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肝功能和营养状况的改善

时间:2021-08-21 来源:未知 编辑:梦想论文 阅读:
Malignant obstructive jaundice mainly by bile duct cancer, liver cancer, of the head of pancreas and ampullary carcinoma and metastatic carcinoma invasion of bile duct caused by, mainly with jaundice as the first symptom, leading to a series of systemic pathophysiological changes, mainly including hyperbilirubinemia, endotoxemia, bleeding tendency, decreased immune function etc., radical fewer opportunities and risks. Percutaneous transhepatic biliary drainage operation (Percutane-ous about cholangial drainage, PTCD) is commonly used in the treatment of malignant biliary obstruction and to improve liver and kidney function, alleviate digestive disorders, improve the quality of life of patients and further to gain time and create operation conditions play an important role. However, the loss of a large number of bile severely affects the absorption and body fluid balance of fat. This study aims to investigate oral bile on liver function of patients, nutritional status improved and adverse reactions were observed, in order to understand oral bile of patients' condition and nutritional status has no improvement, in order to provide reference for clinical nursing practice.
 
 
 
1 data and methods.
 
 
 
1.1 general information.
 
 
 
March -2013 in July 2010 using a convenient sampling method will be a doctor in the Tianjin Cancer Hospital, the patients with malignant obstructive jaundice diagnosed with malignant obstructive jaundice patients receiving PTCD. In this study, 85 cases were included in the study, according to the number of patients were randomly divided into observation group and control group, the observation group of 43 cases, 42 cases of the control group. Observation group of patients aged 42 years old ~74 years old, average 59.4 years old; male 26 cases, female 17 cases; bile duct cancer 25 cases, gallbladder cancer 9 cases, liver cancer 2 cases, pancreatic cancer 7 cases. Control group of patients aged 39 years old ~73 years old, average 58.7 years old; male 25 cases, female 17 cases; bile duct cancer 15 cases, gallbladder cancer 2 cases, liver cancer 5 cases, pancreatic cancer 20 cases. Two groups of patients in age, sex, diagnosis and family economic status, medical treatment and other aspects of the comparison, the difference was not statistically significant (P>0.05), with comparability.
 
 
 
1.2 method.
 
 
 
1.2.1 treatment method.
 
 
 
This research group responsible for the study group members to conduct a unified training and demonstration. Training content: to explain the importance of bile of patients with oral, how to distinguish normal bile color, character; bile filtration method; bile heating method; the amount of each oral bile, bile of patients with oral during dietary guidance. Research leader of the research team on a regular basis of assessment and supervision. Member of the team, each responsible for the jurisdiction of the bile of patients with oral follow-up work, of inpatients daily supervision, discharged patients weekly twice or three times with telephone follow-up, was observed at any time, recorded responses after bile of patients with oral, listening to the patient complained of, feelings, timely feedback and evaluation, this adverse reaction in a timely manner and the doctor in charge of the communication and symptomatic treatment. The observation group underwent PTCD Drainage second days after operation, bile is golden yellow, no bloody, ask the patient with meals oral bile. Patients in the control group were treated with PTCD after the operation, the nurses were removed from the bile, and the patients were not treated with oral bile; the daily dietary intake was the same as the observation group.
 
 
 
Take before bile drainage bag exports disinfection; if the drainage of the bile precipitation or floc, with gauze filter; bile appropriate temperature, not more than 40 DEG C [1]; each 12 hours after oral and drain the fresh bile; each oral bile 150 mL~200 ml, daily total 300 mL~600mL; confirmed or suspected infection of biliary tract pause oral bile; does not limit the patient self eating, diet according to the patient's appetite and digestive tract adjust; oral bile continuously time to surgery before, or removal of PTCD tube; oral bile appeared serious adverse reactions or disease who could not endure, suspends profess to convinced.
 
 
 
1.2.2 inclusion criteria.
 
 
 
(1) by clinical diagnosis for primary malignant tumor (bile duct cancer, liver cancer, of the head of pancreas and ampullary cancer) caused by obstructive jaundice; II PTCD was performed before the reduction yellow. Third, it can finish detecting biochemical indicators; (4) agreed to participate in this study, in line with the completion of this study; the age under 18 years of age.
 
 
1.2.3 exclusion criteria.
 
 
 
Follow-up process occurred in other parts of the tumor metastasis; in a follow-up II death or give up to continue the treatment; (3) heart and lung kidney major somatic diseases; (4) have significant mental disease patient, have urgent chronic gastritis, gastric ulcer effect of patients with gastrointestinal disease patients.
 
 
 
1.2.4 evaluation index.
 
 
 
The observation group and control group patients before PTCD, 1 months after PTCD were observed and evaluated the following indicators:
 
 
 
1. Liver and kidney function: alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphorus acid enzyme (ALP), creatinine (crea), urea (UA); gastrointestinal function: appetite, abdominal distension, diarrhea, abdominal pain, nutritional status: body mass index (BMI), upper arm deltoid skinfold thickness, serum albumin (ALB), total protein (TP), prealbumin (palb); (4) electrolyte: potassium (K +) and sodium (Na +) and chloride (Cl -), calcium (Ca2 +); fifthly, jaundice: direct bilirubin (DBIL), total bilirubin (TBIL).
 
 
 
1.2.5 statistical methods used SPSS17.0 statistical analysis, measurement data using mean + standard difference (x + s), two sample mean t test; count data using chi square test and to P < 0.05, the difference was statistically significant.
 
 
 
2 results.
 
 
 
3 discussion.
 
 
 
This study found that malignant obstructive jaundice patients with liver and kidney function, nutritional status was significantly impaired, second days after the line PTCD skin itching significantly alleviated, seventh days of liver and kidney function, blood serum clear bile. 1 month after PTCD were observed in group of patients with liver function and bilirubin index scores than the control group, but scores were not statistically significant (P > 0.05); observation group patients of triceps skinfold thickness, serum albumin, total protein score was significantly higher than that of the control group, no significant differences (P < 0.05), and body mass index (BMI), prealbumin score difference have statistical significance (P > 0.05). There were significant differences in gastrointestinal function between the two groups (P>0.05). This shows that oral bile in patients with malignant obstructive jaundice patients with liver and renal function recovery is not significant, but the recovery of the patient's nutritional status, there is a good role in promoting. Improvement of the nutritional status of patients can not only improve the tolerability of patients for surgery, but also reduce the amount of intravenous infusion, reduce the body burden and economic burden of patients and to reduce medical costs, enhance patient confidence in treatment. On the other hand, the present study showed that bile, which had some irritation, but oral bile did not increase the burden of gastrointestinal tract.
 
 
 
Malignant tumor leads to the biliary obstruction and normal bile excretion and enterohepatic circulation is destroyed, the bile reflux into the blood forming jaundice [2]. Mainly for the poor nutritional status, loss of appetite, fat absorption and metabolic disorders, abnormal liver and kidney function, electrolyte disturbances. This kind of patient appear clinical symptom, radical small opportunities and risks.
 
 
 
PTCD by biliary drainage can relieve biliary obstruction and biliary tract pressure, effectively reduce the degree of jaundice, reduce bilirubin level, improving the function of liver and kidney; buy time for operation, create conditions, and improve the operation safety and patient of operation of tolerance.
 
 
However, a large number of bile loss causes severe environmental and nutritional status of the patient. The lack of intestinal bile salts, quantity of endotoxin binding and cleavage can be absorbed into blood formation, endotoxemia, cause kidney and other organs damage; lack of bile salts can also affect the digestion and absorption of fat, fat and even cause diarrhea, also the intestinal fat soluble vitamins (A, D, E, K) absorption reduce, affect the absorption of calcium in bone metabolism, bone mineral density decreased [4,5,7]. in intestinal immune function, with bile into the intestine of sIgA is the main source of intestinal secretory antibody, when the loss of bile in vitro, lack of intestinal bile salt antibody decreased rapidly, can cause intestinal immune dysfunction, infection, diarrhea and even enterogenous sepsis may also [6]., with the loss of bile, loss of appetite, diarrhea, patients with intestinal peristalsis reduce symptoms, resulting in water and electricity [8,9]. oral bile can be used to make the outflow of bile by the body re use, can reduce body fluid loss, restore bile salt intestines liver circulation, play its original physiological function.
 
 
 
This study showed that the two groups of patients after PTCD were generally good, did not appear serious complications. The nutritional status of the two groups was different, and the observation group was better than the control group. However, bile, as one of the important digestive juice, can stimulate the digestive tract such as nausea, abdominal pain and so on. Therefore, close observation and careful health guidance is essential. Patients in the observation group were encouraged to take a small amount of time to start (30mL~50mL), oral administration, and gradually increase the amount of bile in order to help them gradually adapt to the patients. We choose sugar as a flavoring agent, and appropriate heating, can ease the smell of bile. These have significantly improved the patient's oral bile compliance, reduce adverse reactions. In the observation group, there was no serious adverse reaction caused by oral bile, only individual patients with gastrointestinal irritation symptoms, after symptomatic treatment, and the incidence rate was no significant difference compared with the control group.
 
 
 
4 summary.
 
 
 
It can be known that the patients with malignant obstructive jaundice after PTCD biliary drainage to improve their nutritional status has a certain effect, but no adverse reactions. Oral bile is a safe, effective, simple and economical method.
 
 
 
Reference
 
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[4] Jin Rounan, Li Lele, Gong Honggui. Analysis of changes in serum bile acid concentration in patients with hepatocellular carcinoma after resection of liver cancer [J]. Journal of pharmaceutical practice, 2013,31 (1): 45-48.
 
[5] Sun Jinmei. Study on the effectiveness of the time effect of bile transfusion on the nursing of the people's Liberation Army of the people's Liberation Army, [J]. (4): 17-18.
 
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[7]Yadav SK1, a Mittal, sapkota K, et al.Ability of biochemical pa-rameters to distinguish between between bile duct cancer and gall bladderstones-a case control study in a tertiary care hospital of PokharaValley[J].Asian PAC J cancer new, 2013 14 (3): 10-14. (2): 817-819.
 
[8] Ren Xiangfang. Nursing progress of late preterm infants [J]. nursing research, 2012,26 (7C): 1924-1926.
 
[9] Yang Qian, Wang Yanwen, Chen Liping. The effect of early nursing intervention on [J]. nursing of premature infants with jaundice. 2012,26 (4B): 1005-1006.
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