa thupi
(I) Zotsatira pa dongosolo la mtima
(II) Zotsatira za coagulation
Kufooka kwa mapulateleti kumachepetsa ntchito ya clotting factor, zomwe zimapangitsa kuti pakhale nthawi yayitali yotaya magazi ndikuwonjezera kuchuluka kwa magazi. Kutentha kochepa kumayambitsanso kusayenda kwa magazi m'mitsempha yamagazi, zomwe zingayambitse thrombosis yakuya mtsempha.
Kutentha kwa thupi kumakhala pansi pa 35 ° C, zizindikiro zotsatirazi zimatalika kwambiri ndi kutentha Zizindikiro zotsatirazi zimatalika kwambiri ndi kuchepa kwa kutentha:
Nthawi yokhazikika ya prothrombin (APTT)
Nthawi ya Prothrombin (PT)
Nthawi ya Prothrombin (TT)
(III) Kuchulukitsa kwa matenda ochekacheka
Kutsika kwa kutentha kwa thupi kumatha kusokoneza mwachindunji chitetezo cha mthupi, kuchepetsa kuperekedwa kwa okosijeni wamagazi pakhungu, ndi kaphatikizidwe ka mapuloteni ndi glial; nthawi yomweyo, kusapaka bwino kwa minyewa ya peri-incisional ndi kuchedwa kuchira kumabweretsa kuchuluka kwa kuchuluka kwa matenda a chilonda.
Kutentha kwa intraoperative pansi pa 35 ° C kunagwirizanitsidwa ndi kuwonjezeka katatu kwa matenda a bala ndi 20% nthawi yayitali m'chipatala.
Kuchokera kwa:Zhang Y. Care of perioperative hypothermia[J]. Xinjiang Chinese mankhwala,2011.29(04).92-94.Operating room unamwino 512
(IV)Kuchedwa kudzuka
-Kuchepa kwa magazi a visceral mu hypothermia
-Kuchepa kwa chiwindi kugwira ntchito
-Kuchepa kwa magazi a aimpso komanso kusefera kwa glomerular
-Slow mankhwala kagayidwe
Hypothermia imalepheretsa kugwira ntchito kwa minyewa yachifundo ndikuchepetsa kupanga kwa catecholamine, komwe kumachepetsa kuyankhidwa kwa thupi kuzinthu zakunja, pomwe mankhwala opha ululu amapangidwa m'thupi pang'onopang'ono, zomwe zimapangitsa kuti pakhale nthawi yotalikirapo kugalamuka ndi kutuluka.
(V) Kusokonezeka kwa metabolic
Zimakhudza kagayidwe ka thupi
-Kusayenda bwino kwa minyewa
- Acidosis, kusalinganika kwa electrolyte
-Kusokonekera kwa chitetezo chamthupi
-Kuchulukitsa kagwiritsidwe ntchito ka oxygen mthupi
-Kusintha kwa chilengedwe chamkati
Hypothermia imachepetsa kagayidwe kachakudya m'thupi, ndipo pa 1C iliyonse yotsika kutentha kwa thupi, kagayidwe kake kamachepa ndi 6%. Pa kutentha kwa thupi 28C, kagayidwe kachakudya ndi 50% yachibadwa.
Kuchokera kwa:Yu Dingning,Li Duo,Kuopsa kwa hypothermia ndi chithandizo chake[J]. Overseas Medicine: Opaleshoni Yachilendo Mankhwala: Opaleshoni,2004,31 (5): 258-261.
VII.Njira zodziwira kutentha kwa thupi panthawi ya opaleshoni
M'malo mwake, kusiyana pakati pa kutentha kwapakati ndi thupi kumakhala kovuta kuyerekeza popanda kulumikizana kwa mzere, chifukwa chake tikulimbikitsidwa kugwiritsa ntchito chowunikira chapabowo kuti muzindikire kutentha kwapakati pazifukwa zololeza.
VIII.Kupewa kwa perioperative hypothermia ndi chisamaliro
(I) Kuthandizira chisamaliro chamaganizo
Ulendo usanayambike (kuwunika):
Kupyolera mu ulendo wa preoperative, mkhalidwe wa wodwalayo umayesedwa mokwanira, kupanga matenda a unamwino, kupereka ndondomeko ya unamwino, kukonzekera mokwanira, ndikugwiritsa ntchito njira zowotha pa tsiku la opaleshoni
kupewa hypothermia.
Pa nthawi yomweyo, kudzera preoperative ulendo, kuonjezera namwino-odwala kuzolowera, zomwe zimathandiza kuti bwino kulankhulana pakati anamwino ndi odwala. kuzindikira, zomwe zimathandiza kuti azilankhulana bwino pakati pa odwala ndi anamwino komanso amachepetsa mantha a odwala. mantha a odwala ndi kutsitsa malire awo kuti azizizira. Pakhomo la wodwalayo pakukondoweza kozizira kudzatsitsidwa.
(II)Kutentha kwa chilengedwe
Kutentha koyendetsedwa bwino ndi 21-25 ° C. Kusunga chinyezi pa 30-60%
Kusunga kutentha koyenera ndi chinyezi kungachepetse kutentha kwa khungu ndipo ndi njira yabwino yopewera hypothermia.
Kutentha ndi chinyezi cha chipinda chopangira opaleshoni kumayendetsedwa ndi mpweya wapakati, kutentha kwa chipindacho kudzasinthidwa mpaka 25 ° C musanayambe opaleshoni ya wodwalayo, ndipo pokhapokha atayamba ntchitoyo idzasinthidwa mpaka 21-23 ° C. Zimatsimikiziridwa kuti wodwalayo sangakhudzidwe ndi chilengedwe chomwe chimakhudza kusintha kwa kutentha kwa thupi.
(III) Kutentha kwamadzi
A. Madzi olowetsedwa omwe atenthedwa kufika 37°C:
Saline yakuthupi kapena madzi a jakisoni omwe amagwiritsidwa ntchito pophera tizilombo pakhungu ndikutsuka amayikidwa mu thermostat ndikusinthidwa mpaka 37°C. Chotsani mu thermostat musanagwiritse ntchito kuti muchepetse kutentha kwa thupi.
B. Kugwiritsa ntchito madzi otenthetsera pothiridwa magazi:
Popereka magazi ambiri, chipangizo chotenthetsera magazi chidzagwiritsidwa ntchito kuonetsetsa kuti madzi omwe amalowa m'thupi la wodwalayo ali pafupi ndi kutentha kwa thupi la wodwalayo.
(IV) Gwiritsani ntchito zida zotsekereza
Chofunda chofewa chofewa chimagwiritsidwa ntchito kuphimba malo osapangira opaleshoni, kugwiritsa ntchito kutentha kwina kwa kutentha kwa thupi la mpweya wothamanga kwambiri kumagwiritsidwa ntchito pamwamba pa thupi kuonjezera kutentha kwa thupi la wodwalayo, kuchepetsa kutentha kwamkati kumalo otsika kutentha, ndikuchita gawo la kudzipatula kwa thupi ndi malo ozizira ozungulira, kutentha kwa khungu la transdermal.
(V) Kuchepetsa nthawi yowonekera pakuyika kosintha malo
A. Pangani njira yokhazikika yoyika malo kuti muchepetse nthawi yowonekera pakusintha kwamalo
B.Positioning for Specialized Surgical Positions
Orthopaedics: malo okhazikika
Thoracic: malo okhala m’mbali
Urology: Malo ogona m’mbali
Lithotomy → makonda malo: percutaneous nephrolithotomy (PCNL), etc.
(VI)Kuletsa madzi
Pewani kapena kuchepetsa kulowetsedwa kwa mapepala.
Phimbani pepala losabala ndi thumba la pulasitiki (ngati silikuwononga komanso kukhudza malo opangira opaleshoni).
Pewani kulowetsedwa kwa wodwalayo ndi nsalu za bedi ndi ma rinses ambiri panthawi ya opaleshoni.
Kwa maopaleshoni omwe amafunikira madzi ambiri onunkhira, monga maopaleshoni a urological (prostate electrocision, percutaneous nephrolithotomy, etc.), Opaleshoni yotsegula (otsegula kwambiri chithandizo cha khansa ya m'matumbo, kutulutsa chiwindi, ndi zina zambiri), opaleshoni ya khansa yachikazi, ndi zina zambiri.
Chidule:
Chodabwitsa cha intraoperative hypothermia pang'onopang'ono kukopa chidwi cha ogwira ntchito zachipatala kudzera kulamulira thupi pamwamba ndi thupi patsekeke kutentha dissipation isanayambe ndi pa opaleshoni, ndi kutengera zosiyanasiyana unamwino miyeso kulenga omasuka mkati ndi kunja thupi chilengedwe akhoza mogwira kuteteza intraoperative hypothermia odwala. Kuchepetsa Kukhoza kuchepetsa mavuto ambiri omwe amayamba chifukwa cha hypothermia, kuchepetsa ululu wa odwala, kuchepetsa tsiku logonekedwa kuchipatala, komanso kuchepetsa mtengo wamankhwala wa odwala, zomwe zimathandiza kuti ayambe kuchira.
Ulalo wankhani yam'mbuyo: https://www.mecanmedical.com/Prevention-and-Care-of-Intraoperative-Hypothermia-Part-1-id61252817.html
