artificial pneumoperitoneum

Artificial pneumoperitoneum: also known as pneumoperitoneum, is a medical term, is a medical method, pneumoperitoneum is the key to the success of laparoscopic surgery. Artificial pneumoperitoneum must be established before surgery to separate the peritoneal wall from the organ, and the abdominal cavity is enlarged. Conducive to surgery, and to avoid damaging the trocar when entering the abdominal cavity. Treatment of diseases: abdominal aortic injury abdominal trauma Indication Artificial pneumoperitoneum is suitable for laparoscopic preparation; X-ray angiography of the stomach; adjuvant treatment of tuberculosis (less applied). Contraindications Suspected ovarian cysts or multiple hilar echinococcosis; acute and chronic inflammation in the abdominal cavity. Preoperative preparation Artificial gas chest, sterile syringe, cleaning plate, 1 pneumoperitoneum needle. Surgical procedure 1. Preparation before gas injection: X-ray fluoroscopy should be performed before operation to observe whether the transverse movement is normal, whether there is adhesion or not; check the abdomen for lumps, sputum and ascites; do not eat before surgery, empty the bladder. 2, gas injection site: take the left abdomen rectus muscle outer edge 2-3cm below the umbilicus or the lower 1/3 of the umbilical cord and the left anterior superior iliac spine. 3. Gas injection step (1) The patient is supine, without a pillow, the legs are stretched out, the abdomen is exposed, the skin is disinfected as usual, a sterile towel is placed, and the peritoneum is infiltrated layer by layer. (2) The left thumb and the index finger tighten the skin, and the right hand presses the gas injection needle. After obliquely passing through the skin, it slowly penetrates into the abdominal cavity vertically, and once it enters the abdominal cavity, there is a feeling of falling. (3) Aspirate the needle with a sterile syringe to determine if the needle is mistakenly inserted into the blood vessel. After the catheter is determined to be in the abdominal cavity, the syringe is removed and the needle is inserted into the artificial pector. (4) Fix the needle position, turn the piston to make it to the pressure gauge, and measure the abdominal cavity pressure. Normal pressure fluctuates only slightly from -98 to +98 Pa (-1 to +1 cm H2O). (5) Twist the piston to make the air enter the abdominal cavity. After injecting 50ml, measure the pressure or not. If it rises obviously, it means that the needle is in the soft tissue, and then puncture a little; if there is no obvious increase, continue to note. gas. Insufflation should not be too urgent to avoid gastrointestinal irritation. For laparoscopic examination, the gas injection volume is generally 2000-4000ml. (6) After the gas injection is completed, the abdominal cavity pressure is retested, usually at +1000 Pa (about 10 cmH2O). Pull out the gas injection needle, disinfect it locally, cover it with sterile gauze, and press the piece complication Pay attention to the following complications (1) Subcutaneous emphysema: generally can disappear on its own, no special treatment, such as heavier pain, can give sedative, analgesic. (2) : can be repaired with ankle strap or surgery. (3) Atelectasis: may be caused by bronchial obstruction, should consider stopping artificial pneumoperitoneum. (4) Ascites: If there is not much ascites, the operation can be continued; if the amount is large, the suspension is considered and the effusion is taken out. (5) Adhesion of diaphragmatic and abdominal organs: If the adhesion is limited, and there is no pain or other adverse reactions after insufflation, the operation can be continued; otherwise, artificial abdomen should be considered and other treatments should be used instead. (6) mediastinal obstruction, pain around the throat, hoarseness, post-sternal pain, difficulty breathing and swallowing, mild cyanosis, neck edema, palpation of the neck may have a feeling of sputum, should be given sedatives and analgesia Drug, if necessary, subcutaneous injection of morphine, suspend artificial pneumoperitoneum. (7) Air embolism: dizziness, headache, fainting, loss of consciousness, sweating, tingling or numbness of the face or limbs, unclear vision, temporary blindness, tonic or clonic convulsions, flaccid paralysis, hemiplegia Or single sputum, irregular pulse, weak breathing, etc., severe cases can be fatal. Treatment: Patients should be placed immediately in the left lower lying position of the head, low in the left lateral position, intravenous central stimulant; if necessary, artificial respiration and other first aid measures. Conditional hyperactive oxygen therapy is feasible.

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