臨床常用診斷技術(shù)肝臟穿刺活體組織檢查術(shù)及肝臟穿刺抽膿術(shù)課件

臨床常用診斷技術(shù)肝臟穿刺活體zu織檢查術(shù)及肝臟穿刺抽膿術(shù)ppt課件匯報(bào)人：文小庫(kù)2024-03-16CONTENTS肝臟穿刺活體zu織檢查術(shù)概述肝臟穿刺抽膿術(shù)概述肝臟穿刺活體zu織檢查術(shù)操作步驟肝臟穿刺抽膿術(shù)操作步驟臨床應(yīng)用與效果評(píng)估并發(fā)癥處理與預(yù)防措施肝臟穿刺活體zu織檢查術(shù)概述01肝臟穿刺活體zu織檢查術(shù)是一種通過(guò)穿刺肝臟獲取zu織樣本進(jìn)行病理學(xué)檢查的方法。定義明確肝臟病變的診斷，評(píng)估疾病的嚴(yán)重程度和預(yù)后，指導(dǎo)治療方案的選擇。目的定義與目的適用于肝臟彌漫性病變、局灶性病變、原因不明的肝功能異常等疾病的診斷。嚴(yán)重凝血功能障礙、大量腹水、肝性腦病、嚴(yán)重心肺功能不全等患者禁忌進(jìn)行肝臟穿刺活體zu織檢查術(shù)。適應(yīng)癥與禁忌癥禁忌癥適應(yīng)癥以下附贈(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.術(shù)前準(zhǔn)備完善相關(guān)檢查，如血常規(guī)、凝血功能、肝功能等；進(jìn)行必要的影像學(xué)檢查，如B超、CT等，明確穿刺部位；術(shù)前禁食禁水一定時(shí)間，確保手術(shù)安全。注意事項(xiàng)向患者及家屬詳細(xì)解釋手術(shù)目的、風(fēng)險(xiǎn)及術(shù)后注意事項(xiàng)，簽署知情同意書(shū)；術(shù)前進(jìn)行必要的心理干預(yù)，緩解患者的緊張情緒；嚴(yán)格遵守?zé)o菌操作原則，避免感染等并發(fā)癥的發(fā)生。術(shù)前準(zhǔn)備及注意事項(xiàng)肝臟穿刺抽膿術(shù)概述02定義肝臟穿刺抽膿術(shù)是一種通過(guò)穿刺肝臟膿腫，抽取膿液以達(dá)到治療目的的手術(shù)方法。目的緩解肝臟膿腫引起的癥狀，如疼痛、發(fā)熱等；防止膿腫擴(kuò)大和感染擴(kuò)散；通過(guò)抽取的膿液進(jìn)行化驗(yàn)，以指導(dǎo)后續(xù)治療。定義與目的適用于單發(fā)或多發(fā)性肝膿腫；肝膿腫直徑大于3cm，且經(jīng)非手術(shù)治療無(wú)效者；肝膿腫穿破引起腹膜炎或胸腔積膿者等。適應(yīng)癥嚴(yán)重凝血功能障礙者；不能配合手術(shù)者，如意識(shí)不清或躁動(dòng)患者；對(duì)麻醉藥物過(guò)敏者等。禁忌癥適應(yīng)癥與禁忌癥完善相關(guān)檢查，如血常規(guī)、凝血功能、心電圖等；術(shù)前禁食禁水6-8小時(shí)；備皮、消毒手術(shù)區(qū)域；建立靜脈通道等。術(shù)前準(zhǔn)備向患者及家屬解釋手術(shù)目的、過(guò)程和可能的風(fēng)險(xiǎn)，并簽署知情同意書(shū)；術(shù)前應(yīng)用抗生素預(yù)防感染；對(duì)于緊張、焦慮的患者，可給予適當(dāng)?shù)逆?zhèn)靜劑；穿刺過(guò)程中應(yīng)密切觀察患者生命體征變化等。注意事項(xiàng)術(shù)前準(zhǔn)備及注意事項(xiàng)肝臟穿刺活體zu織檢查術(shù)操作步驟03穿刺點(diǎn)選擇與定位穿刺點(diǎn)選擇在超聲或CT引導(dǎo)下，選擇離病變部位最近、且能避開(kāi)大血管和膽管的穿刺路徑。定位方法采用體表標(biāo)記或術(shù)中實(shí)時(shí)超聲/CT定位，確保穿刺針準(zhǔn)確到達(dá)目標(biāo)區(qū)域。ju部麻醉在穿刺點(diǎn)周圍進(jìn)行ju部浸潤(rùn)麻醉，減輕患者疼痛。切口制作用手術(shù)刀在穿刺點(diǎn)處做一小切口，便于穿刺針進(jìn)入。局部麻醉與切口制作穿刺針進(jìn)入在超聲或CT引導(dǎo)下，將穿刺針經(jīng)切口插入肝臟，直至到達(dá)病變部位。0102zu織取樣通過(guò)穿刺針獲取病變zu織樣本，注意避免損傷周圍正常zu織。穿刺針進(jìn)入與組織取樣VS觀察患者生命體征，保持傷口清潔干燥，避免感染。并發(fā)癥預(yù)防采取止血、抗感染等措施，預(yù)防出血、感染等并發(fā)癥的發(fā)生。同時(shí)，密切觀察患者病情變化，及時(shí)處理可能出現(xiàn)的異常情況。術(shù)后處理術(shù)后處理及并發(fā)癥預(yù)防肝臟穿刺抽膿術(shù)操作步驟04穿刺點(diǎn)選擇與定位在B超或CT引導(dǎo)下，選擇離體表較近、膿腔較大、避開(kāi)大血管及重要臟器的部位作為穿刺點(diǎn)。穿刺點(diǎn)選擇可采用體表標(biāo)記法、B超實(shí)時(shí)引導(dǎo)法或CT三維重建定位法，確保穿刺針準(zhǔn)確進(jìn)入膿腔。定位方法在穿刺點(diǎn)周圍進(jìn)行ju部浸潤(rùn)麻醉，減輕患者疼痛。用手術(shù)刀在穿刺點(diǎn)處切開(kāi)皮膚及皮下zu織，長(zhǎng)度約0.5-1cm，為穿刺針進(jìn)入膿腔做準(zhǔn)備。ju部麻醉切口制作局部麻醉與切口制作將穿刺針沿切口刺入膿腔，注意避開(kāi)血管和神經(jīng)。穿刺針進(jìn)入連接注射器，抽取膿液，直至膿腔縮小或膿液抽盡。必要時(shí)，可用生理鹽水沖洗膿腔，以促進(jìn)膿液排出。膿液抽取穿刺針進(jìn)入與膿液抽取術(shù)后處理術(shù)后加壓包扎穿刺點(diǎn)，觀察患者生命體征及穿刺點(diǎn)有無(wú)出血、滲液等異常情況。并發(fā)癥預(yù)防預(yù)防性使用抗生素，降低感染風(fēng)險(xiǎn)。密切觀察患者病情變化，及時(shí)發(fā)現(xiàn)并處理可能出現(xiàn)的并發(fā)癥，如出血、氣胸、膽汁漏等。術(shù)后處理及并發(fā)癥預(yù)防臨床應(yīng)用與效果評(píng)估05肝臟穿刺活體組織檢查術(shù)在臨床中的應(yīng)用確診肝臟疾病通過(guò)肝臟穿刺活體zu織檢查術(shù)，可以獲取肝臟zu織樣本，進(jìn)行病理學(xué)檢查，從而確診各種肝臟疾病，如肝炎、肝硬化、肝癌等。指導(dǎo)治療根據(jù)肝臟穿刺活體zu織檢查結(jié)果，醫(yī)生可以制定更加精準(zhǔn)的治療方案，提高治療效果。評(píng)估預(yù)后通過(guò)肝臟穿刺活體zu織檢查術(shù)，可以評(píng)估患者的預(yù)后情況，為患者的康復(fù)和治療提供有力支持。治療肝膿腫肝臟穿刺抽膿術(shù)是治療肝膿腫的有效手段，通過(guò)穿刺抽取膿液，可以迅速減輕患者癥狀，促進(jìn)康復(fù)。輔助診斷肝臟穿刺抽膿術(shù)還可以獲取膿液樣本，進(jìn)行細(xì)菌培養(yǎng)和藥敏試驗(yàn)，為診斷和治療提