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胃手术后腹腔冲洗的护理要点课件

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术后 腹腔 冲洗 护理 要点 课件
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Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胃肠手术后腹腔冲洗的护理胃肠手术后腹腔冲洗的护理 要点要点 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 腹腔冲洗是通过液体的有效冲洗和持续低 负压吸引 彻底清除腹腔内的坏死组织 渗液 积血和脓液 从而可减少腹腔内细 菌数量 去除毒性物质 促进组织恢复和 愈合 减少肠粘连和脓肿的形成 降低伤 口感染率和死亡率 从而缩短康复过程 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 一般的冲洗区域皆为手术区域 术中提前放 置引流管 一般为双套管 自制 根据患 者情况判断是否进行腹腔冲洗 需要冲洗的症状 1 腹痛 腹胀 2 高热 3 引流液浑浊 有异味或有消化液流出 同时结合实验室检查内容 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 腹腔三套管 2 腹腔双套管 3 单腔引流管 普通引流管 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 里面没有内 套管 有需 要再放置 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 老式导尿管 压脉带 一次性吸痰管 质地柔 软 起到 支撑作用 用于接灌洗液 用于接负压吸 引 接头方便 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 一次性 吸痰管 输液针头 连接 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 腹腔持续低流量冲洗 常用 2 间断冲击式冲洗 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 生理盐水 2 生理盐水加抗生素 3 碳酸氢钠溶液 4 蒸馏水 5 双氧水 6 5 葡萄糖溶液 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 在持续负压引流过程中 根据引流液量 引流物 的黏稠度进行负压的调整 一般负压为10 20kPa 75 150mmHg 以能顺 利吸出引流物为宜 引流液黏稠时适当加大滴入水的速度和负压 负 压可达20kPa 以稀释稠厚的液体 负压过大造成肠粘膜吸附于管壁引起损伤和出血 负压过小造成引流不充分 当瘘管形成 漏出液少时 应降低压力 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 术后生命体征平稳后 取斜坡卧位 30 45 或半坐卧位 每1 1 5 变换体位 以利 于引流 根据腹腔双套管放置的不同部位 选择左侧 或右侧不同卧位 并经常更换卧位 以利于 充分引流 更换体位是避免过度牵拉 防止脱出 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 灌洗液的量及速度取决于引流液的量及性状 一 般每天的灌洗量为2000 4000ml左右 速度为 40 60滴 分 引流液颜色呈灰白色 稠厚 豆 腐渣样或引流管玻璃接头处滞有大量混浊液体时 可予以快速冲洗 当颜色变澄清 透明时减慢冲 洗速度或改为间断冲洗 不可过快或过慢 过快 则滴入的液体来不及被吸出 过慢会造成干吸而 导致出血和引流不畅 灌洗液以等渗盐水为主 若腹腔内感染严重时 可加入敏感抗生素 保持 灌洗液的温度在30 40 避免过冷 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 注意听双套管的吸引声 发出流水声与负压 声交织在一起的 呼呼 声为正常 2 吸引连接管内看到随吸引器的不断吸引出现 一环一环 的转动式水柱波动 说明双套管是 通畅的 3 当发出细而尖的 鸣笛声 时则可能是吸入了 纤维组织或导管周围的肉芽组织 可适当调整 内吸管 4 当听不到吸引声时 说明双套管已阻塞或不 通畅 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 严密观察患者的灌洗过程中有无不良反应 一 旦发现立即停止灌洗 对症处理 监测血常规 肝功能 生化指标 防止水电解质酸碱失衡 关注患者的腹部体征 定期做消化道造影 密切观察引流液的色 质 量 并准确记录冲 入量和冲出量 量出为入 有多根引流管同时 冲洗时 应分别标记和观察 引流瓶低于引流 部位 及时倾倒引流液 不超过2 3 伤口 敷料有渗液及时更换 漏出液 冲出量 冲入量 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 腹部症状 体征消失腹部症状 体征消失 血生化指标正常血生化指标正常 排出的引流液清亮 消化道造影显示排出的引流液清亮 消化道造影显示 局部情况良好局部情况良好 停止灌洗停止灌洗 接引流袋接引流袋 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 并发症 BB E E C C DD AA 腹腔出血 引流效果 不佳 皮肤溃疡 感染 引流不畅 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 引流液为淡红色 吸引负压过大 冲洗滴速过慢冲洗液滴完造成干吸引流 管与窦道组织摩擦 引流液为鲜红色 立即停止吸引 行手术治疗 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 表现为伤口红肿 疼痛 瘙痒等不适感 同时 密切关注体温变化 连续高热或三天后又高热 的病人及时报告医生 防护措施 手消毒 严格无菌操作 套管通气口处用无菌纱布包裹 引流瓶位置低于伤口平面 引流液及时倾倒 不超过2 3 按需换药 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 妥善固定 避免扭曲 打折 及时调整负压 胶 布交叉螺旋固定于腹壁 避免套管移位 脱落 可沿引流管自上而下挤压引流管 防止管道堵塞 常见原因是压力过高 双套管扭曲 受压内外套 管腹腔端阻塞 可调整体位 轻轻转动引流管管 头的方向 避免长期处于同一位置 用60ml注射 器抽取生理盐水反复进行冲洗 必要时更换堵塞 的引流管 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 保持引流管周围皮肤干燥 用凡士林纱布保护皮 肤 周围皮肤易被引流液浸蚀者可用氧化锌软膏涂抹 病人体位不当 负压吸引压力过小 冲洗液滴速过快 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial
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