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骨髓活zu織檢查術(shù)操作步驟及注意事項目錄并發(fā)癥預(yù)防與處理策略實驗室檢查項目選擇與結(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）通過穿刺骨髓腔，抽取骨髓液進行細(xì)胞學(xué)、原蟲和細(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）通過穿刺針或活檢鉗取出骨髓zu織進行病理學(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、寄生蟲等疾病，了解疾病的病理生理過程，指導(dǎo)臨床治療。定義與目的以下附贈各項管理制度英文版（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.護理文書書寫制度:

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)前評估簽署知情同意書物品準(zhǔn)備患者準(zhǔn)備操作前準(zhǔn)備評估患者病情、凝血功能、血小板計數(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)險及注意事項，并簽署知情同意書。患者取仰臥位或側(cè)臥位，穿刺點定位并標(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02通常選擇髂前上棘、髂后上棘或胸骨等部位作為穿刺點，避開重要臟器及血管。穿刺部位選擇穿刺前需對穿刺部位進行常規(guī)消毒，確保無菌操作環(huán)境。消毒處理確定穿刺部位與消毒一般采用ju部浸潤麻醉，減輕患者疼痛感。穿刺針需與骨面垂直，緩慢旋轉(zhuǎn)進針，避免損傷周圍zu織。麻醉及進針技巧進針技巧麻醉方式當(dāng)穿刺針進入骨髓腔后，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菌紗布覆蓋穿刺點，壓迫止血，避免感染。觀察要點術(shù)后需密切觀察患者生命體征及穿刺部位情況，如出現(xiàn)異常情況及時處理。同時，還需注意患者有無疼痛、出血等并發(fā)癥的發(fā)生。拔針后處理及觀察要點骨髓活zu織檢查術(shù)操作步驟及注意事項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)驗判斷。消毒處理用碘伏或酒精對活檢部位進行常規(guī)消毒，確保無菌操作環(huán)境。VS一般采用ju部浸潤麻醉，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)計根據(jù)活檢部位和醫(yī)生經(jīng)驗，設(shè)計合適的切口，通常切口長度約1-2cm，深度達(dá)骨膜。麻醉方式麻醉及切口設(shè)計活檢鉗選擇根據(jù)活檢部位和zu織類型選擇合適的活檢鉗，確保其能夠順利進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。同時避免損傷周圍血管和神經(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，用無菌紗布覆蓋傷口，并進行縫合處理，以確保傷口能夠順利愈合?？p合傷口縫合傷口后，用無菌紗布或繃帶對傷口進行加壓包扎，以減輕患者疼痛和防止出血。同時密切觀察患者傷口情況，如有異常及時處理。加壓包扎并發(fā)癥預(yù)防與處理策略04穿刺時可能損傷血管，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)防措施原因穿刺過程中未嚴(yán)格執(zhí)行無菌操作，可能導(dǎo)致ju部感染。降低策略嚴(yán)格無菌操作，穿刺前消毒皮膚；穿刺后ju部覆蓋無菌敷料；避免觸摸污染穿刺部位。感染風(fēng)險降低策略穿刺時可能損傷周圍神經(jīng)，導(dǎo)致感覺或運動功能障礙。神經(jīng)損傷骨髓壞死脂肪栓塞罕見并發(fā)癥，可能與穿刺時損傷骨髓血管有關(guān)。穿刺過程中脂肪滴進入血液循環(huán)，可能引起脂肪栓塞。030201其他可能并發(fā)癥介紹實驗室檢查項目選擇與結(jié)果解讀05包括紅細(xì)胞計數(shù)、血紅蛋白測定、白細(xì)胞計數(shù)及分類等，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，用于評估患者全身代謝狀況。血生化包括凝血酶原時間、部分活化凝血活酶時間等，用于評估患者凝血功能狀況。凝血功能檢查常規(guī)檢查項目介紹特殊檢查項目選擇依據(jù)疑似血