04:11,18,Jun,2011 | (446/0/0) | Original

subacute intestinal obstruction


[Abstract] Objective: To improve the standard of care of patients with intestinal obstruction. Methods: From December 2000 to December 2005 356 cases of intestinal obstruction in patient care. Results: 158 cases of obstruction is relieved with conservative treatment, surgery in 198 cases, 1 case of bowel fistula, adhesion of 98 cases. Conclusion: The prevention of postoperative adhesions over the production of soft require surgery to minimize the pollution of the abdominal cavity, the abdominal cavity thoroughly washed, after adequate drainage, the rational use of antibiotics, early ambulation, to ensure full and effective decompression, gastric recovery of intestinal function recovery after a reasonable diet is essential to ensure conditions.
[Key words] intestinal obstruction; nursing experience; discussion
Intestinal obstruction is a common disease of the abdominal surgery, intestinal obstruction caused by many reasons, more common causes are intestinal obstruction, volvulus, intussusception, incarcerated hernia and bowel obstruction caused by cancer.
1. General Information
In our hospital from December 2000 to December 2005 were 356 cases of intestinal obstruction were treated, of which 306 cases of adhesive intestinal obstruction, volvulus 8 cases, 8 cases of intussusception, incarcerated hernia in 15 cases, colon cancer and intestinal obstruction 16 cases, the other 3 cases, length of stay 5 d ~ 35 d, after an operation of the 171 cases, 23 cases of secondary surgery, 4 cases of three operations. Conservative treatment of 158 patients, aged 10 months to 98 years old.
2. Nursing
2.1 warmly received along with the doctor in charge of patients with history taking, assisting doctors to patients to do inspection and guidance to help patients with a variety of laboratory examinations confirmed that patients are not intestinal obstruction, intestinal obstruction is a typical manifestation of abdominal pain, bloating, vomiting, stop the anal defecation, exhaust. After further clearly confirmed the existence of intestinal strangulation obstruction, or strangulation of the existing trend of those who do a good job strangulation preoperative preparation, surgical treatment as soon as possible.
2.2 Conservative treatment can not be determined for the care of the location and nature of obstruction in patients, usually given to conservative treatment, conservative treatment methods are mainly gastrointestinal decompression, correction fluid and electrolyte imbalances, antibiotics and symptomatic treatment. Effective decompression can be sucked out of swallowed air in the air and intestinal gas and digestive juice produced, reduce bloating, improve breathing and circulation. A small number of colon cancer patients can be changed through effective emergency surgery for gastrointestinal decompression surgery for the period, so better prepared before surgery [1]. In patients with gastrointestinal decompression operation for nurses to
be patient, compassionate and well explained guide the work, so that patients received psychological, operating light, steady, accurate and reduce the suffering of patients, set a good gastric tube after the end of the tube connected disposable suction device (suction over the front to make the air, anti-air to squeeze into the stomach), and properly fixed, open the switch to slowly suck in order to avoid a sudden increase of negative pressure caused gastric mucosal injury; close observation of nature and the amount of drain and record the beginning decompression drain into the general is to eat the food, then gradually become dark green of the gastrointestinal fluid; during the decompression times a day with normal saline 2 maintain tube patency, and good oral care. Simple mechanical intestinal obstruction after conservative treatment can be alleviated in many patients, some patients may be the formation of strangulating intestinal obstruction, should be closely observed changes in condition, one of the following performance, should consider the possibility of strangulation intestinal obstruction. Abrupt onset of abdominal pain, severe, paroxysmal increase was sustained; early shock, anti-infective treatment improvement was not obvious, and increased temperature, pulse faster, higher white blood cell count; significant peritoneal irritation; abdominal distension and asymmetry, can be touched swelling of the intestinal loop in isolation; vomit, gastrointestinal decompression, extracts, to bloody anal discharge, or abdominal puncture out of bloody fluid; X-ray examination see isolated, swollen bowel loops, due to the passage of time does not change the position , or the gap widening suggestive of intestinal ascites, or tumor-like shadow of false, or portal exists in a gas [2]. Observation time is normally ≤ 4 h ~ 6 h; of simple intestinal obstruction, observed time normally ≤ 12 h ~ 24 h [3]. Because intestinal obstruction in patients with different causes, various diseases, symptoms vary, especially the elderly poor response to the body, some patients despite the existence of peritonitis, but no obvious signs of peritonitis, 1 case of our subjects admitted to the 87-year-old from rural female patients , internal medicine to indigestion, gastrointestinal dysfunction treatment because of abdominal distension clear and transferred to our department, the patient was pale, thin pulse, immediately side of anti-shock, side, it was discovered significant abdominal distention, ulcerated skin, groin, emergency laparotomy for femoral hernia incarcerated small bowel necrosis, forced removal of the small intestine 12 cm, intestinal anastomosis, inguinal hernia repair, postoperative active anti-shock, anti-infection, parenteral nutrition therapy, it saved their lives, but the quality of life has been a great impact, and therefore should not be too much emphasis on elderly patients typical symptoms, treatment should take a positive attitude. Intestinal obstruction in children should be particularly vigilant and repeated observation, careful examination, so as not to miss the best time for surgery, conservative treatment has some effect, but longer course of subacute intestinal obstruction, the conservative treatment time not more than 1 week. Medical Education Network
2.3 Surgical treatment of patients thought the care to do the work, make clear the need for surgery, so that patients have a positive scenario in the operation of psychological response, stable and safe through the operative period [4]. After completion of surgery patients back to the ward, monitoring blood pressure, pulse, respiration, consciousness, urine output and record; to the bar on athletic patients, encourage, help patients take a deep breath, effective cough, cough, hold the wound to relieve pain, conventional ultrasonic fog of inhalation (aerosol inhalation in the next guardian of nurses), to keep the airway moist, conducive to cough up sputum. 6h after epidural anesthesia or general anesthesia awake supine blood pressure stable, should take the semi-recumbent position, condition permission on postoperative day 1 to help patients get out of bed, let the patient sitting on the bed legs swinging, no dizziness unwell and then get out of bed, activity may be based on individual differences. Do all kinds of drainage tube care, to ensure unobstructed drainage, and record the nature and amount of drainage, general abdominal drain water for washing the meat, the day of drainage fluid after more than about 20 ml ~ 100 ml. And then gradually reduced, if appears a sudden increase in drainage volume, color changes, they should immediately report physician, confirmed the occurrence of anastomotic leakage without. Drainage for 3 days to 5 days after the drainage tube wrapped around the organization has not achieve drainage effect. Drainage tube may be placed on long-term oppression of intestine, affecting blood supply, is also a source of retrograde infection [5]. So let go of danger drainage tube is not force, as long as no liquid outflow to extubation. Early postoperative anal expansion, early discharge, early consumption is conducive to the healing anastomosis [6]. General postoperative 2 h ~ 3 h began expanding anal, 2 h / times. 24 h ~ 72 h after resumption of bowel movements, anal discharge tube should be prescribed by a doctor pulled out and began to drink salt water, 20 ml / second or so, 1 h / time ~ 2 h / times, elimination of mucosal edema, 2 ~ 3 patients with no nausea after the discomfort, can be given fluids, enteral nutrition can promote mucosal cell proliferation, repair, the maintenance of intestinal barrier function in [6]. Food intake 50 ml / second ~ 80 ml / second, the first 2 100 ml / second ~ 150 ml / second, slow intake, 6 / d ~ 8 times / d, intake with high protein, high vitamin foods, should be Easy to avoid the gas production of food to bowl of soup, vegetable soup, lotus root starch is better, 4 days into the porridge, from thin thickens from less to more, from 1 month to 3 months into easy to digest food, the staple food and side dishes should be soft, easy to digest, avoid into the blunt, fried, tea, alcohol and spicy spicy food.
3. Discussion
The patients in the conservative treatment of obstruction is relieved of the 158 cases, 1 case of bowel fistula, adhesion of 98 cases hospitalized again. Although the adhesion is the mechanism of tissue damage as part of the healing, excessive adhesion of normal physiological function, thus generating the prevention of postoperative adhesions, need for surgery gently to minimize pollution of the abdominal cavity, the abdominal cavity thoroughly washed, after adequate drainage, and reasonable use of antibiotics, early ambulation, to ensure full and effective decompression. Recovery of gastrointestinal function recovery after a reasonable diet is essential to ensure conditions.
References:
[1] Jianping. Colorectal Cancer Treatment of acute intestinal obstruction [J]. Chinese Journal of Practical Surgery, 2000,20 (8): 459.
[2] Zhang Yanling. Intestinal obstruction in the early detection of intestinal ischemia [J]. Chinese Journal of Practical Surgery, 2000,20 (8): 453.
[3] Wang and, Ruancan Ping. Intestinal hard resistance operation time [J]. Chinese Journal of Practical Surgery, 2000,20 (8): 458.
[4] pool gold, Wenjing. Analysis of preoperative anxiety and nursing [J]. Nursing Research, 2005,19 (11B): 2351.
[5] Gao Feng. Diagnosis and treatment of low intestinal obstruction [J]. Chinese Journal of Practical Surgery, 2000,20 (8): 461.
[6] Jie-shou. Support the clinical care of the past and future [J]. Chinese Journal of Practical Surgery, 2000,20 (1): 7.
subacute intestinal obstruction

Medical HEALTH "> Medical>> Pediatrics>> Summary of sub-acute intestinal obstruction in infants symptoms of intussusception were 2 cases of misdiagnosis reviews Recommended online download full-text collection of paper Yuan Jihua [1] Yang Hua   Hubei Huanggang City of Pediatrics and Child Health Hospital District, Huang Zhou [2] in Hubei Province Huangzhou district MCH ultrasound room, Hubei Huanggang 438000 "Chinese doctors" No. 8 of 2010 survey of fast food awards Abstract: This paper is not the typical infant intestinal The clinical features of intussusception to raise intussusception in infants was the diagnosis of subacute intestinal obstruction. Emphasis on diagnosis and treatment of intussusception in infants is not typical to pay special attention to palpation, palpation and repeated the analysis of atypical clinical symptoms. Number of pages: a page range :99-99 Key words: intussusception with subacute intestinal obstruction misdiagnosed subject classification: R725.7 [medicine, HEALTH "Pediatrics> Pediatric within SCIENCES" digestive and abdominal diseases in children] Related Articles: Reference topic (2)
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