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文档简介
GeneralOperative
SurgerySurgerySurgery
is
medical
treatment
in
whichsomeone's
body
is
cut
open
so
that
adoctor
can
repair,
remove,
or
replace
adiseased
or
damaged
part.Classification
of
surgery(1)based
on
the
condition
emergencyselective
operation(
benign
tumour
)limited
operation
(
therioma)rupture
of
spleen
、3.
emergency
operation(trauma)(3)
based
on
the
lesion
propertiesand
difficultyone-stage
operationtwo-stageoperationMulti
period
operationAppearancewound
dressing,
skin
closure,
and
youCleanNo
religiousNo
political
buttonsOpetatingRoom-OR75%
questions
aboutanatomyNever
argue
with
the
scrubnurseDo
not
touchanythingKeep
quiet,
never
runFeel
faintFeel
swellASEPSISASEPSISHistoryBasic
ConceptionMethodsTechniqueThe
OriginHippocrates(460-377
BC)The
Oath
of
Medicinewounds
must
be
cleaned
withwine,
boiled
wateror
clean
rain
waterKoch(1881)GermanHot
steamBeginning
ofsterilizationHalsted
(1852~1922)The
first
surgeonprofessor in
JohnsHopkinsGlovesThe
father
ofAmerican
SurgeryBASIC
CONCEPTIONAseptic
technique-
Aseptictechnique
isthe
technique
aiming
to
prevent
all
kinds
ofmicroorganisms
from
invading
the
body
in
theprocess
of
medical
treatment
and
nursing
careand
it
also
means
the
technique
that
preventgerm
free
articles
and
environment
fromcontaminated.BASIC
CONCEPTIONSterilization-
useof
physicalprocedures
orchemical
agents
to
destroy
all
microbialforms,
including
bacterial
sporesDisinfection-
useof
physicalproceduresorchemical
agents
to
destroy
most
microbialforms;
bacterial
spores
and
other
relativelyresistant
organisms
may
remain
viableSterilizationTotal
destruction
of
all
microbes,
includingBacterial
sporesMycobacteria,
TBNonenveloped
(nonlipid)
virusesFungiDisinfectionDestroying
most
of
the
microbial
formsBacterial
spores
and
relatively
resistant
organismsremain
viableDisinfectants
are
subdivided
into
high-,intermediate-,
low-
level
agentsSterilizationPhysical
methodsChemical
methodsSterilizationPhysical
methods:HeatFiltrationRadiationSterilization
by
heatMoist
heatDry
heatDry
heat171°C
1h160°C
2hSpecial
chambersGlasswareMoist
heat:
Boiling100°C5-6mindisinfectioinMoist
heat:AutoclavingSteam
under
pressureThe
most
reliablesterilizationAny
heat
and
moist
resistantmaterialsdownward
displacementPressure
=104.0~137.3
kPaTemperature
=121~126℃Time
=30minpre-vacuum
autoclavePressure
=170
kPaTemperature
=133℃Time
=4~6minMoist heat:AutoclavingMilkBeer63°C
30min72°C
15
minMoist heat:PasteurizationMoist
heatDry
heatPenetrating
potencyhigherlowerTemp
for
protein
clottinglowerhigherTimeshortlongSterilizing
potency:
Moist
heat
>>
DryheatRemoves
bacteria
and
fungiFrom
air
and
solutionsThey
can
not
removeviruses
and
smaller
bacteriaSterilization
by
filtrationUltraviolet
(limitation:
direct
exposure)Lonizing
radiation
(microwave
or
gammarays)Sterilization
by
radiationEthylene
oxide
(
Strict
regulations:extremely
toxic)Formaldehyde
gasHydrogen
peroxide
vaporsSterilization-chemical
methods:Gas
vapor
sterilantsPeracetic
acid
0.2%
An
oxidizing
agentExcellent
activityNon-toxic
end
produtsGluteraldehyde
2%Toxic:
care
must
be
used
when
handingthischemicalSterilization-chenmical
methods:Liquid
chemical
sterilantsDisinfectionDestroying
most
of
the
microbial
formsBacterial
spores
and
relatively
resistant
organismsremain
viableDisinfectants
are
subdivided
into
high-,intermediate-,
low-
level
agentsDisinfection-Chemical
Methods:HighKilling
all
microbesincluding
endospores
andTBglutaric
dialdehydeformaldehyde
peroxyaceticacidepoxy
ethaneMediumKilling
all
non-sporemicrobes
includingTBalcoholchlorinesiodophorsLowKilling
vegetative
bacteriaand
lipophilic
viruses,butresisted
by
endospores,
TBand
hydrophilic
(non-enveloped)
viruseschlorhexidinebromogeramineExcellent
activity
against
all
groups
oforganismsExcept
sporesNon-toxicInactivated
by
organic
materialAlcoholsExcellent
activity
(
skin
antiseptics)Slightly
more
toxicInactivated
by
organic
materialFrequently
used
with
alcoholsIodophorsPrinciple
of
Aseptic
TechniquePrinciple
of
Aseptic
Technique-11.
The
surroundings
should
be
clean,
roomy.①
Thesurroundings②
The
operating-table③
30
minutes,
stop
cleaning
and
minimize
movingPrinciple
of
Aseptic
Technique-2appearance
shouldThe
hospital
personnel’sconform
to
the
standard.cap
and
masktrim
fingernailswash
handsPrinciple
of
Aseptic
Technique-3Knowing
the
basic
concept.Aseptic
areaNon-aseptic
areaAseptic
supplyPrinciple
of
Aseptic
Technique-44.
The
articles
should
be
placed
orderly
and
labeledclearly.①
Keep
aseptic
articles
in
sterile
containers
or
sterilepackages②
the
label
on
thepackage③
only
used
oncePrinciple
of
Aseptic
Technique-55.
Sense
of
aseptic
in
theprocedure.①
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