胃癌术后十二指肠残端瘘护理研究.docVIP

胃癌术后十二指肠残端瘘护理研究 　　摘要：目的 总结胃癌术后十二指肠残端瘘的观察和护理方法。方法 对2014年1月～12月收治的4例胃癌术后并发十二指肠残端瘘患者的临床资料进行回顾性分析。在患者治疗期间做好各引流管及造瘘口的护理；加强抗炎、肠内外联合营养支持及肠液回输的护理；密切观察患者皮肤情况，预防压疮和感染发生；重视心理护理和生活护理，增进患者舒适。结果 4例患者均痊愈出院，无死亡病例。结论 十二指肠残端瘘是胃癌术后较严重的并发症，危及患者生命。护理人员在胃癌术后要密切观察患者的病情变化，及早发现异常症状，配合医生及早诊断。经过护理人员的精心护理，可增强患者的治愈信心，降低住院时间，减轻痛苦，促进其快速康复。 　　关键词：胃癌手术；十二指肠残端瘘；护理 　　Abstract：Objective To summarize the observation and care method of duodenal stump leakage after gastric cancer operation. Methods The retrospective analysis is implemented on the clinical data of 4 cases of complicated duodenal stump leakage patients after gastric cancer operation， who are treated between January and December in 2014. During the treatment the drainage tube and stoma care are well done， anti-inflammatory， enteral and parenteral nutrition support and intestinal transfusion care are strengthened， the skin condition of patients is closely observed， the pressure sores and infections are prevented， psychological care and life nursing are paid attention to， and the patient comfort is improved. Results 4 patients have been cured and no death case appears. Conclusion The duodenal stump leakage is the most devastating complication after gastric cancer operation， which is a serious threat to the lives of patients. After gastric cancer operation the patient condition should be closely observed by nurses， abnormal symptoms should be detected as early as possible， and diagnosis is carried out in cooperation with doctors. After intensive care the confidence of patients is enhanced and rapid recovery is promoted， while the hospital stay and suffering are reduced significantly. 　　Key words：Gastric cancer； Duodenal stump leakage； Care 　　十二指肠残端瘘是胃癌胃大部切除Billroth II式吻合术后早期较严重的并发症，多为高流量瘘（500ml/24h），发生率为1%～4%，病死率在10%左右[1]。随着肠内肠外营养及生长抑素在临床的广泛使用，目前胃癌术后并发十二指肠残端瘘的治愈率显著提高，现将护理体会报告如下。 　　1 临床资料 　　男3例，女1例，年龄48～64岁，平均55.3岁。十二指肠残端瘘的诊断标准：①术后2～5d或超过10d，突然出现上腹部剧烈疼痛或腹膜炎体征；②高热、脉速、心率加快，血常规回报白细胞数增高；③腹腔引流管引流液或腹腔穿刺为浑浊脓性液体或胆汁样液体；④口服水溶性造影剂进行检查；⑤影像学检查腹部积液现象