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After resection of esophageal and gastric obstruction in cardiac care


To clinical manifestations of abdominal distension, vomiting, acid back, chest tightness, shortness of breath, flustered. Our hospital in April 1986 implemented in April 1999 一 esophageal cancer, 1962 cases of cardiac surgery, postoperative complication of gastric obstruction in 12 cases, incidence was 062%, and 12 were down effect of secondary surgery in 1 patient discharged , the rest were cured ll down. We conclude from the stomach obstruction j-patient care experience, are as follows. 1 The clinical data of 12 cases, 7 males and 5 females, aged 45 ~ 7O years old, average 59.5 years old. 8 cases of esophageal cancer, gastric cardia 4 down, are the stomach on behalf of the esophagus, the left thoracotomy in 11 cases, 6 cases of aortic arch anastomosis, arch anastomosis 5 down, kissed the top right thoracotomy chest units in 1. Gastrointestinal decompression after 5-7 days, the daily drainage of the stomach tuck 700 ~ 1200m1. An average of 780ml. 12 cases of gastric obstruction in patients with gastrointestinal decompression tube can I re-flow into the gastric juice 1000-1800ml. Oral barium x-ray examination, have a lot of barium retention. Well visible peristaltic wave active. 2 patients had preoperative symptoms of anastomotic leakage, intraoperative have been confirmed. The implementation of pyloroplasty group were 5 cases, 2 cases of expansion of the diaphragm hole, gastrojejunostomy, jejunum air drying side to side anastomosis in 2 cases, 2 cases of adhesiolysis wood, and 1 patients underwent duodenal ulcer repair and anterior there pyloroplasty gastric obstruction. Gastrojejunostomy performed again, side to side anastomosis of the jejunum jejunum cure. The patients from the obstructive symptoms occur twice a mean operative time was 1O days. 2 observation of complications observed incidence of 2.1 points when the point of this group were asked Shuttleworth to stop the phenomenon of decompression obstruction occurs the day 2 down,[link widoczny dla zalogowanych], 7 patients within 2 weeks, 3 weeks, 2 down, 1 patient after 9 weeks, and more occurred after removal of gastric tube or start eating, and some can not eat there abdominal distention, vomiting, acid back, chest tightness, shortness of breath, palpitation and other symptoms. Ipsilateral breath sounds low, x ray film extreme expansion of the stomach, barium meal barium can not be displayed or linear through the pylorus, 24h after the review still see the barium retention. The symptoms of decompression in the tube reinserted after remission occurs after occlusion of the gastric tube. Should pay attention to and able to observe the expansion of the stomach, pyloric spasm phase identification. Resection of esophageal and gastric cardia, the stretch by the destruction of internal organs, vagus nerve is cut, there may be a temporary reduction of gastric tone, gastric peristalsis slowly, disappear, or gastric dilatation, and more in the 35 days recovery. . j. General reserves during this period even if the gastric juice increase the amount of decompression often not taken seriously. Inability to expand in the removal of the stomach after gastric tube obstruction symptoms may appear similar to the stomach, but the observation see: the first wave disappeared or weak gastric motility, endoscopy, gastroscopy can reach the pylorus, and gastric obstruction in a more active peristaltic waves. Endoscopy can not be site of obstruction. The case of pyloric spasm, 12 1% procaine to relieve obstructive symptoms, oral barium 24h after the review is only part of the retention. Obstruction may be due to stomach cancer, postoperative adhesions cardiac compression; pyloric stomach is pulled over on the raised flat; diaphragm hole too tight, distorted pylorus, duodenal ulcer caused. Surgical repair of must, but no definite diagnosis in the conservative treatment should be taken to avoid the blind surgical exploration, increase patient unnecessary suffering and economic burden. 2.2 Observation of vomit summer the amount of gastric juice drainage, color, nature of the stomach obstruction, vomiting vomiting for the overflow, particularly when turning right lateral position more likely. Vomit for a large number of gastric juice, bile and food residues, yellow-green or white in color, accompanied by bleeding mucosal erosion, gastric juice was brown, the volume more. Stomach obstruction should be taken seriously enough. Gastric retention, expansion of the stomach, gastric peristaltic waves and vomiting caused by increased intragastric pressure and steep fuel increases gastric stump or anastomosis can tear resulting from fistula. The group produced by obstruction of the stomach and gastric fistula esophageal fistula and 1 down, so be sure to maintain the decompression tube patency. Once the diagnosis of gastric obstruction, surgical treatment as soon as possible. 3,1 * 3 nursing care management of patients in this group have varying degrees of fear, anxiety, worry about the prognosis, particularly worried about the second surgery will be successful. To this end, we proceed from the care of patients sympathy, to establish a good relationship between nurses and patients, using plain language to explain to patients the cause of gastric obstruction, the need for secondary surgery to explain the case of a successful operation, so that to eliminate concerns of patients and establish confidence, and enhance awareness with Taiwan, the best state of mind. Fasting during the summer 32 continued decompression, nutrition, gastric obstruction due to stomach pressure increases, easy to produce gastric esophageal fistula and gastric fistula kiss sets 12, it should be fast in time, continuous gastrointestinal decompression, High intravenous nutrition is particularly important, because the esophagus and cardia restricted diet before surgery, plus plane after injury, vomiting shame, for a long time can not eat, consuming the body can easily cause a negative nitrogen balance and water medium disorder. To ensure the safety of the second operation, I