VI. Migumisiro ye intraoperative kuderedza kupisa kwemuviri
(Ini) Mhedzisiro pamoyo wemoyo system
(II) Mhedzisiro pane coagulation
Kupera simba kweplatelet basa kunoderedza clotting factor basa, zvichiita kuti ropa riwedzere nguva uye kuwedzera kuwanda kwekubuda ropa. Tembiricha yakaderera zvakare inotungamira mukudzika kweropa mukudzika kweropa mutsinga, izvo zvinogona kukonzera yakadzika vein thrombosis nyore.
Tembiricha yemuviri iri pazasi 35 ° C, zvinotevera zviratidzo zvinorebesa kurebesa tembiricha Zviratidzo zvinotevera zvinorebesa zvakanyanya nekudzikira tembiricha:
Partially activated prothrombin time (APTT)
Prothrombin nguva (PT)
Prothrombin nguva (TT)
(III) Kuwedzera kwezvirwere zvekucheka
Kudzika kwekushisa kwemuviri kunogona kukanganisa zvakananga maitiro ekudzivirira muviri, kuderedza kugoverwa kweokisijeni yeropa paganda, uye mapuroteni uye glial synthesis; panguva imwecheteyo, kusvibiswa kusina kunaka kwe-peri-incisional tissues uye kunonoka kupora kupora kunotungamirira kukuwedzera kwehuwandu hwehuwandu hwehutachiona hwemaronda hunowedzera.
Intraoperative tembiricha iri pasi pe35 ° C yakabatanidzwa nekuwedzera katatu kwehutachiona hwemaronda uye 20% kwenguva refu yekugara muchipatara.
Zvakatorwa kubva ku:Zhang Y. Care of perioperative hypothermia[J]. Xinjiang Chinese mushonga,2011.29(04).92-94.Operating room nursing 512
(IV)Kunonoka kumuka
-Kuderera kweropa re visceral mu hypothermia
-Kuderera kwechiropa kushanda
-Kuderedzwa renal kuyerera kweropa uye glomerular filtration rate
-Slower zvinodhaka metabolism
Hypothermia inhibisa tsinga dzinonzwira tsitsi uye inoderedza kugadzirwa kwekatecholamine, iyo inonetesa mhinduro yemuviri kune yekunze kukurudzira, nepo anesthetics inogadziriswa mumuviri zvishoma nezvishoma, zvichikonzera nguva yakati rebei yekumuka uye extubation.
(V) Metabolic disorder
Inokanganisa metabolism yemuviri
-Sloved nerve conduction
Acidosis, kusaenzana kwe electrolyte
-Kusashanda zvakanaka kwemuviri
-Kuwedzera kushandiswa kweokisijeni mumuviri
-Kuchinja kwemukati nharaunda
Hypothermia inoderedza mwero wemetabolism yemuviri, uye kune yega yega tembiricha ye1C yakaderera, mwero wemetabolism unoderedzwa ne6%. Pakupisa kwemuviri kwe28C, metabolic rate i50% yezvakajairwa.
Yakatorwa kubva:Yu Dingning,Li Duo,Njodzi ye hypothermia uye kurapwa kwayo[J]. Overseas Medicine: Kuvhiya Mushonga Wekunze:Kuvhiya,2004,31(5):258-261.
VII.Nzira dzekuona kupisa kwemuviri panguva yekuvhiyiwa
Muchokwadi, mutsauko uripo pakati pepakati uye tembiricha yepamusoro yemuviri wakaoma kufungidzira pasina hukama hwemutsara, saka zvinokurudzirwa kushandisa cheki chemuviri chemukati chekuongorora kunyatsoona tembiricha yemuviri kana mamiriro achibvumidza.
VIII.Kudzivirira kweperioperative hypothermia uye kutarisira
(I) Kupindira kwekuchengetwa kwepfungwa
Pre-operative kushanya (kuongorora):
Kuburikidza nekushanya kwepreoperative, mamiriro emurwere anoongororwa zvakakwana, kuita chirwere chemukoti, kupa zano reukoti, kuita gadziriro yakakwana, uye kuita matanho ekudziya pazuva rekuvhiyiwa.
kudzivirira hypothermia.
Panguva imwecheteyo, kuburikidza nekushanya kwepreoperative, wedzera ruzivo rwemukoti-murwere, izvo zvinobatsira pakukurukurirana zviri nani pakati pevanamukoti nevarwere. kuzivikanwa, izvo zvinobatsira pakukurukurirana zviri nani pakati pevarwere nevakoti uye kunoderedza kutya kwevarwere. kutya kwevarwere uye kudzikisa chikumbaridzo chavo chekukurudzira kutonhora. Chikumbaridzo chemurwere chekukurudzira kutonhora chichaderedzwa.
(II)Tembiricha yezvakatipoteredza
Dynamically yakadzorwa tembiricha yekamuri 21-25°C. Kuchengetedza humidity pa 30-60%
Kuchengetedza tembiricha yakakodzera uye hunyoro kunogona kuderedza kupisa kubva paganda uye inzira inoshanda yekudzivirira hypothermia.
Kupisa uye kunyorova kwekamuri yekushanda kunodzorwa nechepakati pemhepo, kutonhora kwekamuri kuchagadziriswa kusvika 25 ° C kusati kwatanga kushanda kwemurwere, uye chete mushure mekutanga kwekushanda kuchagadziriswa kusvika 21-23 ° C. Inovimbiswa kuti murwere haazokanganiswa nemamiriro ezvinhu anokanganisa kuchinja kwekushisa kwemuviri.
(III) Kudziya kwemvura
A. Infusion zvinwiwa zvinodziya kusvika 37°C:
Physiological saline kana mvura yejekiseni inoshandiswa kuuraya utachiona paganda uye kugezeswa inoiswa mu thermostat uye inogadziridzwa kusvika 37°C. Bvisa mu thermostat usati washandisa kuderedza kurasikirwa nekupisa kwemuviri.
B. Kushandisa infusion inodziya panguva yekuwedzerwa ropa:
Pakuisira ropa rakawanda, muchina wekudziya weropa uchashandiswa kuona kuti mvura inenge yaiswa mumuviri wemurwere iri pedyo nekupisa kwemuviri wemurwere.
(IV) Shandisa midziyo yekudzivirira
Gumbeze rakapfava rinoputira rinoshandiswa kufukidza iyo isiri yekuvhiya nzvimbo, kushandisa imwe tembiricha kumuviri wepamusoro tembiricha yemhepo yakakwira yekuchinjisa gasi inoiswa kumuviri wepamusoro kuwedzera tembiricha yemuviri wemurwere, kuderedza kupisa kwemukati kune yakadzika tembiricha nharaunda, uye kutamba basa rekuparadzanisa muviri uye yakatenderedza nharaunda inotonhora, transdermal ganda rinoshanda kupisa.
(V) Yakaderedzwa kuratidzwa nguva yekuiswa kwechinzvimbo chekuchinja
A.Kugadzira yakamisikidzwa nzvimbo yekuisa maitiro ekudzikisa kuratidzwa nguva yekuchinja kwenzvimbo
B.Positioning for Specialized Surgical Positions
Orthopaedics: nzvimbo yakakombama
Thoracic: kudivi-kurara chinzvimbo
Urology: Side-yenhema chinzvimbo
Lithotomy → prone position: percutaneous nephrolithotomy (PCNL), nezvimwewo.
(VI)Kudzivirira mvura
Dzivisa kana kuderedza kunyura kwemashizha.
Fukidza pepa risingaiti nemucheka wepurasitiki (chero bedzi isingasvibisi uye inokanganisa nzvimbo yekuvhiya).
Kudzivirira kunyura kwemurwere uye mubhedha werineni nehuwandu hwakawanda hwema rinses panguva yekuvhiyiwa.
Kuvhiya kunoda kuwanda kwemvura inonhuhwirira, sekuvhiyiwa kweurological (prostate electrocision, percutaneous nephrolithotomy, zvichingodaro), Kuvhiya kwakavhurika (kuvhurika radical kurapwa kwegomarara remudumbu, kubviswa kwechiropa, nezvimwewo), kuvhiyiwa kwegomarara revakadzi, nezvimwe.
Pfupiso:
Chiitiko che intraoperative hypothermia chave chichikwezva zvishoma nezvishoma kutarisa kwevashandi vekiriniki kuburikidza nekudzora muviri wepamusoro uye mhango yemuviri kupisa kupisa kusati kwaitika uye panguva yekuvhiyiwa, uye kutora matanho akasiyana-siyana ekuyamwisa kuti agadzire nzvimbo yakasununguka yemukati nekunze kwemuviri inogona kudzivirira zvakasimba intraoperative hypothermia muvarwere. Yakaderedzwa Inogona kuderedza matambudziko akawanda anokonzerwa ne hypothermia, kuderedza marwadzo evarwere, kupfupisa zuva rekuiswa muchipatara, uye kuderedza mari yekurapa yevarwere, iyo inobatsira kukurumidza kupora.
Nyaya yapfuura link: https://www.mecanmedical.com/Prevention-and-Care-of-Intraoperative-Hypothermia-Part-1-id61252817.html
