胃癌病人的护理课堂

1、1,胃癌病人的护理,2,消化道恶性肿瘤中,占第一位,40-60,岁多见,男多于女,3:1,3,病因,胃幽门螺杆菌感染,胃的慢性疾病：如胃溃疡、胃息肉、萎缩性,胃炎、胃切除术后残胃等,胃粘膜上皮异型性增生（癌前病变,环境、饮食、遗传因素,4,病理,胃窦部,50,其次是贲门、胃小弯,5,1,早期胃癌,仅侵及粘膜或粘膜下层者，不,论病灶大小或有无淋巴结转移,2,进展期胃癌,超过粘膜下层，“中、晚期胃癌,Borrmann,分型：结节型、溃疡局,限型、溃疡浸润型、弥漫浸润型,大,体,类,型,6,结节型,7,溃疡局限型,8,溃疡浸润型,9,弥漫浸润型,皮革样胃,10,以腺癌最多见,鳞癌、腺鳞癌、未分化癌、

2、特殊型癌等,组,织,学,类,型,11,直接浸润,淋巴转移,血行转移,腹腔种植,转,移,途,径,12,直接浸润：穿透小弯侧浆膜层,13,直接浸润：侵犯肝脏,14,淋巴结,转移,15,血行转移：肺,16,腹腔种植,Krukenberg,瘤（经腹膜种殖至卵巢,17,临床表现,早期症状不明显，可为上腹隐痛不适、嗳,气、返酸、食欲下降,呕吐、进食梗阻感,出血：呕血、便血、潜出血,贫血、消瘦、恶病质,晚期上腹部可触及肿块,转移表现：左锁骨上淋巴结肿大、肝肿大,腹水,18,诊断检查,血常规：贫血,大便常规,OB,试验阳性,X,线钡餐检查,胃镜检查,腹部,B,超、超声胃镜,CT,脱落细胞学检查,19,20,2

3、1,22,23,处理原则,早期发现、早期诊断、早期治疗,手术为主的综合治疗,24,25,练习与思考,26,1,溃疡病幽门梗阻病人的主要临床表现,A,突发上腹部剧烈疼痛,B,呕血、黑便,C,肠鸣音消失,D,腹膜刺激征,E,呕吐大量宿食,27,2,胃、十二指肠溃疡急性大出血主要临床,表现,A,突发上腹部剧烈疼痛,B,呕血、黑便,C,肠鸣音消失,D,腹膜刺激征,E,呕吐宿食,28,3,以下有关胃、十二指肠溃疡急性穿孔的临,床表现的叙述错误的是,A,肠鸣音亢进,B,腹式呼吸减弱,C,肝浊音界缩小,D,有时可出现右下腹疼痛,E,突发上腹部剧烈疼痛,29,4,幽门梗阻病人的术前护理中可减轻胃黏膜,水肿的主

4、要措施是,A,术前禁食,B,营养支持,C,口腔护理,D,术前,3,天温盐水洗胃,E,纠正水电解质酸碱失衡,30,5,胃大部切除后，最早易出现的并发症是,A,吻合口瘘,B,倾倒综合征,C,上消化道出血,D,低血糖综合症,E,十二指肠残端破裂,31,6,女性病人，毕,式胃大部切除术后第,5,天,突发右上腹剧痛，伴有腹膜刺激征，应考,虑,A,吻合口瘘,B,倾倒综合征,C,上消化道出血,D,低血糖综合症,E,十二指肠残端破裂,32,7,男性病人，胃大部切除术后一周，进食后,出现上腹饱胀，呕吐，呕吐物中无胆汁,可能发生了,A,吻合口梗阻,B,倾倒综合症,C,十二指肠残端破裂,D,吻合口近端空肠段梗阻,E

5、,吻合口远端空肠段梗阻,33,8,胃癌最好发的部位是,A,胃小弯,B,贲门部,C,胃窦部,D,胃底部,E,胃体部,34,9,胃大部切除术后,2,天内，除生命体征外应,重点观察的是,A,神志,B,伤口敷料,C,肠鸣音,D,腹胀,E,胃管引流液,35,10,溃疡病急性穿孔非手术治疗期间最重要的,护理措施是,A,半卧位,B,补液,C,胃肠减压,D,应用抗生素,E,全身支持治疗,36,11,女性病人,50,岁，胃大部切除术后,2,周,患者进食后约,15,分钟出现上腹饱胀，恶心,呕吐、头晕、心悸、出汗、腹泻等，应考,虑并发了,A,吻合口炎症,B,吻合口梗阻,C,倾倒综合征,D,吻合口破裂,E,消化道出血

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