Electrosurgery yog siv txoj hauv kev kho qhov muag kom txiav, coagulate, dissect, fulgurate, ablate thiab ntsws cov ntaub so ntswg. Loj qhov siab (100 kilohertz txog 5 megahertz), hloov hluav taws xob ntawm ntau qhov hluav taws xob (200-10,000 Volts) tau dhau los ntawm cov nqaij mos ua kom muaj cua sov. Ib chav ntsuas hluav taws xob (ESU) muaj lub tshuab hluav taws xob thiab cov khoom siv tes nrog ib lossis ntau qhov hluav taws xob. Cov cuab yeej tswj tau raug siv los hloov ntawm tus tes lossis lub pob nyem hloov.
Cov tshuab hluav taws xob tshuab hluav taws xob tuaj yeem tsim hluav taws xob ntau. Raws li cov kev hloov pauv no, yog li ua lub ntsej muag cuam tshuam cov ntaub so ntswg.
Hauv bipolar electrosurgery (Daim Duab 1), ob qhov nquag ua haujlwm electrode thiab rov qab electrode tso haujlwm tau nyob ntawm thaj chaw phais. Ob lub tswv yim ntawm forceps ua cov nquag thiab rov qab electrode zog. Tsuas yog cov ntaub so ntswg ua kom zoo hauv lub forceps suav nrog hauv hluav taws xob hluav taws xob. Vim tias qhov ua haujlwm rov qab yog ua los ntawm ib qho ntawm lub quab yuam, tsis muaj tus neeg mob rov qab electrode ntxiv. Bipolar electrosurgery ua haujlwm tsis hais txog qhov nruab nrab uas nws siv, tso cai rau coagulation hauv dej ib puag ncig - ib qho txiaj ntsig zoo thaum sim ua kom coagulate hauv thaj chaw ntub dej. Raws li qhov tshwm sim, bipolar electrosurgery feem ntau hu ua 'thaj chaw ntub dej' ceev faj.
Hauv monopolar electrosurgery (daim duab 2), lub tshuab hluav taws xob nquag tau muab tso rau ntawm qhov chaw phais mob. Tus neeg mob rov qab electrode (tseem hu ua 'dispersive ncoo' tso rau lwm qhov chaw ntawm tus neeg mob' s lub cev. Qhov tam sim no dhau los ntawm tus neeg mob vim nws ua tiav Circuit Court los ntawm cov hluav taws xob nquag mus rau tus neeg mob rov qab electrode. ntawm tus neeg mob rov qab electrode yog tshem tawm tam sim no los ntawm tus neeg mob kom zoo .Txoj hluav taws xob rov qab yuav tshwm sim yog tias cov cua sov ua, dhau sijhawm, tsis muaj kev nyab xeeb los ntawm qhov loj me lossis kev coj ntawm tus neeg mob rov qab electrode.
Lub tshuab hluav taws xob niaj hnub no tau tsim kho kom muaj kev nyab xeeb los tiv thaiv qhov kub nyhiab vim tias kev tiv thaiv tsis zoo ntawm tus neeg mob thiab cov hluav taws xob rov qab thaum siv hom monopolar.
Feem ntau, lo lus 'hluav taws xob hluav taws xob' tsis raug siv los piav qhia txog kev xoo hluav taws xob. Electrocautery hais txog qhov ncaj qha tam sim no (hluav taws xob ntws mus rau ib qho kev taw qhia) hos cov electroururgery siv tam sim no sib hloov. Hauv kev siv tshuab hluav taws xob, tus neeg mob tau suav nrog hauv Circuit Court thiab tam sim no nkag mus rau tus neeg mob' s lub cev. Thaum hluav taws xob hluav taws xob, tam sim no tsis nkag mus rau tus neeg mob' s lub cev. Hloov chaw, tam sim no ntws los ntawm cov cua kub, uas hlawv cov ntaub so ntswg los ntawm kev hloov tshav kub ncaj qha. Electrocautery lossis, ntau dua, cov thawv sov ua kom sov (Daim Duab 3) feem ntau siv tau cov roj teeb txawb tau siv tau uas muaj peev xwm muab pov tseg lossis rov siv tau.
Mus rau:
Siv ESU yam xyuam xim
ESUs tsim cov khoom siv hluav taws xob ntau heev uas tuaj yeem raug mob rau cov neeg mob thiab cov neeg ua haujlwm yog tias tsis siv thiab tswj. Ntau yam teeb meem tau cuam tshuam nrog kev siv ESUs, xws li kub hnyiab ntawm qhov chaw xa hluav taws xob rov qab thiab hluav taws kub phais. Qee qhov kev nyab xeeb muaj peev xwm yuav zam tau los ntawm kev ua tib zoo saib xyuas yooj yim.
Dos
Cov tes ntxuav tes yuav tsum tau muab tso rau hauv qhov tsis xws li lub ntsej muag thaum tsis siv.
Yuav tsum siv cov tshuab hluav taws xob qis tshaj plaws uas yuav ua tiav cov nyhuv xav tau phais. Thaum siab dua qhov tsim nyog siv cov kev ntsuas yog siv, qhov ntau ntawm qhov arcing tau nce. Yog tias tus kws phais neeg txuas ntxiv thov kom muaj chaw siab dua, qhov no tuaj yeem ua lub cim taw qhia tias qhov ncaj ncees ntawm daim tawv nqaij / cov nplaim hluav taws xob sib kis tau zoo.
So lub electrode taub ntau. Raws li eschar (cov ntaub so ntswg tuag los ntawm hlawv) ua rau lub taub, hluav taws xob cuam tshuam ntau ntxiv thiab qhov no tuaj yeem ua rau arcing, tawg lossis taws thiab nplaim taws ntawm eschar. Thaum ntxuav cov electrode, cov eschar yuav tsum tau muab so kom tsis txhob siv daim txhuam cev zoo dua li ntawm cov ntaub qhwv to txhawm rau, vim tias cov ntaub qhwv no yuav kos cov zawj rau hauv cov electrode taub, nce eschar txhim kho.
Cov ntaub ntawv sab nraud uas tuav daim duab, ua piv txwv, thiab lwm yam.
Don' ts
ESUs yuav tsum tsis txhob siv nyob rau hauv qhov muaj cov pa luam yeeb lossis hauv cov pa oxygen-enriched ib puag ncig.
Zam kev siv cov tshuaj lom neeg uas tuaj yeem tiv los ntawm cov txim taws, xws li dej cawv thiab cov tawv nqaij ua paug. Yog tias koj yuav tsum siv cov tshuaj pleev xim rau tawv nqaij kom huv si, tsis txhob cia lawv mus pas dej ze rau qhov chaw uas tsis zoo; Nco ntsoov tias cov tshuaj npaj tau yog ua kom qhuav thiab pa taws tau dissipated ua ntej ESU ua kom.
Cov yeeb yaj kiab roj hmab roj hmab lossis lwm cov khoom siv yuav tsum tsis txhob siv los ua cov hnab riam ntawm cov khoom siv hluav taws xob zoo.
Cov kab hluav taws xob yuav tsum tsis txhob qhwv ib ncig ntawm cov twj siv hlau, vim tias qhov tam sim no uas nkag los ntawm lawv tuaj yeem hla mus rau hauv cov cuab yeej hlau, ua rau kub nyhiab.
Tsis txhob siv cov phuam da dej ntse los yog cov cuab yeej hlau los txuas cov hlua rau ntawm daim ntaub. Cov hlau ntse ntse tuaj yeem tsim kev puas tsuaj hluav taws xob xaim hluav taws xob lossis muab qhov chaw tsis xav tau ntawm tus neeg mob' s tawv nqaij Overlapping hluav taws xob
ib qho xaim nyob ib ncig ntawm cov yeeb yaj kiab hlau tsim hluav taws xob hloov hluav taws xob uas tuaj yeem ua rau muaj kev phom sij thiab tuaj yeem zes zuaj.
Tsis txhob siv cov khoom siv hluav taws xob nrog tes ntub lossis hnab looj tes ntub. Yog tias looj hnab looj tes muaj qhov nyob hauv lawv, hluav taws xob hluav taws xob tuaj yeem hla dhau. Nco ntsoov tias txhua tus neeg ua haujlwm hauv thaj chaw phais tau muaj hnab looj tes khov kho.
Tsis txhob siv cov khoom siv hluav taws xob hluav taws xob thaum lub ntsej muag ntub dej. Ua kom lub ko taw pedal qhuav. Tiv thaiv nws los ntawm kua txeej dej los ntawm npog nws nrog cov ntshiab, npog npog dej.
Monopolar electrosurgery
Kev txiav txim siab seb tus neeg mob puas tau siv tshuaj pleev hlau, suav nrog tus neeg lub plawv dhia. Muaj peev xwm ua kom raug mob yog tias tus neeg mob rov qab electrode tso rau ntawm daim tawv nqaij dua li cov hlau orthopedic cog.
Rau kev nyab xeeb zoo tshaj plaws, kom tus neeg mob tshem tawm ib qho khoom pleev kom tsis txhob muaj teeb meem los ntawm xau dej tam sim no.
Txoj hauj lwm thiab ntxig tus neeg mob kom nws tsis txhob chwv ib qho khoom hlau.
Xaiv ib qho chaw rau rov qab electrode / dispersive ncoo uas ze rau qhov chaw ua haujlwm ntau li ntau tau, huv thiab qhuav, zoo vascularised, thiab dhau ntawm cov leeg nqaij loj. Zam kev bony nce qib, adipose cov ntaub so ntswg, caws pliav nqaij, daim tawv nqaij dua li cov hlau ua kom lub ntsej muag, cov plaub hau thiab cov ntsiab lus siab. Yog tias tsim nyog, chais plaub hau heev ntawm daim tawv nqaij ntawm qhov chaw dispersive. Nco ntsoov tias cov gelive conductive noo thiab zoo sib xws kis thoob plaws thaj chaw sib chwv thiab tias cov ncoo dispersive ua tiav kev sib cuag nrog tus neeg mob' s tawv nqaij.
Txoj Haujlwm ECG electrodes deb ntawm qhov chaw xa khoom siv hluav taws xob thiab txoj kev tam sim no los ntawm lub cev.