痔瘡護(hù)理論文手術(shù)護(hù)理論文手術(shù)室整體護(hù)理論文PPH治療重度痔的護(hù)理

1、痔瘡護(hù)理論文手術(shù)護(hù)理論文手術(shù)室整體護(hù)理論文PPH治療重度痔的護(hù)理【摘要】：痔瘡是常見病,多數(shù)患者經(jīng)保守治療可以好轉(zhuǎn),但重度痔(度、度內(nèi)痔)多有長(zhǎng)期便血和痔塊脫出,對(duì)藥物治療不佳且手術(shù)切除困難,注射硬化劑雖然簡(jiǎn)便,但復(fù)發(fā)率高.我院采用吻合器痔瘡環(huán)狀切除術(shù)(PPH)治療重度痔瘡16例,效果滿意,有效率為100%.【關(guān)鍵詞】： PPH; 痔; 護(hù)理1臨床資料本組共14(男8,女6)例,年齡2572(平均48)歲,病史130 a不等. 14例均有大便出血,手術(shù)前均經(jīng)過藥物治療.其中5例曾行內(nèi)痔硬化治療,3例有痔切除手術(shù)史.2圍手術(shù)期護(hù)理2.1術(shù)前護(hù)理患者術(shù)前多有精神緊張,個(gè)別患者因?yàn)槭菑?fù).,發(fā),所以對(duì)

2、此方法有懷疑心理.耐心細(xì)致的宣教很重要,術(shù)前應(yīng)避免患者情緒波動(dòng),囑患者進(jìn)全流食,適當(dāng)po緩瀉劑.因術(shù)前需常規(guī)灌腸,而患者多數(shù)直腸粘膜充血水腫,所以要選擇技術(shù)熟練的護(hù)士操作,避免損傷粘膜,加重病情.2.2術(shù)后護(hù)理要點(diǎn)3討論重度痔從病理解剖和生理功能都為不可逆性病變,選擇合適的手術(shù)方法是有必要的. PPH是治療重度痔的一種新技術(shù),其優(yōu)點(diǎn)是:治愈或顯著改變術(shù)前癥狀.手術(shù)、住院時(shí)間短.術(shù)后并發(fā)癥少,無肛門狹窄和大便失禁.術(shù)后恢復(fù)快. PPH比傳統(tǒng)痔手術(shù)切除更加安全、有效.護(hù)理時(shí)應(yīng)高度重視術(shù)后出血、尿潴留等并發(fā)癥,盡早發(fā)現(xiàn),及時(shí)處理,才能確保最佳治療效果.輕、中度脊髓空洞逐漸消失或明顯縮小.對(duì)于遠(yuǎn)隔節(jié)段

3、的空洞,解除延、頸髓受壓,打通4腦室正中孔,重建CSF循環(huán)通路,也有顯著的效果.本組117例脊髓空洞病例中的81例,在重建CSF循環(huán)通路后均未作脊髓空洞穿刺或切開分流術(shù),術(shù)后隨訪發(fā)現(xiàn)空洞消失38例,明顯縮小43例. Fujii認(rèn)為在空洞與脊髓的比值35%時(shí)行分流手術(shù)較適宜.我們對(duì)于重度的脊髓空洞(空洞與脊髓的比值50%),術(shù)中見受累脊髓明顯膨大,張力較高,部分脊髓組織已有變性的36例患者在重建CSF循環(huán)通路后,施行了脊髓空洞穿刺或切開分流術(shù),目的在于迅速解除脊髓受壓、改善血供和挽救已有部分變性的脊髓組織,阻斷疾病的惡性循環(huán).術(shù)后32例空洞明顯縮小,神經(jīng)功能障礙改善滿意;另4例空洞雖有所縮小,但

4、神經(jīng)功能障礙改善不明顯.考慮到這4例患者病程都在20 a以上,術(shù)后療效不佳,可能與病程過長(zhǎng),脊髓組織長(zhǎng)期受壓變性有關(guān).【參考文獻(xiàn)】1 Arnett B. Arnold-Chiari malformation J.Arch Neurol, 2003;60(6):898-900.2 Cheng JS, Nash J, Meyer GA. Chiari type I malformation revisit-ed: diagnosis and treatment J.Neurology, 2002;8(6):357-362. 3 Nash J, Cheng JS, Meyer GA, Remler

5、BF. Chiari type I malfor-mation: Overview of Diagnosis and treatment J.WMJ, 2002;101(8):35-40.4 Iwasaki Y, Hida K, Koyanagi I, Abe H. Reevaluation of syringo-subarachnoid shunt for syringomyelia with Chiari malformation J.Neurosurgery, 2000;46(2):407-412.5 Hori A. Treatment of the Chiari malformatio

6、n by Drs. H.E. Jamesand A. Brant J.Childs Nerv Syst, 2002;18(9-10):461-462.6 Oldfield EH. Cerebellar tonsils and syringomyelia J.J Neuro-surg, 2002;97(5):1009-1010.7 Gardner WJ. Hydrodynamic mechanism of syringomyelia: Its rela-tionship to myelocele J.JNeurol NeurosurgPsychiat, 1965;28:247-259.8 Wil

7、liams B. Cough headache due to craniospinal pressure dissociationJ.Arch Neurol, 1980;4:230-266.9 Williams B. On pathogenisis of syringomyelia: A review J.J RSoc Med, 1980;73(11):798-806.10 Williams B. Simultaneous cerebral and spinal fluid pressure record-ing 2. Cerebrospinal dissociation with lesio

8、ns at the foramen mag-num J.Acta Neurochir ( Wien), 1981;59(1-2):123-142.11 Buxton N, Jaspan T, Punt J. Treatment of Chiari malformation,syringomyelia and hydrocephalus by neuroendoscopic third ventricu-lostomy J.Minim Invasive Neurosurg, 2002;45(4):231-234.12 Fujii K, Natori K, Nakagaki H, Fukui M. Management of sy-ringomyelia associated with Ch