内科胸腔镜治疗胸腔积液术后并发症的护理
|
摘要
目的探讨局麻下行可弯曲内科胸腔镜诊治结核性胸腔积液的护理措施。方法对260例胸腔积液患者做好术前护理;术中加强生命体征监测;术后保证引流管通畅,合理止痛,严密观察并发症的发生并做好处理。结果 260例中210例确诊为结核性胸腔积液,确诊肺癌24例,肺寄生虫病2例,胸膜间皮瘤1例,脓胸1例,22例临床诊断结核性胸膜炎。其中男166例,女94例,年龄15-77岁,平均年龄37.72岁。右侧150例,左侧110例。术中无不良反应发生;术后明显疼痛需药物治疗85例,皮下气肿45例,渗液144例,发热5例,复张性肺水肿1例,无一例发生漏气、胸腔出血及感染等并发症。结论内科胸腔镜是诊断和治疗结核性胸腔积液有效的方法之一,通过充分的术前准备、心理护理、术中指导及术后积极采取相应的护理措施,为病人手术成功提供了保障,减少并发症发生,有效地提高胸腔镜的完成率。利用可弯式内科胸腔镜治疗结核性胸腔积液护理措施非常重要。
Objective To investigate the nursing measures for the diagnosis and treatment of tuberculous pleural effusion by flexible internal thoracic surgery under local anesthesia. Methods 260 patients with pleural effusion were treated preoperatively; vital signs were monitored during operation; postoperative drainage tube was ensured, reasonable pain relief, strict observation of complications and treatment. Results Of the 260 patients, 210 cases were diagnosed as tuberculous pleural effusion, 24 cases were diagnosed with lung cancer, 2 cases with pulmonary parasitic disease, 1 case with pleural mesothelioma, 1 case with empyema, and 22 cases with clinical diagnosis of tuberculous pleurisy. There were 166 males and 94 females, aged 15 to 77 years, with an average age of 37.72 years. There were 150 cases on the right side and 110 cases on the left side. No adverse reactions occurred during the operation; 85 cases of drug treatment were needed for postoperative pain, 45 cases of subcutaneous emphysema, 144 cases of exudate, 5 cases of fever, and 1 case of recurrent pulmonary edema, no complications such as air leaks, chest bleeding and infection occurred. Conclusions Thoracoscopy is one of the effective methods for the diagnosis and treatment of tuberculous pleural effusion, through adequate preoperative preparation and psychological nursing, intraoperative guidance, and postoperative active nursing measures, it provides a guarantee for the success of patients, reduce the incidence of complications and effectively improve the completion rate of thoracoscopy. It is very important to use the flexible internal thoracoscopy to treat tuberculous pleural effusion.
Objective To investigate the nursing measures for the diagnosis and treatment of tuberculous pleural effusion by flexible internal thoracic surgery under local anesthesia. Methods 260 patients with pleural effusion were treated preoperatively; vital signs were monitored during operation; postoperative drainage tube was ensured, reasonable pain relief, strict observation of complications and treatment. Results Of the 260 patients, 210 cases were diagnosed as tuberculous pleural effusion, 24 cases were diagnosed with lung cancer, 2 cases with pulmonary parasitic disease, 1 case with pleural mesothelioma, 1 case with empyema, and 22 cases with clinical diagnosis of tuberculous pleurisy. There were 166 males and 94 females, aged 15 to 77 years, with an average age of 37.72 years. There were 150 cases on the right side and 110 cases on the left side. No adverse reactions occurred during the operation; 85 cases of drug treatment were needed for postoperative pain, 45 cases of subcutaneous emphysema, 144 cases of exudate, 5 cases of fever, and 1 case of recurrent pulmonary edema, no complications such as air leaks, chest bleeding and infection occurred. Conclusions Thoracoscopy is one of the effective methods for the diagnosis and treatment of tuberculous pleural effusion, through adequate preoperative preparation and psychological nursing, intraoperative guidance, and postoperative active nursing measures, it provides a guarantee for the success of patients, reduce the incidence of complications and effectively improve the completion rate of thoracoscopy. It is very important to use the flexible internal thoracoscopy to treat tuberculous pleural effusion.
引文
[1]童朝辉,王臻,王辰.内科胸腔镜技术及其临床应用[J].中华结核和呼吸杂志,2007,30(3):220-222.
[2]杜伟,熊小伟.胸腔镜活检并胸腔闭式引流在积液胸腔积液患者围术期的护理研究[J].中国医刊,2015,50(12):99-101.
[3]程小兰,金廷会,刘丽.预防和减少胸腔镜术后并发症的护理体会[J].中国医学创新,2013,10(27):57-58.
[4]柯彩霞,郑志惠,刘琼慧.诊断性内科胸腔镜术的护理配合[J].中国医药导报,2008,5(27):138-139.
[5]赵文萍,杜世霞.内科胸腔镜技术护理体会[J].中国社区医师,2009,11(3):85-86.
[6]黄瑜,周春萍,曾春梅.可弯式内科胸腔镜治疗结核性胸腔积液的护理体会[J].特别健康,2016,15:33,41.
[7]王颖丽.内科胸腔镜联合导管留置引流治疗结核性胸腔积液的护理分析[J].中国卫生标准管理,2017(14):150-152.
[8]王翔波,张瑞娇,杨从容,等.复张性肺水肿的临床观察及护理体会[J].昆明医科大学学报,2013,(2):167-168.
[9]刘福升.胸腔镜辅助治疗早期结核性包裒性胸腔积液112例[J].中国微创外科杂志,2014,14(7)::618-620.
[10]中国医师协会整合医学分会呼吸专业委员会.内科胸腔镜诊疗规范[J].中华肺病杂志(电子版),2018,11(1):6-13.
[11]韦庆,唐毓宜,韦真,等.内科胸腔镜对胸腔积液的诊断价值及安全性分析[J].检验医学与临床,2017,14(5):721-722.
[12]刘长江,徐晓荣,郑亮,等.内科胸腔镜对胸腔积液的诊断价值及安全性分析[J].影像研究与医学应用,2018,2(13):197-198.
[2]杜伟,熊小伟.胸腔镜活检并胸腔闭式引流在积液胸腔积液患者围术期的护理研究[J].中国医刊,2015,50(12):99-101.
[3]程小兰,金廷会,刘丽.预防和减少胸腔镜术后并发症的护理体会[J].中国医学创新,2013,10(27):57-58.
[4]柯彩霞,郑志惠,刘琼慧.诊断性内科胸腔镜术的护理配合[J].中国医药导报,2008,5(27):138-139.
[5]赵文萍,杜世霞.内科胸腔镜技术护理体会[J].中国社区医师,2009,11(3):85-86.
[6]黄瑜,周春萍,曾春梅.可弯式内科胸腔镜治疗结核性胸腔积液的护理体会[J].特别健康,2016,15:33,41.
[7]王颖丽.内科胸腔镜联合导管留置引流治疗结核性胸腔积液的护理分析[J].中国卫生标准管理,2017(14):150-152.
[8]王翔波,张瑞娇,杨从容,等.复张性肺水肿的临床观察及护理体会[J].昆明医科大学学报,2013,(2):167-168.
[9]刘福升.胸腔镜辅助治疗早期结核性包裒性胸腔积液112例[J].中国微创外科杂志,2014,14(7)::618-620.
[10]中国医师协会整合医学分会呼吸专业委员会.内科胸腔镜诊疗规范[J].中华肺病杂志(电子版),2018,11(1):6-13.
[11]韦庆,唐毓宜,韦真,等.内科胸腔镜对胸腔积液的诊断价值及安全性分析[J].检验医学与临床,2017,14(5):721-722.
[12]刘长江,徐晓荣,郑亮,等.内科胸腔镜对胸腔积液的诊断价值及安全性分析[J].影像研究与医学应用,2018,2(13):197-198.