文档介绍：1例剧烈呕吐所致食管胸膜瘘患者的护理
摘要:目的探讨自发性食管破裂的治疗和护理。方法通过1例SER并发食管胸膜瘘患者,探讨自发性食管破裂的护理方法,通过患者的临床资料和有效的治疗总结护理的经验。结果患者痊愈出院。结论自发性食管破裂起病急、发病快,病死率高,病程较长,通过有效的急救治疗和良好的护理措施,可减少新的并发症出现。
关键词:自发性食管破裂;胃肠减压;胸腔闭式引流管;股静脉置管;护理
Abstract:Objective Treatment and nursing of spontaneous rupture of esophagus. Method Through a case of plicated with esophageal fistula, explore the nursing methods of spontaneous esophageal rupture, through the patient's clinical data and effective treatment summary of nursing experience. Result Patients were discharged from hospital. Conclusion Spontaneous esophageal rupture onset, rapid onset, high mortality, longer course of disease, through effective first aid treatment and good care measures, can reduce plications.
Key words:Spontaneous rupture of esophagus; Gastrointestinal pression; Thoracic closed drainage tube; Femoral vein catheter; Nursing
自发性食管破裂(SER)又称布尔哈夫综合征(BS),是指健康人突然发生非外伤性的食管壁全层破裂[1]。剧烈呕吐是最常见的病因,也称之为呕吐性食管破裂[2]。是较为少见的急性胸部疾患,国外文献报道病死率高达31%~40%[3],常易误诊或延误治疗,导致急性胸腔感染,感染性休克,脓胸,严重者可危及生命,死亡率较高。2015年6月我科收治1例SER并发食管胸膜瘘患者,护理体会报告如下:
1 临床资料
患者,女,49岁,突发左侧胸痛11 h。患者缘于2015年6月5日凌晨一点左右突发剧烈呕吐后即感胸痛,胸闷,伴左上腹部痛疼,呕吐物为胃内容物,咖啡色,具体量不详,无畏寒、发热,就诊当地医院行胸腹CT示:左侧液气胸伴纵隔少许积气,留置胸腔闭式引流管一根,具体住院治疗不详,患者自感症状未见明显好转,就诊于我院急诊科,行胸腹部CT:左侧液气胸伴纵隔积气,行B超引导下胸腔穿刺提示咖啡色液体,综合考虑食管胸膜瘘,请我科会诊,拟“食管胸膜瘘”收住入科。入院T: ℃,P:124 次/min,血压:128/89 mmHg,(2015-06-05)血常规示:WBC:×109 g/L,中性粒细胞:×109 g/L 、%、