老年患者冠状动脉搭桥术后胃肠功能紊乱的辨证施护

1998年9月-2006年12月冠状动脉搭桥手术后出现胃肠功能紊乱的老年患者156例，均表现为腹胀、纳呆、恶心呕吐、便秘等症状，辨证属痰浊闭塞证73例，气滞血淤证37例，阴血虚证16例，阳气虚证30例。各证型患者均给予电针双足三里20min，2次／d；进食淮山芡实瘦肉粥，或炖苹果水1次／d；黑芝麻15g加蜂蜜调服1次／d；按摩腹部大横穴1次／d；睡前予开天门按摩及安寐散（朱砂3～5g）贴涌泉穴30min，1次／晚。在此基础上，分别予以中医辨证施护：痰浊闭塞证者指导饮食以清热化痰为宜，避免进食产气之品，密切观察体温变化，对发热者予对症处理；气滞血淤证者预防情志刺激，指导选择活血化淤之饮食；阴血虚证者头晕时指导卧床休息，心悸气短时予氧气吸入，指导患者养成良好的睡眠习惯，在睡前行开天门按摩或温水浴足，遵医嘱行耳穴埋豆等处理，指导饮食选择补气养阴之品；阳气虚证者注意防寒保暖，饮食以低脂、高热量、补气助阳之品为宜。经护理，改善了腹胀、纳呆、恶心呕吐、便秘等胃肠功能紊乱症状得以改善。

Dialectical Execution of Nursing Care for the Elderly Patients with Gastrointestinal Dysfunction after Bypass Operation of Coronary Artery

156 elderly patients with bypass operation of coronary artery from Sep. 1998 to Dec. 2006, developed with gastrointestinal dysfunction of abdominal distension, anorexia, nausea and vomiting and constipation. Dialectical diagnosis showed 73 cases of sputum obstruction syndrome, 37 cases of stagnation of vital energy and blood gas and 16 cases of Yin-blood deficient syndrome and 30 cas- es of Yang-qi deficient syndrome. All patients were treated by puncturing the acupoint of Zusanli with electronic needle for 20 min twice a day and served with lean meat porridge with Chinese yam and gordon euryale or boiled apple soup once a day, 15 g sesami nigrum added with honey once a day. Besides, Daheng at the belly was massaged once a day and Kaitianmen and Anmei Powder were pasted on the acupoint of Yongquan for 30 min once a night. Additionally, TCM dialectical care was performed according to clinical manifestations of each patient to alleviate the symptoms of gastrointestinal dysfunction like abdominal distension, anorexia, nausea and vomiting and constipation.