【作者】 穆双月； 朱红卫； 刘亚丽； 梁聚芹；

【Author】 Mu Shuang-Yue Zhu Hong-Wei LfuYa-Li 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:探讨介入治疗在宫颈癌大出血中的应用及治疗中、治疗后有效的观察和护理,方法:选择我科2005年1 月-2006年1月6例宫颈癌大出血患者,她们均经局部填塞止血失败,出血量较多。在完善术前准备后,常规铺消毒单, 用Seldinger氏法,经右侧动脉穿刺插管将5FCOBRA导管至左、右侧髂内动脉,然后进一步将导管分别插至左、右髂内动脉的脏支,经造影证实后,用明胶海绵颗粒、真丝线段及明胶海绵条(在透视下)缓慢栓塞左、右侧髂内动脉脏支, 造影显示双侧髂内动脉脏支闭塞,肿瘤染色消失。术后拔出导管,局部加压包扎。观察和护理(1)生命体征:半小时测血压、脉搏、呼吸一次,平稳后改2小时测一次,监测24小时,测体温4／日次连测三天。(2)下肢血循环:足背动脉搏动双侧比较观察,重点右侧,双下肢皮肤温度及颜色、感觉及肌力,并与对侧及术前比较。(3)穿刺点包扎是否错位、敷料有无渗血。(4)阴道出血情况:一周内可有少量阴道排液, 应保持外阴清洁,预防感染,每日碘伏溶液擦洗外阴一次。 (5)腹部情况:观察腹部有无外科情况,一般介入后患者腹部有不适、疼痛、腰酸等感觉呈阵发性,持续时间长短不等, 一般对症处理能有效缓解疼痛,如疼痛超过一周并较剧烈应警惕继发感染、误栓等严重并发症及早报告医师进行处理。 (6)介入并发症的观察:造影剂副反应的观察、动脉插管并发症的观察、栓塞术后综合征的观察。(7)绝对卧床休息,患者在术后24小时内取平卧位并且右侧下肢制动不少于6小时。(8)做好健康教育,使患者很好的配合不出现意外。(9) 做好心理护理。结果:行介入治疗后止血成功率100％,无并发症发生。结论:血管性介入治疗由于是直接栓塞出血血管, 所以它简单、可靠、有效的解决了中晚期宫颈癌大出血的难题,使妇产科疾病微创治疗成为现实,而术后有针对性的观察和护理是介入治疗成功的保障。更多还原

【Abstract】 Objective: To explore the clinical effects of arterial interventional embolism treatment in cervical cancer with massive bleeding, and effective methods of nursing for cervical cancer with massive bleeding in arterial interventional embolism treatment. Methods: From January. 2005 to January. 2006, six patients with cervical cancer with massive bleeding underwent seldinger internal iliac artery remobilization, the 5FCOBRH catheter was placed into the double internal iliac artery with polyvinyl Alcohol foam(PVA) particles as the embroider, the blockage of the blood sup- ply can be seen by angiography. Observation and nursing: (1)vital signs of life, (2)to observing the blood circulation of the legs the operation, regarding right side as the point, (3)to observe whether there was vagina hemorrhage, (4)to observe abdominal signs, (5)to observe the complications of patients, such as pelvic ischemic pain ,fever and nausea in some cases, (6) to give health education for patients, (7) to summarized the psychological problems in all patients of cervical cancer with massive bleeding, do well the psychological treatment for the patients, (8)to keep the patients rest in bed absolutely, (9)to control and prevent infection. Results: The response rate was 100% and no severe complications occurred. Conclusion: The arterial interventi- onal embolism treatment is one of the best and least invasive way to treat cervical cancer with massive bleeding. To observe the changes of disease in time and do well predictability nursing could reduce and prevent the occurrence of nursing complications.更多还原