外科术后危重患者经皮内镜下胃／肠造口的护理.docVIP

外科术后危重患者经皮内镜下胃／肠造口的护理 2007年l2月 第l4卷第l2期 护理 JournalofNursing(China) December,2007 V()1.14No.12 【临床护理】 外科术后危重患者经皮内镜下胃/肠造口的护理 韩益平,马龙滨,乔玉培 (1.华北煤炭医学院附属人民医院,河北唐山063001;2.唐山市眼科医院,河北唐山063001) 【摘要】25例外科手术后危重患者进行经皮内镜下胃/肠造口(PEG/PEJ),建立了胃肠减压及肠内营养通路,护理要点包括: 术前停止鼻饲8h,术前暂时抽出气管插管球囊内的气体;术后加强局部皮肤的观察,保持PEJ管道通畅,加强造口旁感染或渗血, PEJ管堵塞,导管尖端移位等症状的观察与护理;肠内营养的护理等.认为加强肠内营养及对导管的护理,是降低和预防严重并发 症的关键.本组患者均操作成功,置管肠内营养平均gt;35d,5例出现造口周围皮下感染,2例少量渗血,2例肉芽组织增生,2例分 别在后期出现PEJ管阻塞和移位,未发生与PEG/PEJ操作相关的死亡和严重并发症 【关键词】经皮内镜下胃/肠造口(PEG/PEJ);肠内营养;并发症;外科护理 【中图分类号】R656.6【文献标识码】A【文章编号】1008—9969(2007)12—0042—02 CareofthePatientswithPercutaneousEndoscopicGastrostomy/JejunostomyafterSurgicalOperation HANYi-ping,MALong-bin,QIAOYu—pei . eAffiliatedPeoplesHospitd,NoahChinaCoolMedwdCollege,Tangshan063001,China; 2.TangshanOphtholmologyHospital,Tangshan063001,China) Abstract:25criticalpatientsunderwentpercutaneousendoscopicgastrostomy,jejunostomy(PEG/PEJ)aftersurgicaloperation.Apart fromgastrointestinaldecompressionandconstructionofnutritionpassage.thecarestrategiesincludedstoppingnasalfeedingf0r8 hoursandtemporarilypumpingoutairinsacculuspropriusoftracheacannulabeforePEG/PEJ,andenhancingobservationonskin. keepingPEJcannulaunobstructedandintensifvingtheobservationoverinfectionsandbleedingaroundstoma,PEJcannula obstruction,displacementofeannulaheadafterPEG/PEJ,aswellasthecareofenteralnutrition.Theyarguedthatenhancedenteral nutritionandcareofcannulawerekeytOreducingandpreventingseverecomplications.Themanipulationinallthe25caseswas successful,thecannulaforenteralnutritionsustainingformorethan35days.Subcutaneousinfectionsaroundstomaoeeu~edin5of them.minorbleedingin2.hyperblastosisofgranulationtissuesin2andobstructionanddisplacementofPEJeannulain2att}lelate stage,buttherewerenodeathorseverecomplicationsrelatedtoPEG/PEJmanipulations. Keywords:pereutaneousendoscopicgastrostomy,jejunostomy:enteralnutrition:complication;surgicalcare 经皮内镜下胃/肠造口(percutaneousendoscopic gastrostomy/jejunostomy,PEG/PEJ)是一项微创胃肠 造瘘新技术,外科术后出现并发症的危重患者,为了 有效地维持人体正常营