第二章术前准件

第一节动物的准备第二节手术器械、物品等的准备与灭菌第三节手术室的准备与消毒第四节手术人员的准备与消毒第二章术前准备主要内容第一节动物的准备一、术前诊断（一）病史调查（二）现症检查

（三）实验室检查、特殊检查。

生理参数！临床意义！目的

确诊是否为手术适应症，手术是否为必须的治疗手段；了解动物全身机能状况（判断动物的抵抗力、组织修复的能力、对手术和麻醉的耐受力等）。二、确定手术时机

紧急手术择期手术

限期手术三、确定术前治疗措施（一）禁食、禁水

特别是反刍动物；一般禁食24h、禁水12h。小动物因消化道较短，禁食一般不超过12h,过长时间的禁食、禁水是不适宜的。（二）灌肠、制酵、胃肠减压

防止胃肠臌气，以及肛门、直肠、阴门手术的污染。肺部疾病，要作特殊的肺部检查因为麻醉、手术和动物的体位变化均能影响肺的通气量，如果肺通气量减少到85%以下者，并发感染增加，故宜早些采取措施。肝功能不良的病畜应检查肝功能，评价出对手术的耐受力。肾是调节水、电解质和酸碱平衡的重要器官，若发现异常，在术前要进行纠正。术前和术后避免应用对肾有明显损害的药物。有些对肾血管产生强烈收缩的药物，如去甲肾上腺素等也应避免使用。术前用电推子和专用剪毛剪，去除手术区域内的被毛（逆毛方向进行），然后用剃刀、手术刀、刮胡刀等，顺毛方向剃毛。或用脱毛剂脱毛：四、术部的准备与消毒（一）术部除毛配方1：硫化钠7~8g，加水100ml配方2：硫化钠7g，加水100ml，加甘油10~15ml。注意脱毛范围，个别个体敏感。（二）术部的消毒

5%碘酊，70~75%酒精注意：先后次序。间隔时间。站立保定时的特殊情况创伤术部术部除毛、消毒StepbyStepPhotoSeriesofSurgicalPrepoftheLargeAnimalPatient

Step1:Clipping:Generouslyclipareaaroundtheproposedincisionwith#40surgicalclipperblade.Isopropylalcoholpouredonsitewillfacilitateclipping.VacuumorbrushanddisposeofclippedhairanddebrisStep2:GrossPreparation:Useasurgicalscrubproduct,orProvidone-iodineandtapwater.Scrubandrinseuntilareaisfreeofdebrisandwaterbeadsasitflushesacrossskin.Rinsewithtapwater

Step4:FinalSkinPreparation:Saturate10-15gauzespongeswithantisepticsolution(2%Nolvasan®Betadine®).AddtenmillilitersofNolvasan®orBetadine®surgicalscrubtothetopsponges.Scrubinacircularmotionstartingatthesurgicalsiteandmovingtowardtheperiphery.Neverscrubinthedirectionoftheperipherytowardstheproposedincisionsite.Totalcontacttimeshouldbe5minutesWhenpickingupthespongestobeginscrubbing,foldandholdthecornersofthespongesothatyoudonottouchthesurfaceofthespongesthatwillbeincontactwiththesurgicalsite.

Startingwith1to3sponges,scrubincircularmotionstartingattheproposedincisionsiteandmovingtowardstheperiphery.Discardspongesasyoureachtheperiphery(donotmoveperipheraldebristowardthecentralincisionsite).Repeatforatotaloffiveminutes

Step5:Rinse:Rinsewithsterilesalineor70%isopropylalcohol.Continuerinsinguntiltheareaisfreeoffatand/orsurgicalscrubresidue(rinsingsolutionwillbeadasitisflushedacrossskin.Rinsingsolutionshouldalwaysflowfromcentral(clean)toperiphery(contaminated).

Step6:FinalAntisepticPreparation:Apply70%Isopropylalcoholtoskinandletdry.Finishbyapplyinganevencoatingof2%Nolvasan®orBetadine®solutionwithspraybottleStepbyStepPhotoSeriesofSurgicalPrepoftheSmallAnimalPatientStep1:Clipping:Clipoperativesite(wideborders)andremoveallhair(centralvacuum).Wipeskinwithcleanmoist4x4gauzespongetoremoveallhairanddebrisHairisremovedinorderreducecontaminationofthesurgicalsitebybacteriaonthepatient'sskinandinthepatient'shairfollicles.ShavingisalessacceptablemethodofremovinghairbecauseshavingdamagestheskintoagreaterdegreethanclippingAnymethodofhairremovaldamagesthepatient'sskin.Inflammationincreasestheriskofbacterialcolonization.Inordertoreducethisrisk,hairisremovedimmediatelypriortosurgeryFororthopedicproceduresonlongbones,theentirelimbmustbeclippedtodorsalmidline.WoundswithinthesurgicalsitemustbecoatedwithawatersolublejellysothattheydonotcollecthairanddebrisduringtheprocessofclippingStep2:InitialScrubStep3:ScrubIncisionSiteStep4:PeripheryScrubSoakanewscrubbrushwithtapwaterandChlorhexidineGluconatescrubStep5:RinseStep6:FinalAntisepticSprayTheentirescrubbedareaisthensprayedwithafinalpreparationsolutionof0.5%ChlorhexidineDiacetatein70%isopropylalcohol.Thisspraysolutionismadebydiluting1partNolvasan®(2%ChlorhexidineDiacetate)in3parts70%isopropylalcohol（三）术部的隔离使用有孔创布或用四块创布依次围在切口周围，用巾钳固定，使术部与周围完全隔离。创布要有足够的大小创布铺好后，只准向手术区外移动，不许向手术区内移动。一旦污染，及时更换。蹄和四肢可用灭菌塑料袋套住站立保定手术时隔离的特殊性使用一块或数块一次性自粘手术薄膜Placementoffielddrapestoisolateunpreparedareasnearthesurgicalsite

Towelling-intoreduceskinexposedtothesurgicalwoundUnfoldingtheDrapeThedrapeisunfoldedandanedgefoldedundertowardsthepatient.Wrapthecornersofthedrapearoundhands.PlacementofDrapesThedrapeshouldbefloatedabovethepatientandplacedintheappropriateposition(i.e.donotdragthesteriledrapealongthepatient'scontaminatedbody).Whenapplyingthedrapesmakesurethesteriledrapeisinbetweenthesurgeon'ssterilegownandtheunsterile(undraped)surgicaltable.Thedrapeshouldonlybeadjustedminimallyonceithasbeenlaidontothepatient.IfthedrapeneedstobeadjusteditshouldonlybemovedinadirectionAWAYfromthesterilesurgicalsiteandNEVERtowardsthesterilesite.SecuringtheDrapesDrapesaresecuredtoeachotherandtothepatient'sskinwithBackhaustowelclamps.Thetowelclampsaretuckedunderneaththedrapes,makingsurethattheyarenotlyingonthepatient'sskin.Thefunctionofdrapingistoseparatethesteri