肝动脉化疗栓塞和经皮乙酸消融治疗巨块型肝癌的围手术期护理

Perioperative nursing care for patients receiving hepatic artery chemoembolization together with percutaneous acetic acid ablation for massive hepatocarcinomas

目的总结肝动脉栓塞化疗(TACE)和经皮乙酸消融(PAI)双介入治疗巨块型肝癌56例的护理经验。方法术前对患者进行心理干预和支持,介绍双介入治疗的重要性、安全性和优越性,缓解患者焦虑、恐惧情绪;术前指导患者进行呼吸训练,以更好地配合手术;术中严密观察生命体征和过敏反应发生情况;术后严密观察肝肾功能及腹部疼痛等症状。结果本组患者治疗后,肿块全部缩小。其中54例缩小1/3,3例缩小1/4,未发生化学性腹膜炎等严重并发症。结论对患者进行系统有效的护理取得了良好效果,有效地预防了并发症的发生,使患者的生活质量明显提高。

Objective To summarize the nursing experience in assisting the performance of dual interventional therapy, i.e. transcatheter arterial chemoembolization （TACE） together with percutaneous acetic acid ablation （PAI）, for patients with massive hepatocarcinomas. Methods A total of 56 patients with massive hepatocarcinoma received TACE and PAI. Preoperative measures were as follows： psychological intervention and support, brief introduction the importance, safety and advantages of the dual interventional therapy, making efforts to relieve patient＇s anxiety and feat, etc. Before the surgery, the nurse in charge trained the patient to breathe properly in order to enable the patient to well cooperate with the surgeon. During the operation the patient was kept under close observation for any changes of vital signs and for the possible allergic reaction. After the operation, strict observation on the hepatic and renal function, the occurrence of abdominal pain, etc. was carried out. Results After the treatment, a reduction of tumor size was seen in all patients. One third regression of the tumor was seen in 54 cases, and one fourth regression of the tumor was obtained in 3 cases. No severe complications such as chemical peritonitis occurred. Conclusion Systematic and effective nursing measures produce excellent results for hepatocarcinoma patients who are receiving dual interventional therapy. This treatment can effectively prevent the occurrence of complications and remarkably improve the patient＇s living quality.（J Intervent Radiol, 2012, 21： 873-875）