臨床常用診斷技術(shù)骨髓穿刺術(shù)及骨髓活組織檢查術(shù)課件

臨床常用診斷技術(shù)骨髓穿刺術(shù)及骨髓活zu織檢查術(shù)ppt課件匯報(bào)人：xxx20xx-03-16骨髓穿刺術(shù)與骨髓活zu織檢查術(shù)概述骨髓穿刺術(shù)操作步驟及注意事項(xiàng)骨髓活zu織檢查術(shù)操作步驟及注意事項(xiàng)目錄并發(fā)癥預(yù)防與處理策略實(shí)驗(yàn)室檢查項(xiàng)目選擇與結(jié)果解讀病例分享與討論環(huán)節(jié)目錄骨髓穿刺術(shù)與骨髓活zu織檢查術(shù)概述01骨髓穿刺術(shù)（BoneMarrowPuncture）通過(guò)穿刺骨髓腔，抽取骨髓液進(jìn)行細(xì)胞學(xué)、原蟲(chóng)和細(xì)菌學(xué)等方面的檢查，是診斷造血系統(tǒng)疾病和其他相關(guān)疾病的重要手段。骨髓活zu織檢查術(shù)（BoneMarrowBiopsy）通過(guò)穿刺針或活檢鉗取出骨髓zu織進(jìn)行病理學(xué)檢查，以了解骨髓細(xì)胞增生程度、細(xì)胞形態(tài)和成熟情況，以及纖維zu織、脂肪zu織和血管等結(jié)構(gòu)的變化。目的明確或排除某些血液病、腫瘤、寄生蟲(chóng)等疾病，了解疾病的病理生理過(guò)程，指導(dǎo)臨床治療。定義與目的以下附贈(zèng)各項(xiàng)管理制度英文版（不需要可刪）急救藥品、器材管理制度:1.Rescuedrugsandequipmentshouldbe"fivefixed"(fixedquantityandvariety,designatedplacement,designatedpersonstorage,regulardisinfectionandsterilization,regularinspectionandmaintenance)and"twotimely"(timelyinspectionandmaintenance,timelyreceiptandsupplementation).Theitemisclearlymarkedandcannotbeusedarbitrarily.2.Thenecessaryrescueequipmentiscomplete,ingoodperformance,andinstandbycondition.3.Therescuedrugsarecomplete,withcleardruglabelsandnodiscoloration,deterioration,expiration,ordamage.Theyshouldbeplacedandusedintheorderofdrugexpirationdates(fromrighttoleft).4.Emergencydrugsanditemsforeachdepartment'srescuevehicleshallbeuniformlyequippedaccordingtorequirements.Specializedemergencydrugsanditemsmustbereviewedandapprovedbythedepartmentdirectortodeterminethetype,quantity,specifications,anddosagetobeequipped.Rescuevehiclesmustbeplacedindesignatedlocationsandmanagedbydesignatedpersonneltoensuresafetyandeaseofuse.5.Afterusingrescuedrugsandequipment,theyshouldbefullyreplenishedwithin24hours.Iftheycannotbereplenishedduetospecialreasons,theyshouldbenotedonthehandoverregistrationformandreportedtotheheadnurseforcoordinationandresolutiontoensuretimelyuseduringpatientrescue.6.Thereisaregistrationbookfortheprovisionofdrugsandequipment.Ensureconsistencybetweenaccountsandmaterials,andhandoverbetweenshifts.7.Managementofsealedrescuevehicles:Beforesealing,theheadnurse(ornurseincharge)andanothernurseshallcountthedrugsandequipmentaccordingtotheregistrationbookofdrugandequipmentequipment,verifytheiraccuracy,andsealthemwithaseal.Twopeopleshallsignandfillinthesealingtime.Nurseschecktheconditionofthesealsoncepershiftandcompletethehandover.Theresponsiblenursescheckonceaweek,andtheheadnurseandresponsiblenursesopenthesealsandinspectthedrugsandequipmentintheambulanceonceamonth,withrecordskept.8.Nonsealedrescuevehiclemanagement:Eachshiftshallcountthedrugsandequipmentaccordingtotheregistrationbookandcompletethehandover.Theresponsiblenurseshallinspectonceaweek,andtheheadnurseshallinspectonceeverytwoweeksandkeeprecords,ensuringthattheaccountsmatchthematerials.護(hù)理文書(shū)書(shū)寫(xiě)制度:

1.Nursingstaffstrictlyfollowthelatestrequirementswhenwritingnursingmedicalrecords.2.Thecontentofnursingrecordsshouldbeobjective,truthful,accurate,timely,complete,andstandardized.3.Allnursingdocumentsshouldbewrittenwithablueblackorcarboninkpen.4.AllnursingdocumentsshouldbewritteninArabicnumeralsfordateandtime,withdatesinyears,months,anddays,usinga24-hoursystem,specifictominutes.5.WritingshoulduseChinese,medicalterminology,andcommonlyusedforeignlanguageabbreviations;Completerecorditems;Thetextisneat,thehandwritingisclear,andthelayoutisclean;Accurateexpression,fluentsentences,simpleandconcise:correctformatandpunctuation,notypos.6.Whenerrorsoccurduringthewritingprocess,doublelinethemonthewrongwords,keeptheoriginalrecordclearanddistinguishable,signthemodifier,indicatethemodificationtime,continuetowritethecorrectcontent,anddonotusescraping,sticking,paintingorothermethodstocoveruporremovetheoriginalhandwriting.Eachpageshouldbemodifiednomorethantwotimes,otherwisetheoriginalrecorderwillpromptlycopyagain(exceptformodificationsmadebysuperiors).7.Nursingrecordswrittenbyinternnurses,probationarynurses,orunregisterednursesshouldbereviewedandsignedbynurseswithlegalprofessionalqualificationsinthismedicalinstitution.8.Furthertrainingnursescanonlywritenursingdocumentsafterbeingrecognizedbythemedicalinstitutionreceivingthetrainingfortheirworkability.9.Superiornursingstaffhavetheresponsibilitytoreviewandmodifythewrittenrecordsofsubordinatenursingstaff.Whenmakingmodifications,reddoublelinesshouldbeusedtomarkerrors,writethemodifiedcontent,signandindicatethemodificationtime.10.Temperaturerecords,medicalorders,patientcarerecords,andsurgicalinventoryrecordsshouldbearchivedontime.各種血液病的診斷、鑒別診斷及治療隨訪；不明原因的紅細(xì)胞、白細(xì)胞、血小板數(shù)量增多或減少及形態(tài)學(xué)異常；不明原因發(fā)熱的診斷與鑒別診斷；惡性腫瘤骨髓轉(zhuǎn)移的診斷等。適應(yīng)癥血友病患者禁止進(jìn)行骨髓穿刺術(shù)和骨髓活zu織檢查術(shù)；穿刺部位有感染灶或ju部皮膚感染者；晚期妊娠婦女慎做骨髓穿刺術(shù)。禁忌癥適應(yīng)癥與禁忌癥術(shù)前評(píng)估簽署知情同意書(shū)物品準(zhǔn)備患者準(zhǔn)備操作前準(zhǔn)備評(píng)估患者病情、凝血功能、血小板計(jì)數(shù)等，明確手術(shù)指征和禁忌癥。準(zhǔn)備骨髓穿刺包、消毒用品、無(wú)菌手套、ju部麻醉藥物、穿刺針、活檢鉗等手術(shù)器械和物品。向患者及家屬解釋手術(shù)目的、風(fēng)險(xiǎn)及注意事項(xiàng)，并簽署知情同意書(shū)。患者取仰臥位或側(cè)臥位，穿刺點(diǎn)定位并標(biāo)記，常規(guī)消毒鋪巾，ju部麻醉后等待手術(shù)。骨髓穿刺術(shù)操作步驟及注意事項(xiàng)02通常選擇髂前上棘、髂后上棘或胸骨等部位作為穿刺點(diǎn)，避開(kāi)重要臟器及血管。穿刺部位選擇穿刺前需對(duì)穿刺部位進(jìn)行常規(guī)消毒，確保無(wú)菌操作環(huán)境。消毒處理確定穿刺部位與消毒一般采用ju部浸潤(rùn)麻醉，減輕患者疼痛感。穿刺針需與骨面垂直，緩慢旋轉(zhuǎn)進(jìn)針，避免損傷周?chē)鷝u織。麻醉及進(jìn)針技巧進(jìn)針技巧麻醉方式當(dāng)穿刺針進(jìn)入骨髓腔后，接上干燥的注射器，適當(dāng)抽吸即可獲得骨髓液。抽取方法抽取的骨髓液量應(yīng)根據(jù)患者病情及檢查需要而定，一般不超過(guò)0.2ml。量控制抽取骨髓液方法及量控制拔針處理拔針后需用無(wú)菌紗布覆蓋穿刺點(diǎn)，壓迫止血，避免感染。觀察要點(diǎn)術(shù)后需密切觀察患者生命體征及穿刺部位情況，如出現(xiàn)異常情況及時(shí)處理。同時(shí)，還需注意患者有無(wú)疼痛、出血等并發(fā)癥的發(fā)生。拔針后處理及觀察要點(diǎn)骨髓活zu織檢查術(shù)操作步驟及注意事項(xiàng)03確定活檢部位與消毒選擇活檢部位通常選擇髂后或髂前上棘，也可選擇胸骨、棘突等部位，根據(jù)患者病情和醫(yī)生經(jīng)驗(yàn)判斷。消毒處理用碘伏或酒精對(duì)活檢部位進(jìn)行常規(guī)消毒，確保無(wú)菌操作環(huán)境。VS一般采用ju部浸潤(rùn)麻醉，將麻醉藥物注入活檢部位皮下及骨膜，以減輕患者疼痛。切口設(shè)計(jì)根據(jù)活檢部位和醫(yī)生經(jīng)驗(yàn)，設(shè)計(jì)合適的切口，通常切口長(zhǎng)度約1-2cm，深度達(dá)骨膜。麻醉方式麻醉及切口設(shè)計(jì)活檢鉗選擇根據(jù)活檢部位和zu織類(lèi)型選擇合適的活檢鉗，確保其能夠順利進(jìn)入骨髓腔并取出足夠的zu織樣本。zu織取樣技巧將活檢鉗插入骨髓腔后，旋轉(zhuǎn)并適當(dāng)用力，以獲取足夠的zu織樣本。同時(shí)避免損傷周?chē)芎蜕窠?jīng)。活檢鉗使用方法及組織取樣技巧縫合傷口并加壓包扎取出zu織樣本后，用無(wú)菌紗布覆蓋傷口，并進(jìn)行縫合處理，以確保傷口能夠順利愈合?？p合傷口縫合傷口后，用無(wú)菌紗布或繃帶對(duì)傷口進(jìn)行加壓包扎，以減輕患者疼痛和防止出血。同時(shí)密切觀察患者傷口情況，如有異常及時(shí)處理。加壓包扎并發(fā)癥預(yù)防與處理策略04穿刺時(shí)可能損傷血管，導(dǎo)致ju部出血或血腫形成。熟悉解剖結(jié)構(gòu)，避開(kāi)大血管；穿刺后ju部壓迫止血；凝血功能障礙者謹(jǐn)慎操作。原因預(yù)防措施出血或血腫形成原因及預(yù)防措施原因穿刺過(guò)程中未嚴(yán)格執(zhí)行無(wú)菌操作，可能導(dǎo)致ju部感染。降低策略嚴(yán)格無(wú)菌操作，穿刺前消毒皮膚；穿刺后ju部覆蓋無(wú)菌敷料；避免觸摸污染穿刺部位。感染風(fēng)險(xiǎn)降低策略穿刺時(shí)可能損傷周?chē)窠?jīng)，導(dǎo)致感覺(jué)或運(yùn)動(dòng)功能障礙。神經(jīng)損傷骨髓壞死脂肪栓塞罕見(jiàn)并發(fā)癥，可能與穿刺時(shí)損傷骨髓血管有關(guān)。穿刺過(guò)程中脂肪滴進(jìn)入血液循環(huán)，可能引起脂肪栓塞。030201其他可能并發(fā)癥介紹實(shí)驗(yàn)室檢查項(xiàng)目選擇與結(jié)果解讀05包括紅細(xì)胞計(jì)數(shù)、血紅蛋白測(cè)定、白細(xì)胞計(jì)數(shù)及分類(lèi)等，用于初步了解患者血液系統(tǒng)狀況。血常規(guī)包括肝腎功能、血糖、血脂等，用于評(píng)估患者全身代謝狀況。血生化包括凝血酶原時(shí)間、部分活化凝血活酶時(shí)間等，用于評(píng)估患者凝血功能狀況。凝血功能檢查常規(guī)檢查項(xiàng)目介紹特殊檢查項(xiàng)目選擇依據(jù)疑似血