《【医学ppt课件】无菌术antisepsis》由会员分享，可在线阅读，更多相关《【医学ppt课件】无菌术antisepsis（48页珍藏版）》请在金锄头文库上搜索。
1、无 菌 术 ANTISEPSIS,普通外科 韩承新,无菌术,无菌术的历史 无菌术的概述 抗菌 灭菌 手术室的消毒与清洁 手术人员的术前准备 病员的术野准备 手术进行中的无菌原则,古代手术场景,感染非常常见，以至于认为是不可避免的甚至是愈合过程中的必然过程 也有些措施，如火烧，油烫，油膏,The Agnew Clinic,The Agnew Clinic distinguished surgeon, Dr. David Hayes Agnew, on the eve of his retirement from the University of Pennsylvania Medical Sch
2、ool. The surgical team is set off from the attentive students by the illumination from an unseen source of daylight. A young member of the surgical team administers open drop ether vapors through a gauze cone to a limp female form. The surgical team labors as Dr. Agnew elaborates on his surgical tec
3、hnique for cancer of the breast.,“The First Operation with Ether“,The controversy over the invention of general anesthesia and the first public demonstration of diethyl ether at the Massachusetts General Hospital on October 16, 1846 is matched by the uncertain origin of this recreation of the event
4、by Robert Cutler Hinckley completed in Paris in 1892. A photographer (daguerreotypist), Josiah Hawes, is said to have been so frightened that he was unable to record this momentous event. “The First Operation with Ether“ is painted after the style of Thomas Eakins (1844-1916). The participants have
5、been identified as: Gilbert Abbott, the patient; John Collins Warren, MD, the surgeon; William T. G. Morton, the anesthetist; and Henry J. Bigelow, MD, the junior surgeon. Each one knew that he was a participant in medical history. The inscription on Mortons graveside monument pays tribute to him as
6、 the “Inventor and Revealer of Anesthetic Inhalation. BEFORE WHOM In all time Surgery was Agony. BY WHOM Pain in Surgery was averted and annulled. SINCE WHOM Science has control of pain.“ The painting hangs in th,Billroth,The torch of modern surgery was lit by Christian Albert Theodor Billroth, MD (
7、1829-1894) when he became chief of surgery at Allegemeines Krankenhause in Vienna. Billroth passed his techniques to many including William Stewart Halstead, MD (1852-1922) who in turn trained Harvey Williams Cushing, MD (1869-1939). Billroth reached his surgical fame during a Belle poque of surgery
8、 due in no small part due to the introduction of ether and chloroform general anesthesia in the middle of the 19th century. The image painted in 1890 by Adalbert Franz Seligmann shows Billroth at the age of 60 demonstrating surgery in a brightly lit operating theater to an admiring audience. Billrot
9、hs eternal fame did not result from this operation for trigeminal neuralgia but from the complex abdominal surgery on the stomach and small bowel still referred to by his name.,The Operation (1929),Christian Schad visited the operating rooms in Geneva and recorded his impressions in his painting tit
10、led The Operation (1929). Schad combines the precision of a medical illustrator with the shortened perspective and muted earth tones of the avant garde artists of his era. The carefully drawn surgical instruments and glistening red appendix (apparently normal) with adjacent caecum create a sense of
11、realism and authenticity (Sachlichkeit). The surgical team consists of Dr. Haustein, his assistant and two nuns wearing brown rubber gloves. Although the nuns wear sectarian head covers, the scene describes a time before the widespread acceptance of surgical caps and masks. The facial expressions of
12、 the surgical team are without emotion. The patients eyelids are slightly closed as he rests comfortably under what is probably spinal anesthesia,无菌术的认识历程,Heppocrates(公元前 460-377)：古希腊,化脓性伤口，非化脓性伤口，术前清洁。 Pasteur(1865):法国，认识到微生物致病 Lister (1867):英国，采用石炭酸消毒 Bergmann(1877):德国，采用蒸汽灭菌 手术室空气消毒，器械消毒，无菌手术单，手套
13、等无菌术内容日益完善,Pasteur,“Proof that microbes are reproduced from parent organisms, and do not result from spontaneous generation, came from careful experiments in makeshift laboratories of Frances famed chemist and biologist, Louis Pasteur (1822-1895), at the Ecole Normale, Paris. Behind him are portraie
14、s of his father and mother, which he painted during his youth. Mme. Pasteur waits patiently for him to complete an observation.“ On the table is a replica of the experiment of Lizaro Spalanzani. Pasteur is holding one of his “Swan-necked“ flasks.,Joseph Lister (1827-1912),“When Surgeon Joseph Lister
15、 (1827-1912) of Glascow Royal Infirmary removed dressings from James Greenlees compound fracture, he found the wound had healed without infection-something unheard of before. For six weeks, Lister had treated the boys wound with carbolic acid. Now Listerhad proof of success of his principle of antis
16、epsis-which was to revolutionize methods of treatment and to open new vistas in practice of surgery, of medicine, and of environmental sanitation“.,Antony von Leeuwenhoek,draper of seventeenth-century Delft, Holland, in his spare time retired to his “closet“ to observe the wonders of the microscopic
17、 world through tiny lenses he laboriously ground and mounted. He was first to report having seen “animalcules“ -protozoa and bacteria- and to confirm by direct observation circulation of the blood. Through 200 years elapsed before practical application of his discoveries contributed to medicine, his work laid the foundation of modern medicines tremendous century-long onslaught against disease caused by bacteria and other microbiologic entities-a world-wide campaign which has resulted in saving millions of lives.,
