重症急性胰腺炎术后监测与护理

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1、重症急性胰腺炎术后监测与护理1临床资料52例重症胰腺炎，男25例，女27例，年龄在2854岁之间。本组患者均行胰坏死组织清除，胰床引流，胆总管T管引流，胃肠减压，手术后住院时间最长40天，最短14天，平均住院25天，51例痊愈，1例死亡。2护理体会2.1病情观察及护理（1）严密观察血压、脉搏变化、当100次/min，收缩压80mmHg，脉压差20mmHg时提示血容量不足和休克，此时需进行积极抗休克治疗。（2）体温曲线的观察:体温超过39或持续低热说明有术后并发症的发生，主动向医师反映，提高重视，制定有效的治疗方案。（3）呼吸情况:注意呼吸频率和深度，呼吸困难者，给予吸氧。呼吸频率30次/min

2、，应警惕肺部感染，ARDS发生。（4）尿量及24h出入水量的观察:护理上需要准确记录24h出入水量，并根据病情调节补液速度和量，低血容时开放两条静脉通路，保证尿量在30ml/h以上。（5）要加强监测项目:如实验室检查，心电图等，及时发现胰外病变和全身病变。2.2各引流管的观察及护理（1）胰床引流管及腹腔引流管的护理:术后用生理盐水加庆大霉素行胰床灌洗，引流，是治疗重症胰腺炎的一个主要环节，有效地冲洗能清除胰腺坏死组织，防止胰床脓肿和胰腺假性囊肿的产生:了解双管在腹腔内的位置，做到心中有数。连接好注水管与吸水管保证注入液体有效地吸出，以免腹膜吸收产生水钠潴留。灌洗温度在39左右，特别是冬季，防止

3、冷刺激诱发寒战。防止双管折叠、扭曲、受压及被坏死组织堵塞等情况的发生，尤其在变换体位时更应注意引流管脱出。准确记录灌洗与引出量，密切观察引流液的颜色，发现异常及时报告医师。（2）胃管及胆道引流管的护理:这两者均起到了降低胆道、胰管、胃肠道的压力作用，能使胰液产生减少，胰酶激活减少，控制胰腺炎的进一步发展。要保证两管的通畅，准确记录出入量，使引流保持在最佳状态，细致观察引流的颜色与量，同时要看护好病人，防止误把引流管拔掉。（3）加强基础护理:体位:术后麻醉清醒、血压平稳后，采取半坐卧位，有利于腹腔引流，使感染局限。保持呼吸道通畅:鼓励病人咳嗽，定时协助病人坐起，嘱其深吸气，必要时经超声雾化药液吸

4、入2次/d。做好晨晚间护理:保持床单及病人皮肤干净，做好口腔护理，防止并发症。（4）营养支持疗法:重症胰腺炎时，禁食时间长，机体处于高分解代谢状态，同时由于大量消化液的丢失，如无合理的营养支持疗法，必将使病人病情更加恶化，降低机体抵抗力，延缓康复，因此营养支持疗法，对护理人员提出了更高的要求。TRN的护理:术后治予TRN支持疗法，以高渗葡萄糖、脂肪乳、白蛋白等为主要能量，静脉供治，护理上要求严格无菌操作，及时监测血糖、尿糖情况，严密观察病情变化，对各并发症的发生做到早发现、早报告、早处理。口服饮食的护理:术后45周恢复期方可经口饮食，从流质、半流质过渡至普食，期间均须高热量、高蛋白、低糖、低脂

5、肪、少吃多餐，食物多样化，切不可暴饮暴食，防止再诱发此病。（5）心理护理及卫生宣教:热情和蔼地接待病人，体贴、尊重病人，使病人产生信任感和安全感。细致观察病人情绪变化，针对不同心理状态，实施有效的语言安慰。加强卫生宣教:介绍有关疾病知识、讲解术后禁食、放置引流管意义、帮助及指导病人进行床上床下活动，避免刺激性食物，禁烟酒。C29C91AFE4CED1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFEDD1B6C87D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4C

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