Txoj Kev Ua Haujlwm
(I) Kev Siv Tshuaj loog
Siv cov tshuaj loog brachial plexus block rau cov ceg sab saud, siv cov tshuaj loog epidural lossis subarachnoid block rau cov ceg sab qis, thiab siv tshuaj loog dav dav lossis tshuaj loog hauv zos raws li qhov tsim nyog.
(II) Txoj Haujlwm
Cov ceg sab saud: supine, lub luj tshib flexion, forearm nyob rau hauv pem hauv ntej ntawm lub hauv siab.
Cov ceg qis dua: pw, khoov lub duav, rub tawm, khoov lub hauv caug thiab pob qij txha pob qij txha hauv 90 degree dorsal extension position.
(III) Kev ua haujlwm ua ntu zus
Qhov kev ua haujlwm tshwj xeeb ntawm lub tshuab kho sab nraud yog kev hloov pauv ntawm kev teeb tsa dua, xov thiab kho.
[Txheej Txheem]
Uas yog, qhov tawg yog thawj zaug hloov chaw (kho qhov kev hloov pauv thiab kev sib tshooj ntawm qhov deformities), tom qab ntawd tho nrog cov pins distal rau kab tawg thiab pib kho, tom qab ntawd ntxiv hloov chaw thiab tho nrog cov pins proximal rau kab tawg, thiab thaum kawg hloov chaw kom txaus siab rau qhov tawg thiab tom qab ntawd kho tag nrho. Hauv qee kis tshwj xeeb, qhov tawg kuj tuaj yeem kho tau los ntawm kev pinning ncaj qha, thiab thaum qhov xwm txheej tso cai, qhov tawg tuaj yeem hloov chaw, kho thiab rov kho dua.
[Kev Txo Qhov Pob Txha]
Kev txo qhov pob txha tawg yog ib feem tseem ceeb ntawm kev kho pob txha tawg. Seb qhov pob txha tawg puas raug txo kom txaus siab puas muaj feem cuam tshuam ncaj qha rau qhov zoo ntawm kev kho pob txha tawg. Qhov pob txha tawg tuaj yeem kaw lossis pom ncaj qha raws li qhov xwm txheej tshwj xeeb. Nws kuj tseem tuaj yeem hloov kho raws li zaj duab xis X-ray tom qab cim qhov chaw ntawm lub cev. Cov txheej txheem tshwj xeeb yog raws li nram no.
1. Thaum pom tseeb: Rau cov pob txha tawg qhib uas muaj qhov kawg ntawm pob txha tawg, qhov pob txha tawg tuaj yeem rov pib dua thaum pom tseeb tom qab rho tawm tag nrho. Yog tias qhov pob txha tawg kaw tsis ua haujlwm, qhov pob txha tawg kuj tuaj yeem txo qis, tho thiab kho thaum pom tseeb tom qab phais me me li 3 ~ 5cm.
2. Txoj kev txo qis kaw: ua ntej ua qhov tawg rov qab zoo li qub thiab tom qab ntawd ua haujlwm raws li qhov sib law liag, tuaj yeem siv tus pin hlau ze ntawm kab tawg, thiab siv txoj kev tsa thiab wrenching los pab qhov tawg kom rov qab dua kom txog thaum nws txaus siab thiab tom qab ntawd kho. Nws kuj tseem ua tau los ua qhov kev hloov kho kom haum rau qhov kev hloov pauv me me lossis lub kaum sab xis raws li X-ray tom qab kwv yees txo thiab kho raws li lub cev nto lossis cov cim pob txha. Cov kev cai rau kev txo qhov tawg, hauv paus ntsiab lus, yog kev txo qis anatomical, tab sis qhov tawg loj heev, feem ntau tsis yooj yim los rov qab ua daim ntawv anatomical qub, lub sijhawm no qhov tawg yuav tsum muaj kev sib cuag zoo dua ntawm qhov tawg thaiv, thiab kom tswj tau qhov yuav tsum tau ua kom muaj zog zoo.
[Kev Sib Tw]
Kev siv txoj hlua khi yog txoj kev ua haujlwm tseem ceeb ntawm kev kho pob txha sab nraud, thiab txoj kev siv txoj hlua khi zoo lossis phem tsis yog tsuas yog cuam tshuam rau kev ruaj khov ntawm kev kho pob txha tawg xwb, tab sis kuj cuam tshuam rau qhov muaj mob ntau lossis tsawg. Yog li ntawd, cov txheej txheem ua haujlwm hauv qab no yuav tsum tau ua raws li thaum xaws koob.
1. Tsis txhob ua rau puas tsuaj ntxiv: Nkag siab txog qhov chaw tho qhov thiab tsis txhob ua rau cov hlab ntsha tseem ceeb thiab cov hlab ntsha raug mob.
2. Kev siv tshuaj tua kab mob nruj me ntsis, lub koob yuav tsum nyob deb li 2 ~ 3cm sab nraum thaj chaw mob.
3. Cov txheej txheem tsis mob hnyav: thaum hnav ib nrab koob thiab tuab tag nrho koob, qhov nkag thiab qhov tawm ntawm koob hlau nrog rab riam ntse kom ua qhov txiav tawv nqaij 0.5 ~ 1cm; thaum hnav ib nrab koob, siv cov forceps haemostatic los cais cov leeg thiab tom qab ntawd muab lub cannula thiab tom qab ntawd tho qhov. Tsis txhob siv lub zog ceev ceev thaum tho lossis ncaj qha xov koob. Tom qab xov koob, cov pob qij txha yuav tsum tau txav mus los xyuas seb puas muaj kev nruj ntawm daim tawv nqaij ntawm koob, thiab yog tias muaj kev nruj, daim tawv nqaij yuav tsum tau txiav thiab xaws.
4. Xaiv qhov chaw thiab lub kaum sab xis ntawm rab koob kom raug: rab koob yuav tsum tsis txhob hla dhau cov leeg nqaij me li sai tau, lossis rab koob yuav tsum tau ntxig rau hauv qhov sib txawv ntawm cov leeg nqaij: thaum rab koob raug ntxig rau hauv ib lub dav hlau, qhov deb ntawm cov koob hauv ib ntu tawg yuav tsum tsis pub tsawg dua 6 cm; thaum rab koob raug ntxig rau hauv ntau lub dav hlau, qhov deb ntawm cov koob hauv ib ntu tawg yuav tsum loj li sai tau. Qhov deb ntawm cov koob thiab kab tawg lossis qhov chaw sib koom ua ke yuav tsum tsis pub tsawg dua 2cm. Lub kaum sab xis hla ntawm cov koob hauv ntau lub dav hlau koob yuav tsum yog 25 ° ~ 80 ° rau cov koob puv thiab 60 ° ~ 80 ° rau ib nrab koob thiab cov koob puv.
5. Xaiv hom thiab txoj kab uas hla ntawm rab koob hlau kom raug.
6. Siv daim ntaub qhwv cawv thiab daim ntaub qhwv huv los qhwv lub qhov koob kom tiaj.
Qhov chaw ntawm rab koob nkag mus rau hauv lub cev sab nraud piv rau cov hlab ntsha ntawm sab caj npab sab saud (Qhov chaw uas pom hauv daim duab yog thaj chaw nyab xeeb rau kev xov rab koob.)
[Kev teeb tsa thiab kho]
Feem ntau, kev txo qhov tawg, kev ntsia hlau thiab kev kho yog ua tiav ib qho zuj zus, thiab kev kho tiav raws li qhov xav tau thaum cov hlau ntsia hlau uas tau teem tseg lawm tau raug tho. Cov pob txha tawg ruaj khov raug kho nrog kev nias (tab sis lub zog ntawm kev nias yuav tsum tsis txhob loj dhau, txwv tsis pub yuav muaj qhov tsis zoo li lub kaum sab xis), cov pob txha tawg uas raug sib tsoo raug kho rau hauv qhov chaw nruab nrab, thiab cov pob txha tsis zoo raug kho rau hauv qhov chaw cuam tshuam.
Kev zam ntawm kev kho kom zoo tag nrho yuav tsum tau them sai sai rau cov teeb meem hauv qab no: 1.
1. Sim qhov ruaj khov ntawm kev kho: txoj kev yog los tswj qhov sib koom ua ke, kos duab ntev lossis thawb sab nraud ntawm qhov kawg ntawm qhov tawg; qhov kawg ntawm qhov tawg ruaj khov yuav tsum tsis muaj kev ua ub no lossis tsuas yog me ntsis ntawm kev ua haujlwm elastic. Yog tias qhov ruaj khov tsis txaus, cov kev ntsuas tsim nyog tuaj yeem ua kom nce qhov ruaj khov tag nrho.
2. Qhov nrug ntawm tus kho pob txha sab nraud mus rau daim tawv nqaij: 2 ~ 3cm rau sab ceg sab saud, 3 ~ 5cm rau sab ceg qis, txhawm rau tiv thaiv kev nias ntawm daim tawv nqaij thiab pab kho qhov raug mob, thaum qhov o loj lossis qhov raug mob loj, qhov deb tuaj yeem tso kom loj dua thaum ntxov, thiab qhov deb tuaj yeem txo qis tom qab qhov o ploj mus thiab qhov raug mob tau kho.
3. Thaum muaj kev raug mob hnyav rau cov nqaij mos mos, qee qhov tuaj yeem ntxiv rau kom ceg raug mob dai lossis dai saum taub hau, txhawm rau pab kom ceg o thiab tiv thaiv kev raug mob los ntawm kev nias.
4. Tus kho pob txha sab nraud ntawm cov pob txha yuav tsum tsis txhob cuam tshuam rau kev ua haujlwm ntawm cov pob qij txha, qhov ceg qis yuav tsum yooj yim taug kev hauv qab lub nra hnyav, thiab qhov ceg sab saud yuav tsum yooj yim rau kev ua ub no txhua hnub thiab kev saib xyuas tus kheej.
5. Qhov kawg ntawm rab koob hlau tuaj yeem raug rau ntawm rab koob hlau li 1cm, thiab yuav tsum txiav tus tw ntev dhau ntawm rab koob tawm. Qhov kawg ntawm rab koob nrog lub hau yas lossis daim kab xev qhwv, kom tsis txhob tho qhov tawv nqaij lossis txiav daim tawv nqaij.
[Cov kauj ruam yuav tsum tau ua rau cov xwm txheej tshwj xeeb]
Rau cov neeg mob uas raug mob ntau yam, vim raug mob hnyav lossis raug mob hnyav thaum lub sijhawm ua kom rov qab muaj sia nyob, nrog rau thaum muaj xwm txheej ceev xws li kev pab thawj zaug hauv thaj teb lossis kev raug mob ntau zaus, lub koob tuaj yeem raug xov thiab ruaj ntseg ua ntej, thiab tom qab ntawd rov kho dua, kho, thiab ruaj ntseg thaum lub sijhawm tsim nyog.
[Cov Teeb Meem Feem Ntau]
1. Kab mob Pinhole; thiab
2. Kev puas tsuaj ntawm daim tawv nqaij; thiab
3. Kev raug mob ntawm cov hlab ntsha hauv lub paj hlwb
4. Kev kho mob qeeb lossis tsis kho qhov pob txha tawg.
5. Cov pins tawg
6. Kev tawg ntawm txoj hlab pas
7. Kev ua haujlwm tsis zoo ntawm cov pob qij txha
(IV) Kev kho mob tom qab phais
Kev kho mob tom qab phais mob zoo yuav cuam tshuam ncaj qha rau qhov ua tau zoo ntawm kev kho mob, yog tsis ua li ntawd ces yuav muaj teeb meem xws li kev kis kab mob ntawm qhov pob txha thiab pob txha tawg tsis sib koom ua ke. Yog li ntawd, yuav tsum tau ua tib zoo saib xyuas kom zoo.
[Kev kho mob dav dav]
Tom qab phais tas, yuav tsum tsa ceg uas raug mob kom siab, thiab yuav tsum saib xyuas cov ntshav ncig thiab o ntawm ceg uas raug mob; thaum daim tawv nqaij raug nias los ntawm cov khoom ntawm cov pob txha kho sab nraud vim qhov chaw lossis o ntawm ceg, yuav tsum tau kho raws sijhawm. Yuav tsum tau nruj cov ntsia hlau xoob raws sijhawm.
[Tiv thaiv thiab kho cov kab mob]
Rau kev kho pob txha sab nraud, tsis tas yuav siv tshuaj tua kab mob los tiv thaiv kev kis kab mob ntawm qhov pinhole. Txawm li cas los xij, qhov pob txha tawg thiab qhov txhab nws tus kheej tseem yuav tsum tau kho nrog tshuaj tua kab mob raws li qhov tsim nyog. Rau cov pob txha tawg qhib, txawm tias qhov txhab tau raug tshem tawm tag nrho, cov tshuaj tua kab mob yuav tsum tau siv rau 3 txog 7 hnub, thiab cov pob txha tawg uas kis kab mob yuav tsum tau muab tshuaj tua kab mob rau lub sijhawm ntev dua raws li qhov tsim nyog.
[Kev saib xyuas qhov pinhole]
Yuav tsum tau ua haujlwm ntxiv tom qab kho pob txha sab nraud kom saib xyuas cov qhov pinholes tas li. Kev saib xyuas qhov pinhole tsis raug yuav ua rau muaj kev kis kab mob ntawm qhov pinhole.
1. Feem ntau cov ntaub qhwv yuav tsum tau hloov ib zaug rau hnub thib 3 tom qab phais, thiab cov ntaub qhwv yuav tsum tau hloov txhua hnub thaum muaj dej ntws los ntawm lub qhov koob.
2. 10 hnub lossis li ntawd, daim tawv nqaij ntawm lub qhov pinhole yog fibrous qhwv, thaum ua kom daim tawv nqaij huv thiab qhuav, txhua 1 ~ 2 hnub hauv daim tawv nqaij pinhole tee ntawm 75% cawv lossis iodine fluoride kua tuaj yeem ua tau.
3. Thaum muaj kev nruj ntawm daim tawv nqaij ntawm lub qhov, sab nruj yuav tsum txiav kom raws sijhawm kom txo qhov nruj.
4. Ua tib zoo saib xyuas qhov kev ua haujlwm aseptic thaum kho qhov kho pob txha sab nraud lossis hloov qhov kev teeb tsa, thiab tua kab mob ntawm daim tawv nqaij nyob ib puag ncig lub qhov thiab rab koob hlau tsis tu ncua.
5. Tsis txhob muaj kev sib kis kab mob thaum lub sijhawm saib xyuas qhov pinhole.
6. Thaum muaj kab mob pinhole, yuav tsum tau phais kom raug raws sijhawm, thiab yuav tsum tsa ceg uas raug mob kom so thiab siv cov tshuaj tua kab mob kom raug.
[Kev tawm dag zog ua haujlwm]
Kev tawm dag zog kom raug thiab raws sijhawm tsis yog tsuas yog pab kom cov pob qij txha rov qab ua haujlwm xwb, tab sis kuj tseem pab kom cov ntshav rov qab zoo thiab txhawb kev ntxhov siab kom pab kho cov pob txha tawg. Feem ntau, cov leeg nqaij thiab cov pob qij txha tuaj yeem ua tau hauv txaj hauv 7 hnub tom qab phais. Cov ceg sab saud tuaj yeem tuav thiab tuav tes thiab txav tau ntawm lub dab teg thiab lub luj tshib, thiab kev tawm dag zog tig tau tuaj yeem pib 1 lub lim tiam tom qab; cov ceg sab hauv qab tuaj yeem tawm hauv txaj nrog kev pab los ntawm cov pas nrig tom qab 1 lub lim tiam lossis tom qab qhov txhab zoo lawm, thiab tom qab ntawd maj mam pib taug kev nrog lub cev hnyav tag nrho 3 lub lim tiam tom qab. Lub sijhawm thiab hom kev tawm dag zog ua haujlwm sib txawv ntawm ib tus neeg mus rau ib tus neeg, feem ntau nyob ntawm qhov chaw thiab lub cev. Thaum lub sijhawm tawm dag zog, yog tias qhov pinhole zoo li liab, o, mob thiab lwm yam kev o, yuav tsum tsum tsis txhob ua, tsa ceg uas raug mob mus pw.
[Tshem tawm cov khoom kho pob txha sab nraud]
Yuav tsum tshem tawm cov khoom siv kho sab nraud thaum qhov pob txha tawg tau mus txog cov qauv kho mob rau kev kho pob txha tawg. Thaum tshem tawm cov khoom siv kho pob txha sab nraud, lub zog kho ntawm qhov pob txha tawg yuav tsum tau txiav txim siab kom raug, thiab qhov kho pob txha sab nraud yuav tsum tsis txhob raug tshem tawm ua ntej lub sijhawm yam tsis muaj kev paub tseeb ntawm kev txiav txim siab lub zog kho ntawm pob txha thiab cov teeb meem pom tseeb ntawm qhov kho pob txha sab nraud, tshwj xeeb tshaj yog thaum kho cov mob xws li pob txha tawg qub, pob txha tawg me me, thiab pob txha tsis sib koom ua ke.
Lub sijhawm tshaj tawm: Lub Yim Hli-29-2024
