P R Koninckx, A Ussia, B Amro, M Prantner, J Keckstein, S Keckstein, L Adamyan, A Wattiez, A Romeo
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引用次数: 0
摘要
阻抗(R)、电流(I)和电压(V)对组织的影响以及对电外科装置设置的理解,如果从现场手术中的许多问题来看,并不明显。电压低于 200 V 时,电流会加热组织,直到沸腾的蒸汽停止电流。因此,由于能量较小或接触面积较大,加热速度较慢,凝固程度较深。电压高于 200 V,占空比(通电时间的百分比)大于 50%(黄色踏板)时,火花会变成电弧,热量会导致表层细胞爆炸,即切割。电压更高时,切割会与凝固(即混合电流)相关联。电压更高,占空比
Electrosurgery: heating, sparking and electrical arcs.
The translation of impedance (R), current (I), and voltage (V) into tissue effects and the understanding of the settings of electrosurgical units is not obvious if judged by the many questions during live surgery. Below 200 V, the current heats the tissue until the steam of boiling stops the current. Thus, slower heating, because of less energy or a larger contact area, results in deeper coagulation. Above 200 V and a duty cycle (per cent of time electricity is delivered) of >50% (yellow pedal), sparks become electric arcs, and the heat causes the explosion of superficial cells, i.e. cutting. With higher voltages, cutting is associated with coagulation, i.e. blended current. With even higher voltages and a duty cycle <10% preventing arching, only coagulation occurs (blue pedal; forced coagulation). Voltage being crucially important for tissue effects, newer electrosurgical units deliver a constant voltage and limit the energy output (Maximal Watts: W=I*V= joules/sec). Unfortunately, the electrosurgical units indicate the combination of voltage and duty cycles as a force of cutting (pure cutting or blended) or coagulation (soft, forced or spray) current. It is important that the surgeon understands whether electrosurgical units control voltages or output, as well as the electrical basics of the different settings and programs used.