10例严重胰腺损伤行胰胃吻合并胰管外引流术的护理.pdfVIP

• 590 • 中华护理杂志 2013 年 7 月第 48 卷第 7 期 Chin J Nurs ,July 20日，VoI48 ， No.7 10例严重膜腺损伤行膜胃吻合并膜管外引流术的护理 谢亚姊左晓艳刘星田敏张香兰喻娇花 [摘要] 总结了 10例严重且是腺损伤患者行股胃吻合并股管外引流术的护理)充分了解手术方式及特点，明确胃管、空肠造痪管、 月亮胃吻合口旁腹腔引流管、股管引流管留置的临尿意义，加强各引流管管理;制订针对性的政液回输及肠内营养护理方案，根据 患者实际营养状况许估结果，适时调整肠内营养方案二本主且l 例患者因合并肝脏严重挫裂伤、十二指肠破裂及门静脉挫伤于术 后IOh死亡;其他9例术后未出现胶痪、吻合口痪等并发症，未出现明显焕腺内外分泌功能障碍r [关键词] 肢腺; 创伤和损伤; 吻合术，外科; 引流术; 护理 Nursing care of 10 patients with severe pancreatic injuries undergoing pancreaticogastrostomy combined with external drainage of pancreatic ductJXIE Ya-di ,ZUO Xiao-yan ,LIU Xing ,TIAN Min ,ZHANG Xiang-Ian ,YU Jiao-hua [Abstract] This paper introduces the experience of nursing care of 10 patients with severe pancreatie injuries undergoing pancreaticogastrostomy combined with extemal drainage of pancreatic duct. The key points in nursing were strengthening drainage management based on fully understanding of the charaeteristics of pancreaticogastrostomy and the significanee of gastric tube ,jejunostomy tube and drainage of pancreatic duct ,formulating and adjusting the protocol of reinfusion of pancreatic juice and enteral nutrition based on dynamic nutritional assessment. As a result , a patient died of seve陀 liver InJU町， duodenal rapture and portal vein InJury at 10 hours after operation ,and the other nine patients recovered without pancreatic fistula or anastomotic fistula ,or pancreatic secretion disorders. [Key words] Pancreas; Wounds and Injuries; Anastomosis ,Surgical; Orainage; Nursing Care 进腹后先行止血，处理其他脏器损伤。膜腺坏死组织彻 膜腺损伤的处理是腹部损伤中较为棘手的问题，同外报 底清创后找到膜管断裂处，将近侧膜腺断端缝合，远侧膜腺 道称膜腺外伤病死率高达17%_65%， 11ο 膜胃吻合并膜管外引 断端游离2-3cm ，将远侧膜腺断端与胃后壁靠拢，在胃后壁行 流术根据损伤控制原则治疗膜腺损伤，在最大程度控制膜漏 一与膜腺断面平行的切口，胃浆肌层与膜腺被膜缝合同定， 等并发症发生的同时，尽