保留腎單位腎部分切除術(shù)患者的圍手術(shù)期護理

1/1保留腎單位腎部分切除術(shù)患者的圍手術(shù)期護理保留腎單位腎部分切除術(shù)患者的圍手術(shù)期護理【摘要】目的：

探討保留腎單位的腎部分切除術(shù)的術(shù)前、術(shù)后護理方法，總結(jié)護理經(jīng)驗，以提高護理質(zhì)量。

方法：

選取泌尿外科12例腎癌（直徑?4cm）患者施行保留腎單位的腎部分切除術(shù)，并進行有效的術(shù)前術(shù)后護理，觀察術(shù)后早期恢復(fù)情況、并發(fā)癥及舒適程度。

結(jié)果：

12例患者均手術(shù)成功，無明顯并發(fā)癥，恢復(fù)情況良好。

結(jié)論：

精湛的手術(shù)技巧，充分的術(shù)前準(zhǔn)備和精心的圍手術(shù)期護理及病情觀察是保證手術(shù)順利進行、提高手術(shù)成功率、減少和預(yù)防手術(shù)并發(fā)癥的發(fā)生、促進患者康復(fù)的重要措施。

【關(guān)鍵詞】腎癌；保留腎單位；腎部分切除術(shù)；圍手術(shù)期；護理腎癌（renalcarcinoma）亦稱腎細(xì)胞癌，是起源于腎實質(zhì)泌尿小管上皮系統(tǒng)的惡性腫瘤，為最常見的腎實質(zhì)惡性腫瘤，約占成人惡性腫瘤的2%--3%。

外科手術(shù)治療的主要方法有根治性腎切除術(shù)和保留腎單位的腎部分切除術(shù)（NSS）。

保留腎單位手術(shù)主要適用于早期的偶發(fā)腎癌，且腫瘤直徑?4cm的患者，先天性孤立腎、對側(cè)腎功能不全或無功能者以及雙側(cè)腎癌等。

保留腎單位手術(shù)后局部復(fù)發(fā)率0―10%，而腫瘤4cm手術(shù)后局部復(fù)發(fā)率0―3%。

（1）有研究顯示腎部分切除術(shù)與根治性腎切除術(shù)比較，其5年生存率分別為85%和93%，無顯著性差異。

由于腎組織脆嫩，血運豐富，不易愈合，腎部分切除術(shù)后易發(fā)生出血，因此術(shù)后的觀察與護理非常重要。

我院自2011年9月―2013年5月共行開放性保留腎單位的腎部分切除術(shù)12例，術(shù)后恢復(fù)良好，現(xiàn)將護理體會總結(jié)如下：

1.1臨床資料本組病例12例，其中男9例，女3例，年齡在29-76歲之間，平均年齡52歲，均無明顯臨床癥狀，平時體健，于體檢時發(fā)現(xiàn)，均為單側(cè)腎癌，對側(cè)腎臟健康，腫瘤直徑均小于4CM，術(shù)后一例發(fā)生脂肪液化，其余均順利恢復(fù)。

1.2手術(shù)方法本組手術(shù)均采用氣管插管全麻，健側(cè)臥位，升高腰橋，妥善固定肢體，行保留腎單位腎部分切除術(shù)。

增加內(nèi)容2.護理2.1術(shù)前護理2.1.1心理護理了解病人的心理需要，根據(jù)病人不同的心理特點，以明確的語言，誠懇的態(tài)度向病人詳細(xì)介紹手術(shù)的意義、必要性和注意事項。

并介紹既往成功病例，講解手術(shù)方法和步驟，使患者對手術(shù)及術(shù)后效果有正確的認(rèn)識。

鼓勵家屬共同參與到患者的護理中，使患者以良好的精神狀態(tài)迎接手術(shù)。

對晚上睡眠不佳的患者，可適當(dāng)給予鎮(zhèn)靜藥物。

2.2.2了解全身狀況協(xié)助患者做好術(shù)前各項檢查，了解患者心、肝、腎等器官情況，監(jiān)測體溫、血壓、血糖等，使其維持在正常范圍內(nèi)。

作腎圖檢查，了解患側(cè)及對側(cè)腎功能。

2.2.3常規(guī)術(shù)前準(zhǔn)備：

常規(guī)備皮、備血，指導(dǎo)患者練習(xí)床上進食和大小便，向患者及家屬講解術(shù)后絕對臥床的重要性。

術(shù)前戒煙2周以上，術(shù)前禁食12小時，禁飲6-8小時，術(shù)前晚灌腸，術(shù)晨留置胃管，以減輕術(shù)后腹脹。

2.2術(shù)后護理2.2.1術(shù)后去枕平臥6小時，頭偏向一側(cè)，防止舌后綴及分泌物誤吸引起吸入性肺炎。

尤其術(shù)后使用麻醉鎮(zhèn)痛泵的患者，因藥物副作用，部分患者會出現(xiàn)惡心、嘔吐癥狀，注意保持患者呼吸道的通暢，必要時可遵醫(yī)囑給予止吐藥物。

2.2.2術(shù)后嚴(yán)密觀察生命體征的變化術(shù)后常規(guī)給持續(xù)低流量吸氧2升/分，心電監(jiān)測24―48小時，嚴(yán)密觀察心率、血壓、指脈氧等情況。

2.2.3術(shù)后取平臥位休息，由于腎組織脆嫩，血運豐富，不易愈合，因此腎部分切除的患者需絕對臥床休息2周以上，告知?azleWcqOaWsOeUn+Wls+WptOWvvOWwv+acr+S4reeahOaViOaenOinguWvn0XkuKTnp43lr7zlsL/nrqHlm7rlrprmlrnms5XlnKjmlrDnlJ/lpbPlqbTlr7zlsL/mnK/kuK3nmoTmlYjmnpzop4Llr59kAmwPZBYCZg8VBAAOemdiczIwMTMwNzExODUs5LuZ5Lq65o6M5aSW5pW35rK755aX6L6T5ray5oCn6Z2Z6ISJ54KONjDkvoss5LuZ5Lq65o6M5aSW5pW35rK755aX6L6T5ray5oCn6Z2Z6ISJ54KONjDkvotkAm0PZBYCZg8VBAAOemdiczIwMTMwNzExODY56Z2Z6ISJ6Ieq5o6n6ZWH55eb55So5LqO5pat5oyH5YaN5qSN5pyv5ZCO55qE5Li05bqK5bqU55SoOemdmeiEieiHquaOp+mVh+eXm+eUqOS6juaWreaMh+WGjeakjeacr+WQjueahOS4tOW6iuW6lOeUqGQCbg9kFgJmDxUEAA56Z2JzMjAxMzA3MTE4NzPlvILkuJnphZrpnZnohInpurvphonlnKjkurrlt6XmtYHkuqfmnK/kuK3nmoTlupTnlKgz5byC5LiZ6YWa6Z2Z6ISJ6bq76YaJ5Zyo5Lq65bel5rWB5Lqn5pyv5Lit55qE5bqU55SoZAJvD2QWAmYPFQQADnpnYnMyMDEzMDcxMTg4NuaUueiJr+miiOWklumdmeiEieepv+WIuuaWueazleS7peaPkOmrmOepv+WIuuaIkOWKn+eOhzbmlLnoia/poojlpJbpnZnohInnqb/liLrmlrnms5Xku6Xmj5Dpq5jnqb/liLrmiJDlip/njodkAnAPZBYCZg8VBAAOemdiczIwMTMwNzExODlB55S15a2Q57uT6IKg6ZWc5LiL5rK755aXNjTkvovogIHlubTkurrnu5PogqDmga/ogonkvovkuLTluorkvZPkvJpB55S15a2Q57uT6IKg6ZWc5LiL5rK755aXNjTkvovogIHlubTkurrnu5PogqDmga/ogonkvovkuLTluorkvZPkvJpkAnEPZBYCZg8VBAAOemdiczIwMTMwNzExOTAk5Zyw5aGe57Gz5p2+55qE5LiN6Imv5Y+N5bqU5Y+K6Ziy5rK7JOWcsOWhnuexs+advueahOS4jeiJr+WPjeW6lOWPiumYsuayu2QCcg9kFgJmDxUEAA56Z2JzMjAxMzA3MTE5MTbpmLLpgIbmtYHlnovnlZnnva7pkojlnKjpnZnohInovpPmtrLkuK3nmoTlupTnlKjmjqLorqg26Ziy6YCG5rWB5Z6L55WZ572u6ZKI5Zyo6Z2Z6ISJ6L6T5ray5Lit55qE5bqU55So5o6i6K6oZAJzD2QWAmYPFQQADnpnYnMyMDEzMDcxMTkyMOmjn+euoeeZjOacr+WQjuaXqeacn+iCoOWGheiQpeWFu+eahOS4tOW6iuW6lOeUqDDpo5/nrqHnmYzmnK/lkI7ml6nmnJ/ogqDlhoXokKXlhbvnmoTkuLTluorlupTnlKhkAnQPZBYCZg8VBAAOemdiczIwMTMwNzExOTMe5rWF6LCI5Y6L55au55qE5Y6f5Zug5Y+K6aKE6ZiyHua1heiwiOWOi+eWrueahOWOn+WboOWPiumihOmYsmQCdQ9kFgJmDxUEAA56Z2JzMjAxMzA3MTE5NCHlvKXmvKvmgKfovbTntKLmjZ/kvKTor4rmsrvkvZPkvJoh5byl5ryr5oCn6L2057Si5o2f5Lyk6K+K5rK75L2T5LyaZAJ2D2QWAmYPFQQADnpnYnMyMDEzMDcxMTk1O+aXoOW8oOWKm+eWneS/ruihpeacr+ayu+eWl+iFueiCoeayn+aWnOeWnTc45L6L5Li05bqK5L2T5LyaO+aXoOW8oOWKm+eWneS/ruihpeacr+ayu+eWl+iFueiCoeayn+aWnOeWnTc45L6L5Li05bqK5L2T5LyaZAJ3D2QWAmYPFQQADnpnYnMyMDEzMDcxMTk2OOS4reilv+WMu+e7k+WQiOayu+eWl+W/g+iCvumYs+iZmuWei+eXheeqpue7vOWQiOW+gTIx5L6LOOS4reilv+WMu+e7k+WQiOayu+eWl+W/g+iCvumYs+iZmuWei+eXheeqpue7vOWQiOW+gTIx5L6LZAJ4D2QWAmYPFQQADnpnYnMyMDEzMDcxMTk3OOelm+iFkOeUn+iCjOaVo+ayu+eWl+aFouaAp+S9k+ihqOa6g+eWoTE05L6L55aX5pWI6KeC5a+fOOelm+iFkOeUn+iCjOaVo+ayu+eWl+aFouaAp+S9k+ihqOa6g+eWoTE05L6L55aX5pWI6KeC5a+fZAJ5D2QWAmYPFQQADnpnYnMyMDEzMDcxMTk4MTHkvovlnoLkvZPlkI7lj7bntKDoh7Tlv4Pnjoflh4/mhaLnmoTmiqTnkIbkvZPkvJoxMeS+i+WeguS9k+WQjuWPtue0oOiHtOW/g+eOh+WHj+aFoueahOaKpOeQhuS9k+S8mmQCeg9kFgJmDxUEAA56Z2JzMjAxMzA3MTE5OUTpq5jpvoTmiL/poqTmgqPogIXpnZ7lv4PohI/miYvmnK/nmoTpurvphonlpITnkIbvvIjpmYQyMOS+i+aKpeWRiu+8iUTpq5jpvoTmiL/poqTmgqPogIXpnZ7lv4PohI/miYvmnK/nmoTpurvphonlpITnkIbvvIjpmYQyMOS+i+aKpeWRiu+8iWQCew9kFgJmDxUEAA56Z2JzMjAxMzA3MTIwMB3lubzlhL/mgKXnlrk1NuS+i+ayu+eWl+S9k+S8mh3lubzlhL/mgKXnlrk1NuS+i+ayu+eWl+S9k+S8mmQCfA9kFgJmDxUEAA56Z2JzMjAxMzA3MTIwMSjmgKXor4rovpPlsL/nrqHnu5Pnn7PnmoRFU1dM5rK755aX5L2T5LyaKOaApeiviui+k+Wwv+euoee7k+efs+eahEVTV0zmsrvnlpfkvZPkvJpkAn0PZBYCZg8VBAAOemdiczIwMTMwNzEyMDIq5rWF6LCI5oqk55CG5bel5L2c55qE5rKf6YCa5oqA5ben5ZKM5L2T5LyaKua1heiwiOaKpOeQhuW3peS9nOeahOayn+mAmuaKgOW3p+WSjOS9k+S8mmQCfg9kFgJmDxUEAA56Z2JzMjAxMzA3MTIwMy3lvq7ms6LnkIbnlpfnlKjkuo7mnK/lkI7liIflj6PnmoTnlpfmlYjop4Llr58t5b6u5rOi55CG55aX55So5LqO5pyv5ZCO5YiH5Y+j55qE55aX5pWI6KeC5a+fZAJ/D2QWAmYPFQQADnpnYnMyMDEzMDcxMjA0MeWwj+WEv+WbnuebsumDqOaGqeWupOepv+WtlOS8tOaApeaAp+mYkeWwvueCjjLkvosx5bCP5YS/5Zue55uy6YOo5oap5a6k56m/5a2U5Ly05oCl5oCn6ZiR5bC+54KOMuS+i2QCgAEPZBYCZg8VBAAOemdiczIwMTMwNzEyMDUyQU/plIHpqqjpkqnpkqLmnb/lnKjmgKXor4rpqqjnp5HliJvkvKTkuK3nmoTlupTnlKgyQU/plIHpqqjpkqnpkqLmnb/lnKjmgKXor4rpqqjnp5HliJvkvKTkuK3nmoTlupTnlKhkAoEBD2QWAmYPFQQADnpnYnMyMDEzMDcxMjA2KumdmeiEieepv+WIuui/m+mSiOS4juaLlOmSiOaWueazleeahOaOouiuqCrpnZnohInnqb/liLrov5vpkojkuI7mi5Tpkojmlrnms5XnmoTmjqLorqhkAoIBD2QWAmYPFQQADnpnYnMyMDEzMDcxMjA3J+S7i+e7jeS4gOenjeaWsOWei+S9k+a4qeiuoea2iOavkuijhee9rifku4vnu43kuIDnp43mlrDlnovkvZPmuKnorqHmtojmr5Loo4Xnva5kAoMBD2QWAmYPFQQADnpnYnMyMDEzMDcxMjA4G+mVieaxoeafk+WPiuWFtumYsuayu+WvueetlhvplYnmsaHmn5Plj4rlhbbpmLLmsrvlr7nnrZZkAoQBD2QWAmYPFQQADnpnYnMyMDEzMDcxMjA5KuWNgeS6jOaMh+iCoOa6g+eWoeepv+WtlOWkluenkeayu+eWl+S9k+S8mirljYHkuozmjIfogqDmuoPnlqHnqb/lrZTlpJbnp5HmsrvnlpfkvZPkvJpkAoUBD2QWAmYPFQQADnpnYnMyMDEzMDcxMjEwIUNOUOWcqOaIkemZouS6p+enkeeahOW6lOeUqOWIhuaekCFDTlDlnKjmiJHpmaLkuqfnp5HnmoTlupTnlKjliIbmnpBkAoYBD2QWAmYPFQQADnpnYnMyMDEzMDcxMjExR+e7j+WkluWRqOmdmeiEieWvvOWFpeS4reW/g+mdmeiEiee9rueuoeacr++8iFBJQ0PvvInlnKhOSUNV5Lit55qE5bqU55SoR+e7j+WkluWRqOmdmeiEieWvvOWFpeS4reW/g+mdmeiEiee9rueuoeacr++8iFBJQ0PvvInlnKhOSUNV5Lit55qE5bqU55SoZAKHAQ9kFgJmDxUEAA56Z2JzMjAxMzA3MTIxMhXlurflpI3msrvnlpfnmoTlupTnlKgV5bq35aSN5rK755aX55qE5bqU55SoZAKIAQ9kFgJmDxUEAA56Z2JzMjAxMzA3MTIxMyTogIHlubTkurrogrrngo7or4rmsrvnmoTkuLTluorkvZPkvJok6ICB5bm05Lq66IK654KO6K+K5rK755qE5Li05bqK5L2T5LyaZAKJAQ9kFgJmDxUEAA56Z2JzMjAxMzA3MTIxNDDohJHpkqDogr3lnKjlv4PoobDmgqPogIXor4rmsrvlupTnlKjkuK3nmoTkvZznlKgw6ISR6ZKg6IK95Zyo5b+D6KGw5oKj6ICF6K+K5rK75bqU55So5Lit55qE5L2c55SoZAKKAQ9kFgJmDxUEAA56Z2JzMjAxMzA3MTIxNTbkuIDkvovotLLpl6jnmYzmgqPogIXov57nu63kuKTmrKHmiYvmnK/nmoTmsrvnlpfkvZPkvJo25LiA5L6L6LSy6Zeo55mM5oKj6ICF6L+e57ut5Lik5qyh5omL5pyv55qE5rK755aX5L2T5LyaZAKLAQ9kFgJmDxUEAA56Z2JzMjAxMzA3MTIxNjPlrqvohZTplZzlnKjoioLogrLlmajlj5blh7rlm7Dpmr7or4rmsrvkuK3nmoTlupTnlKgz5a6r6IWU6ZWc5Zyo6IqC6IKy5Zmo5Y+W5Ye65Zuw6Zq+6K+K5rK75Lit55qE5bqU55SoZAKMAQ9kFgJmDxUEAA56Z2JzMjAxMzA3MTIxNw/ljIXnmq7njq/liIfmnK8P5YyF55qu546v5YiH5pyvZAKNAQ9kFgJmDxUEAA56Z2JzMjAxMzA3MTIxODLph43lnovpooXohJHmjZ/kvKTmnK/kuK3ohJHohqjlh7oyNuS+i+WkhOeQhuS9k+S8mjLph43lnovpooXohJHmjZ/kvKTmnK/kuK3ohJHohqjlh7oyNuS+i+WkhOeQhuS9k+S8mmQCjgEPZBYCZg8VBAAOemdiczIwMTMwNzEyMTkt6ICB5bm05oKj6ICF5b+D6ISP55Oj6Iac55eF5aSW56eR5rK755aX5L2T5LyaLeiAgeW5tOaCo+iAheW/g+iEj+eTo+iGnOeXheWkluenkeayu+eWl+S9k+S8mmQCjwEPZBYCZg8VBAAOemdiczIwMTMwNzEyMjAh5byA5bGV5LyY6LSo5oqk55CG5pyN5Yqh55qE5L2T5LyaIeW8gOWxleS8mOi0qOaKpOeQhuacjeWKoeeahOS9k+S8mmQCkAEPZBYCZg8VBAAOemdiczIwMTMwNzEyMjEk6IKy6b6E5aaH5aWz57Sn5oCl6YG/5a2V5bi455So5pa55rOVJOiCsum+hOWmh+Wls+e0p+aApemBv+WtleW4uOeUqOaWueazlWQCkQEPZBYCZg8VBAAOemdiczIwMTMwNzEyMjI/5Za36Zu+55aX5rOV5Zyo5ZK95ZaJ5LiN6YCC5Lul5Y+K5ZG85ZC457O757uf55a+55eF5Lit55qE5bqU55SoP+WWt+mbvueWl+azleWcqOWSveWWieS4jemAguS7peWPiuWRvOWQuOezu+e7n+eWvueXheS4reeahOW6lOeUqGQCkgEPZBYCZg8VBAAOemdiczIwMTMwNzEyMjNL6YG/5YWJ6L6T5ray5Zmo6IGU5ZCI5Zac55aX5aal6IO95pyJ5pWI6ZmN5L2O5Yev5pe25omA6Ie06Z2Z6ISJ54KO5Y+R55Sf546HS+mBv+WFiei+k+a2suWZqOiBlOWQiOWWnOeWl+WmpeiDveacieaViOmZjeS9juWHr+aXtuaJgOiHtOmdmeiEieeCjuWPkeeUn+eOh2QCkwEPZBYCZg8VBAAOemdiczIwMTMwNzEyMjRU5YWN6LS55a2V5YmN5LyY55Sf562b5p+l6Z2Z6ISJ6YeH6KGA5byV6LW355qE5L2O6KGA57OW5Y+N5bqU55qE5Y6f5Zug5Y+K5aSE55CG5o6q5pa9VOWFjei0ueWtleWJjeS8mOeUn+etm+afpemdmeiEiemHh+ihgOW8lei1t+eahOS9juihgOezluWPjeW6lOeahOWOn+WboOWPiuWkhOeQhuaOquaWvWQClAEPZBYCZg8VBAAOemdiczIwMTMwNzEyMjUw5ZG85ZC46YGT5qKX6Zi75oCl5pWR54mp5ZOB566x55qE6K6+6K6h5LiO5bqU55SoMOWRvOWQuOmBk+ail+mYu+aApeaVkeeJqeWTgeeuseeahOiuvuiuoeS4juW6lOeUqGQClQEPZBYCZg8VBAAOemdiczIwMTMwNzEyMjYe6KGA5ray54GM5rWB5Zue6KGA5pa55rOV5pS56ImvHuihgOa2sueBjOa1geWbnuihgOaWueazleaUueiJr2QClgEPZBYCZg8VBAAOemdiczIwMTMwNzEyMjcg6YeN6KaB56Wb55aj5pa55rK755aX6La+55ajMzbkvosg6YeN6KaB56Wb55aj5pa55rK755aX6La+55ajMzbkvotkApcBD2QWAmYPFQQADnpnYnMyMDEzMDcxMjI4ReS4jeWQjOearuiCpOWHhuWkh+aWueazleacr+WQjuWIh+WPo+aEn+afk+eahOWJjeeeu+aAp+eglOeptuWPiumihOmYskXkuI3lkIznmq7ogqTlh4blpIfmlrnms5XmnK/lkI7liIflj6PmhJ/mn5PnmoTliY3nnrvmgKfnoJTnqbblj4rpooTpmLJkApgBD2QWAmYPFQQADnpnYnMyMDEzMDcxMjI5KuWuq+WGheiKguiCsuWZqOW1jOmhv+eahOS4tOW6iuayu+eWl+S9k+S8mirlrqvlhoXoioLogrLlmajltYzpob/nmoTkuLTluormsrvnlpfkvZPkvJpkApkBD2QWAmYPFQQADnpnYnMyMDEzMDcxMjMwEuaMieaRqeayu+eWl+WktOeXmxLmjInmkanmsrvnlpflpLTnl5tkApoBD2QWAmYPFQQADnpnYnMyMDEzMDcxMjMxP+WutuW6reiHqua1i+ihgOWOi+WcqOWmiuWooOmrmOihgOWOi+e7vOWQiOW+geaCo+iAheS4reeahOW6lOeUqD/lrrbluq3oh6rmtYvooYDljovlnKjlporlqKDpq5jooYDljovnu7zlkIjlvoHmgqPogIXkuK3nmoTlupTnlKhkApsBD2QWAmYPFQQADnpnYnMyMDEzMDcxMjMyIeS4iei4neWFs+iKgumqqOaKmOeahOaJi+acr+ayu+eWlyHkuInouJ3lhbPoioLpqqjmipjnmoTmiYvmnK/msrvnlpdkApwBD2QWAmYPFQQADnpnYnMyMDEzMDcxMjMzJ+eJqeeQhuWboOWtkOayu+eWl+iCqeWRqOeCjueWl+aViOinguWvnyfniannkIblm6DlrZDmsrvnlpfogqnlkajngo7nlpfmlYjop4Llr59kAp0BD2QWAmYPFQQADnpnYnMyMDEzMDcxMjM0QuiCm+iCoOeXheaCo+iAheacr+WQjueUqOS4reiNr+eGj+a0l+S8pOWPo+eahOayu+eWl+S4jueWl+aViOinguWvn0LogpvogqDnl4XmgqPogIXmnK/lkI7nlKjkuK3oja/nho/mtJfkvKTlj6PnmoTmsrvnlpfkuI7nlpfmlYjop4Llr59kAp4BD2QWAmYPFQQADnpnYnMyMDEzMDcxMjM1J+e7iOatouWmiuWooOacr+i/keacn+W5tuWPkeeXh+eahOmYsuayuyfnu4jmraLlporlqKDmnK/ov5HmnJ/lubblj5Hnl4fnmoTpmLLmsrtkAp8BD2QWAmYPFQQADnpnYnMyMDEzMDcxMjM2GOmrmOihgOWOi+eahOWBpeW6t+aVmeiCshjpq5jooYDljovnmoTlgaXlurfmlZnogrJkAqABD2QWAmYPFQQADnpnYnMyMDEzMDcxMjM3XemiheWGhemdmeiEieeqpuihgOagk+W9ouaIkOeahOeXheWboOOAgeS4tOW6iuihqOeOsOOAgeW9seWDj+WtpuaUueWPmOOAgeayu+eWl+WPiumihOWQjuWIhuaekF3pooXlhoXpnZnohInnqqbooYDmoJPlvaLmiJDnmoTnl4Xlm6DjgIHkuLTluorooajnjrDjgIHlvbHlg4/lrabmlLnlj5jjgIHmsrvnlpflj4rpooTlkI7liIbmnpBkAqEBD2QWAmYPFQQADnpnYnMyMDEzMDcxMjM4O+WFs+iKguadvuWKqOacr+mFjeWQiOmSiOeBuOayu+eWl+iCqeWRqOeCjjMw5L6L55aX5pWI6KeC5a+fO+WFs+iKguadvuWKqOacr+mFjeWQiOmSiOeBuOayu+eWl+iCqeWRqOeCjjMw5L6L55aX5pWI6KeC5a+fZAKiAQ9kFgJmDxUEAA56Z2JzMjAxMzA3MTIzOTPmtYXosIjlv4PnkIbmsrvnlpflr7nmipHpg4HmgqPogIXlurflpI3nmoTph43opoHmgKcz5rWF6LCI5b+D55CG5rK755aX5a+55oqR6YOB5oKj6ICF5bq35aSN55qE6YeN6KaB5oCnZAKjAQ9kFgJmDxUEAA56Z2JzMjAxMzA3MTI0MBjlgaXlurfku47igJzpvb/igJ3lvIDlp4sY5YGl5bq35LuO4oCc6b2/4oCd5byA5aeLZAKkAQ9kFgJmDxUEAA56Z2JzMjAxMzA3MTI0MTHpnZ7miYvmnK/msrvnlpfliY3luq3lpKfohbrlm4rogr845L6L55aX5pWI6KeC5a+fMemdnuaJi+acr+ayu+eWl+WJjeW6reWkp+iFuuWbiuiCvzjkvovnlpfmlYjop4Llr59kAqUBD2QWAmYPFQQADnpnYnMyMDEzMDcxMjQyPemrmOihgOWOi+eXheS8tDLlnovns5blsL/nl4XmgqPogIXooYDohILmsLTlubPnmoTkuLTluorop4Llr5896auY6KGA5Y6L55eF5Ly0MuWei+ezluWwv+eXheaCo+iAheihgOiEguawtOW5s+eahOS4tOW6iuinguWvn2QCpgEPZBYCZg8VBAAOemdiczIwMTMwNzEyNDM55om56YeP5aSn6Z2i56ev54On5Lyk5oKj6ICF5rCU566h5YiH5byA5Y+K5rCU6YGT55qE566h55CGOeaJuemHj+Wkp+mdouenr+eDp+S8pOaCo+iAheawlOeuoeWIh+W8gOWPiuawlOmBk+eahOeuoeeQhmQCpwEPZBYCZg8VBAAOemdiczIwMTMwNzEyNDRD5Lq65bel5rWB5Lqn5pyv5ZCO5bm25Y+R5a2Q5a6r57KY6L+eNuS+i+eahOayu+eWl+mihOmYsuS4tOW6iuinguWvn0Pkurrlt6XmtYHkuqfmnK/lkI7lubblj5HlrZDlrqvnspjov5425L6L55qE5rK755aX6aKE6Ziy5Li05bqK6KeC5a+fZAKoAQ9kFgJmDxUEAA56Z2JzMjAxMzA3MTI0NSTmgI7moLfpooTpmLLovpPmtrLlvZPkuK3nmoTlpJbmuJfvvJ8k5oCO5qC36aKE6Ziy6L6T5ray5b2T5Lit55qE5aSW5riX77yfZAKpAQ9kFgJmDxUEAA56Z2JzMjAxMzA3MTI0NkXml6nlrZXotJ/ljovlkLjlrqvmnK/lupTnlKjpl7Toi6/kuInphZrplYfnl5vnmoTkuLTluorliIbmnpDkuI7kvZPkvJpF5pep5a2V6LSf5Y6L5ZC45a6r5pyv5bqU55So6頰嘸凹沂舨皇實鋇幕疃?蜆?縵麓不疃?岬賈律霾卸似屏殉鲅?＃?）因此翻身時需保持患者腰背部呈直線，防止因翻身、劇烈咳嗽等動作而發(fā)生出血。

臥床期間進行關(guān)節(jié)及肢體的按摩和被動活動，促進血液循環(huán)，減少下肢血栓形成。

兩周后可先在床上做踏車之類輕微的活動，促進肌肉張力恢復(fù)。

待病情允許后，可在家屬參與下進行床旁活動。

2.2.4引流管的護理2.2.4.1留置尿管的護理保持尿道口及會陰部的清潔，每日用0.5%的碘伏棉球消毒2次，保持尿管引流通暢，避免引流袋高于恥骨聯(lián)合，同時注意觀察尿液的顏色及尿量。

2.2.4.2腹膜后引流管的護理保持引流通暢，避免引流管打折彎曲或脫出，每日更換引流袋并準(zhǔn)確記錄引流液的性質(zhì)、顏色及量，引流袋低于創(chuàng)口水平，防止逆行感染。

如引流量100ml/h且顏色鮮紅，時間持續(xù)2小時以上，應(yīng)立即通知醫(yī)生處理。

2.2.5術(shù)后并發(fā)癥的觀察及護理2.2.5.1出血出血多發(fā)生于術(shù)后3-5天，術(shù)后出血主要由于腎創(chuàng)面止血不徹底引起。

應(yīng)密切觀察心率、血壓、呼吸、尿液等生命體征的變化。

注意傷口敷料有無滲血，腰腹部有無腫脹、飽滿甚至淤血情況。

（3）注意