1例高龄喉癌术后合并Ⅳ型巨大食管裂孔疝患者的护理

Nursing care of an elderly postoperative laryngeal cancer patient with a large type Ⅳ hiatal hernia

总结1例高龄喉癌术后合并Ⅳ型巨大食管裂孔疝患者的护理经验。护理要点:监测休克指数及改良早期预警评分,及时启动快速反应团队;积极液体复苏,持续监测中心静脉压,预防心肺功能衰竭;术后实施个性化肺康复计划,促进肺复张,预防肺部感染;监测并控制腹内压,实施以腹内压监测为导向的肠内营养管理方案;限制性液体管理策略,消除组织水肿,维持水电解质平衡;实施“医院-社区-家庭”一体化健康管理,提升患者的生活质量。患者住院23 d顺利出院,随访3个月,恢复良好。

To summarize the nursing experience of an elderly postoperative laryngeal cancer patient who developed a Type Ⅳ hiatal hernia.Key nursing care points included the monitoring of shock index and MEWS to promptly activate the rapid response team and implement the Surviving Sepsis Campaign,active fluid resuscitation and continuous monitoring of central venous pressure to prevent cardiopulmonary failure,implementing a personalized postoperative respiratory rehabilitation plan to promote lung re-expansion and prevent pulmonary infection,monitoring and controlling intra-abdominal hypertension,and implementing an intra-abdominal pressure-guided enteral nutrition management plan,employing a restrictive fluid management strategy to reduce tissue edema and maintain fluid and electrolyte balance,implementing an integrated“hospital-community-home”health management plan to improve the patient’s quality of life.The patient was hospitalized for 23 days and discharged smoothly,with good recovery after a 3-month follow-up.