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肝胆腔镜外科留置t管的护理课件

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肝胆 外科 留置 护理 课件
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单击此处编辑母版标题样式 单击此处编辑母版副标题样式 留置T管的护理 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial T管简介 肝胆腔镜外科 留置T管的护理 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial T管用于引流胆汁 一端通向肝管 一端通向十二指肠 由腹壁戳口穿出体外 接引流袋 T管简介 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胆汁的生成与代谢 肝细胞分泌胆汁 每日分泌量约800 1000ml 胆汁呈黄 绿色 PH值为6 0 8 8 97 是水 溶质有胆盐 胆色素 胆固醇 卵磷脂 脂肪酸 电解质和大量的肝脏代谢产物 胆汁的浓缩和贮存 胆囊黏膜具有吸收水和电解质的功能 能将淡黄色稀薄的 肝胆汁浓缩5 10倍后转变为棕黄色黏稠的胆囊胆汁 贮存于 胆囊中 少量直接进入肠道帮助消化 胆汁的排出 当油脂饮食及酸性胃液进入十二指肠后 刺激肠黏膜分泌 胆囊收缩素 有收缩胆囊和舒张胆总管下段及Oddi括约肌的作 用 将贮存于胆囊中的大量胆汁排空入十二指肠 因此 胆道 系统最主要的生理功能是输送和调节肝细胞分泌的胆汁进入至 十二指肠 肝胆腔镜外科 胆道系统生理功能 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胆系疾病 凡是切开胆总管 解除胆总管梗阻的操作都有指征T管引流 如 胆总管探 查术 胆总管切开取石 急性梗阻性化脓性胆管炎 胆管癌姑息手术 胆道 蛔虫 胆管炎性狭窄 胆总管外伤 胰腺癌侵润胆总管等 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 1 引流胆汁 残余结 石 2 支撑胆道 3 术后进行取石 造影的通道 管的作用 肝胆腔镜外科 裘法祖教授 只要切开胆总管就 应该放置T 型管 哪怕是穿刺一下也要放 置 管 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 留置T管的护理 T管固定 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial T管固定方法 平卧位时 引流袋不高于腋中线 切忌将 管随意放于床上 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial T管固定方法 1 减轻腹部切口缝合部位张 力 缓解伤口疼痛 利于伤口愈 合 2 腹部盆腔术后半卧位 利 于渗出液流入盆腔 使感染局限 也利于有效引流 3 重力作用使膈肌位置下降 胸腔容积扩大 利于呼吸 肝胆腔镜外科 半卧位优点 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝胆腔镜外科 T管固定方法 1 可将引流管用胶布交叉 固定在皮肤上 2 并交待患者注意事项翻 身或活动时一定要先提引流 袋再进行活动 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 站立活动时将引流管固定于腰部 但应 低于腹部切口 避免牵拉 肝胆腔镜外科 T管固定方法 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 留置T管的护理 胆汁的观察 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 观察项目 胆汁的量 1 胆汁的色泽 2 胆汁的性状 3 有无结石 沉淀 絮状物 4 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 观察项目 胆汁的量 1 胆汁的色泽 2 胆汁的性状 3 有无结石 沉淀 絮状物 4 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 观察项目 正常成人胆汁分泌量为800 1200ml d 胆汁一般应由少到多 再从多到少 术后观察引流量 一般为300 500ml d 若1000ml d 应查明原因 1 量的观察 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 观察项目 管受压 打折或部分堵塞或半脱出 突然增加 胆道下端阻塞 十二指肠液倒流 胆汁量 突然减少甚至无胆汁引流出 异常原因 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 观察项目 胆汁的量 1 胆汁的色泽 2 胆汁的性状 3 有无结石 沉淀 絮状物 4 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 观察项目 正常胰液出血异物 肝胆腔镜外科 2 色的观察 术后1 2天胆汁呈混浊的淡黄色 以后逐 渐加深 呈黄色 如引流液颜色较红 即怀疑有胆道出血的 可能 需严密观察 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 观察项目 肝胆腔镜外科 2 色的观察 草绿色 胆汁内的胆红素受细菌作用或受胃酸 的氧化 白色 胆囊颈管或肝胆管内由于长期梗阻 胆 汁中胆色素及胆盐被吸收 由胆囊黏膜 胆管黏 膜所分泌白胆汁所代替 这种白胆汁都在手术后 几小时内引流出来 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 观察项目 胆汁的量 1 胆汁的色泽 2 胆汁的性状 3 有无结石 沉淀 絮状物 4 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 拔管护理 肝胆腔镜外科 留置T管的护理 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 鼓励患者早期活动 注意劳逸结合 指导患者进低脂 高糖 高蛋白 高维生素饮食 多 食蔬菜水果 忌油腻食物及饱餐 养成良好的工作 休息和饮食规律 保持切口清洁干燥 若伤口愈合好 术后1周即可恢复 日常生活 1个月之内基本可恢复正常的社会活动 肝胆腔镜外科 拔管前健康教育 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 夹管 24 48h 造影拔管 动作轻柔 必不可少 拔管三步曲 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 拔管时间为术后10 14天左右 临床上常常让患 者带管出院 1 2月回院拔管 拔管前夹管1 2天 病人无腹胀 腹痛及黄疸 经T管进行胆道造影 无异常影像 引流管开放2 3天 方可拔管 残留窦道用凡士林油纱填塞 1 2天后自行封闭 拔除T管指征 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial T管 肝内胆 管 胆总管 T管造影 T管造影是判断肝内外胆道通畅与否的重要方法 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 拔管前拔管拔管后 拔管 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 出血 若腹腔引流液呈鲜红血性 每小时超过100ml或短 期内引流量较多应引起警惕 并注意观察有无腹痛 压痛 反跳痛 肌紧张等腹膜刺激症状和体征 胆瘘 观察腹腔引流液的色泽 有无黄绿色胆汁样物流出 每小时50ml以上者疑有胆瘘 有无腹膜刺激症状和体征经 T管进行胆道造影 无异常影像 留置T管并发症 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 水电解质失衡 脱管 感染 患者出现高热 腹痛 腹胀疑为胆道感染 留置T管并发症 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 留置T管的护理 带管出院病人的宣教 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 穿松软衣服 防止引流管受压 淋浴时用塑料膜覆盖引流管处 避免提举重物或过度活动 在T管上表明记号 以便观察是否脱出 每日定时更换引流袋 观察引流量和性质 引流管口每日换药一次 肝胆腔镜外科 带管出院病人的健康教育 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial T 管 作用 带管 护理 拔管 护理 健康 宣教 了解掌握熟悉熟悉 总结 肝胆腔镜外科 引流液及并发症的观察 T管的固定 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝胆腔镜外科 习题 A 腹胀 腹痛 B 体温39 1 C 皮肤巩膜黄染加重 D 解陶土样大便 答案 A T管折叠 受压 1 B T管脱出 结石阻塞 2 C 肝功能受损 胆汁分泌减 少 3 D 胆道下端阻塞 十二指肠 倒 流 答案 1 留置T管24小时时引流出 褐色胆汁100ml 可能出 现现了何种情况 2 夹夹管期间间出现现下面哪 些情况应应禁止拔管 A B C A B C D 单击此处编辑母版标题样式 单击此处编辑母版副标题样式 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝胆腔镜外科 T管固定方法 1 可将引流管用胶布交叉 固定在皮肤上 2 并交待患者注意事项翻 身或活动时一定要先提引流 袋再进行活动 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial T管固定方法 平卧位时 引流袋不高于腋中线 切忌将 管随意放于床上 肝胆腔镜外科 LOGO Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 本文观看结束 单击此处编辑母版标题样式 单击此处编辑母版副标题样式 谢 谢 欣 赏 单击此处编辑母版标题样式 单击此处编辑母版副标题样式 祝各位身体健康 万事如意
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