膀胱肿瘤术后膀胱灌注的护理

论文编号:HL177  论文字数:13933.页数:23

论文题目：膀胱肿瘤术后膀胱灌注的护理研究

摘  要
  
 目的：探讨经尿道膀胱肿瘤电切术（TURBT）后的膀胱灌注护理干预方法, 使用比较吡柔比星(THP)、羟基喜树碱（HCPT）、丝裂霉素C(MMC)3种药物膀胱灌注治疗浅表性膀胱癌的疗效和安全性。减少术后膀胱内灌注的副作用，对患者进行灌注预防并发症的发生，提高患者生活质量的对策。
 方法：进行膀胱内药物灌注患者采取一系列的针对性护理措施，并跟踪调查记录：130例经尿道膀胱肿瘤电切术后的浅表性膀胱癌患者, 分为THP（48例）、HCPT（41例）和MMC（41例）3组，采用SPSS 12.0统计学软件包进行统计学处理，各组复发率、不良反应率的比较采用χ2检验，检验水准α=0.05。所有患者术后1～2周开始膀胱内灌注治疗，灌注前先排空尿液,常规消毒后,置导尿管入膀胱,注入灌注液。
 结果 ：130例3组复发率的比较THP、HCPT、MMC组随访24个月后的复发率分别为16.67%，17.07%，36.59%，MMC组明显高于THP、HCPT组（P<0.05）。MMC组术后3个月复发的6例患者,再次手术后改用HCPT灌注治疗,随访2年未出现复发坚持完成全程化疗，患者积极配合治疗，保持比较乐观的态度。随访2a～5a，其中8例复发，有效率达93%。23例患者随访24个月后复发率为22.3%，未见药物性皮炎和化学性尿道炎发生，无膀胱挛缩现象，血常规及肝肾功能未见明显异常。
 结论：应用适当的针对性的护理措施, 术后膀胱灌注配合必要的护理，能降低膀胱肿瘤术后膀胱内灌注的副作用,可有效延缓肿瘤复发及预防病变进展。做好心理护理及膀胱灌注的健康护理教育可防止并发症的发生，使患者顺利完成全程化疗，从而有效预防膀胱肿瘤术后复发和提高术后患者的生活质量。
 关 键 词：膀胱肿瘤；经尿道电切术；膀胱灌注；生活质量；护理
 论文类型：应用研究

Title：Bladder tumor postoperative nursing studies of bladder perfusion

ABSTRACT

 Objectives: To explore the urinary bladder tumor was TURBT (after) the bladder perfusion nursing intervention methods, using comparative were THP (the), hydroxyl (HCPT), the tropics.ophthalmology C (MMC) 3 drug treatment of superficial bladder perfusion efficacy and safety of the bladder. Postoperative bladder perfusion effects on patients with perfusion prevention of complications of, improve their quality of life.
 Results: 13 cases relapse compared 3 groups, HCPT THP MMC, 24 months follow-up group respectively, and the recurrence rate based 17.07%, 36.59% MMC, obviously higher than HCPT THP group, and group (P < 0.05). After 3 months of MMC groups of six patients relapse again after surgery, and to HCPT reperfusion, were not stick to whole recurrent, patients treated with chemotherapy and maintain positive optimistic attitude. Follow-up 2a ~ 5a, including 8 cases of recurrent, efficient reach 93%. 23 patients relapse after 24 months follow-up for CAAC statistics, did not see the drug dermatitis and chemical urethritis, no bladders contracture phenomenon, blood and liver function abnormal without obvious.
 Conclusion: Applying the appropriate postoperative nursing measure of bladder, with the necessary nursing, infusion of bladder tumor can reduce postoperative bladder perfusion side-effects, can effectively delaying tumor recurrence and prevent disease progression. Do psychological care and education of health care can prevent complications, make whole chemotherapy patients, and successfully completed effectively prevent bladder tumor recurrence and raise the quality of life of the patients.
 Key Word: Bladder tumor. Transurethral cutting operation, Bladder perfusion, The quality of life, nursing
  Type of thesis: Applied research

目  录

1  绪论 1
 1.1背景及意义 1
 1.2  研究目的及目标 2
 1.3  关键词及意义 2
 1.4  文献回顾 3
2  研究设计 8
 2.1  研究对象 8
 2.2  一般资料 8
 2.3  研究方法 8
 2.4  研究步骤 8
3  研究结果 9
 3.1  不同三组灌注的护理对比情况 9
 3.2  不良反应发生情况 9
 3.3  影响灌注的护理生活质量回归分析 10
4  讨论          11
 4.1  采用定期膀胱灌注的护理预防疗效 11
 4.2  灌注后提前排药的原因分析及对策 12
 4.3  通过心理干预提高患者的心理健康水平 13
5  推论及建议 15
 5.1   推论 15
 5.2   建议 15
致    谢 17
参考文献 18
声    明 20