【作者】 郝会琴； 李芳； 朱红卫；

【Author】 Hao Hui-Qin Li Fang Zhu Hong-Wei 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:宫颈癌是妇科常见的恶性肿瘤之一,对于阴道大出血的患者,常规使用的方法有“阴道纱条填塞、静脉或肌肉注射止血药物、放射治疗(子宫腔内放疗)止血法”。当瘤体的大血管破裂,采用上述方法无效时,使用介入治疗是近年发展起来的一种新的治疗手段,能达到很好的止血效果。因此需探讨介入治疗宫颈癌大出血的效果及护理措施很有必要。方法:对在2004年3月-2006年2月,住院的38例宫颈癌大出血患者,常规止血措施无效时,采用介入治疗的方法达到了很好的止血的效果。介入治疗的方法是应用Selding技术．经皮股动脉穿刺插管术,将6F或RIM导管送至髂总动脉造影。根据造影所见确定出血的小动脉,将导管超选择地插入肿瘤供血及出血的动脉,注入化疗药物氟尿嘧啶、顺铂、阿霉素,再用明胶海绵丝线段或钢圈进行栓塞的方法。术后拔除导管,压迫止血5分钟,局部加压包扎,患肢制动24小时。术后注意观察足背动脉的搏动,穿刺点有无渗血,生命体征的变化。由于阴道大出血使患者产生焦虑、恐惧等心理变化。常规治疗方法的失败以及经济等原因更加重了这些心理负担我们给予耐心细致的解释工作,使其对介入治疗的方法、效果、注意事项等有所了解,从而树立信心。积极配合术前的合血、备皮、置尿管和术后的注意事项,为抢救成功赢得时间。结果:通过对宫颈癌大出血的患者进行介入治疗的术前的心理护理及常规护理指导,患者克服了心理上的恐惧、焦虑,能够正确认识疾病,通过护理指导无静脉血栓的形成,穿刺处无皮下渗血、血肿,无造影剂过敏反应等并发症的发生。达到了很好的止血效果。结论:对宫颈癌大出血患者采用常规止血的方法存在一定的局限性,而介入治疗是近年来发展起来的一种新的治疗方法,通过介入治疗可以阻断肿瘤的血供,使瘤体缺血坏死,达到止血目的,灌注化疗药使肿瘤缩小,同时给予术前的心理护理和术中、术后的护理指导,减少了患者心理上的焦虑、恐惧。达到了很好的止血效果从而控制了病情,临床疗效明显增加。可见介入治疗富颈癌大出血的患者的效果是显著的。通过良好的、正确的护理使患者顺利地度过危险期,为进一步治疗打下良好的基础。更多还原

【Abstract】 Objective: Cervical carcinoma is a common malignant tumor in women .It is often accompanied with hemorrhage. Our purpose was to explore the effective nursing care for the patients with cervical carcinoma which was accompanied by hemorrhage and who accepted interventional treatment Methods: Materials of the patients with cervical carcinoma and hemorrhage who accepted interventional treatment were summed .38 cases of cervical carcinoma and hemorrhage were studied during March of 2004 and February of 2006. Nursing care of preoperation, operation and post-operation were studied. Results: We helped the patients get rid of fear and in-tensiveness before, during and after the operation .We helped the patients get the correct information about the diseases. No of the 38 cases of cervical carcinoma and hemorrhage had side effects or redden swelling, osmoses, nausea. No hyper allergy action occurred. Our nursing care were effective and proper. Conclusion: Interventional treatment of hemorrhage of cervical was effective .Correct nursing care was important for the patients with hemorrhage. Our nursing care is significant and effective.更多还原