两件式泌尿造口袋在声镜结合治疗急性重症胰腺炎继发胰周脓肿患者中的应用

总结16例重症急性胰腺炎继发胰周脓肿患者将两件式泌尿造口袋用于声镜结合治疗后引流管护理的方法 及优点.在声镜结合治疗至窦道扩张到24 F引流管直径大小并置入22 F引流管时使用两件式泌尿造口袋,先用生理盐水清洁引流管周围皮肤,使用康乐保皮肤保护膜或3 M无痛保护膜涂抹;待干后,使用康乐保造口护肤粉均匀涂抹在引流管周围半径≥5 cm的范围,除去多余浮粉;根据引流管周围窦道的大小裁剪两件式泌尿造口袋底盘,所剪孔比窦道大1～2 mm,并使底盘和皮肤贴合紧密;在泌尿造口袋靠上部位剪一小口,大小以引流管能刚好通过为宜,将造口袋扣上底盘,关闭造口袋下面的活塞.16例患者无1例发生引流管周围皮肤浸渍,减少了医护工作量,为患者节省了费用.     

一件式泌尿造口袋应用于引流管大量渗漏的临床效果

目的探讨引流管大量渗漏时使用一件式泌尿造口袋的临床效果。方法采用便利抽样法选择南方医科大学珠江医院2011年3月至2013年7月行外科手术治疗后发生引流管渗漏的患者102例,采用随机数字表法分成A、B、C三组,每组各34例,A组采用常规换药后覆盖无菌纱布再盖医用无菌棉垫;B组采用剪短引流管保留5~10cm,将引流管末端放置在一件式泌尿造口袋中,造口袋粘贴在引流管口收集引流液和渗漏液;C组采用一件式泌尿造口袋粘贴在引流管口收集渗液,造口袋上剪一开口,引流管末端从造口袋开口穿出后接一次性抗反流尿袋。比较三组患者的舒适度、满意度和周围皮肤刺激性皮炎的发生率以及换药时间、次数和费用。结果 B、C组患者在疼痛/不适及焦虑/沮丧等方面的舒适度及满意度高于A组,刺激性皮炎的发生率低于A组,换药时间、换药次数及换药费用低于A组;B组换药时间及换药费用又低于C组,差异均有统计学意义(均P0.05)。结论应用一件式泌尿造口袋处理引流管大量渗漏能提高患者的舒适度和满意度,减少不良反应和换药次数等;且采用将剪短的引流管末端放置在一件式泌尿造口袋中的方法更能节省换药费用和换药时间,减轻医生和护士的工作量。     

一件式造口袋在引流管渗漏护理中的应用

对64例发生引流管口渗漏的患者,在引流管口周围粘贴一件式造口袋收集漏出液,观察患者引流管周围刺激性皮炎的发生、愈合,以及渗液的引流和收集效果.应用一件式造口袋进行引流管漏出液的收集,避免了渗液浸渍皮肤,有效地预防了刺激性皮炎的发生,促进了皮肤损伤的愈合,同时减少了引流管口敷料的更换次数,降低了换药成本.     

两件式造口袋在外科肠瘘冲洗中的应用

总结了两件式造口袋应用于26例肠瘘冲洗的护理实践.利用造口底盘上的缝线固定引流管及冲洗双套管方便收集引流液,并减少外渗肠液对肠瘘周围皮肤的刺激.本组1例因肿瘤晚期循环衰竭死亡,其他患者肠瘘均愈合.     

3种一件式造口袋的改良方法在不同渗液量收集中的应用

目的探讨单独使用一件式造口袋、一件式造口袋联合一次性负压吸引器、一件式造口袋联合橡胶奶嘴和一次性负压吸引器的3种改良方法在不同渗液量收集中的应用效果。方法对26例有引流管口周围渗液的患者进行评估,根据引流管口渗液量,分为少量、中量和多量,并分别采用一件式造口袋、一件式造口袋联合一次性负压吸引器、一件式造口袋联合橡胶奶嘴和一次性负压吸引器进行渗液收集。结果 26例患者使用上述方法后,均取得满意效果。结论根据伤口不同的渗液情况,采取不同的造口袋改良方法,可降低腹腔感染率,提高患者舒适度,准确记录引流量。     

一件式与两件式造口袋在直肠癌患者Mile's术后护理中的应用

目的对比一件式与两件式造口袋在直肠癌经腹会阴联合切除术(Mile's术)后护理中的应用效果。方法选取行直肠癌Mile's术患者120例,随机分为对照组和试验组,各60例,分别应用一件式和两件式造口袋。自设问卷表评估患者住院期间被服污染情况、底盘粘贴使用时间、并发症等情况,出院时采用诺丁汉健康量表(NHP)评估患者舒适度。结果试验组平均被服污染次数少于对照组,底盘粘贴使用时间多于对照组,皮炎发生率低于对照组(P0.05)。NHP中6个维度得分试验组均低于对照组(P0.05或P0.01)。结论直肠癌患者行Mile's术后使用两件式造口袋的效果优于一件式造口袋。     

泌尿造口袋在腹部引流管周围渗液患者管理中的应用

对31例使用一件式泌尿造口袋管理腹部引流管周围渗液患者的护理资料进行回顾性分析、总结.结果31例患者使用上述方法后,均取得满意效果.认为使用一件式泌尿造口袋管理腹部引流管周围渗液可降低医院感染发生率,提高患者舒适度,准确记录引流量、渗液量,减轻医务人员工作量,减少患者经济负担,节约医疗资源.     

泌尿造口袋在外科手术后伤口渗液护理中的应用

总结了21例使用一件式泌尿造口袋管理伤口、引流管周围渗液患者的护理经验,包括用物准备、造口袋的应用方法及护理.认为使用一件式泌尿造口袋管理伤口、引流管周围渗液可降低医院感染发生率,提高患者舒适度,准确记录引流量、渗液量,变不可控制渗漏成可控制渗漏,减轻医务人员工作量,减少患者经济负担,节约医疗资源.     

一件式造口袋的设计及在胆道闭锁婴儿腹腔引流中的应用

目的 设计一件式造口袋,应用于胆道闭锁婴儿的腹腔引流,并评价其效果。 方法 一件式造口袋由超薄敷料、普通一件式造口袋组成。选取2018年1月—2020年12月于北京市某三级甲等医院普外科收治的79例胆道闭锁婴儿作为研究对象,按住院时间,2020年1月—12月的20例胆道闭锁婴儿为试验组,将一件式造口袋应用于腹腔引流;2018年1月—2019年12月的59例胆道闭锁婴儿作为对照组,采用传统方纱换药的方式对腹腔引流管进行护理。比较两组每周换药次数、换药费用,浸渍性皮炎发生率、引流管脱落情况的差异。 结果 留置腹腔引流管期间,试验组平均每周中位换药次数较对照组少1.3次（P<0.001）,平均每周中位换药费用较对照组多46.1元（P=0.002）;浸渍性皮炎发生率为5%,低于对照组的22%,两组比较,差异无统计学意义（P=0.102）;试验组无引流管脱落发生,对照组2例发生引流管脱落。 结论 胆道闭锁婴儿腹腔引流中使用一件式造口袋可减少换药次数,降低浸渍性皮炎的发生率,腹水引流量计算更准确,临床护理效果良好。     

一件式造口袋接负压引流装置在神经外科腹泻患者中的应用效果

目的探讨一件式造口袋接负压引流装置在神经外科腹泻患者中的应用效果。方法随机选取2015年1~5月武汉协和医院西区神经外科收治的50例腹泻患者作为研究对象,随机分为对照组和实验组各25例。对照组采用温水清洗法,实现组采用一件式造口袋接负压引流装置,比较两组患者皮肤完好率和清洗大便总次数。结果实验组皮肤完好率高于对照组,清理大便总次数少于对照组,差异有统计学意义(P0.05)。结论在腹泻患者中采用一件式造口袋接负压引流装置的方式有助于保护患者皮肤,提高护理工作效率。     

重症急性胰腺炎38例临床护理

目的:探讨重症急性胰腺炎(SAP)的护理方法.方法:对38例SAP患者给予生命体征监测、静脉置管、用药护理、引流管护理、营养支持和健康指导等护理措施.结果:本组35例治愈,3例自动出院.结论:对SAP患者,在治疗的基础上配合精细的护理措施,严密观察病情,可促进患者康复,减少并发症的发生.     

重症急性胰腺炎后胰腺脓肿引流方法的比较

目的：总结重症急性胰腺炎后胰腺脓肿的治疗经验,将脓肿加以分型,并就其引流方法与疗效的关系进行比较。以指导临床工作。方法：收集本院近20年共48例胰腺脓肿病例,根据胰腺脓肿的大小、位置和形状分成三型,采用剖腹引流、经皮穿刺引流、低位小切口不经腹引流和F管引流四种方法。结果：剖腹引流25例,其中8例需再次手术,3例经三次手术治愈,因大出血、肠痿等并发症死亡4例;经皮穿刺引流8例,4例治愈,4例中转开腹后治愈;经后腰低位小切口不经腹引流10例,均获痊愈。F管引流5例,治愈3例。结论：重症胰腺炎后胰腺脓肿引流方法的选择与治疗效果直接相关,脓肿分型与选择合适的引流方法对临床工作具有指导意义。     

急性重症胰腺炎手术病人术后引流管堵塞危险因素调查

目的:探讨急性重症胰腺炎手术病人术后引流管堵塞的危险因素。方法:选取我院收治的380例急性重症胰腺炎病人为研究对象,回顾性分析急性重症胰腺炎病人术后引流管堵塞危险因素,并根据分析结果探讨急性重症胰腺炎病人术后引流管护理对策。结果:根据单因素分析结果显示,病人性别、年龄、术后室内温度、负压稳定性、引流管曲折、引流管漏液、血凝块堵塞、手术时机等与急性重症胰腺炎病人术后引流管堵塞的发生具有显著相关性(P<0.05);多因素分析结果显示,年龄、术后室内温度、引流管负压稳定性、引流管曲折、引流管漏液、血凝块堵塞以及手术时机是导致急性重症胰腺炎病人术后引流管堵塞的独立高危影响因素(P<0.05)。结论:急性重症胰腺炎病人术后引流管堵塞受多方面因素影响,医护人员在病人术后应加强对引流管路的清理、检查力度,及时检查管路有无脱管、曲折、负压不稳、血液凝块等现象,并有针对性地进行应对处理。     

U形管引流胰周、腹膜后脓肿的效果评价

目的 :探讨胰周、腹膜后脓肿清创术后引流的有效方法。方法 :回顾总结 1987年～ 2 0 0 1年 34例重症胰腺炎并发胰周、腹膜后脓肿行清创后U形管、双套管引流病人的临床资料。结果 :U形管组和双套管组的引流管阻塞、再手术清创及脓肿治愈时间有显著差异 (P <0 .0 5 ) ,U形管临床效果优于双套管。结论 :重症胰腺炎胰周、腹膜后脓肿清创后U形管引流效果较好     

Anterior abdominal abscess - a rare manifestation of severe acute pancreatitis: A case report

BACKGROUNDSevere acute pancreatitis (SAP) is a common critical disease of the digestive system. In addition to the clinical manifestations and biochemical changes of acute pancreatitis, SAP is also accompanied by organ failure lasting more than 48 h. SAP is characterized by focal or extensive pancreatic necrosis, hemorrhage and obvious inflammation around the pancreas. The peripancreatic fat space, fascia, mesentery and adjacent organs are often involved. The common local complications include acute peripancreatic fluid collection, acute necrotic collection, pancreatic pseudocyst, walled off necrosis and infected pancreatic necrosis. After reviewing the literature, we found that in very few cases, SAP patients have complications with anterior abdominal wall abscesses.CASE SUMMARYWe report a 66-year-old Asian male with severe acute pancreatitis who presented with intermittent abdominal pain and an increasing abdominal mass. The abscess spread from the retroperitoneum to the anterior abdominal wall and the right groin. In the described case, drainage tubes were placed in the retroperitoneal and anterior abdominal wall by percutaneous puncture. After a series of symptomatic supportive therapies, the patient was discharged from the hospital with a retroperitoneal drainage tube after the toleration of oral feeding and the improvement of nutritional status.CONCLUSIONWe believe that patients with SAP complicated with anterior abdominal abscess can be treated conservatively to avoid unnecessary exploration or operation.     

经皮肾镜治疗重症胰腺炎患者术后应用三腔负压引流管的护理

目的：总结10例经皮肾镜治疗重症胰腺炎（SAP）术后应用三腔负压引流管的护理经验。方法：对10例SAP接受经皮肾镜手术并放置三腔负压引流管的患者做好引流管路的风险评估、观察巡视,及时调整处理,规范交接记录,加强卧位管理和心理护理。结果：10例患者通过精心护理全部治愈出院。结论：重症胰腺炎患者进行经皮肾镜治疗术后留置三腔负压引流管,在护士动态、有效、规范化的管道管理维护与配合下,引流效果理想,治疗效果优良,值得推广。     

Management of the critically ill patient with severe acute pancreatitis

OBJECTIVE: Acute pancreatitis represents a spectrum of disease ranging from a mild, self-limited course requiring only brief hospitalization to a rapidly progressive, fulminant illness resulting in the multiple organ dysfunction syndrome (MODS), with or without accompanying sepsis. The goal of this consensus statement is to provide recommendations regarding the management of the critically ill patient with severe acute pancreatitis (SAP). DATA SOURCES AND METHODS: An international consensus conference was held in April 2004 to develop recommendations for the management of the critically ill patient with SAP. Evidence-based recommendations were developed by a jury of ten persons representing surgery, internal medicine, and critical care after conferring with experts and reviewing the pertinent literature to address specific questions concerning the management of patients with severe acute pancreatitis. DATA SYNTHESIS: There were a total of 23 recommendations developed to provide guidance to critical care clinicians caring for the patient with SAP. Topics addressed were as follows. 1) When should the patient admitted with acute pancreatitis be monitored in an ICU or stepdown unit? 2) Should patients with severe acute pancreatitis receive prophylactic antibiotics? 3) What is the optimal mode and timing of nutritional support for the patient with SAP? 4) What are the indications for surgery in acute pancreatitis, what is the optimal timing for intervention, and what are the roles for less invasive approaches including percutaneous drainage and laparoscopy? 5) Under what circumstances should patients with gallstone pancreatitis undergo interventions for clearance of the bile duct? 6) Is there a role for therapy targeting the inflammatory response in the patient with SAP? Some of the recommendations included a recommendation against the routine use of prophylactic systemic antibacterial or antifungal agents in patients with necrotizing pancreatitis. The jury also recommended against pancreatic debridement or drainage for sterile necrosis, limiting debridement or drainage to those with infected pancreatic necrosis and/or abscess confirmed by radiologic evidence of gas or results or fine needle aspirate. Furthermore, the jury recommended that whenever possible, operative necrosectomy and/or drainage be delayed at least 2-3 wk to allow for demarcation of the necrotic pancreas. CONCLUSIONS: This consensus statement provides 23 different recommendations concerning the management of patients with SAP. These recommendations differ in several ways from previous recommendations because of the release of recent data concerning the management of these patients and also because of the focus on the critically ill patient. There are a number of important questions that could not be answered using an evidence-based approach, and areas in need of further research were identified.     

鼻空肠管在重症急性胰腺炎早期肠内营养中的应用及护理

目的探讨重症急性胰腺炎（SAP）早期经鼻空肠管行肠内营养支持的方法和护理措施。方法回顾分析37例SAP患者早期使用鼻空肠管行肠内营养支持和护理的临床资料。结果37例患者中,5例发生腹胀,3例发生轻度腹泻,37例均未发生误吸和SAP复发,全部痊愈出院。结论鼻空肠管是SAP患者行肠内营养支持的重要手段,做好鼻空肠管的日常护理,预防和处理各种并发症,是SAP患者肠内营养护理的关键内容。     

One-piece and two-piece pouches: what's the difference?

Within any area of nursing, it is possible to encounter an ostomate (person with a stoma). Most ostomates are independent with their stoma needs but some do require advice on which appliance or pouch they should use. The three main types of stoma; the colostomy, ileostomy and urostomy, pass different outputs and so require different appliances, which are discussed. This article then explores the differences between one- and two-piece pouches and provides several short scenarios to explain why the use of one- or two-piece pouches might be more appropriate in specific situations.