【作者】 马明娜；

【Author】 Ma Ming-Na The Fourth Hospital of Hebei medical university & Hebei provincial tumor hospital, Shijiazhuang, 050011, China

【机构】 河北医科大学第四医院暨河北省肿瘤医院；

【摘要】 目的:血管壁损伤、血流减慢、血液凝固性增高是术后患者发生血栓的三种重要机制。又因恶性肿瘤组织细胞可释放高凝物质进入血液循环,使血液凝固性增加,易促发静脉血栓形成。因此,恶性肿瘤是继肥胖、高血压、糖尿病之后,又一易诱发下肢静脉栓塞的高危人群。下肢静脉栓塞是腹部术后患者常见的并发症之一,如何减少或控制下肢静脉栓塞的发生,改变观念是关键。方法:1．及早使用抗凝药在术后24小时即开始用低分子肝素钙5000单位腹部皮下注射, 每日一次共3—5天．。低分子肝素其分子量是4000—6500的一种肝素,治疗剂量相对固定,对于预防有血栓栓塞倾向的发病与普通肝素同样有效。其特点:抗因子Xa作用较强。生物利用度高,半衰期长,一般不会出现自发性出血。在进行皮下注射时,选择神经少,组织松弛状况良好,骨组织与血管均较深的部位,因此我们选择腹部皮下注射,注射时常规消毒后用拇指和食指将要注射部位组织捏起,形成一个小丘状, 然后注入皮下,如此可使注射的药液停留在较深的皮下组织内,注射完毕,用酒精棉球轻轻按摩注射部位,以助药物分布及吸收。2．鼓励患者术前／后多饮流食即含高营养的汤水。针对患者由于进行充分的肠道清洁而带来体内液体丢失情况, 术前6小时应鼓励患者多饮水、营养丰富的高汤及术前3—4 小时之内适当的从静脉补充液体。术后,在充分补充液体的同时鼓励其尽早进水及易被体内吸收的汤。3．加强下肢的护理静脉栓塞的原因之一就是血流减慢,术后由于患者惧怕疼痛或其它原因不敢活动而处于较长时间的制动状态。此时加强腿部的护理尤为重要。因为腿部肌肉尤其是比目鱼肌与腓肠肌内存在许多静脉窦,这些静脉内的血流,几乎只有依靠肌肉泵的作用,才能向心回流,仰卧时这种情况更为突出。因此,我们在术后第2日即开始鼓励病人床上活动,膝下不垫枕,协助病人在床上做下肢伸展运动,内收外展动作,足和趾主动活动。同时做腓肠肌按摩,每日二次,时间5-10分钟, 使腓肠肌发挥有效的泵作用,促进局部血液循环,改善下肢血流缓慢的状态,延缓或阻止下肢静脉血栓形成。结果通过采取以上三种互相关联的做法,有效的减少下肢静脉栓塞的形成。自从2004年10月到2006年6月对临床381例恶性肿瘤患者治疗护理,其中:宫颈癌149例,卵巢癌121例子宫内膜癌111例,均达到满意的效果。结论:过去,由于恶性肿瘤手术切除范围比较大,术后常规使用止血药来预防术后可能出现的伤口出血或渗血;对于抗凝类药物,由于担心出现自发性出血而使用受限;因为手术范围较大,反复使用泻药／清洁灌肠,又因术前／后又限制患者进水的时间及量,对于身体组织中缺水现象估计不足;再者对腿部护理认识不够。如今在改变观念进行积极的预防的同时认真做好宣教工作, 使病人及家属认识到这三种治疗护理的重要性使其配合也是非常重要的。更多还原

【Abstract】 Objective: the vessel wall hurted,blood flowing slowly and blood coagulability increasing were the three kinds of important mechanisms when the postoperation patient genesis thrombus. because the rhagiocrine cell of malignant tumor could release high co-agulable agent to the blood circulation, then the blood coagulability increased, it was easy to form venous thrombosis. accordingly,the patient of malignant tumor was another high-risk group to appear embolism of Veins of lower extremity after adipositas,hyperpiesia and diabetes. The Vein embolism of lower extremity was one of the frequent complications after the operation of the abdominal part How to decrease or control the Vein embolism of lower extremity, changing the concept was the key point. Methods: 1. we could use the anticoagulant drug as possible as early ,at postoperation 24 hours began to use Low Molecular Heparin 5000 units in abdominal part, hypodermic injection, once daily,3 to 5 days. 2. The patients could be encouraged to drink water preoperation or postoperation. 3. The taking care for lower extremity should be enhanced. Results: Through these three above correlated methods, the vein embolism of lower extremity should be decreased. Form 2004,10 to 2006,6 ,we chose 381 cases of malignant tumor to cure, including: 149 cases of cervixl, 121 cases of ovarian cancer,111 cases of endometria cancer, all of them got the satisfactory effect Conclusion: Due to the extent of malignant tumor exairesis is bigger,we could use the hemostatic to prevent hemorrhage or errhysis of the wounds, according to a nticoagulant, as we worried to autogenous hemorrhage, so it was confined to use .Because the scope of operation is bigger, repeating to use cathartic/ cleaning enema but the time and amount of the water is confined at preoperation/postoperation, then to hydropenia phenomenon of body tissue we could not estimate very well ,and the nursing of lower limb would not be learned well. we must propagandize seriously simultaneously we changed concept to progress energetic prophylaxis, so that the patient and his families knew the important of these three nursing.更多还原