手术学-无菌术

无菌术ANTISEPSIS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TheAgnewClinicTheAgnewClinicdistinguishedsurgeon,Dr.DavidHayesAgnew,ontheeveofhisretirementfromtheUniversityofPennsylvaniaMedicalSchool.Thesurgicalteamissetofffromtheattentivestudentsbytheilluminationfromanunseensourceofdaylight.Ayoungmemberofthesurgicalteamadministersopendropethervaporsthroughagauzeconetoalimpfemaleform.ThesurgicalteamlaborsasDr.Agnewelaboratesonhissurgicaltechniqueforcancerofthebreast.TheFirstOperationwithEtherThecontroversyovertheinventionofgeneralanesthesiaandthefirstpublicdemonstrationofdiethyletherattheMassachusettsGeneralHospitalonOctober16,1846ismatchedbytheuncertainoriginofthisrecreationoftheeventbyRobertCutlerHinckleycompletedinParisin1892.Aphotographer(daguerreotypist),JosiahHawes,issaidtohavebeensofrightenedthathewasunabletorecordthismomentousevent.TheFirstOperationwithEtherispaintedafterthestyleofThomasEakins(1844-1916).Theparticipantshavebeenidentifiedas:GilbertAbbott,thepatient;JohnCollinsWarren,MD,thesurgeon;WilliamT.G.Morton,theanesthetist;andHenryJ.Bigelow,MD,thejuniorsurgeon.Eachoneknewthathewasaparticipantinmedicalhistory.TheinscriptiononMorton'sgravesidemonumentpaystributetohimastheInventorandRevealerofAnestheticInhalation.BEFOREWHOMInalltimeSurgerywasAgony.BYWHOMPaininSurgerywasavertedandannulled.SINCEWHOMSciencehascontrolofpain.ThepaintinghangsinthBillrothThetorchofmodernsurgerywaslitbyChristianAlbertTheodorBillroth,MD(1829-1894)whenhebecamechiefofsurgeryatAllegemeinesKrankenhauseinVienna.BillrothpassedhistechniquestomanyincludingWilliamStewartHalstead,MD(1852-1922)whointurntrainedHarveyWilliamsCushing,MD(1869-1939).BillrothreachedhissurgicalfameduringaBelleÉpoqueofsurgerydueinnosmallpartduetotheintroductionofetherandchloroformgeneralanesthesiainthemiddleofthe19thcentury.Theimagepaintedin1890byAdalbertFranzSeligmannshowsBillrothattheageof60demonstratingsurgeryinabrightlylitoperatingtheatertoanadmiringaudience.Billroth’seternalfamedidnotresultfromthisoperationfortrigeminalneuralgiabutfromthecomplexabdominalsurgeryonthestomachandsmallbowelstillreferredtobyhisname.TheOperation(1929)ChristianSchadvisitedtheoperatingroomsinGenevaandrecordedhisimpressionsinhispaintingtitledTheOperation(1929).Schadcombinestheprecisionofamedicalillustratorwiththeshortenedperspectiveandmutedearthtonesoftheavantgardeartistsofhisera.Thecarefullydrawnsurgicalinstrumentsandglisteningredappendix(apparentlynormal)withadjacentcaecumcreateasenseofrealismandauthenticity(Sachlichkeit).ThesurgicalteamconsistsofDr.Haustein,hisassistantandtwonunswearingbrownrubbergloves.Althoughthenunswearsectarianheadcovers,thescenedescribesatimebeforethewidespreadacceptanceofsurgicalcapsandmasks.Thefacialexpressionsofthesurgicalteamarewithoutemotion.Thepatient’seyelidsareslightlyclosedasherestscomfortablyunderwhatisprobablyspinalanesthesia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，手套等无菌术内容日益完善PasteurProofthatmicrobesarereproducedfromparentorganisms,anddonotresultfromspontaneousgeneration,camefromcarefulexperimentsinmakeshiftlaboratoriesofFrance'sfamedchemistandbiologist,LouisPasteur(1822-1895),attheEcoleNormale,Paris.Behindhimareportraiesofhisfatherandmother,whichhepaintedduringhisyouth.Mme.Pasteurwaitspatientlyforhimtocompleteanobservation.OnthetableisareplicaoftheexperimentofLizaroSpalanzani.PasteurisholdingoneofhisSwan-neckedflasks.JosephLister(1827-1912)WhenSurgeonJosephLister(1827-1912)ofGlascowRoyalInfirmaryremoveddressingsfromJamesGreenlees'compoundfracture,hefoundthewoundhadhealedwithoutinfection-somethingunheardofbefore.Forsixweeks,Listerhadtreatedtheboy'swoundwithcarbolicacid.NowListerhadproofofsuccessofhisprincipleofantisepsis-whichwastorevolutionizemethodsoftreatmentandtoopennewvistasinpracticeofsurgery,ofmedicine,andofenvironmentalsanitation.AntonyvonLeeuwenhoekdraperofseventeenth-centuryDelft,Holland,inhissparetimeretiredtohisclosettoobservethewondersofthemicroscopicworldthroughtinylenseshelaboriouslygroundandmounted.Hewasfirsttoreporthavingseenanimalcules-protozoaandbacteria-andtoconfirmbydirectobservationcirculationoftheblood.Through200yearselapsedbeforepracticalapplicationofhisdiscoveriescontributedtomedicine,hisworklaidthefoundationofmodernmedicine'stremendouscentury-longonslaughtagainstdiseasecausedbybacteriaandothermicrobiologicentities-aworld-widecampaignwhichhasresultedinsavingmillionsoflives.WilliamS.HalstedHegraduatedfromtheCollegeofPhysiciansandSurgeonsin1877.In1881hediscoveredthatbloodcouldbeaeratedandreinfused.Hedevelopedconductionanesthesia(1885)byexperimentingwithinjectinghisownnervetrunkswithcocaine,asubstancetowhichhesubsequentlybecameaddicted(thoughlatercured).AtJohnsHopkinsUniversityheestablishedthefirstsurgicalschoolintheU.S.Anearlychampionofasepticprocedures,Halstedintroducedtheuseofthinrubberglovesinsurgery(1890).Heemphasizedhomeostasisduringsurgery,gentlenessinhandlin