混合痔中医护理查房课件

Withtheimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety混合痔中医护理查房十二病区卓悦WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety查房目标WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety查房目标WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety查房流程一、病例介绍二、存在的护理问题三、知识链接四、查房小结WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety病姓名：叶笑琴性别：女性年龄：42岁费用类别：农保住院号：63206入院时间：2014-10-1309：例介绍婚姻：已婚民族：汉族职业：农民文化程度：初中26步行入院WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety病例介绍入院诊断：中医：混合痔——气滞血瘀证西医：1、混合痔2、高血压主诉：反复肛门口肿物脱出3年。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety病例介绍患者3年前排便时感肛门口有肿物脱出，质软，排便后肿块自行回纳消失。3年来患者感肛门口肿物反复出现且进行性增大、增多均未正规治疗。今来我院求诊。入院查体：T36.5℃，R19次/分，BP134/88mmHg，P80次/分。神志清，精神欠佳，步行入院，呼吸平稳，听诊无殊。腹平软，无压痛。肛门口可见花瓣样肿物脱出，水肿明显，脱出肿块触痛明显，部分脱出粘膜破损，有新鲜渗血，无脓性液渗出。肛门镜检查：肛门外可见痔核脱出，稍水肿，齿状线上粘膜充血水肿明显。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety病例介绍既往史：高血压病史7年，长期口服药物治疗，现血压控制良好。个人史：长期居住丽水，无其他不良嗜好。一子一女，配偶体健。家族史：无过敏史：无WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety中医护理评估BP134/88mmHg，SPO298%,疼痛评分2分。生命体征：T:36.5℃，P：80次/分，R：20次/分，1、望诊:表情平和，面色红润，舌质红，苔白腻。2、闻诊：心肺听诊无殊3、问诊：寒热：无汗：正常头：无外伤，无头痛身：无活动不利二便：大便干硬，小便不畅。饮食：纳食香甜听力视力：正常旧病：高血压WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety中医护理评估此次病因：无诱因服药：无月经：规律，无不规则阴道流血睡眠：夜寐不酣嗜好：无特殊4、切诊：脉弦细，腹平软，腹皖无压痛WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety中医辨证分析患者以“反复肛门口肿物脱出3年”为主诉，结合查体，辨证当属中医“混合痔”范畴，根据舌、脉表现，证属气滞血瘀证。患者因饮食不节、过食辛辣醇酒厚味，燥热内生，下近大肠，以及便秘努责，致血行不畅，血液淤积，热与血相搏，气血纵横，筋脉交错，结滞不散而成。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗经过?因患者夜眠不酣，入院后予神门、心、枕耳穴压豆，以益气安神，调节睡眠。?术前晚给予白术、炒枳实、番泻叶、火麻仁等中药方剂灌肠，以润肠通便，减轻肠道压力。?于2015年10月15日在腰硬联合麻醉下行混合痔肛垫悬吊术，术后诊断：1、混合痔疮；2、高血压病。术后患者生命体征平稳，手术创口无明显渗血，疼痛评分约3分，术后小便能自解。?术后用药：予头孢唑啉针、替硝唑针抗感染，七叶皂苷钠消肿及补液对症治疗，并配合血府逐瘀汤合桃红四物汤活血化瘀、行气止痛。?术后为防止患者大便干结，取木香、佛手、厚朴等中药贴敷于双侧足三里穴，以达理气通便之功。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety现状患者神志清，精神较前稍振，呼吸调匀，无畏寒发热，肛门处创口无渗血渗液，未见痔核脱出，排便后创口疼痛轻。胃纳尚佳，大便软，无便血，小便无殊。舌淡，苔白，脉细。因患者要求出院，经何建胜主任查看后认为患者术后平稳，于2014年10月18日办理出院。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety查房流程一、病例介绍二、存在的护理问题三、知识链接四、查房小结WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety存在的护理问题一、疼痛——术前与肛内肿物脱出、肛缘水肿有关；术后与创口疼痛有关。1、观察疼痛的部位、性质、强度、伴随症状和持续时间。2、协助患者取舒适卧位。3、指导患者采取放松疗法，如缓慢深呼吸、全身肌肉放松、听舒缓的音乐。4、遵医嘱给予口服或注射止痛药。5、取足三里、承山穴位按摩。6、取肛门、直肠、神门等耳穴贴压。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety存在的护理问题二、知识缺乏——缺乏本病的防治知识1、疾病指导：向患者介绍本病的病因、症状、预防，自我护理方法。2、饮食有规律，宜清淡，避免辛辣刺激之物，纠正偏食习惯，达到均衡饮食，保持大便通畅。3、用药指导：指导患者按医嘱正确用药，告知药物的作用及相关注意事项。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety存在的护理问题三、焦虑——与患者对手术的恐惧紧张有关术前耐心向患者讲解手术的必要性，术中的配合及术后的不适等情况，以消除患者的紧张恐惧心理，使患者对疼痛有正确认识，调整心态，积极配合治疗。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety存在的护理问题四、潜在的并发症：出血——1、术后不要太早下床活动，24小时内严密监测生命体征变化，并观察创口敷料是否完整清洁。如患者出现面色苍白，头晕出汗，脉搏细数，血压下降等情况及时报告医师。2、术后一周内指导患者避免剧烈活动。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety查房流程一、病例介绍二、存在的护理问题三、知识链接四、查房小结WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety什么是混合痔？混合痔，中医病名，以发生于肛门同一方位齿线上下，静脉曲张形成团块，内外相连、无明显分界为主要表现的痔病类疾病。临床表现为便血及肛门部肿物，可有肛门坠胀、异物感或疼痛，可伴有局部分泌物或瘙痒。与西医病名相同。本病若早期治疗，一般预后良好。但也有部分患者，病程中伴发贫血等并发症。本病多由脏腑本虚，静脉壁薄弱，兼因久坐，负重远行，或长期便秘，或泻痢日久，或临厕久蹲努责，或饮食不节，过食辛辣肥甘之晶，导致脏腑功能失调，风燥湿热下迫，气血瘀滞不行，阻于魄门，结而不散，筋脉横解面生痔。或因气血亏虚，摄纳无力，气虚下陷，则痔核脱出。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety混合痔的分型1、风伤肠络证：大便带血，滴血或喷射状出血，血色鲜红，大便秘结或有肛门瘙痒。舌质红，苔薄黄。2、湿热下注证：便血色鲜，量较多，肛内肿物外脱，可自行回纳，肛门灼热，重坠不适。舌质红，苔黄腻。3、气滞血瘀证：肛内肿物脱出，甚或嵌顿，肛门紧缩，坠胀疼痛，甚则内有血栓形成，肛缘水肿，触痛明显。舌质暗紫，苔白。4、脾虚气陷证：肛门松弛，似有便意，内痔脱出不能自行回纳，需用手法回纳。便血色鲜或淡，伴头晕、气短、面色少华，神疲自汗、纳少、便溏等。舌淡，苔薄白。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗原则本病主要以手术治疗为主。1、风伤肠络证治法：清热凉血祛风代表方：凉血地黄汤。常用药：生地养阴润燥，赤芍、归尾活血凉血;地榆、槐花凉血止血;升麻升提解毒以散瘀热;黄芩、黄连燥湿清热解毒;花粉生津泻火;枳壳行气导滞;荆芥疏风活血止血，共同起到清热凉血止血，润燥疏风之作用，故对痔疮诸疾有较好疗效。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗原则2.湿热下注证治法：清热渗湿之血方药：脏连丸常用药：黄连、黄芩、猪大肠清利大肠实(湿)热;槐角、地榆清肠热而止血;荆芥、防风疏风止血;当归、阿胶养血止血;生地、赤芍清热凉血。诸药合用，清湿热，止便血。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗原则3、脾虚气陷证治法：健脾益气方药：补中益气汤。常用药：黄芪，补中益气、升阳固表，配伍人参、炙甘草、白术补气健脾，当归和营养血，陈皮理气和胃，炙甘草调和诸药。诸药合用，使气虚者补气，气陷者升提，气虚者发热，得此甘温益气而除之，元气内充，清阳得升，诸症自愈。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗原则4、气滞血瘀证治法：清热利湿，祛风活血方药：止痛如神汤。常用药：秦艽祛风利湿止痛为君药;伍以桃仁、当归、槟榔理气活血，化瘀止痛，使滞者行，瘀者化，通则不痛;苍术、黄柏、防风祛肠风，运水湿;大黄清热解毒，逐瘀通络，荡涤肠腑实热;泽泻利水通淋止痛，泽泻配槟榔亦可行气利水消肿，诸药相配，共奏祛风利湿，理气活血，清热之痛之功。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety健康指导（一）生活起居1、保持肛门及会阴部清洁，指导患者每日便后及每晚温水清洗。2、避免肛门局部刺激，便纸宜柔软，不穿紧身裤及粗糙内裤。3、指导患者养成定时排便的习惯，便秘时指导患者绕脐周顺时针按摩腹部，每日3次，每次20-30圈。4、指导患者避免增加腹压，避免用力排便、咳嗽、久站、久蹲等。5、指导患者进行提肛运动。运动方法：深吸气时收缩并提肛门，呼气时将肛门缓慢放松，一收一放为1次；每日晨起及睡前各做一遍，每遍做20-30次。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety健康指导（二）饮食指导1、风伤肠络证：宜食清热凉血的食品，如绿豆、苦瓜、芹菜、马蹄等。2、湿热下注证：宜食清热利湿的食品，如菜花、赤小豆、绿豆、薏苡仁、小米等。3、气滞血瘀证：宜食理气活血的食品，如山楂、木耳、桃仁、番茄、黑米等。4、脾虚气陷证：宜食益气活血的食品，如茯苓、山药、薏苡仁、鸡肉等。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety健康指导5、便血者，进软食、多饮水，多食蔬菜水果及补血之品，忌粗糙、坚硬食品。6、忌食辛辣刺激肥甘之物，术后初期避免进食产气食品。（三）情志调理1、指导患者保持心情舒畅，避免烦躁、恐惧等不良情绪。2、多与患者沟通，了解其心理状态，及时予以心理疏导。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety查房流程一、病例介绍二、存在的护理问题三、知识链接四、查房小结WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety谢谢聆听！WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety混合痔中医护理查房十二病区卓悦WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety查房目标WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety查房目标WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety查房流程一、病例介绍二、存在的护理问题三、知识链接四、查房小结WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety病姓名：叶笑琴性别：女性年龄：42岁费用类别：农保住院号：63206入院时间：2014-10-1309：例介绍婚姻：已婚民族：汉族职业：农民文化程度：初中26步行入院WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety病例介绍入院诊断：中医：混合痔——气滞血瘀证西医：1、混合痔2、高血压主诉：反复肛门口肿物脱出3年。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety病例介绍患者3年前排便时感肛门口有肿物脱出，质软，排便后肿块自行回纳消失。3年来患者感肛门口肿物反复出现且进行性增大、增多均未正规治疗。今来我院求诊。入院查体：T36.5℃，R19次/分，BP134/88mmHg，P80次/分。神志清，精神欠佳，步行入院，呼吸平稳，听诊无殊。腹平软，无压痛。肛门口可见花瓣样肿物脱出，水肿明显，脱出肿块触痛明显，部分脱出粘膜破损，有新鲜渗血，无脓性液渗出。肛门镜检查：肛门外可见痔核脱出，稍水肿，齿状线上粘膜充血水肿明显。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety病例介绍既往史：高血压病史7年，长期口服药物治疗，现血压控制良好。个人史：长期居住丽水，无其他不良嗜好。一子一女，配偶体健。家族史：无过敏史：无WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety中医护理评估BP134/88mmHg，SPO298%,疼痛评分2分。生命体征：T:36.5℃，P：80次/分，R：20次/分，1、望诊:表情平和，面色红润，舌质红，苔白腻。2、闻诊：心肺听诊无殊3、问诊：寒热：无汗：正常头：无外伤，无头痛身：无活动不利二便：大便干硬，小便不畅。饮食：纳食香甜听力视力：正常旧病：高血压WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety中医护理评估此次病因：无诱因服药：无月经：规律，无不规则阴道流血睡眠：夜寐不酣嗜好：无特殊4、切诊：脉弦细，腹平软，腹皖无压痛WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety中医辨证分析患者以“反复肛门口肿物脱出3年”为主诉，结合查体，辨证当属中医“混合痔”范畴，根据舌、脉表现，证属气滞血瘀证。患者因饮食不节、过食辛辣醇酒厚味，燥热内生，下近大肠，以及便秘努责，致血行不畅，血液淤积，热与血相搏，气血纵横，筋脉交错，结滞不散而成。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗经过?因患者夜眠不酣，入院后予神门、心、枕耳穴压豆，以益气安神，调节睡眠。?术前晚给予白术、炒枳实、番泻叶、火麻仁等中药方剂灌肠，以润肠通便，减轻肠道压力。?于2015年10月15日在腰硬联合麻醉下行混合痔肛垫悬吊术，术后诊断：1、混合痔疮；2、高血压病。术后患者生命体征平稳，手术创口无明显渗血，疼痛评分约3分，术后小便能自解。?术后用药：予头孢唑啉针、替硝唑针抗感染，七叶皂苷钠消肿及补液对症治疗，并配合血府逐瘀汤合桃红四物汤活血化瘀、行气止痛。?术后为防止患者大便干结，取木香、佛手、厚朴等中药贴敷于双侧足三里穴，以达理气通便之功。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety现状患者神志清，精神较前稍振，呼吸调匀，无畏寒发热，肛门处创口无渗血渗液，未见痔核脱出，排便后创口疼痛轻。胃纳尚佳，大便软，无便血，小便无殊。舌淡，苔白，脉细。因患者要求出院，经何建胜主任查看后认为患者术后平稳，于2014年10月18日办理出院。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety查房流程一、病例介绍二、存在的护理问题三、知识链接四、查房小结WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety存在的护理问题一、疼痛——术前与肛内肿物脱出、肛缘水肿有关；术后与创口疼痛有关。1、观察疼痛的部位、性质、强度、伴随症状和持续时间。2、协助患者取舒适卧位。3、指导患者采取放松疗法，如缓慢深呼吸、全身肌肉放松、听舒缓的音乐。4、遵医嘱给予口服或注射止痛药。5、取足三里、承山穴位按摩。6、取肛门、直肠、神门等耳穴贴压。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety存在的护理问题二、知识缺乏——缺乏本病的防治知识1、疾病指导：向患者介绍本病的病因、症状、预防，自我护理方法。2、饮食有规律，宜清淡，避免辛辣刺激之物，纠正偏食习惯，达到均衡饮食，保持大便通畅。3、用药指导：指导患者按医嘱正确用药，告知药物的作用及相关注意事项。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety存在的护理问题三、焦虑——与患者对手术的恐惧紧张有关术前耐心向患者讲解手术的必要性，术中的配合及术后的不适等情况，以消除患者的紧张恐惧心理，使患者对疼痛有正确认识，调整心态，积极配合治疗。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety存在的护理问题四、潜在的并发症：出血——1、术后不要太早下床活动，24小时内严密监测生命体征变化，并观察创口敷料是否完整清洁。如患者出现面色苍白，头晕出汗，脉搏细数，血压下降等情况及时报告医师。2、术后一周内指导患者避免剧烈活动。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety查房流程一、病例介绍二、存在的护理问题三、知识链接四、查房小结WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety什么是混合痔？混合痔，中医病名，以发生于肛门同一方位齿线上下，静脉曲张形成团块，内外相连、无明显分界为主要表现的痔病类疾病。临床表现为便血及肛门部肿物，可有肛门坠胀、异物感或疼痛，可伴有局部分泌物或瘙痒。与西医病名相同。本病若早期治疗，一般预后良好。但也有部分患者，病程中伴发贫血等并发症。本病多由脏腑本虚，静脉壁薄弱，兼因久坐，负重远行，或长期便秘，或泻痢日久，或临厕久蹲努责，或饮食不节，过食辛辣肥甘之晶，导致脏腑功能失调，风燥湿热下迫，气血瘀滞不行，阻于魄门，结而不散，筋脉横解面生痔。或因气血亏虚，摄纳无力，气虚下陷，则痔核脱出。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety混合痔的分型1、风伤肠络证：大便带血，滴血或喷射状出血，血色鲜红，大便秘结或有肛门瘙痒。舌质红，苔薄黄。2、湿热下注证：便血色鲜，量较多，肛内肿物外脱，可自行回纳，肛门灼热，重坠不适。舌质红，苔黄腻。3、气滞血瘀证：肛内肿物脱出，甚或嵌顿，肛门紧缩，坠胀疼痛，甚则内有血栓形成，肛缘水肿，触痛明显。舌质暗紫，苔白。4、脾虚气陷证：肛门松弛，似有便意，内痔脱出不能自行回纳，需用手法回纳。便血色鲜或淡，伴头晕、气短、面色少华，神疲自汗、纳少、便溏等。舌淡，苔薄白。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗原则本病主要以手术治疗为主。1、风伤肠络证治法：清热凉血祛风代表方：凉血地黄汤。常用药：生地养阴润燥，赤芍、归尾活血凉血;地榆、槐花凉血止血;升麻升提解毒以散瘀热;黄芩、黄连燥湿清热解毒;花粉生津泻火;枳壳行气导滞;荆芥疏风活血止血，共同起到清热凉血止血，润燥疏风之作用，故对痔疮诸疾有较好疗效。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗原则2.湿热下注证治法：清热渗湿之血方药：脏连丸常用药：黄连、黄芩、猪大肠清利大肠实(湿)热;槐角、地榆清肠热而止血;荆芥、防风疏风止血;当归、阿胶养血止血;生地、赤芍清热凉血。诸药合用，清湿热，止便血。WiththeimprovingqualityofWiththeimprovingqualityoflifeaswellastheever-acceleratingpaceoflife,thequalityofpeople'sfoodneedsandratealsochanging.Inordertomeettheneedsofsociety治疗原则3、脾虚气陷证治法：健脾益气方药：补中益气汤。常用药：黄芪，补中益气、升阳固表，配伍人参、炙甘草、白术补气健脾，当归和营养血，陈皮理气和胃，炙甘草调和诸药。诸药合用，使气虚者补气，气陷者升提，气虚者发热，得此甘温益气而除之，元气内充，清阳得升，诸症自愈。WiththeimprovingqualityofWith