肺癌医学课件

肺癌 LungCancer Brochopulmonarycarcinoma JIANGHANUNIVERSITYCollegeofnursingandmedicaltechnology江汉大学护理与医学技术学院 Caseofillness 病例 健康史 患者王某 男 67岁 行政人员 10年前有吸烟史 无慢性呼吸系统疾病史及家族史 因左肺鳞癌化疗后9年 反复咯血1月余入院 既往史 患者9年前因反复咳嗽 于当地医院诊断 肺低分化鳞癌 予多次化疗后 症状好转未予追踪治疗 1月前患者无明显诱因出现咯血 咯暗红色血凝块 量少 无咳嗽 咳痰无发热盗汗 腹痛 吞咽困难等查体 生命体征均平稳 听诊左肺呼吸音清 右侧呼吸音稍低 双侧未闻及明显干湿啰音 其他未见异常辅助检查 CT检查提示 右肺门占位性病变诊疗 手术方式 全麻下右上肺切除术 Definition 定义 primarylungcancer 原发性支气管肺癌 简称肺癌 LungCancerisoriginstunicamucosabronchiorumorgland Epidemiology 流行病学 Mostcommon mostrapid是目前最常见 发展最快的恶性肿瘤 Topofcancer全球肺癌发病率 男性 局癌症发生的榜首 Leadingcauseofdeath占癌症死亡原因的第一位 Toptencancerdeathbysex CancerAnnualreport 2008 Causes 病因 1 Smoking是公认的肺癌危险因素 Smokecontainsmorethantwentykindsofcarcinogensthemostimportantcause 2 Occupation theincidenceoflungcanceramongasbestosworkerswaseighttimeshigherthanthatofsmokers and92timeshigherthanthatofnonsmokers 已知石棉 asbestos 煤焦油 coaltal 沥青 石油 无机砷 烟草加热产物 芥子气等与肺癌有关 3 Airpollution煤 石油燃烧废气 公路沥青 厨房油烟气 含苯并比 4 Lonizingradiation自然界 医疗 工矿产生的辐射线 5 Others Stimulants气道慢性刺激 inflammation scar genetics遗传因素 Geneticfactoristhemainfactor geneexpressionandgenemutation classification 分型 根据临床细胞分化程度和形态特征分为 Smallcelllungcancer SCLC 小细胞癌 Non smallcelllungcancer NSCLC 非小细胞癌 includessquamouscellcarcinoma 鳞癌 adenocarcinoma 腺癌 largecellcarcinoma 大细胞癌 1 squamouscellcarcinoma 鳞癌 themostcommoninlungcancerisabout50 whichiscloselyrelatedtosmoking andmorecommoninelderly2 adenocarcinoma 腺癌 about25 morecommoninwoman3 largecellcarcinoma 大细胞癌 relativelyrare highdegreeofmalignancy4 smallcelllungcancer 小细胞肺癌 about20 morecommoninmales 按生长部位分为 centrallungcancer 中心型肺癌 Originatedinthemainbronchi lobarbronchus locatednearthelung forexample mostsquamouscellcarcinoma 鳞癌 largecellcarcinoma 大细胞癌 smallcelllungcancer 小细胞癌 Peripherallungcancer 周围型肺癌 Growthinasegmentofthebronchus locatedinthelungperiphery forexample adenocarcinoma 腺癌 centrallungcancer Peripherallungcancer Clinicalmanifestation 临床表现 1 Symptomscausedbyprimarytumour 原发肿瘤引起的症状 coughThemostcommonmanifestationiscough stimulatingdrycoughaccompaniedwithsmallamountsofmucusearlyanti inflammatoryisnoneffective 最常见 刺激性干咳 少量黏液痰 抗炎无效 早期 早期 刺激性 顽固性 阵发性肿瘤增大 堵塞官腔 阻塞性 高调金属音 BloodsputumCentrallungcancermorecommon usuallywithbloodorasmallamountofhemoptysis hemoptysis alargenumberofrare 中心型多见 痰中带血丝 少量咯血 senseofsuppressioninthechestandfever Chestpain Shortnessofbreath Becomethiner 2 Symptomscausedbylocalmetastasis 肿瘤局部转移引起的症状 Chestpain 胸痛 侵犯肋骨 胸膜dyspnea 呼吸困难 肿瘤或肿大淋巴结压迫气管 大支气管Swallowingdifficulty 吞咽困难 肿瘤压迫或侵犯食道Hoarseness 声音嘶哑 压迫喉返神经Arrhythmia hydropericardium 心律失常 心包积液 侵犯心包Precavaoppressionsydrome 上腔静脉压迫综合征 侵犯纵隔压迫上腔静脉 引起头面部 颈部和上肢水肿 胸前壁瘀血和静脉曲张 Horner sSyndrome Horner综合征 压迫颈交感节引起同侧瞳孔缩小 上眼睑下垂 眼球内陷 患侧无汗和感觉异常等颈交感神经综合征 Brachialnervecompressionsyndrome 臂丛神经压迫征 肩关节 上肢剧痛或感觉异常 3 symptomscauseddistantmetastasis 远处转移引起的症状 brain 颅内高压头痛 呕吐 脑疝 bone 疼痛及压痛 liver 肝肿大 肝区痛 黄疸 腹水 厌食 lymphnode 淋巴结肿大 4 outsidepulmonaryperformance又称副癌综合征 paraneoplasticsyndrome Bonejointsyndrome 骨关节综合征 Acropachy 杵状指 肥大性骨关节病 cushingsyndrome 库欣综合征 cushingsyndrome 库欣综合征 Gonadotropin 促性腺激素升高 Malebreasthypertrophy AuxiliaryExamination 辅助检查 1 cytoscopyofsputum 痰细胞学检查 Itisasimpleandeffectivemethodfortheinvestigationanddiagnosisoflungcancer 普查和诊断 简便有效 2 Imagingexamination 影像学检查 X ray CT MRI3 Fiberbronchoscopy 纤维支气管镜检查 Thepositiverateofdiagnosisoflungcancerishigher Fiberbronchoscopy 纤维支气管镜检查 Treatment 治疗 Non smallcelllungcancer 非小细胞癌 operation radiotherapy chemotherapy Immunetherapy TraditionalChinesemedicinetreatment手术 主要 早期 放疗 化疗 免疫治疗 中医中药治疗 Smallcelllungcancer 小细胞癌 chemotherapy radiotherapy operation化疗 放疗为主 手术 手术方法 经典 手术方法 胸腔镜 手术方法 小切口开胸 Nursingassessment 护理评估 1 Haelthhistory 健康史 10yearsofsmokinghistory Nofamilyhistory 2 Physicalcondition 身体状况 thepatientdevelopedhemoptysisandhaddarkredbloodclot thenutritionstateisgood Patientcantoleratesurgery3 Psychologicialandsocialcondition 心理和社会支持状况 patitentpsychologicalisanxietyandfear Hegotsomecomfortfromrelativeandcooperatepositively Preoperativeassessment术前评估 Anesthesiaandsurgerywentwell Nobloodloss Vitalsignisstable Woundandpipeconditionisgood MentationandCognitiondegreeisgood 术后评估患者麻醉 手术情况 失血情况 生命体征 伤口和管道状况 心理和认知程度 Postoperativeassessment术后评估 Nursingdiagnosis 护理诊断 Gasexchangeimpirment气体交换受损Nutritionaldisoders营养失调Anxietyandfear焦虑与恐惧Pain疼痛Potentialcomplications潜在并发症 Nursingmeasures 护理措施 Preoperativenursing 术前护理 1 ImproverespiratoryfunctionandpreventpostoperativeinfectionQuitsmoking theoperationshouldgiveupsmokingformorethantwoweeksMaintainairwaypatencyControltheinfection payattentiontooralhygiene 口腔卫生 Abdominalbreathingandeffectivecoughtraining 2 Improvenutritionalstatushighcalorie chocolate cream cake beefhighprotein egg milk chicken tofu fishhighvitamin greenpepper strawberry nut3 Psychologicalnursing Postoperativenursing 术后护理 1 Appropriatebodyposition 采取合适体位 Thepatientwasnotawake Anesthesiasober bloodpressurestable 2 Observationofillness 病情观察 Acromelictemperature 肢端温度 nail 甲床 lips 口唇 skincolor 皮肤颜色 3 Respiratorytract 呼吸道 Oxygen observation deepbreathingandcoughing4 Dilutesputum 稀释痰液 chymotrypsin 糜蛋白酶 dexamethasone 地塞米松 aminophylline 氨茶碱 5 Maintainfluidbalanceandsupplementnutrition 维持液体平衡和补充营养 controllingtheamountandspeedoftransfusion supplementarynutrition6 reducepain 减轻疼痛 Analgesicdrug7 Activityandrest 活动与休息 Earlyactivities ApplicationofChinesemedicinetreatmentinnursing 中医在护理中的应用 LungcancerisduetoQidificiencyoflungandspleen lungandkidney Qiandblooddeficiency phlegmandbloodstasis toxicheatfireknotetc 肺脾气虚 肺肾阴虚 气虚血亏 痰湿瘀阻 热毒火结 TCMfornourisingqi spleenandkidney 益气养血 健脾补肾为主 扶正却邪 攻补兼施 Thoracalgia 胸痛 dandelion 蒲公英 Decreaseofwhitebloodcellscausedbyradiotherapyandchemotherapy 放 化疗所致白细胞减少 spatholobus 鸡血藤 otherChineseherbalmedicine chinesefirbark 杉木皮 oldenlandiadiffusa 白花蛇舌草 scutellariabarbata 半枝莲 sarcandraglabra 肿节风 etc Observationandnursingofcomplications 并发症的观察和护理 1 Bleeding 出血 Nursingmeasures tospeedupbloodtransfusionandinfusionrate 输血补液 applicationofhemostaticagents 止血药 tomaintainthepatencyofthethoracicdrainagetube 引流 whennecessary toopenthechesttostopthebleeding 开胸探查止血2 Pulmonarycomplication 肺部并发症 Nursingmeasures earlyassistpatientwithdeepbreathingandeffectivecough 早期深呼吸 有效咳嗽 strictlycontrollingthespeedandquantityoftransfustion 控制输液速度 量 3 Arrhythmia 心律失常 Mostoccurredwithin4daysafteroperation Nursingmeasures ECGmonitoring 心电监测 Applicationofantiarrhythmiadrugs 药物 Controltheamountandspeedofvenoustransfusion 控制输液速度 量4 Bronchialfistula 支气管胸膜瘘 oneoftheseriouscomplications mainlyoccurrsinabout1 2weeksafteroperation Nursingmeasures Immediatelynotifythedoctor 通知医生 Letthepatientgetlateralposition 患侧卧位 Applicationofantibiotics 抗生素 Continuetomaintiantheclosedthoracicdrainage 引流 Healthguidence 健康指导 1 Effectivecoughanddeepbreathing 有效咳嗽和深呼吸Afterseveralweeksofdischarge theabdominalbreathingandeffectiv ecoughstillneedtobecarriedout 2 Restandactivity 休息与活动Graduallyincreasetheamountofactivity shallnotengageinheavyphysicalactivitywithinhalfayear3 Prventionofrespiratorytractinfections 预防呼吸道感染Maintaingoodoralhygieneandavoidcontactwithsmoke chemicalirrit ant publicplaces 4 Supplementarynutrition补充营养Guidepatientstoeathighcalorie highprotein highvita mindiet5 Timelyreview定期复查Ifthereisawoundp