微波消融术治疗肝癌护理体会

1、微波消融术治疗肝癌护理体会（xx市人民医院普外科 ）【关键词】 微波消融术 治疗 肝癌 护理体会原发性肝癌（plc）是一种常见病，全球发病率逐年增长，已超过62.6万/年，居于恶性肿瘤的第5位；死亡率接近60万/年，位居肿瘤相关死亡的第3位。我国是肝炎大国，plc在我国高发，目前，我国患者数约占全球的55%；在肿瘤相关死亡中仅次于肺癌，位居第二 。迄今为止，大约只有20%30%的肝癌患者适合于手术切除，其余70%80%左右的只能采取非手术治疗。微波消融（microwave ablation）以创伤小、安全可靠、治疗彻底、复发率低、并发症少、一次性杀灭肿瘤等优点，广泛的应用于肝癌的非手术治疗，成

2、为国内外肝癌治疗的一个热点。b超引导下经皮肝癌微波消融治疗近来发展迅速，在小肝癌，早期肝癌的治疗中已获得与外科手术切除相近的远期疗效1。超声引导下微波消融疗法是振荡频率（2450mhz）通过组织时可以使电极周围组织中的水分子高速振荡，高速振荡分子因摩擦产生大量的热量，治疗区温度范围约有80-100，由中心向周围递减，消融区呈椭圆形，其短径3.5cm-4cm左右，并且其内的细胞完全死亡，因此，已经成为追求某些实体恶性肿瘤原位根治的方法之一2。自20092011年，我科行微波消融治疗肝癌共98例,现本文就微波消融术前术后的护理报告如下。1 资料与方法 本组98例，男性75例，女性23例，年龄376

3、3岁，平均50岁。均为住院病人，经微波消融术治疗肝癌 效果满意。 2 手术前的护理 2.1 术前的心理护理评估患者手术前的心理状态，患者易产生紧张、焦虑不安等负性心理。简单介绍该治疗的基本原理及操作过程、疗效，介绍治疗的安全性，术后可能出现的并发症等，使患者对术中可能出现的情况有充分地心理准备，介绍成功的病例，从而减轻患者的焦虑、恐惧、悲观的心理，稳定情绪，积极配合治疗。 2.2 术前准备低脂饮食，术前12小时常规禁食，46小时禁饮水，目的是以防止麻醉或手术中呕吐而引起窒息或吸入性肺炎。术前1-2天在b超下定位，手术当日将磁共振片子带入手术室，术前做好抗生素的过敏试验。手术区皮肤准备（备皮）：

4、术前剃除术区毛发，清洁皮肤，皮肤准备是预防术区感染的重要环节。建立静脉通道，如需全身麻醉，应按全麻做好术前准备工作。 2.3 术中护理患者取平卧位或者右前斜位，准备好微波消融治疗系统发生器及相关电源导线和连接导线，准备好麻醉用药品、急救插管物品、心电监护仪、急救药品，遵医嘱给予注射镇静药物。协助医生常规消毒皮肤，铺无菌治疗单。术中密切观察病情变化，并做好记录，记录消融功率及消融时间，发现问题及时报告医生。保持液体通畅。治疗结束后留观30分钟，如无特殊不适，用平车送回病房。3 手术后的护理3.1 一般护理 回病房后，患者平卧6h，给予心电监护24h，严密观察生命体征及腹部体征的变化。同时注意患者

5、有无胸闷、气促、腹部穿刺点敷料有无渗血等，告知患者3天内不做剧烈运动，禁食6或12小时，适当补液，清淡少量易消化饮食，进食后如无不适，再逐渐恢复到正常饮食。 3.2穿刺部位的护理 注意穿刺部位有无渗液、渗血，并保持穿刺点清洁干燥，术后两天内不能洗澡，可行擦身，防止水污染伤口，如穿刺部位出现红肿或有脓液渗出，为伤口感染，应按医嘱给予抗炎、换药等处理，并严格执行无菌操作。本组出现3例伤口感染。 3.3 疼痛的护理 本组均有不同程度的疼痛，由于微波消融治疗，使肿瘤组织发生凝固坏死，达到治疗目的，同时其热效应，也导致肝包膜灼伤刺激引起疼痛。主要表现为胀痛，其疼痛程度、持续时间与肿瘤大小、位置的深浅及患

6、者的耐受程度等因素有关。术后两天内疼痛较明显，持续35天。护士应密切观察疼痛的部位、范围、强度、持续时间及是否合并腹膜炎体征，向患者做好解释工作，说明疼痛的原因及缓解的时间，疼痛较剧烈者，在排除腹腔内出血等并发症时可适当给予止痛剂，如杜冷丁、吗啡等，观察药 3.4 密切观察体温变化 消融治疗术后第1天开始发热，体温波动在37.538.5，最高可达到39，一般27d转为正常，患者体温升高有多种因素，早期发热是治疗后肿瘤组织坏死被机体吸收后所引起的, 给予物理降温和药物对症处理,1周后体温降至正常3。对高热前有寒战者应注意有无感染。发热超过1周，注意继发感染可能。发热患者及时更换汗湿衣物,注意保暖

7、,做好皮肤护理及基础护理。4 并发症的观察和护理 微波治疗是一种微创技术，虽然损伤小，但也有发生并发症的可能，微波消融治疗术后并发症包括：发热、疼痛比较常见、黄疸、腹腔内出血、皮下出血、胆汁漏、结肠穿孔、电极板烫伤、肝昏迷、呕吐窒息、腹水、肝脓肿，肠梗阻4。如出现腹肌紧张、腹部隆起、有压痛及转移性浊音、皮肤巩膜黄疸加重等应立刻报告医生，及时给予处理，术后监测生命体征，肝功能情况，观察皮肤、巩膜颜色，腹部情况，并积极给予保肝药物治疗，嘱患者多饮水，多食新鲜的水果蔬菜，适当的运动，养成良好的排便习惯。5 出院指导 患者出院后嘱患者要保持良好的心态，注意休息,指导患者学会自我保健，自我调节，自我控制

8、的方法，提高患者心理适应能力和社会生活能力。适当运动，避免劳累，应戒烟酒、忌辛辣食物,按时进餐，进食高营养、高维生素、高热量、低盐、低脂肪清淡易消化的饮食。定期复查超或,血常规，肝功能，及早发现复发的肿瘤并及早给予治疗。6 讨论 微波消融治疗肝癌，具有创伤小，并发症少，安全，近期疗效确切等优点，多数病人经过治疗后症状得到缓解，生存期明显延长。但我们应认真做好术前准备，了解患者的病情、病史，协助做好各种检查。了解其心理状况，做好心理护理，使他们树立起战胜疾病的信心。并做好术中的配合。术后密切观察生命征的变化，做好并发症的观察，做到早发现、及时处理和护理这是治疗成功的保障。 参 考 文 献1 吕明

9、德影像引导肝癌消融治疗的效果和临床地位j中国普外基础与临床杂志,2006，13(2)：1381392梁萍,董宝玮.超声引导微波凝固治疗肝癌m.人民军医出版社,2003,11.3刘梅娟.经皮射频治疗肝肿瘤的配合与护理j.实用护理杂志,2001,17(3):22-234 李洁，李建志，荆雪虹，等超声引导微波消融治疗原发性肝癌的护理j.医学影像学杂志，2009，19(12)：english is the most widely spoken language in the history of our planet, used in some way by at least one out of e

10、very seven human beings around the globe. half of the worlds books are written in english, and the majority of international telephone calls are made in english. english is the language of over sixty percent of the worlds radio programs. more than seventy percent of international mail is written and

11、 addressed in english, and eighty percent of all computer text is stored in english. english has acquired the largest vocabulary of all the worlds languages, perhaps as many as two million words, and has generated one of the noblest bodies of literature in the annals of the human it is now time to f

12、ace the fact that english is a crazy language - the most lunatic and loopy and of all languages. in the crazy english language, the blackbird hen is brown, blackboards can be green or blue, and blackberries are green and then red before they are ripe. even if blackberries were really black and blueb

13、erries really blue, what are strawberries, cranberries, huckleberries, raspberries, and gooseberries supposed to look add to this insanity there is no butter in buttermilk, no egg in eggplant, no grape in grapefruit, no bread in shortbread, neither worms nor wood in wormwood, neither mush nor room i

14、n mushroom, neither pine nor apple in pineapple, neither peas nor nuts in peanuts, and no ham in a hamburger. (in fact, if somebody invented a sandwich consisting of a ham patty in a bun, we would have a hard time finding a name for it.)to make matters worse, english muffins werent invented in engla

15、nd, fries in france, or danish pastries in denmark. and we discover even more culinary madness in the that sweetmeat is made from fruit, while sweetbread, which isnt sweet, is made from this unreliable english tongue, greyhounds arent always grey (or gray); panda bears and koala bears arent bears (t

16、heyre marsupials); a woodchuck is a groundhog, which is not a hog; a horned toad is a lizard; glowworms are fireflies, but fireflies are not flies (theyre beetles); ladybugs and lightning bugs are also beetles (and to, a significant proportion of ladybugs must be male); a guinea pig is neither a pig

17、 nor from guinea (its a south american rodent); and a titmouse is neither is like the air we breathe. its invisible, inescapable, indispensable, and we take it for granted. but, when we take the time to step back and listen to the sounds that escape from the holes in peoples faces and to ex- the par

18、adoxes and vagaries of english, we find that hot dogs can be cold, darkrooms can be lit, homework can be done in school, nightmares can take place in broad daylight while morning sickness and daydreaming can take place at night, tomboys are girls and midwives can be men, hours - especially happy hou

19、rs and rush hours - often last longer than sixty minutes, quick- sand works very slowly, boxing rings are square, silverware and glasses can be made of plastic and tablecloths of paper, most are dialed by being punched (or pushed?), and most bathrooms dont have any baths in them. in fact, a dog can

20、go to the bathroom under a tree - no bath, no room; its still going to the bathroom. and doesnt it seem a little bizarre that we go to the bathroom in order to go to the is it that a woman can man a station but as man cant woman one, that a man can father a movement but a woman cant mother one, and

21、that a king rules a kingdom but a queen doesnt rule a? how did all those renaissance men reproduce when there dont seem to have been any renaissance writer is someone who writes, and a stinger is something that stings. but fingers dont grocers dont, haberdashers dont, hammers dont ham, and humdinger

22、s dont the plural of tooth is teeth , shouldnt the plural of booth be ? one goose, two geese - so one moose, two one index, two indices - one kleenex, two if people ring a bell today and rang a bell yesterday, why dont we say that they a ball? if they wrote a letter, perhaps they also their tongue.

23、if the teacher taught, why isnt it also true that the preacher? why is it that the sun shone yesterday while i shined my shoes, that i treaded water and then trod on the beach, and that i flew out to see a world series game in which my favorite player flied we conceive a conception and receive at a

24、reception, why dont we grieve a and believe a? if a horsehair mat is made from the hair of horses and a camels hair brush from the hair of camels, from what is a mohair coat made? if adults commit adultery, do infants commit infantry? if olive oil is made from olives, what do they make baby oil from

25、? if a vegetarian eats vegetables, what does a humanitarian eat? (and im beginning to worry about those authoritarians.)and if pro and con are opposites, is congress the opposite of you have to believe that all english speakers should be committed to an asylum for the verbally insane. in what other

26、language do people drive in a parkway and park in a driveway? in what other language do people recite at a play and play at a recital? in what other language do privates eat in the general mess and generals eat in the private mess? in what other language do people ship by truck and send cargo by shi

27、p? in what other language can your nose run and your feet can a slim chance and a fat chance be the same and a bad licking and a good licking be the same, while a wise man and a wise guy are opposites? how can sharp speech and blunt speech be the same and quite a lot and quite a few the same, while

28、overlook and oversee are opposites? how can the weather be hot as hell one day and cold as hell the next? how can the expressions whats going on? and whats coming off? mean exactly the samton and unbutton and tie and untie are opposites, why are loosen and unloosen and ravel and unravel he same? if

29、bad is the opposite of good, hard the opposite of soft, and up the opposite of down, why are badly and goodly, hardly and softy, and upright and downright not opposing pairs? if harmless actions are the opposite of harmful why are shameful and shameless behavior the same and pricey objects less expe

30、nsive than priceless appropriate and inappropriate remarks and passable and impassable mountain trails are opposites, why are flammable and inflammable materials, heritable and inheritable property, and passive and impassive people the same and valuable objects less treasured than invaluable ones? if uplift is the same as lift up, why are upset and set up opposite in meaning? why are pertinent and impertinent, canny and uncanny, and famous and infamous neither oppos