食管癌术后应用逆行胃肠减压管与十二指肠营养管的护理体会

Experience of Nursing Care for Postoperative Patients with Esophageal Cancer for Retrogradation Intubating Gastrointestinal Decompression Tube and Duodenal Nutrition Tube

目的改进传统经鼻置入胃肠减压管和十二指肠营养管的方法,总结食管癌根治术后病人应用逆行胃肠减压管和十二指肠营养管的临床护理经验。方法采用常规根治性外科手术,行胃代食管弓下或弓上吻合术,于胃窦部前壁戳孔置入自制胃肠减压管和十二指肠营养管。两管汇合部于胃壁处作荷包包埋处理,大网膜包绕后经左侧肋弓下腹壁穿出固定。对食管癌术后应用逆行胃肠减压管和十二指肠营养管患者实施心理护理、常规护理及术后恢复指导等综合护理措施。结果84例患者中无一例发生胃肠潴留和/或吻合口瘘、肺部感染、管周皮肤严重损害等相关并发症;拔管后无局限性腹膜炎或瘘口迁延不愈。由于术后合理护理,减少了患者恐惧与术后不适,术后无严重并发症发生,精神状态良好,生活质量得以改善。结论使用逆行胃肠减压管和十二指肠营养管置入方式,克服了传统置管的不适,操作简便、安全可靠、易于实施。加强术后护理,可减少术后并发症,明显提高患者的生活质量。

Objective To improve the means of intubating gastrointestnal decompression tube and duodenal nutrition tube for the purpose of decreasing related complication. To summarize the clinical experience of nursing care of the application retrogradation intubating gastrointestinal decompression tube and duodenal nutrition tube after the radical resection of the esophageal cancer. Methods The esophageal replacement with gaster was anastomosed at the level of or below arch of aorta. The special designed gastrointestnal decompression tube and duodenal nutrition tube were restroinserted into the hole which was made in front of the wall of the gastric antrum, and the ending tubes were placed out of abdominal wall below left costal arch. Rational nursing strategies, including psychological direction, routine treatment and rehabilitation guidance, etc, were adopted in postoperation period. Results Among the 84 cases, no gastrointestinal retention and/or anastomotic leakage occurred. There was no pneumonia and skin injury around the tube. No local peritonitis or uncurable fistula occurred after the withdrawal of the tube. The fearfulness and uncomfortable feeling of the patients after operation were relieved. No significant complications appeared during the following up. The lives of all the patients were improved. Conclusion Application of retrogradation intubating gastrointestinal decompression tube and duodenal nutrition tube overcomes the shortage related to nasogastric decompression tube and nasogastric duodenal nutrition tube, which is simple, safe and practical. If doctors and nurses closely observed the pathogenetic con- dition and strengthened pre-operation period nursing care, postoperative complication will decrease, and the quality of life can be improved dramatically.