头颈部肿瘤术后颈部大血管破裂出血的预防与抢救

目的探讨头颈部肿瘤术后颈部大血管破裂出血的预防及抢救护理方法。方法回顾性分析2003年10月-2007年1月6例头颈部肿瘤术后颈部大血管破裂患者的护理过程：大血管破裂前的观察、预防措施,破裂时的救护及术后的护理。结果6例患者中4例抢救成功,2例死亡。无护理并发症发生。结论头颈部肿瘤术后颈部大血管破裂出血的预防及抢救护理包括以下几个方面：1）预防切口感染,给予营养支持,促进切口愈合是预防大血管出血的关键;2）避免诱发大血管破裂的因素,发现破裂先兆时充分准备,制定大血管破裂抢救的应急预案;3）做好患者的心理护理,缓解患者的紧张、烦躁情绪;参与有效的救护;4）患者抢救成功后,做好颈部大血管栓塞、结扎后的观察、护理。     

胸大肌肌皮瓣修复晚期头颈部肿瘤术后组织缺损的护理

目的：总结胸大肌肌皮瓣修复晚期头颈部肿瘤术后组织缺损的护理体会。方法：积极做好晚期头颈部肿瘤患者术后转移胸大肌肌皮瓣术前心理准备、皮肤准备、辅助检查及加强术后皮瓣血运观察、预防创口感染、加强营养、保持引流畅通、心理支持、疼痛的护理。结果：29例晚期头颈部肿瘤患者术后转移胸大肌肌皮瓣，27例皮瓣存活，1例术后因局部感染形成咽瘘未愈，1例因术前放疗血循环差而皮瓣坏死。结论：积极做好术前准备与术后护理有利于提高皮瓣的存活率。     

13例头颈部恶性肿瘤致颈总动脉破裂患者的预防与护理

报告了13例头颈部恶性肿瘤放疗后复发行补救手术后颈总动脉破裂患者的护理.重点为切实做好心理护理,术后采取半卧位并保持头颈部前屈制动,密切观察切口情况,采取各种措施促进血液循环,换药时严格无菌操作,做好呼吸道管理和气管切开用物准备,指导有效咳嗽,给予营养支持,并密切观察有无颅内压升高、脑水肿、血栓形成等并发症.本组11例出院,3例死亡.     

皮瓣修复头颈部肿瘤术后组织缺损的护理

目的探讨皮瓣修复头颈部肿瘤术后组织缺损的护理。方法术前做好心理护理。术后密切观察皮瓣的颜色、温度、张力等，卧位适当，保持引流管通畅，预防感染，做好口腔护理，做好营养护理，合理应用扩血管药物。结果16例皮瓣移植患者14例成功，1例二次手术抢救成功，1例失败。结论做好围手术期护理能提高皮瓣移植成活率。     

头颈部肿瘤38例放射治疗的护理

放射治疗是利用辐射能对生物组织作用后的临床效应来作为治疗恶性肿瘤的主要手段之一,头颈部肿瘤治疗首选放疗。在放疗过程中,常出现不同程度的放疗反应,不仅给患者带来痛苦,而且严重反应可使患者中断治疗。为使放疗顺利进行,应当做好各方面的临床护理工作,现将头颈部肿瘤放疗的护理介绍如下。     

剖宫产术后大出血80例预防抢救与护理体会

2005年1月~2006年10月,我们共救治80例剖宫产术后大出血,经积极抢救与精心护理,效果满意。现将体会报告如下。1临床资料本组80例,20~39岁,平均29.5岁,出血量500~3765m。l初产妇57例,经产妇23例;无人流史25例,人流1次9例,大于1次46例。出血原因:宫缩乏力56例,占70%,胎盘因素17例     

头颈部肿瘤放射治疗后皮肤护理进展

恶性肿瘤患者中约有60％在其治疗的不同阶段需要接受放射治疗（放疗）^[1];而其中最主要的并发症之一就是放射性皮肤损伤,约有87％的放疗患者会出现皮肤反应^[2];尤其在头颈部肿瘤中常见。轻者出现轻微的皮肤红斑,有烧灼感、刺痛、瘙痒等不适,重者可能会出现湿性脱皮、溃疡等,需要中断放疗,严重影响患者的生活质量及放疗疗效。     

头颈部肿瘤术后鼻饲营养并发症的预防与护理

2009年2月～2011年7月,我们共收治喉癌、下咽癌、口腔癌患者78例,术后给予鼻饲肠内营养支持,经精心护理,效果满意。现报告如下。1临床资料选择同期收治的行肿瘤切除术的头颈部肿瘤患者78例,其中男69例,女9例;年龄25～86岁。喉癌43例,下咽癌16例,颌面部肿瘤19例。喉癌、下咽癌患者于手术日晨或术中置入鼻饲管;颌面部肿瘤:口腔癌、舌癌患者于术后第1天放     

头颈部肿瘤治疗后致命性大出血的急救和护理

<正>头颈部肿瘤手术后的大出血,是术后的严重并发症之一。一般发生于颈动脉或无名动脉破裂的出血。大出血发生时病情凶险,常常危及患者的生命。及时正确的抢救措施对挽救患者的生命有至关重要的作用。     

头颈部肿瘤患者使用面罩放疗后的皮肤护理

放射治疗是头颈部肿瘤治疗的重要手段,为提高放疔时肿瘤摆位的准确性和重复性,目前普遍采用面罩固定。随射线能量的增加,模体表面剂量下降,最大剂量点深度增加,百分深度剂量增加。因此,使用面罩后皮肤表面量比不用面罩时增加。     

颈椎手术后硬膜外血肿形成的预防护理

目的：探讨颈椎术后硬膜外血肿形成原因及预防护理干预措施。方法：我科2008年1月～2010年12月收住颈椎手术患者256例,术后均给予观察病情、定期翻身、引流管护理、观察四肢感觉运动变化等措施。结果：本组中有17例出现引流管引流不畅,给予及时处理,未发生硬膜外血肿形成,其余病例均没有血肿形成。结论：颈椎术后硬膜外血肿形成的原因很多,而护理干预对硬膜外血肿形成的预防起到十分重要的作用。     

宫颈癌术后尿潴留的预防与护理

宫颈癌系常见的妇科恶性肿瘤,其发病率占女姓生殖系统恶性肿瘤半数以上,而死亡率居妇女恶性肿瘤的首位。当今人们对早、中期宫颈癌的治疗绝大多数采用手术治疗,但因手术切除范围广,创伤程度大,涉及多处邻近器官并易伤及骨盆内脏神经和血管,因此在术后常可发生多种并发症,而其中以尿潴留最为常见。尽管人们采取多种改良方法、电针治疗及多种预防措施以使术后尿潴留的发生率有所下降,但相关的有效护理措施,仍是临床学者研究的重点。本文着重介绍宫颈癌患者术后所出现的尿潴留的症状以及当今所采用一系列护理干预在临床治疗中的效果,现报道如下。     

Endocrine complications after radiotherapy for tumors of the head and neck

One hundred sixty-six patients 6 to 80 years of age with nasopharyngeal cancer and paranasal sinus tumors who were free of the primary disease were studied from 1 to 26 years after radiotherapy. Studies in 65 of these patients were performed prospectively. Both the hypothalamus and the anterior pituitary gland were in the field of irradiation. The median radiation dose was estimated to be 5700 rad to the anterior pituitary gland and 5000 rad to the hypothalamus. We found evidence of endocrine deficiencies in 134 of the 166 patients observed. One hundred eleven patients showed evidence suggestive of hypothalamic lesions and 67 patients showed evidence of primary pituitary deficiency. Forty-eight of the 110 patients who received radiotherapy to the neck for treatment or prevention of lymph node metastasis showed evidence of primary hypothyroidism. The median dose to the thyroid area was 5000 rad. Adolescents younger than 15 years of age had a higher incidence of growth hormone deficiency soon after radiotherapy, but the older group showed adrenocortical and luteinizing hormone deficiency. These results indicate that endocrine deficiencies after radiotherapy for tumors of the head and neck are common. The highest incidence of complications occurred 1 to 5 years after radiotherapy, but long-term follow-up is indicated because complications may appear years after radiotherapy.     

颈椎前路手术前后康复护理工作要点

BACKGROUND: The operation of anterior vertebrae often cause the injury of superior laryngeal nerve and inferior laryngeal nerve and it is important of enough preoperative preparations and postoperative care for patients.OBJECTIVE: To investigate the effect of rehabilitation care on patient before and after anterior cervical operation.UNIT: Zhujing Hospital of First Military Medical University     

Irinotecan pharmacokinetic and pharmacogenomic alterations induced by methylselenocysteine in human head and neck xenograft tumors

The combination of methylselenocysteine and irinotecan (CPT-11) is synergistic against FaDu and A253 xenografts. Methylselenocysteine/CPT-11 increased tumor cure rate to 100% in FaDu and to 60% in A253. In this study, the effect of methylselenocysteine on pharmacokinetic and pharmacogenetic profiles of genes relevant to CPT-11 metabolic pathway was evaluated to identify possible mechanisms associated with the observed combinational synergy. Nude mice bearing tumors (FaDu and A253) were treated with methylselenocysteine, CPT-11, and a combination of methylselenocysteine/CPT-11. Samples were collected and analyzed for plasma and intratumor concentration of CPT-11 and 7-ethyl-10-hydroxyl-camptothecin (SN-38) by high-performance liquid chromatography. The intratumor relative expression of genes related to the CPT-11 metabolic pathway was measured by real-time PCR. After methylselenocysteine treatment, the intratumor area under the concentration-time curve of SN-38 increased to a significantly higher level in A253 than in FaDu and was associated with increased expression of CES1 in both tumors. Methylselenocysteine/CPT-11 treatment, compared with CPT-11 alone, resulted in a significant decrease in levels of ABCC1 and DRG1 in FaDu tumors and an increase in levels of CYP3A5 and TNFSF6 in A253 tumors. No statistically significant changes induced by methylselenocysteine/CPT-11 were observed in the levels of other investigated variables. In conclusion, the significant increase in the cure rate after methylselenocysteine/CPT-11 could be related to increased drug delivery into both tumors (CES1), reduced resistance to SN-38 (ABCC1 and DRG1) in FaDu, and induced Fas ligand apoptosis (TNFSF6) in A253. No correlation was observed between cure rate and other investigated variables (transporters, degradation enzymes, DNA repair, and cell survival/death genes) in either tumor.     

改良颈围在颈椎病术后患者中的应用

颈椎病的发生是由于长期慢性劳损引起颈椎间盘、韧带等结构退行性改变,导致颈椎失稳、压迫邻近组织结构而引起的一系列症状。人工颈椎间盘置换术作为一项新的符合人的生理功能的治疗手段被应用于颈椎病保守治疗无效患者,它具有安全性好、康复快和术后痛苦小等优点,已成为目前治疗颈椎病的主要方法。颈椎病术后患者1周内需佩戴颈围制动,避免颈部过度屈伸和旋转活动。