Ib qhov txhab yog kev puas tsuaj rau cov ntaub so ntswg thaum muaj kev ua txhaum ntawm kev ncaj ncees ntawm daim tawv nqaij. Lub xub ntiag ntawm qhov txhab, tsis yog qhov nqaij tawv lossis hematoma, tuaj yeem txiav txim siab los ntawm cov tsos mob xws li mob, ntuav, los ntshav, ua haujlwm tsis zoo thiab kev ncaj ncees. PST ntawm lub qhov txhab yog nqa tawm hauv thawj 72 teev tom qab raug mob, yog tias tsis muaj contraindications.
Ntau yam mob
Txhua qhov txhab muaj kab noj hniav, phab ntsa thiab hauv qab. Nyob ntawm qhov xwm txheej ntawm kev puas tsuaj, txhua qhov txhab raug muab faib ua stab, txiav, chopped, bruised, tom thiab tshuaj lom. Thaum lub sij hawm PST ntawm qhov txhab, qhov no yuav tsum tau coj mus rau hauv tus account. Tom qab tag nrho, cov yam ntxwv ntawm kev pab thawj zaug yog nyob ntawm qhov raug mob.
- Cov qhov txhab yog ib txwm tshwm sim los ntawm ib qho khoom tho, xws li rab koob. Ib qho tshwj xeeb ntawm kev puas tsuaj yog qhov tob tob, tab sis kev puas tsuaj me me rau lub integument. Nyob rau hauv tas li ntawd, nws yog tsim nyog los xyuas kom meej tias tsis muaj kev puas tsuaj rau cov hlab ntsha, lub cev los yog cov hlab ntsha. Cov qhov txhab raug mob yog qhov txaus ntshai vim cov tsos mob me. Yog li yog tias muaj qhov txhab ntawm lub plab, muaj peev xwm ua rau daim siab puas. Qhov no tsis yog ib txwm yooj yim pom thaum lub sij hawm PST.
- Ntxhis qhov txhabthov nrog cov khoom ntse, yog li cov ntaub so ntswg puas me me. Nyob rau tib lub sijhawm, qhov khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob. Cov qhov txhab zoo li no kho tau zoo, thiab kho tau sai, tsis muaj teeb meem.
- Taws qhov txhab yog tshwm sim los ntawm kev raug mob nrog ib qho khoom ntse tab sis hnyav, xws li rab hneev. Nyob rau hauv cov ntaub ntawv no, qhov kev puas tsuaj sib txawv nyob rau hauv qhov tob, lub xub ntiag ntawm ib tug dav gaping thiab bruising ntawm cov ntaub so ntswg nyob sib ze yog yam ntxwv. Vim li no, lub peev xwm rov tsim dua raug txo.
- qhov txhab qhov txhab tshwm sim thaum siv cov khoom tsis meej. Cov kev raug mob no yog tus cwj pwm los ntawm qhov muaj ntau cov ntaub so ntswg puas hnyav hnyav nrog cov ntshav. Thaum ua PST ntawm qhov txhab, nws yuav tsum tau coj mus rau hauv tus account tias muaj qhov ua tau ntawm suppuration.
- qhov txhab raug mob yog qhov txaus ntshai vim qhov nkag mus ntawm cov qaub ncaug ntawm tus tsiaj, thiab qee zaum tus neeg. Muaj kev pheej hmoo ntawm kev kis tus kab mob hnyav thiab tshwm sim ntawm tus kab mob rabies.
- Tshuaj lom qhov txhab feem ntau tshwm sim los ntawm nab los yog kab laug sab tom.
- Cov phom phom sib txawv ntawm hom riam phom siv, cov yam ntxwv ntawm kev puas tsuaj thiab kev nkag mus. Muaj feem kis tau tus kab mob.
Thaum ua PST ntawm qhov txhab, qhov muaj suppuration ua lub luag haujlwm tseem ceeb. Cov kev raug mob no yog purulent, tshiab kis thiab aseptic.
Lub hom phiaj ntawm PST
Kev phais thawj zaug yog qhov tsim nyog los tshem tawm cov kab mob tsis zoo uas tau nkag mus rau qhov txhab. Rau qhov no, tag nrho cov ntaub so ntswg puas lawm, nrog rau cov ntshav txhaws, raug txiav tawm. Tom qab ntawd, sutures yog muab tso rau thiabYog tias tsim nyog, kev tso dej yuav ua tiav.
Cov txheej txheem yuav tsum tau ua thaum muaj cov ntaub so ntswg puas nrog cov npoo tsis sib xws. Cov qhov txhab sib sib zog nqus thiab cov kab mob kis tau zoo ib yam. Lub xub ntiag ntawm kev puas tsuaj rau cov hlab ntsha loj, thiab qee zaum cov pob txha thiab cov hlab ntsha, kuj yuav tsum tau ua haujlwm phais. PHO yog nqa tawm ib txhij thiab tag nrho. Kev pab ntawm tus kws phais yog tsim nyog rau tus neeg mob txog li 72 teev tom qab lub qhov txhab raug mob. Thaum ntxov PST tau ua thaum thawj hnub, hnub thib ob yog ncua kev phais mob.
pho tools
Yam tsawg kawg yog ob daim ntawv luam ntawm cov khoom siv rau kev pib kho qhov txhab. Lawv raug hloov thaum lub sijhawm ua haujlwm, thiab tom qab theem qias neeg lawv raug muab pov tseg:
- Clamp "Korntsang" ncaj, uas ua rau kev phais;
- scalpel taw, plab;
- linen claws yog siv los tuav hnav khaub ncaws thiab lwm yam khoom siv;
- Kocher, Billroth thiab yoov tshaj cum yog siv los nres los ntshav, lawv tau siv ntau thaum PST;
- txiab, lawv ncaj, nrog rau nkhaus raws lub dav hlau lossis ntug hauv ob peb daim ntawv;
- Kocher sojntsuam, grooved thiab belled;
- needle set;
- needle tuav;
- tweezers;
- hooks (ntau khub).
Cov khoom siv phais rau cov txheej txheem no kuj suav nrog cov khoom siv suture, koob txhaj tshuaj, koob txhaj tshuaj, cov ntaub qhwv ntsej, pob paj ntaub, hnab looj tes roj hmab, txhua yam ntawm cov raj thiabnapkins. Txhua yam khoom uas yuav xav tau rau PST - suture thiab hnav khaub ncaws cov khoom siv, cov cuab yeej thiab tshuaj npaj rau kev kho qhov txhab - tau muab tso rau ntawm lub rooj phais.
Cov Tshuaj Tseem Ceeb
Kev kho mob thawj zaug ntawm qhov txhab tsis ua tiav yam tsis muaj tshuaj tshwj xeeb. Feem ntau siv yog:
- 70% cawv;
- 3% hydrogen peroxide tov;
- 1% tshuaj iodopyrone lossis 0.5% tshuaj chlorhexidine bigluconate;
- 10% NaCl tov;
- 0.25% - 0.5% novocaine tov.
PHO theem
Kev kho mob thawj zaug tau ua nyob rau ntau theem:
- Kev kuaj mob ntawm qhov txhab nrog nws cov kev kho mob tom ntej nrog tshuaj tua kab mob.
- Tshem tawm cov ntaub so ntswg puas, lub cev txawv teb chaws, cov pob txha tawg. Lub qhov txhab yog incised raws li xav tau.
- Tuag ntshav.
- kwv dej.
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Kev kho mob thawj zaug
How PHO is done
Kev phais, tus neeg mob muab tso rau ntawm lub rooj. Nws txoj hauj lwm nyob ntawm qhov chaw ntawm qhov txhab. Tus kws phais yuav tsum tau xis nyob. Lub qhov txhab yog tso rau hauv chav dej, qhov chaw ua haujlwm yog ua tiav, uas yog delimited los ntawm cov ris tsho hauv qab uas tsis muaj menyuam. Tom qab ntawd, lub hom phiaj tseem ceeb yog ua tiav, txhawm rau kho cov qhov txhab uas twb muaj lawm, thiab siv tshuaj loog. Feem ntau, cov kws phais siv txoj kev Vishnevsky - lawv txhaj 0.5%daws ntawm novocaine ntawm qhov deb ntawm ob centimeters los ntawm ntug ntawm qhov txiav. Cov tshuaj tib yam yog txhaj los ntawm lwm sab. Nrog rau qhov tseeb cov tshuaj tiv thaiv ntawm tus neeg mob, "txiv qaub tev" yog pom ntawm daim tawv nqaij ib ncig ntawm lub qhov txhab. Cov phom phom feem ntau xav kom tus neeg mob tau txais tshuaj loog.
Cov npoo ntawm kev puas tsuaj txog li 1 cm yog tuav nrog Kochcher clamp thiab txiav tawm hauv ib qho thaiv. Thaum ua cov txheej txheem, cov ntaub so ntswg uas tsis muaj peev xwm raug txiav tawm ntawm lub ntsej muag lossis ntiv tes, tom qab ntawd siv cov suture nruj. Cov hnab looj tes thiab cov cuab yeej raug hloov.
Lub qhov txhab raug ntxuav nrog chlorhexidine thiab tshuaj xyuas. Txhaj qhov txhab nrog me me tab sis tob incisions yog dissected. Yog tias cov npoo ntawm cov leeg raug puas, lawv raug tshem tawm. Ua tib yam nrog cov pob txha tawg. Tom ntej no, hemostasis yog ua. Sab hauv ntawm qhov txhab raug kho ua ntej nrog kev daws thiab tom qab ntawd nrog tshuaj tua kab mob.
Cov qhov txhab kho tsis muaj cov tsos mob ntawm tus kab mob sepsis yog sutured nruj nrog thawj phau ntawv suture thiab npog nrog cov ntaub qhwv aseptic. Seams tau ua, sib npaug ntawm txhua txheej hauv qhov dav thiab qhov tob. Nws yog ib qho tsim nyog kom lawv kov ib leeg, tab sis tsis txhob rub ua ke. Thaum ua hauj lwm, nws yog ib qho tsim nyog yuav tsum tau txais cov tshuaj pleev ib ce tom qab kho.
Qee zaum, tsis siv cov sutures thawj zaug. Lub qhov txhab txiav tuaj yeem loj dua li nws zoo li thaum xub thawj siab ib muag. Yog tias tus kws phais neeg tsis ntseeg siab, ib qho kev ncua sij hawm tseem ceeb yog siv. Txoj kev no yog siv yog tias lub qhov txhab tau kis. Suturing yog nqa tawm mus rau cov ntaub so ntswg rog, thiab cov seams tsis nruj. Ob peb hnub tom qab kev soj ntsuam, lub qhov txhab yog suturedmus txog hnub kawg.
Ntshai qhov txhab
PHO qhov txhab, tom lossis raug lom, nws muaj qhov sib txawv. Thaum raug cov tsiaj uas tsis muaj venomous tom, muaj feem yuav kis tau tus kab mob rabies. Thaum ntxov, tus kab mob yog suppressed los ntawm anti-rabies serum. Xws li qhov txhab feem ntau dhau los ua purulent, yog li lawv sim ncua PHO. Thaum lub sij hawm tus txheej txheem, ib tug thawj ncua sij hawm suture yog siv thiab siv tshuaj tua kab mob.
Ib tug nab tom lub qhov txhab yuav tsum tau ib tug nruj tourniquet los yog ntaub qhwv. Tsis tas li ntawd, lub qhov txhab yog khov nrog novocaine los yog txias yog thov. Anti-snake serum yog txhaj rau neutralize lub venom. Kab laug sab tom yog thaiv los ntawm poov tshuaj permanganate. Ua ntej ntawd, cov tshuaj yog nyem tawm, thiab lub qhov txhab yog kho nrog tshuaj tua kab mob.
Kev nyuaj siab
Kev kho mob tsis zoo ntawm lub qhov txhab nrog tshuaj tua kab mob ua rau suppuration ntawm qhov txhab. Kev siv tshuaj loog tsis raug, nrog rau kev raug mob ntxiv, ua rau muaj kev ntxhov siab rau tus neeg mob vim muaj qhov mob.
tus cwj pwm tsis zoo rau cov ntaub so ntswg, kev paub tsis zoo ntawm lub cev ua rau muaj kev puas tsuaj rau cov hlab ntsha loj, cov kab mob hauv nruab nrog cev thiab cov hlab ntsha. hemostasis tsis txaus ua rau mob.
Nws yog ib qho tseem ceeb heev uas qhov kev kho mob thawj zaug ntawm qhov txhab yog ua los ntawm tus kws kho mob tshwj xeeb hauv txhua txoj cai.
