人流手术记录表

精品文档.人工流产（负压吸宫、钳刮）手术 记录 混凝土 养护记录下载土方回填监理旁站记录免费下载集备记录下载集备记录下载集备记录下载 表姓名___________年龄____职业_________就诊日期_________年______月______日住址______________电话______________邮编__________身份证______________主诉_________________________________________________________________月经史：初潮年龄_____岁经期______天周期______天经量(多中少)痛经（无轻重）末次月经________年______月______日婚育史：未婚已婚孕___次产___次现有子女___男___女哺乳：否是(___个月)末次妊娠终止日期_____年____月____日 末次妊娠结局_________________避孕史：末次避孕方法____________________避孕失败原因__________________既往病史：___________________________药敏史:___________________________体格检查：体温____________℃ 脉搏___________次/分血压__/__mmHg心________肺__________肝___________脾____________其他____________妇科检查：外阴_________________阴道_______________宫颈_________________子宫_______________位大小_______软硬度_________活动度__________附件______________腹部压痛____（如有，部位____）其他_____________辅助检查：血常规____________________________________出血时间________________凝血时间_________________________________白带常规：滴虫念珠菌清洁度尿妊娠试验________________________B超显示胚囊平均直经_______________________mm其他__________________诊断：________________________________________________________________医生签名：______________________年_____月_____日手术日期：______年_____月_____日手术名称：负压吸宫术钳刮术手术情况：子宫____位子宫大小孕___周宫腔深度：术前____cm术后____cm宫颈：未扩扩张____号至____号吸管号：________负压：_________mmHg吸出物：绒毛（有无）胚囊（有无）约____________大小(新鲜坏死)出血量：____________ml刮宫：未是术中用药：____________________________________________________________术中特殊情况及采取措施：___________________________________________________________________________________________________________________术后处理：药物：________________________________________________________人工流产后放置IUD：种类_______型号________生产企业_______________告知术后注意事项（是否），预约随访日期：______年____月____日手术者签名：_______________________年______月______日宫内节育器放置手术记录表 姓名_____________年龄_____岁 职业_____________初诊日期______年____月____日家庭住址______________________________电话_______________邮编______________月经史：经期/周期/天经量：多中少痛经：无轻重末次月经：__年__月__日婚育史：未婚 已婚 孕/产次 / 次 阴道分娩____剖宫产___现有子女___男___女末次妊娠终止日期：____年__月__日 末次妊娠结局：_______哺乳: 否 是(__个月)避孕史：末次避孕方法：_____________________避孕失败原因：___________________既往病史：_____________________________药敏史：____________________________体格检查：体温___℃ 脉搏____次/分 血压  /  mmHg 心________肺__________         肝_____________脾_____________其他_______________________________妇科检查：外阴_________________阴道______________宫颈_______________________        子宫位置_________大小_____软硬度_____活动度____附件______其他_____辅助检查：血常规___________________________________________________________白带常规：清洁度______________滴虫_____________念珠菌____________妊娠试验___________________其他__________________________________B超：_______________________________________________________________________诊断：______________________________________________________________________处理：______________________________________________________________________ 医生签名：________________    ______年_____月_____日 放置日期：______年____月____日放置日期：月经净后_____天、本次经期第_____天、阴道分娩时，剖宫产时、    产后__天(恶露净未净)、人流吸宫术后即时、钳刮术后即时、中引清宫术后即时    哺乳闭经：否、是（____个月）其他：________________________术时情况：子宫__________位  宫腔深度_______cm         宫颈扩张：未扩 从________号扩张至________号         手术：顺利、困难（详述）______________________________         出血：无 有：少量、大于100ml        腹痛：无 有（轻、中、重）宫内节育器种类：_________大小____号 尾丝：无  有（留丝_______cm）襻状尾丝术中用药及特殊情况：_____________________________________________________宫内节育器生产企业：______________________预计可放置年限：__________________术后处理：1、给药：         2、告知术后注意事项（是 否），预约随访日期：______年____月____日                  手术医生签名：________________  ______年_____月_____日输精管结扎手术记录 姓名____________ 年龄____ 职业_____________ 就诊日期_____年_____月____日住址____________________邮编_____________电话____________身份证___________主   诉：__________________________________________________________________药敏史：__________________________________________________________________婚育史：未婚    已婚      现有子女______男______女既往病史：__________________________________________________________________体格检查：体温________℃  脉搏__________次/分________血压     /     mmHg         心_________肺_________肝_________脾__________其他________________专科检查：阴 囊：左___________________________右___________________________         精 索：左___________________________右___________________________         睾 丸：左___________________________右___________________________         附 睾：左___________________________右___________________________输精管：左___________________________右___________________________其 他：左___________________________右___________________________辅助检查：血常规____________________________________________________________        出血时间_____________分     凝血时间___________分        尿常规____________________________________________________________        其他______________________________________________________________诊   断：__________________________________________________________________ 医生签名：_____________________ _______年____月____日手术日期：_______年____月____日手术野消毒：_______________________________________________________________麻醉药物及方式：____________________________________________________________手术方法：直视钳穿法__________________传统方法______________其他____________输精管切除：左：__________________cm  右：________________cm附睾端包埋：左：__________________ 右：_________________精囊灌注：药物___________________剂量：____________________术中情况及处理：_______________________________________________________________________________________________________________________________________手术者签名：____________助手签名：___________巡回护士签名：___________术后处理：留观__________小时，观察情况：____________________________________告知术后注意事项（是 否 ），预约随访日期：________________年____月____日观察者签名：__________________ ______年____月____日