【1473】各种止血(1 / 1)

电刀进不去,医生看也看不见,于是电凝止血这个方法率先被否决掉。

在外科手术里头,大出血怎么办,阻断出血的源头动静脉。在目前这种情况下,医生在万不得已的情形下之前是不准备给患儿做开胸手术的,因而不可能采取这种做法。不开胸想阻断动脉,有另一个法子,是介入手术常用的栓塞动脉。这是呼吸内的介入手术了。

国协的呼吸内并没有开展这样的介入手术,这同样是为什么呼吸内在国协内部被称之为弱科的缘故。技术上达不到消化内科和心血管内科的高度,很多同病种疾病治疗根本没法和有传统历史和有名的心胸外相比。

呼吸内科估计觉得最痛苦的是,自己未开展这样的手术,自己本院的心血管内科打算抢业务了。上回心血管内科已经预备做肺动脉溶栓术。更被提在心血管介入手术领域赫赫有名的国陟,做的肺介入手术技术远远甩掉国协内科一大截。

说回目前这个病例,做介入是不可能的。口腔科手术室里根本没有造影机这样的介入手术设备,人家不开展介入手术。

新技术用不上,只能用老技术了。有时候,最原始的技术反而是最可靠的。因为新技术很多不过是在老技术的基础上进行发展。

外科学里头,教医学生止血,第一步教的不是什么开刀,也不是用什么止血药,而是压迫止血。人体本身有凝血机制可以自己止血。压迫止血是医生借助人体自身凝血机制,让血管破口变小,血流变缓,给血小板纤维蛋白等这些凝血物质争取时间在破口处凝结形成血栓止血,减少血栓四处跑跑到不需要的地方去。xqqxs八

谢婉莹来国协救的第一例病人,采用的正是压迫止血。压迫止血不仅限于现场急诊急救。在手术里头,很多时候医生同样会采用压迫止血法。

譬如之前在内镜手术和介入手术里头说过的球囊。球囊对医生是个法宝有多种用途,可以用来扩张管腔,扩张消化道内径和血管内径扩张来让堵塞的窄口疏通。

球囊另一个作用还有什么?谢婉莹去普外二实习时见过的,三腔二囊管压迫止血。

现在用三腔二囊管剪一段运用到这里止血可以吗?不行,管子过粗。人的消化道比气管粗多了,更别说这是患儿气管。没关系,原理通用。自己来做一个相似的球囊。

于是想到无菌手套了。手套做成球囊止血,在外科圈里有先例的,是在产科。产科常见的水囊止血法。医生在无菌手套里注入生理盐水扎起来变成个球状水囊,放入大出血的产妇子宫里头压迫出血的子宫壁进行止血。

如此简陋的自制工具人家产科医生早就不需要了,医疗器械产商根据临床需要生产出各式各样的产科止血球囊供医生挑选。况且,这个方法一开始创作发明时医生用的不是无菌手套和水囊,而是导尿管加避孕套。

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