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献给所有外科医生:手术中的“不”

2017-07-17 佚名 中国医学博士联络站

这几个“不”,你做到了吗?

手术者

1.手术者自己做不到的事不要要求别人去做,身教重于言教。

2. 不要把手术野显露不好的责任归罪于助手;不当的责怪会有负效应。

3.手术者不要忘记助手的存在和重要性;

4.术者不要忘记手术护士和麻醉师的存在;他们发挥着手术者不可替代的作用。

5.手术者不要忘记把术式告诉护士和麻醉师;直接告诉是一种尊重。

6.不要随意推迟手术时间,除非有正当理由;

7.手术者不要在助手洗手后才来到手术室;

8.不要训斥助手唠唠叨叨;点到为止。

9.手术者不要发怒;

10.不要乱扔护士递错的器械;

11.不忌讳在自己为难时请上级医生协助完成手术;今天请人为了以后不请人。

12.不要忽视手术前向家属交待手术相关事项;这一条必须遵守。

13.手术中发现新病情不要忘记告知患者家属;忽视了这 一步就留有后患。

14.不要逃避手术;该做的一定要做。

15.不做无目的的手术;

16.不要过高估计自己的实力,贸然做自己不会做的手术;安全第一。

17.不得从手术开始就慌慌张张;

18.不要疏于倾听手术前后患者的主诉;这是第一手资料。

19.不要疏于倾听手术组成员的建议;

20.关腹前不要忘记清点纱布和器械;

21.术后不得拖延手术标本的处理;

22.决不能丢失手术标本;

23.不要以任何原因解释没有在手术后就写手术记录;

24不要有别人代下手术后医嘱;

25.不要忘记手术后当晚的查房;

26.不要忘记对手术的回忆和反省;

助手

1.助手的视线不要离开手术者的左手;手术者的左手才是他的(第一助手),助手若能起到术者左手的作用,就是一个很称职的助手。

2.助手不能遮挡手术者的视线;

3助手不要忘记先洗手;

4.助手不得怠慢手术野的显露和现场的清理;

5.开放消化管腔时,助手的手不要离开吸引器。

6.术者在用刀剪时助手不得乱动其操作部位;

7.术者征求助手意见时,助手不得闪烁其词。

8.助手不要随意伸手探查或伸头探视;

9.不要接触手术者的身体;

手术组全员

1.手术组人员分工不能含混;

2.手术室内不要废话连篇,喋喋不休;

3.手术前夜不酗酒、不过劳;

4.不将私情带进手术室;

5.不要在手术台上评价同事的手术高低;

6.不要破坏手术组人员的和谐气氛;

7.手术人员的视线不得从手术野游出;

8.进手术室前不要忘了关手机;

基本素养

1.不得违背医学伦理去做手术;不该开的开了、不该切的切了、把小刀开大了把病灶留下了。

2.不开连自己都不放心的手术;哪些是杰作,哪些是败笔,只有自己知道

3.不随意放弃原定的手术方案而降低手术质量;怕下不了台、怕担风险、草草结束手术、缩小手术范围、随意关腹了事。

4.不能只盯住手术野而不顾及患者的整体情况;因为违背了一个基本的治疗原则:任何治疗方法都不能以牺牲机体整体利益为代价。

5.再熟的手术也不得大意;没有绝对相同的事物,何况是千变万化的疾病,如果成了经验主义,进步不会再有,失误就会接二连三。

6.手术中不要一遇困难就打退堂鼓;胜利就在努力之中。

7.不打乱手术进程,不破坏手术节奏;节奏含义:术式、步骤、层面、协调、配合、信心、心境等等。

8.手术中不要一意孤行;勇于修正错误。

9.不为标新立异而独出心裁,随意翻新花样;

10.不要忘记有时候撤退也是一种有益的选择;

11.不图毛糙快;

12.不要怕修正自己手术中的错误;面子和生命,孰重孰轻?

13.遇事不要慌张;

14、不要过分在意手术时间;质量第一时间第二。

15.相同的错误不要重犯;

16.再手术需要慎重但不要犹豫不决;

17.不顾手术后生活质量的手术有害无益;

学习与提高

1.手术前不要忘记翻书;

2.不要好高骛远;

3.不要不观摩别人的手术;别人总有高于自己的地方。

4.不要光靠手术录像学手术;

5.不要忘记到相关科室学习他人的手术技巧;

6.不得做花里胡哨的手术动作;华而不实,日常生活中也是忌讳的。

爱护组织与器官

1.不得随意粗暴处理患者的组织与器官;爱护器官与组织,是医疗道德的要求。

2.不用电刀切肠管;电刀切开处的周围有数毫米的烧伤区,蛋白凝固和组织缺血,是缝合不全的罪魁祸首。

3.不得让肠管干燥;浆膜干燥是手术后粘连的重要原因。

4.不要忽视对周围器官和组织的保护;

5.不能随意把肠管拖出切口外;

6.手术当中能做的事不要丢到以后再做;按一定的步骤一步步做下去。

基本操作

一.无菌操作:

1.不要忘记无菌手术发生感染是外科医生的耻辱;

2.口罩不要露出鼻子;

3.颜面部不要离手术野太近;

4.不乱丢乱放脏纱布;

5.不要忘记换下破损的手套;

6.缝皮前不要忘记洗手;

7.不要忘记消毒接触粘膜的器械和手指;

8.吸引器管有菌和无菌的不能混用;

9.不要用标注不明的或过期的失效的一次性材料;

二.结扎:

1.不做不确实的结扎、不打滑结;

2.打结时不要断线;

3不要用太粗的结扎线;

4不要在打第一个结时双手就交叉;

5.用合成线结扎时不要忘记打三个结;

6.不得大块结扎大网膜;

7.集束结扎线不得剪得过短,吻合口线不要留得过长;

前者防松脱,后者减少异物残留。

8.结扎时不得牵拉组织;

9.外科医生不得放弃练习打结;

三.止血:

1.不得放任活动性出血;

2.不因出血点小而疏于止血;

3.不要忘记全身和局部易出血的因素存在;

4.意外的出血不得乱夹乱扎;

5.不要忽视器官断面的出血;

6.不用纱布搓擦出血部位;

7.在确认无出血前不得关腹;

四.缝合:

1.缝合时拔针抽线不要过快;

2.不对脾脏随意下针乱缝;

3.缝合不要过紧、过松、过疏、过密;

4.不得用器械吻合来掩饰自己缝合技术的拙劣;

5.不要认为吻合器都是好的;

五.切开与显露:

1.手术切口不是越小越好;

2.不要死拉钩、拉死钩;

3.不要将创口和内脏裸露在外;

4.大棉垫的系带不得塞进腹内;

5.不得在眼睛看不到的地方钳夹;

6.不在一处做过深的游离,不在小视野内盲目操作;

7.不要闲置左手;

8.游离肿块不得孤军深入,要学会打包围战;

六.探查:

1.开腹后探查不得马虎了事;

2.探查不得从病变部位开始;

3.手术探查不得“翻箱倒柜”,费时过长;

4.术中不得忽视出血颜色的变化;

七.引流:

1.引流管头部不得靠近吻合口;端口要离开吻合口1—3cm。

2.引流管固定线不要离皮肤太远;

3.引流管不要从原切口引出体外;

4.不过分相信和依赖引流管;引流管是补救性措施。

5.该放的引流物不要犹豫;

6.吸引器的负压不要太大;

八.无瘤化操作:

1.不在肿瘤上操作;

2.不随意扩大癌根治手术范围;

3.不用手直接接触肿瘤;

4.不要忘记肿瘤的综合治疗;

九.器械使用:

1.止血时血管钳不要张口太大;

2.圆弧刀片不用刀尖,尖刀片不用刀腹;

3.持针器长轴不要和切口长轴成角;

4.不得将带钩的器械用在腹内操作;

5.手和器械不得放在患者的胸前

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    2017-07-20 大爰

    学习了谢谢分享!!

    0

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    2017-07-20 159****9725

    学习了

    0

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    2017-07-18 中医痴

    不错的,学习了,谢谢分享!

    0

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    2017-07-18 135****7952平儿

    学了。。。。。。。。。。。。

    0

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    2017-07-18 lyh994

    总结得不错(⊙o⊙)哦

    0

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    2017-07-18 半夏微凉

    学习了谢谢分享

    0

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然而,内科医生是越来越热衷于用外科手段解决内科问题。

Ann Surg:快看看如何挑选你的手术主刀医生!

进行食管切除术的外科医生的经验、身体和心理能力可能随着医生年龄的增长而改变。那么随着外科医生年龄的增加,患者的生存率是否也会提高呢?近期,一项发表在杂志Ann Surg上的文章对这一有趣的问题进行了评估。此项研究是基于人群的队列研究,研究对象包括1987年至2010年在瑞典进行食管癌切除术的所有患者,随访至2016年。进行风险调整累积量(RA-CUSUM)分析,以估计外科医生年龄和患者90天死亡率

吴孟超:95岁仍站在手术台边的外科医生

他说,要倒下去,就倒在手术室吧......

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