痔疮护理论文手术护理论文手术室整体护理论文PPH治疗重度痔的护理

1、痔疮护理论文手术护理论文手术室整体护理论文PPH治疗重度痔的护理【摘要】：痔疮是常见病,多数患者经保守治疗可以好转,但重度痔(度、度内痔)多有长期便血和痔块脱出,对药物治疗不佳且手术切除困难,注射硬化剂虽然简便,但复发率高.我院采用吻合器痔疮环状切除术(PPH)治疗重度痔疮16例,效果满意,有效率为100%.【关键词】： PPH; 痔; 护理1临床资料本组共14(男8,女6)例,年龄2572(平均48)岁,病史130 a不等. 14例均有大便出血,手术前均经过药物治疗.其中5例曾行内痔硬化治疗,3例有痔切除手术史.2围手术期护理2.1术前护理患者术前多有精神紧张,个别患者因为是复.,发,所以对

2、此方法有怀疑心理.耐心细致的宣教很重要,术前应避免患者情绪波动,嘱患者进全流食,适当po缓泻剂.因术前需常规灌肠,而患者多数直肠粘膜充血水肿,所以要选择技术熟练的护士操作,避免损伤粘膜,加重病情.2.2术后护理要点3讨论重度痔从病理解剖和生理功能都为不可逆性病变,选择合适的手术方法是有必要的. PPH是治疗重度痔的一种新技术,其优点是:治愈或显著改变术前症状.手术、住院时间短.术后并发症少,无肛门狭窄和大便失禁.术后恢复快. PPH比传统痔手术切除更加安全、有效.护理时应高度重视术后出血、尿潴留等并发症,尽早发现,及时处理,才能确保最佳治疗效果.轻、中度脊髓空洞逐渐消失或明显缩小.对于远隔节段

3、的空洞,解除延、颈髓受压,打通4脑室正中孔,重建CSF循环通路,也有显著的效果.本组117例脊髓空洞病例中的81例,在重建CSF循环通路后均未作脊髓空洞穿刺或切开分流术,术后随访发现空洞消失38例,明显缩小43例. Fujii认为在空洞与脊髓的比值35%时行分流手术较适宜.我们对于重度的脊髓空洞(空洞与脊髓的比值50%),术中见受累脊髓明显膨大,张力较高,部分脊髓组织已有变性的36例患者在重建CSF循环通路后,施行了脊髓空洞穿刺或切开分流术,目的在于迅速解除脊髓受压、改善血供和挽救已有部分变性的脊髓组织,阻断疾病的恶性循环.术后32例空洞明显缩小,神经功能障碍改善满意;另4例空洞虽有所缩小,但

4、神经功能障碍改善不明显.考虑到这4例患者病程都在20 a以上,术后疗效不佳,可能与病程过长,脊髓组织长期受压变性有关.【参考文献】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