Continuous peritoneal washing for the prevention o

ncycgdxhl · Wysłany: Nie 22:34, 13 Mar 2011

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Continuous peritoneal washing for the prevention of intestinal adhesion after abdominal surgery Effect

Varying degrees of organ adhesion intestinal adhesion intestinal obstruction in which a higher incidence of postoperative rehabilitation of patients with greater impact and quality of life. I Division with 38 ℃ 0.9 sodium chloride solution plus gentamicin and 5 FU-line of a continuous peritoneal lavage,[link widoczny dla zalogowanych], the results showed that the incidence of intestinal obstruction in the observation group were significantly lower than the control group (P <0.05), suggests that this method can effectively prevent or reduce the incidence of adhesive intestinal obstruction and improve the quality of life of patients. 5-FU phosphorylation in the human body into deoxyuridine, thymine nucleotide synthase inhibition caused by a lack of intracellular acid glycosides chest, the cell DNA synthesis blocked, cells can not proliferate. To be successful with a permanent adhesive fiber cells and endothelial cells generate new blood vessels. 5-FU inhibition of fibroblast proliferation and angiogenesis when the synthesis of DNA, inhibiting the formation of these two cells, thus blocking the formation of adhesions. In addition, the 5 FU in the body into a one-fluorouracil nucleoside 5 (5 a FUR), but also into RNA, inhibition of proliferation of cell protein synthesis, secretion of angiogenic factors to the dysfunction, not to the adhesion of endothelial cells band growth, thus effectively preventing abdominal stick JournalofNursingScienceOct. 2006Vo1.21No. 20 (SurgeryEdition) with the place. 5 FU, while a one anticancer drugs, due to dilution in the abdominal cavity of memory in the concentration of 0.05, the concentration of small, rapidly from the peritoneal lavage after the discharge, less damaging to normal tissues and the liver quickly inactivated, in the form of carbon dioxide and urea excretion from the lungs and kidneys, will not occur when chemotherapy stomatitis, hair loss, bloody diarrhea, skin pigmentation and other adverse reactions. Stimulated peritoneal edema occurred after, a large amount of serous effusion, exudate a large number of neutrophils, macrophages, and a lot of necrotic tissue, bacteria, and fibrin coagulation, so that in turn become turbid exudate pus, in particular, is more common E. coli-based pus. The peritoneal cavity for the hypoxic environment, easy to grow Gram-negative bacteria. Gentamicin for the amino-glycosides, amino sugars from the non-sugar molecules and a combination of some of aglycone. The antibacterial mechanism of action is to hinder bacterial protein synthesis I3]. Major role in the process of protein synthesis in bacteria, so that abnormal protein synthesis, protein synthesis has hindered the release of the bacterial cell membrane permeability caused by leakage of a number of important physiological substance, causing bacterial death. The sulfate solution stability, strong antibacterial activity, broad spectrum antibiotic, for most Gram-negative bacteria such as E. coli, Klebsiella, Enterobacter, Proteus and Shigella was stronger, and its production of bacteria resistance slowly. In the abdominal cavity can control the Gram-negative bacteria, to limit the spread of intra-abdominal infections, protect cells, to reduce the permanent adhesion. By 38. C0.9 sodium chloride solution can not only wash foreign body within the abdominal cavity (such as talcum powder) or necrotic tissue, and because it has sufficient heat, can make the blood vessels to dilate, increasing intestinal blood circulation, reducing its oxygen, thus avoiding cell Hypoxia causes a positive angiogenic factors secretion, which has anti-adhesion effect. Combination of the three wash the abdominal cavity, with a set of mutually complementary and add effects, can prevent the occurrence of postoperative intestinal adhesion. Peritoneal lavage process should be noted: ① appropriate temperature around 38 ℃, the water temperature is too low can lead to intestinal cramps, body temperature is higher than the stimulation of the gut decreased. ② speed not too fast, each irrigation time can not be less than 30min. In case of abdominal distension and slowed down the speed lavage, abdominal pain, stop the infusion case, paternity abdominal pain to continue after reperfusion. ③ Each lavage volume to 500 ~ 1000ml appropriate. ④ accurately record the amount of irrigation and drainage, close observation of the color of drainage fluid, abnormal timely reporting physician. ⑤ lavage procedure, the patient should be constantly changing position, so that uniform distribution of drug in the abdominal cavity. Maintaining unobstructed drainage, regular checks of Jinie drainage tube, when the drainage tube is blocked, the use of drainage tube from the proximal abdominal wall outward continuous extrusion method. ⑥ drainage tube to prevent folding, twisting, compression and blockage by necrotic tissue occurs, especially in the changing position when the drainage tube should be taken to avoid prolapse.