微创技术治疗上尿路结石并肾功能不全护理43例.docVIP

微创技术治疗上尿路结石并肾功能不全护理43例【摘要】 目的 探讨微创治疗上尿路结石并肾功能不全的护理。方法 对43例经皮肾镜、输尿管镜碎石术治疗上尿路结石并肾功能不全患者加强术前心理护理及各项准备,术后做好病情观察、引流管护理、并发症的观察处理以及健康指导。结果 43例术后无死亡,平均肌酐从术前的712.4 μmol/L降至186.2 μmol/L,结石复发9例。所有患者经术前、术后护理能以积极健康的心态配合手术治疗。结论 有效的护理在微创治疗上尿路结石并肾功能不全中十分重要。 【关键词】微创;上尿路结石并肾功能不全;护理 Nursing Care of Obstructive Kidney Disfunction Caused by Upper Urinary Stones with Mcrotraumatic Treatment YE Hong-yan,WAN Jin-ping.Department of Urology,Xiangxi People’s Hospital,Jishou,Hunan,416000,China 【Abstract】 Objective To explore the way of nursing care mcrotraumatic treatment of obstructive kidney disfunction caused by upper urinary stones.Methods All 43 cases of mcrotraumatic treatment of obstructive kidney disfunction caused by upper urinary stones were strengthened psychological nursing and preoper afive prepare,were strengthened illness observation,drainage tube nursing,complications observation and health instruction.Results In all 43 cases,no case died and their mean serum creatinine decreased from 712.4 μmol/L to 186.2 μmol/L.stone recurred in 9 cases.All cases could coordinate with treatment through preoperative and postoperative nursing.Conclusion Effective nursing is very important in mcrotraumatic treatment of obstructive kidney disfunction caused by upper urinary stones 【Key words】Mcrotraumatic treatment; Obstructive kidney disfunction; Upper urinary stone; Nursing 作者单位:416000湖南省湘西自治州人民医院泌尿外科/吉首大学第一附属医院泌尿外科 上尿路结石梗阻所致肾功能不全是泌尿外科急症之一,病情危重,如不及时救治,可能危及生命致使延误就诊抢救时机,加重肾功能损害,临床治疗原则是安全尽快地解除梗阻,引流尿液、改善肾脏功能。随着泌尿外科腔镜技术的发展,特别是肾镜、输尿管镜等微创技术的发展,国内外近年来报道开放手术治疗已降至2%~5%[1]。2002年8月至2008年6月我科用微创的方法治疗43例上尿路结石并肾功能不全患者,取得较好的效果,护理报告如下。 1 临床资料 1.1 一般资料 本组43例,男27例,女16例,年龄16~82岁,平均44.5岁,主要表现为恶心、呕吐、腹胀、腰痛;其中31例表现为无尿或少尿,另12例尿量正常。以浮肿入院者14例。其中双侧输尿管结石18例,双侧输尿管并单侧或双侧肾结石13例;一侧输尿管结石并对侧肾结石6例;一侧输尿管结石合并对侧肾无功能6例。合并有尿路感染8例。实验室检查:血肌酐326.0~2882.7 μmol/L,平均856.2 μmol/L;血尿素氮(BUN)11.2~52.6 mmol/L,平均24.5 mmol/L;血钾(K?+)4.8~7.5 mmol/L,伴贫血35例。 1.2 治疗方法 43例上尿路结石合并肾功能不全的患者中有4例因尿毒症,全身情况极差,合并有水电解质酸碱平衡失调,手术耐受