Koninckx P R, Ussia A, Amro B, Prantner M, Keckstein J, Keckstein S, Adamyan L, Wattiez A, Romeo A
Facts Views Vis Obgyn. 2024 Sep;16(3):281-290. doi: 10.52054/FVVO.16.3.026.
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.
如果根据手术过程中出现的诸多问题来判断，将阻抗（R）、电流（I）和电压（V）转化为组织效应以及理解电外科设备的设置并非易事。在200伏以下，电流会使组织升温，直到沸腾产生的蒸汽阻止电流通过。因此，由于能量较少或接触面积较大导致加热速度较慢，会产生更深的凝血效果。在200伏以上且占空比（通电时间的百分比）>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。电压越高，切割就会伴随着凝血，即混合电流。电压更高且占空比<10%以防止电弧形成时，只会发生凝血（蓝色踏板；强制凝血）。电压对组织效应至关重要，新型电外科设备提供恒定电压并限制能量输出（最大功率：W = I * V = 焦耳/秒）。不幸的是，电外科设备将电压和占空比的组合表示为切割（纯切割或混合）或凝血（软凝、强制或喷射）电流的强度。外科医生了解电外科设备是控制电压还是输出，以及所使用的不同设置和程序的电学基础知识非常重要。
