外科术后危重患者经皮内镜下胃/肠造口的护理

Care of the Patients with Percutaneous Endoscopic Gastrostomy/Jejunostomy after Surgical Operation

25例外科手术后危重患者进行经皮内镜下胃/肠造口(PEG/PEJ),建立了胃肠减压及肠内营养通路,护理要点包括:术前停止鼻饲8 h、术前暂时抽出气管插管球囊内的气体;术后加强局部皮肤的观察,保持PEJ管道通畅,加强造口旁感染或渗血、PEJ管堵塞、导管尖端移位等症状的观察与护理;肠内营养的护理等。认为加强肠内营养及对导管的护理,是降低和预防严重并发症的关键。本组患者均操作成功,置管肠内营养平均>35 d,5例出现造口周围皮下感染,2例少量渗血,2例肉芽组织增生,2例分别在后期出现PEJ管阻塞和移位,未发生与PEG/PEJ操作相关的死亡和严重并发症。

25 critical patients underwent percutaneous endoscopic gastrostomy/jejunostomy （PEG/PEJ） after surgical operation. Apart from gastrointestinal decompression and construction of nutrition passage, the care strategies included stopping nasal feeding for 8 hours and temporarily pumping out air in saeculus proprius of trachea eannula before PEG/PEJ, and enhancing observation on skin, keeping PEJ eannula unobstructed and intensifying the observation over infections and bleeding around stoma, PEJ cannula obstruction, displacement of eannula head after PEG/PEJ, as well as the care of enteral nutrition. They argued that enhanced enteral nutrition and care of cannula were key to reducing and preventing severe complications. The manipulation in all the 25 cases was successful, the eannula for enteral nutrition sustaining for more than 35 days. Subcutaneous infections around stoma occurred in 5 of them, minor bleeding in 2, hyperblastosis of granulation tissues in 2 and obstruction and displacement of PEJ eannula in 2 at the late stage, but there were no death or severe complications related to PEG/PEJ manipulations.