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yxfbbiedtj · Wysłany: Pon 3:56, 14 Mar 2011

Surgical Care craniopharyngiomas

Management: The patient conscious, stable blood pressure taken after head elevation l5 ~ 30. Slope lying in order to facilitate blood return and reduce intracranial pressure and maintain drainage flow, limiting head rotation, in the stand, the treatment, the action should be gentle, slow, small-angle, non-stretch drainage tube drainage tube to prevent slippage. Always check whether the drainage tube compression, distortion, or into a corner and found the problem in time. A day in replacement of drainage under aseptic bottle dressings and drainage holes, to observe the drainage of fluid volume, color and character. (5) to strengthen primary care: first, to give patients a quiet environment, restricted family visits, maintain good indoor ventilation, strict aseptic techniques,[link widoczny dla zalogowanych], strengthening the skin and oral care, according to the patient turn over the state of consciousness to develop plans to keep mattress clean to prevent bedsores occur. Encourage patients to more into the highly nutritious, easily digested food absorption, and promote disease recovery. 3.3 The prevention of postoperative complications and care (1) intracranial hemorrhage: is the most serious complications after surgery. 24h after the most easily lead to intracranial hemorrhage, so care is very important within 24h, such as disturbance of consciousness does not restore or increase, blood pressure, pulse, respiratory rate is a typical manifestation of Cushing syndrome, suggesting that the early rise of intracranial pressure high; if accompanied by unilateral or bilateral mydriasis, suggesting occurrence of hernia, and timely reports to physicians, for emergency treatment; ready for emergency medicine and the use of timely and accurate implementation of the prescription thing. (2) cerebral edema: Brain edema after 2 ~ 3d peak period, patients prone to all kinds of accidents, so to strengthen the inspection of this period, patients taking low head tall, head up 30. , Enter the dehydration,[link widoczny dla zalogowanych], diuretics, etc., and with the application of adrenal cortex hormones, control brain edema and reduce intracranial pressure. (3) prevention of infection: moving the patient and put in the drainage bottle to take, pay attention to drainage bottles were not higher than head back to prevent drainage of fluid, causing retrograde infection. (4) endocrine disorders: Routine records of hourly urine output, dynamic determination of serum sodium, urine sodium, urine specific gravity, especially in intensive care after 1 week should pay attention to the demeanor of patients, vital signs, central venous pressure and urine output changes. (5) body disorders: the hypothalamus after a serious injury,[link widoczny dla zalogowanych], causing high fever or body temperature did not rise after surgery. Application of drugs for central cooling effect of poor heat is required to take physical cooling, such as body sponge bath, head cold packs, etc.; the same time to prevent infection and prevent infectious fever. If the body temperature did not rise should keep warm. 4 Discussion of water and sodium balance disorder is a common complication after surgery of craniopharyngioma. Group of causes of cloth,[link widoczny dla zalogowanych], that once the following conditions should be taken into account sodium and water balance disorders: (1) patients with thirst, polydipsia and polyuria, urine volume, 200ml / h or more; (2), drowsiness, headache, fatigue, weakness, listlessness, convulsions and even coma; (3) laboratory examination appears hyponatremia, high urine sodium; (4) decreased blood pressure and central venous pressure, brain CT excluded intracranial hematoma. The patients found that sodium and water balance disorders occurred several hours after surgery to 7d. It should be emphasized that routine records after an hour urine volume, dynamic determination of serum sodium, urine sodium, urine specific gravity, especially in intensive care after 1 week should pay attention to the demeanor of patients, vital signs, central venous pressure and urine volume change. Sellar tumor after surgery, to correct water and sodium balance disorders related to the ability to obtain satisfactory treatment of the treatment effect. It was reported that if the serum sodium decreased to 24h 120mmol / L or less, more than 50% of adult mortality. The group were satisfied with the results due to treatment in a timely manner, the authors believe that, once discovered sellar tumor after sodium and water balance disorders, should be for different types of sodium and water balance disorders with appropriate treatment, a definite purpose. Diabetes insipidus or the main services should be given ISl fluid infusion, intramuscular injection of vasopressin or diabetes insipidus stop. Syndrome of inappropriate secretion of antidiuretic hormone should be limited to water, generally <1000ml/24h, to cause a negative water balance, make the appropriate sodium, particularly in the disturbance of consciousness should be a positive complement of sodium, the serum sodium rose to 130mmol / L; mannitol also appropriate dehydration. Cerebral salt wasting syndrome should be given additional blood volume, intravenous or oral sodium chloride, when injected with multiple urinary vasopressin to maintain sodium and water balance and maintain blood volume. [
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