英文个案--1例肝癌患者围手术期加速康复护理

Accelerated recovery perioperative care for patients with liver cancer

Abstract: This paper is a case about the perioperative care of a patient with accelerated recovery from hepatocellular carcinoma. The patient was given a comprehensive nursing assessment, meticulous condition observation, perfected a series of preoperative examinations, a joint medical and nursing care plan was formulated, disease related knowledge was well educated during hospitalization, psychological care of the patient and family members was strengthened, and the patient was observed for any complications after surgery to ensure smooth discharge. Keywords: hepatocellular carcinoma; laparoscopic surgery; accelerated rehabilitation; activity guidance Liver cancer is a malignant tumor occurring in the liver, related to alcohol consumption, viral hepatitis and consumption of moldy food. Liver cancer can be divided into two categories: primary liver cancer[1] and secondary liver cancer. Liver cancer is one of the most common malignant tumors in China. According to the data, there are 370,000 cases of liver cancer, ranking fourth in malignant tumors, and 326,000 cases of death, ranking second in malignant tumors. 1. Clinical information Patient, male, 52 years old, was admitted to the ward on 05-21 with "weakness and discomfort in the liver area for one week". After admission, the patient underwent laparoscopic resection of the left outer lobe of the liver under general anesthesia on 05-31, and the tumor was located in segment III of the liver, partly protruding outside the liver, with a size of about 2.0*1.5*1.5cm, clear boundary, with envelope, and 1-3cm tumor cutting edge. Intraoperative diagnosis: primary hepatocellular carcinoma in the left outer lobe of the liver. The patient was discharged cured after surgery, and the summary of her nursing experience is reported as follows: 2. Nursing measures 2.1. Preoperative care The patient, a middle-aged male, was worried about the progn osis of the disease and the possible complications of the surger y, and had a heavy psychological burden and slight anxiety. The charge nurse, together with the bedside doctor, explained the im portance and necessity of the surgery to the patient and introdu ced the cases of other patients who were cured in order to obtai n the understanding and cooperation of the patient and his famil y. The patient can actively participate in the process of nursin g care and increase confidence in treating the disease. Actively improve all preoperative examinations, introduce the purpose of surgery and anesthesia to patients and their families, inform t hem of postoperative position, diet, medication, activity guidanc e, care of drains, pain, psychological guidance and other precau tions, as well as possible complications and their causes and ob servation points. A good explanation for patients before each op eration can reduce patients' suspicion and anxiety and promote t he harmony between doctors and patients. 2.1.1 Dietary care If the surgery is scheduled later, the patient can be instructed to take 400ml of pulses the night before surgery and 400ml of pulses at 05:00 in the morning of the same day, and to enter appropriate rehydration fluid intravenously. By shortening the duration of fasting and drinking, the patient's postoperative recovery can be accelerated. 2.1.2 Medication administration and examination guidance Preoperatively, vitamin K1 was given to improve coagulation function and prevent intraoperative and postoperative bleeding; if albumin was low, protein supplementation was given to maintain basal body requirements; if bilirubin was high, hepatoprotective drugs were given; antibiotics were used, and instructions on medication were given; preoperative artificial liver examination was performed to determine whether surgical treatment could be performed; whether the patient's liver function was good according to the Child-Pugh liver function grading criteria. 2.1.3 Activity guidance Preoperatively, patients with liver cancer were given effective coughing instruction and balloon blowing to exercise their lung function, and were introduced to ankle pump exercise and hip lift exercise, which can prevent venous thrombosis in their lower limbs, and were performed in 10 groups/time three times a day. Postoperatively, patients and their family members were informed of the advantages of early activity, which can promote blood circulation and accelerate recovery, and promote intestinal function recovery to prevent intestinal adhesions. 2.2 Postoperative care 2.2.1 Observation of vital signs Monitor patients' vital signs, closely observe patients' vital signs and changes in consciousness, especially pay attention to blood pressure, heart rate and blood ammonia, and prevent hepatic encephalopathy. Make hourly rounds of the ward and report any abnormalities to the physician and record them in a timely manner. 2.2.2 Posture and activity guidance On the postoperative day, the patient was placed in a flat position and should not move excessively to avoid bleeding from the liver section; on the second day after surgery, the patient was placed in a semi-recumbent position, encouraged to cough to protect the incision, and could hold the abdomen with two hands to prevent wound rupture. Nurses and family members should assist in turning, once every 2 hours, but avoid premature activities. Patients with hepatocellular carcinoma should not be strenuously active for 24 hours after surgery, take semi-recumbent position, bed rest is the main focus, and functional exercise of ankle pump exercise and hip lift exercise can be carried out to prevent venous thrombosis of their lower limbs. The patient and his family should be informed of the advantages of early activity, which can promote blood