3例胡桃夹综合征合并左精索静脉曲张的护理体会
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摘要
目的:总结胡桃夹综合征合并左精索静脉曲张围手术期的护理方法,为提高护理质量提供参考。方法:分析3例胡桃夹综合征合并左精索静脉曲张患者的临床资料。采用心理护理,抬臀透气,用腹带固定术区,活动四肢等方法护理。结果:3例患者行左肾静脉下移术,其中1例术中结扎左精索内静脉,术后第4天出现淋巴漏,经低脂饮食后乳糜液逐渐减少,术后第8天消失并拔除腹腔引流管,术后1周血尿消失,1月蛋白尿消失。随访5~23个月,左精索静脉曲张消失2例,1例减轻,精液质量改善,未出现左肾静脉吻合口狭窄,血尿、蛋白尿。评价护理效果满意。结论:围手术期护理对减少不恰当的活动牵拉伤口,减少咳嗽、活动等腹压增加时导致术区出血,减少患者翻身活动引起的疼痛,避免压疮、下肢静脉血栓等并发症的发生,提高患者舒适度,促进患者康复有利;心理护理、心理疏导改善患者对血尿、蛋白尿及不育症的恐惧有效,并可消除血尿、蛋白尿对导致尿毒症的误解;叮嘱患者出院后定期门诊随诊,确保患者的良好医从性对保证医疗质量至关重要。
Objective: To summarize the perioperative nursing methods of Nutcracker syndrome combined with left varicocele and to provide reference for improving nursing quality. Methods: The clinical data of 3 cases of Nutcracker syndrome with left varicocele were analyzed. Care and nursing methods were used as follows: psychological care,hip-lifted for better ventilation,surgery area fixed with belt,limbs mobilization and other methods of care. Results: Three patients underwent left renal vein distal transfer. One of the patients was ligated with left spermatic vein during the operation and Lymphatic leakage occurred on the fourth postoperative day. The chylous fluid gradually decreased after low-fat diet and disappeared and the abdominal drainage tube was removed on the eighth day after operation. Hematuria disappeared within one week and proteinuria disappeared after one month. After 5 to 23 months follow-up,left varicocele disappeared in 2 cases,1 case alleviated and semen quality improved. There was no left renal vein anastomosis stenosis,hematuria,proteinuria. Nursing evaluation result was satisfactory. Conclusion: Proper perioperative nursing can reduce wounds caused by improper activities,reduce bleeding in the surgical area by reducing cough,and other activities that increase abdominal pressure,reduce the pain caused by the patient 's turning activities,avoid pressure ulcers,venous thrombosis of the lower limbs and other complications,improve patient comfort and promote patient recovery. Psychological care and counseling were effective in improving patient's fear of hematuria,proteinuria and infertility and can eliminate the misunderstanding of the relation between hematuria,proteinuria and uremia. Reminding patients' regular clinic follow-up after discharge to maintain patient's good compliance is essential to ensure the quality of medical treatment.
Objective: To summarize the perioperative nursing methods of Nutcracker syndrome combined with left varicocele and to provide reference for improving nursing quality. Methods: The clinical data of 3 cases of Nutcracker syndrome with left varicocele were analyzed. Care and nursing methods were used as follows: psychological care,hip-lifted for better ventilation,surgery area fixed with belt,limbs mobilization and other methods of care. Results: Three patients underwent left renal vein distal transfer. One of the patients was ligated with left spermatic vein during the operation and Lymphatic leakage occurred on the fourth postoperative day. The chylous fluid gradually decreased after low-fat diet and disappeared and the abdominal drainage tube was removed on the eighth day after operation. Hematuria disappeared within one week and proteinuria disappeared after one month. After 5 to 23 months follow-up,left varicocele disappeared in 2 cases,1 case alleviated and semen quality improved. There was no left renal vein anastomosis stenosis,hematuria,proteinuria. Nursing evaluation result was satisfactory. Conclusion: Proper perioperative nursing can reduce wounds caused by improper activities,reduce bleeding in the surgical area by reducing cough,and other activities that increase abdominal pressure,reduce the pain caused by the patient 's turning activities,avoid pressure ulcers,venous thrombosis of the lower limbs and other complications,improve patient comfort and promote patient recovery. Psychological care and counseling were effective in improving patient's fear of hematuria,proteinuria and infertility and can eliminate the misunderstanding of the relation between hematuria,proteinuria and uremia. Reminding patients' regular clinic follow-up after discharge to maintain patient's good compliance is essential to ensure the quality of medical treatment.
引文
[1]Gong Y,Song B.The nutcracker sydrome[J].J urol,2003,169(6):2293-2294.
[2]高逸冰,高建平,程文.胡桃夹综合征的诊断和治疗[J].医学研究生学报,2013,26(8):868-870.
[3]黄姜黎.胡桃夹综合征30例的护理体会[J].护理与康复,2015,14(1):40-42.
[4]毛智慧,张欢,孙晓婷,等.舒适护理及其影响因素的研究进展[J].护理研究,2017(05):513-517.
[5]杨素霞.健康宣教在泌尿外科护理中应用的临床价值[J].中国医药指南,2017(02):195-196.
[6]李艳丽,王金鑫,张卫星,等.左肾静脉压迫综合征精索静脉结扎术患者综合护理管理[J].解放军医院管理杂志,2015,22(7):698-700.
[2]高逸冰,高建平,程文.胡桃夹综合征的诊断和治疗[J].医学研究生学报,2013,26(8):868-870.
[3]黄姜黎.胡桃夹综合征30例的护理体会[J].护理与康复,2015,14(1):40-42.
[4]毛智慧,张欢,孙晓婷,等.舒适护理及其影响因素的研究进展[J].护理研究,2017(05):513-517.
[5]杨素霞.健康宣教在泌尿外科护理中应用的临床价值[J].中国医药指南,2017(02):195-196.
[6]李艳丽,王金鑫,张卫星,等.左肾静脉压迫综合征精索静脉结扎术患者综合护理管理[J].解放军医院管理杂志,2015,22(7):698-700.