原发性肝癌TACE术后并发碘油肺栓塞的护理

Care of lipiodol pulmonary embolism related to TACE treatment of primary liver cancer

目的探讨原发性肝癌肝动脉栓塞化疗(TACE)术后并发碘油肺栓塞的治疗及护理对策。方法通过回顾分析本科室2例并发碘油肺栓塞患者的临床资料,总结发生严重并发症的原因及护理对策。结果 2例碘油肺栓塞患者均出现嗜睡、纳差、胸闷、咳痰无力,胸部CT可见两下肺内异常高密度影。经吸氧、化痰、改善微循环、抗凝等治疗后好转。结论 TACE术对于原发性肝癌是一种微创、安全的治疗方法,但仍有一定的风险。对于巨块型肝癌和(或)存在肝动静脉瘘,碘化油用量超过20 ml的患者,术后加强监护和护理,是防治TACE术后并发碘油肺栓塞的有效措施。

Objective To discuss preventive methods and nursing measures of pulmonary iodized oil embolism in the patients with primary hepatic carcinoma who underwent TACE. Methods To analysis retro- spectively medical records of two patients with pulmonary iodized oil embolism,to summarize the reasons of the occurrences of serious complications and the nursing measures. Results The two patients with pulmonary io- dized oil embolism had the symptoms of sleepiness,anorexia,chest tightness,expectoration weakness,and ab- normal high density in lungs by chest radiographs. The clinical manifestations of the patients improved through giving oxygen,resolving phlegm,improving microcirculation and anticoagulation. Conclusion TACE is a mini- mal invasive and safe treatment method for the primary hepatic carcinoma,but still there is certain degree of risk. For the patients with massive hepatocarcinoma and / or with arteriovenous shunting,and using iodized oil more than 20 ml,it is an effective measure for the prevention of pulmonary iodized oil embolism after the treat- ment of TACE by postoperative intensive care and nursing.