VI. Liphello tsa phokotso ea mocheso oa 'mele oa intraoperative
(I) Liphello tsamaisong ea pelo
(II)Liphello ho coagulation
Ts'ebetso e fokolang ea platelet e fokotsa ts'ebetso ea 'clotting factor', e lebisang ho nako e telele ea mali le ho eketsa ho tsoa mali. Mocheso o tlase o boetse o lebisa ho thekeng ha mali ho thekeng ha mali methapong, e ka bakang thrombosis e tebileng ea mothapo habonolo.
Mocheso oa 'mele o ka tlase ho 35 ° C, matšoao a latelang a lelefalitsoe haholo le mocheso Matšoao a latelang a lelefalitsoe haholo ka mocheso o fokotsehang:
Nako ea prothrombin e kentsoeng hanyane ka hanyane (APTT)
Nako ea Prothrombin (PT)
Nako ea Prothrombin (TT)
(III) Ho eketseha ha tšoaetso ea ho seha
Mocheso o tlase oa 'mele o ka senya ts'ebetso ea' mele oa 'mele ka ho toba, oa fokotsa phepelo ea oksijene ea mali letlalong, le protheine le glial synthesis; ka nako e ts'oanang, pholiso e mpe ea li-tissue tsa peri-incisional le ho lieha ho fola ho lebisa ho sekhahla se eketsehileng sa Tekanyo ea tšoaetso ea maqeba ea eketseha.
Lithempereichara tsa intraoperative tse ka tlase ho 35 ° C li ne li amahanngoa le keketseho ea makhetlo a mararo ea tšoaetso ea maqeba le ho lula sepetlele nako e telele ka 20%.
E nkiloeng ho:Zhang Y. Tlhokomelo ea perioperative hypothermia[J]. Xinjiang meriana ea Sechaena,2011.29(04) .92-94.Operating room booking 512
(IV)Ho lieha ho tsoha
- Fokotsa phallo ea mali ea visceral ka hypothermia
-Ho fokotseha ha mosebetsi oa sebete
- Fokotsa phallo ea mali ea renal le sekhahla sa tlhoekiso ea glomerular
-Ho fokotsa metabolism ea lithethefatsi
Hypothermia e thibela ts'ebetso ea methapo ea kutlo mme e fokotsa tlhahiso ea catecholamine, e fokolisang karabelo ea 'mele ho ts'usumetso e kantle, ha li-anesthetics li kenngoa' meleng butle, e leng se etsang hore ho be le nako e telele ea ho falimeha le ho phatloha.
(V) Bothata ba metabolism
E ama metabolism ea 'mele
-Ho tsamaea butle ha methapo
- Acidosis, ho se leka-lekane ha electrolyte
-Ho se sebetse hantle ha mmele
- Keketseho ea tšebeliso ea oksijene 'meleng
-Liphetoho tikolohong ea ka hare
Hypothermia e fokotsa sekhahla sa metabolism ea 'mele, 'me bakeng sa mocheso o mong le o mong o tlase oa 1C, sekhahla sa metabolism se fokotseha ka 6%. Ka mocheso oa 'mele oa 28C, sekhahla sa metabolism ke 50% ea se tloaelehileng.
E nkiloe ho:Yu Dingning,Li Duo,Kotsi ea hypothermia le phekolo ea eona[J]. Meriana ea Linaheng Tsa Maoatle: Ho Buoa Meriana ea Kantle ho Naha: Ho buuoa,2004,31 (5): 258-261.
VII.Mekhoa ea ho lemoha mocheso oa 'mele nakong ea ho buuoa
Ha e le hantle, phapang pakeng tsa mocheso oa mantlha le mocheso oa 'mele ho thata ho hakanya ntle le kamano e haufi, kahoo ho kgothaletswa ho sebelisa mochine oa ho hlahloba' mele oa 'mele ho lemoha mocheso oa mantlha oa' mele ha maemo a lumela.
VIII.Thibelo ea perioperative hypothermia le tlhokomelo
(I) Mehato ea tlhokomelo ea kelello
Ketelo ea pele ho ts'ebetso (tekolo):
Ka ketelo ea pele ho opereishene, boemo ba mokuli ke tlhahlobo e lekaneng, ho etsa tlhahlobo ea booki, ho etsa tlhahiso ea moralo oa booki, ho etsa litokisetso tse lekaneng, le ho kenya tšebetsong mehato ea ho futhumala ha letsatsi la opereishene.
thibela hypothermia.
Ka nako e ts'oanang, ka ketelo ea pele ho ts'ebetso, eketsa tsebo ea mooki-mokuli, e leng se loketseng puisano e ntle pakeng tsa baoki le bakuli. kananelo, e thusang puisanong e ntlafetseng pakeng tsa bakuli le baoki le ho fokotsa ho tšoha ha bakuli. ho tšoha ha bakuli le ho theola moeli oa bona bakeng sa tšusumetso e batang. Mohaho oa mokuli oa ho susumetsa serame o tla fokotseha.
(II)Mocheso oa tikoloho
Mocheso oa kamore o laoloang ka matla ke 21-25°C. Ho boloka mongobo ho 30-60%
Ho boloka mocheso o nepahetseng le mongobo ho ka fokotsa tahlehelo ea mocheso letlalong mme ke tsela e sebetsang ea ho thibela hypothermia.
Mocheso le mongobo oa kamore ea ts'ebetso li laoloa ke setsi sa moea se bohareng, mocheso oa kamore o tla fetoloa ho 25 ° C pele ho qala ts'ebetso ea mokuli, 'me feela ka mor'a ho qala ts'ebetso e tla fetoloa ho 21-23 ° C. Ho tiisetsoa hore mokuli a ke ke a angoa ke tikoloho e amang phetoho ea mocheso oa 'mele.
(III) Ho futhumala ha metsi
A. Mekelikeli e tšeloa a futhumetse ho fihla ho 37°C:
Letsoai la 'mele kapa metsi a ente a sebelisetsoang ho bolaea likokoana-hloko letlalong le ho hlatsoa a kenngoa ka har'a thermostat 'me a lokisetsoe ho 37°C. E ntše ho thermostat pele e sebelisoa ho fokotsa tahlehelo ea mocheso oa 'mele.
B. Tšebeliso ea metsi a futhumetseng nakong ea tšelo ea mali:
Ha ho etsoa tšelo ea mali e ngata, ho tla sebelisoa sesebelisoa sa ho futhumatsa mali ho etsa bonnete ba hore mokelikeli o kentsoeng 'meleng oa mokuli o haufi le mocheso oa' mele oa mokuli.
(IV) Sebelisa thepa ea ho itšireletsa
Kobo e bonolo e nang le inflatable e sebelisoa ho koahela sebaka seo e seng sa ho buoa, ho sebelisa mocheso o itseng mochesong oa 'mele oa khase e phahameng ea convection e sebelisoa holim'a' mele ho eketsa mocheso oa holim'a 'mele oa mokuli, ho fokotsa mocheso o ka hare ho mocheso o tlase oa mocheso, le ho bapala karolo ea ho arola 'mele le tikoloho e batang e potolohileng, transdermal letlalo le futhumatsang.
(V) Nako e fokotsehileng ea ho pepeseha bakeng sa ho beoa ha maemo
A. Theha mokhoa o tloaelehileng oa ho beha maemo ho fokotsa nako ea ho pepeseha bakeng sa liphetoho tsa boemo
B.Positioning for Specialized Surgical Positions
Orthopedics: boemo bo tloaelehileng
Thoracic/ Boemo ba ho robala ka lehlakore
Urology: Boemo ba ho robala ka lehlakore
Lithotomy → boemo bo tloaelehileng: percutaneous nephrolithotomy (PCNL), joalo-joalo.
(VI)Ho thibela metsi
Qoba kapa u fokotse ho koloba ha maqephe.
Koahela lakane e sa hloekang ka mokotla oa mokotla oa polasetiki (ha feela e sa silafatse le ho ama lebala la ho buoa).
Thibela ho soasoa ha mokuli le line ea bethe ka li-rinse tse ngata nakong ea ho buuoa.
Bakeng sa liopereishene tse hlokang metsi a mangata a nkhang hamonate, joalo ka opereishene ea urological (prostate electrocision, percutaneous nephrolithotomy, joalo-joalo), Opereishene e bulehileng (phekolo e bulehileng ea mofets'e oa mala, ts'ebetso ea sebete, joalo-joalo), opereishene ea mofets'e, jj.
Kakaretso:
Ketsahalo ea hypothermia ea intraoperative e 'nile ea hohela tlhokomelo ea basebetsi ba kliniki butle-butle ka mocheso oa' mele o laolang le mocheso oa mocheso oa 'mele pele le nakong ea opereishene,' me ho nka mehato e fapaneng ea booki ho theha tikoloho e ntle ea 'mele ea ka hare le ea ka ntle e ka thibela ka katleho hypothermia ea intraoperative ho bakuli. E fokotsehile E ka fokotsa mathata a mangata a bakoang ke hypothermia, ho kokobetsa bohloko ba bakuli, ho khutsufatsa letsatsi la ho kena sepetlele, le ho fokotsa litšenyehelo tsa bongaka tsa bakuli, e leng se loketseng ho hlaphoheloa kapele.
Sehokelo sa sengoloa se fetileng: https://www.mecanmedical.com/Prevention-and-Care-of-Intraoperative-Hypothermia-Part-1-id61252817.html
