肝性脑病病人的护理【-】课件

肝性脑病病人的护理上海交通大学医学院附属瑞金医院吴蓓雯肝性脑病病人的护理上海交通大学医学院附属瑞金医院吴蓓1教学目标能简单描述肝性脑病的病因、诱因和发病机制能正确叙述肝性脑病的临床表现和处理原则运用所学的知识，能对肝性脑病病人实施护理评估运用所学的知识，能对肝性脑病病人进行健康教育教学目标能简单描述肝性脑病的病因、诱因和发病机制2肝性脑病严重肝病所致以代谢紊乱为基础中枢神经系统功能失调的综合病征主要表现为意识障碍、行为失常和昏迷肝性脑病严重肝病所致3门—体分流性脑病(PSE)系门静脉高压、门静脉与腔静脉间有侧支循环存在，大量门静脉血绕过肝流入体循环所致门—体分流性脑病(PSE)系门静脉高压、门静脉与腔静脉间有4病因肝炎后肝硬化原发性肝癌各类肝炎所致急性或爆发性肝衰竭期其它疾病:---妊娠期急性脂肪肝、严重胆道感染病因肝炎后肝硬化5诱因上消化道出血大量排钾利尿、放腹水高蛋白饮食安眠镇静药、麻醉药便秘、尿毒症外科手术、感染诱因上消化道出血6发病机制氨中毒学说胺、硫醇和短链脂肪酸的协同毒性作用假性神经递质学说Γ-氨基丁酸/苯二氮卓(GABA/BZ)复合体学说氨基酸代谢不平衡学说发病机制氨中毒学说7发病机制(1)氨中毒学说

发病机制(1)氨中毒学说8发病机制(2)胺、硫醇和短链脂肪酸的协同毒性作用--甲基硫醇和二甲基亚砜可致实验动物意识模糊、定向力丧失、昏睡和昏迷--严重肝病病人甲基硫醇↑--短链脂肪酸诱发实验性肝性脑病发病机制(2)胺、硫醇和短链脂肪酸的协同毒性作用9发病机制(3)

假性神经递质学说

发病机制(3)假性神经递质学说10发病机制(4)Γ-氨基丁酸/苯二氮卓(GABA/BZ)复合体学说发病机制(4)Γ-氨基丁酸/苯二氮卓(GABA/BZ)复合11发病机制(5)氨基酸代谢不平衡学说

发病机制(5)氨基酸代谢不平衡学说12临床表现一期（前驱期）轻度性格改变和行为失常二期（昏迷前期）以意识错乱、睡眠障碍、行为失常为主三期（昏睡期）以昏睡和精神错乱为主四期（昏迷期）神志完全丧失，不能唤醒临床表现一期（前驱期）轻度性格改变和行为失常13处理原则（1）消除诱因减少肠内毒物的生成和吸收--饮食：禁食蛋白质--灌肠和导泻：乳果糖---抑制肠道细菌生长：新霉素、甲硝唑

处理原则（1）消除诱因14处理原则（2）促进有毒物质的代谢清除---降氨药物：谷氨酸钾和谷氨酸钠---纠正氨基酸代谢紊乱药物---GABA/BZ复合受体拮抗药---人工肝处理原则（2）促进有毒物质的代谢清除15处理原则（3）对症治疗---纠正水、电解质和酸碱失蘅---保护脑细胞功能---保持呼吸道通畅---防治脑水肿肝移植

处理原则（3）对症治疗16护理评估健康史身体状况--全身：意识状态、神经系统体征、皮肤和黏膜--局部：蜘蛛痣、肝掌、腹部膨隆和腹壁静脉曲张辅助检查(血氨/脑电图检查/简易智力测验)

护理评估健康史17护理诊断意识模糊照顾者角色困难有受伤的危险护理诊断意识模糊18护理措施意识模糊---严密观察病情变化---加强临床护理，提供情感支持---去除和避免诱发因素---合理饮食---用药护理---昏迷病人护理护理措施意识模糊19护理措施照顾者角色困难---评估照顾者存在的困难和应对能力---给照顾者提供各种社会支持---协调照顾者制定照顾计划护理措施照顾者角色困难20护理措施有受伤的危险

---评估病人的意识状况---移去环境中的不安全装置和物品---对定向力或意识障碍者提供保护措施

护理措施有受伤的危险21健康教育认识和避免诱因合理饮食劳逸结合，保持良好心态按时和遵医嘱服药，定期随访注重肝性脑病的早期征象，早期就诊

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