ï»?!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> 心包切开引æµæœ?/title> <meta name="keywords" content="手术,心包切开引æµæœ?心è„外科手术" /> <meta name="description" content="" /> <link href="http://images.whrenai.com/news_images/new_css.css" rel="stylesheet" type="text/css"> <SCRIPT src="http://images.whrenai.com/by_images/showFlash.js"></SCRIPT> <script type="text/javascript" language="javascript" src="http://images.whrenai.com/js/copy.js "></script> <SCRIPT src="http://images.whrenai.com/by_images/showFlash.js"></SCRIPT> <script language="javascript" src="http://images.whrenai.com/zx.js"></script> <script language='javascript' src='/js/Page.js'></script> <script language='javascript' src='/js/Xmlhttp.js'></script> <script language='javascript' src='/common/InfoViewCount.aspx?ModelId=1&&Id=70608'></script> </head> <body> <!--LOGO--> <div class=z1> <div class=logo><img src="http://images.whrenai.com/tongyong/images/logo.gif" 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<!--time end--> <div class=key>关键è¯ï¼š<a href='/List.aspx?chid=18&Keyword=%e6%89%8b%e6%9c%af&FieldName=tagnamestr' target='_blank'>手术</a></div> <!--key end--> <div class=daodu></div> <!--ad end--> <div class=geyan><label><span>å¥åº·è°šè¯­</span></label></div> <!--geyan end--> <div class=concent fang=08-03-07 17:05:06> <br> <img border="0" src="../../Files/Shoushu/20081271544190677801.jpg" > 1-1　沿左ç¬?肋软骨切å? <img border="0" src="../../Files/Shoushu/20081271544193777802.jpg" > 1-2　ç»å·¦è‚‹å¼“下戳å£ç½®å¼•æµç®? <img border="0" src="../../Files/Shoushu/20081271544193777802.jpg" > 1-3　引æµç®¡ä½ç½? å›?　心包切开引æµæœ? <p>[适应è¯]</p><p>化脓性心包炎ç»ç¡®è¯Šå‡åº”作心包切开引æµæœ¯ï¼Œä¸å®œæ‹–延ã€?/p><p>[术å‰å‡†å¤‡]</p><p>1.抗感染治疗ã€?/p><p>2.全身支æŒç–—法，纠正贫血ã€ä½Žè¡€æµ†è›‹ç™½å’Œç”µè§£è´¨ç´Šä¹±ç­‰ã€?/p><p>3.腹水严é‡ï¼Œå½±å“呼å¸å’Œå¾ªçŽ¯æ˜Žæ˜¾è€…，å¯é€‚当抽腹水å‡è½»åŽ‹è¿«ï¼Œä¸€èˆ¬å®œåœ¨æ‰‹æœ¯å‰2ã€?日进行ã€?/p><p>4.如心è„å—压严é‡ï¼Œåˆä¸èƒ½ç«‹å³è¿›è¡Œå¿ƒåŒ…切开引æµï¼Œå¯äºŽå¼•æµå‰è¡Œå¿ƒåŒ…穿刺å‡åŽ‹ï¼Œä»¥æ”¹å–„心肺功能ã€?/p><p>[麻醉]</p><p>宜用局麻，或肋间神ç»é˜»æ»žåŠ å±€éº»ï¼Œäº¦å¯ç”¨é™è„‰éº»é†‰ï¼Œä½†è¦é¿å…用易致血压下é™çš„麻醉剂ã€?/p><p>[手术步骤]</p><p>实践è¯æ˜Žä¼ ç»Ÿçš„心包切开引æµæ–¹æ³•å¼Šç«¯è¾ƒå¤§ï¼Œæœ¬æ‰‹æœ¯æ–¹æ³•å·²è¯æ˜Žä¼˜äºŽä¼ ç»Ÿæ–¹æ³•ã€?/p><p>1.体ä½ã€€æ–œå¡å§ä½ã€?/p><p>2.切å£ã€€æ²¿å·¦ç¬?肋软骨作5cm横切å£ï¼Œåˆ‡é™¤è‚‹è½¯éª¨çº¦4cm，自肋床进入心å‰åŒºã€‚若有胸膜覆盖，应将其å‘左推开[å›?-1]ã€?/p> <p>3.作心包牵引线　将心包å‰çš„ç–æ¾ç»“缔组织推开，显露出水肿增厚的心包，在心包å‰å£ä½œä¸¤ä¸ªç‰µå¼•çº¿ã€?/p><p>4.穿刺　在两牵引线间穿刺，如获脓液，å³è¯æ˜Žç¡®ç³»å¿ƒåŒ…å‰å£ã€?/p><p>5.切开心包　在牵引线间切开心包，立å³å°†å¸å¼•å™¨ä¼¸å…¥å¿ƒåŒ…腔内å¸å¼•è„“液，以å…溢出。å¸å°½è„“液åŽç”¨æ‰‹æŒ‡ä¼¸å…¥å¿ƒåŒ…内，å‘四周探查，分开所有纤维素隔，剥离附ç€äºŽå¿ƒåŒ…或心表的纤维素å—，并将其æŽå‡ºã€?/p><p>6.切除部分心包　在ä¸æ‰©å¤§èƒ¸å£åˆ‡å£çš„æ¡ä»¶ä¸‹ï¼Œå°½å¯èƒ½å°†å‰å£çš„心包切除（用电刀切å¯åŒæ—¶æ­¢è¡€ï¼Œå¦‚ä¸ç”¨ç”µåˆ€ï¼Œåˆ™åº”将心包血管ç¼æ‰Žï¼‰ï¼Œä¸‹ç¼˜åº”å°†å‰å£å¿ƒåŒ…完全切掉达膈肌处，使心包腔与å‰çºµéš”自由交通，没有阻隔ã€?/p><p>7.置引æµç®¡ã€€äºŽå‰çºµéš”置一软胶皮引æµç®¡ï¼Œç®¡å†…径ä¸å°äº?.8cm，剪1ï½?个侧孔，于剑çªä¸Žå·¦è‚‹å¼“间切一å°å£åŽæ‹‰å‡ºã€‚注æ„引æµç®¡ä¸æ˜¯æ”¾åœ¨å¿ƒåŒ…腔内，而是放在与心包自由交通的å‰çºµéš”内，以å…刺激心è„[å›?-2ï½?]ã€?/p><p>8.ç¼åˆåˆ‡å£ã€€ç¼åˆå¼•æµå£åŽç”¨ç»“扎线固定引æµç®¡ã€‚将切å£åˆ†ä¸¤å±‚ç¼åˆï¼Œå³è‚Œè‚‰ä¸ºä¸€å±‚，皮下组织与皮肤为å¦ä¸€å±‚。ç¼åˆè‚Œè‚‰åŽè¦å½»åº•å†²æ´—伤å£æœ€åŽå†ç¼åˆçš®è‚¤ã€?/p> <p>[术中注æ„事项]</p><p>1.如胸膜破æŸï¼Œåº”å°½é‡ä¿®å¤ã€?/p><p>2.彻底分开心包内纤维素膈，清除纤维素和脓苔，冲洗心包腔和å‰çºµéš”ã€?/p><p>3.切除心包å‰å£æ—¶è¦å½»åº•æ­¢è¡€ï¼Œè¦è¾¹æ­¢è¡€è¾¹åˆ‡é™¤ã€?/p><p>4.引æµç®¡çš„侧孔必须处于病人åŠå§ä½æ—¶çš„最低ä½ã€?/p><p>[术åŽå¤„ç†]</p><p>1.ä¿æŒå¼•æµç®¡é€šç•…，如果为脓苔或纤维素所阻塞，å¯ç”¨å¸å¼•å™¨å¸å¼•ã€å†²æ´—，甚至å¯ä»¥æ›´æ¢å¼•æµç®¡ã€?/p><p>2.拔管的指å¾æ˜¯ã€€â‘ ä½“温和白细胞正常；②x线åŠè¶…声波检查è¯æ˜Žå‰çºµéš”åŠå¿ƒåŒ…内没有积液å¾ï¼›â‘¢è‚ä¸å¤§ï¼Œé™è„‰åŽ‹ä¸é«˜ï¼›â‘£å¼•æµé‡å‡å°‘è¾¾æ¯æ—¥ä¸è¶…è¿?0ml，拔管之åŽå¯æ”¹ä¸ºå¼€æ”¾å¼•æµï¼Œä¹‹åŽæ¯?ï½?日退出引æµç®¡1ï½?cm，直到完全拔除ã€?/p><p>3.术åŽå¯èƒ½å¤§é‡åˆ©å°¿ï¼Œåº”防止水与电解质的平衡紊乱，尤其è¦å……分补钾ã€?/p> </div> <!--concent end--> <div class=next> <p><a href="http://www.whrenai.com/ssdq/xzwk/70607.html">建立体外循环</a></p> <p><a href="http://www.whrenai.com/ssdq/xzwk/70609.html">心è„æ­æ¡¥æ‰‹æœ¯</a></p> </div> <!--next end--> <div class=fanhui><a href="http://www.whrenai.com"><img src="http://images.whrenai.com/news_images/back.gif" width="180" height="34" border="0" /></a><a href="http://dgt.zoosnet.net/LR/Chatpre.aspx?id=DGT13232427" 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