膀胱腫瘤術后膀胱灌注的護理

論文編號:HL177  論文字數:13933.頁數:23

論文題目：膀胱腫瘤術后膀胱灌注的護理研究

摘  要
  
 目的：探討經尿道膀胱腫瘤電切術（TURBT）后的膀胱灌注護理干預方法, 使用比較吡柔比星(THP)、羥基喜樹堿（HCPT）、絲裂霉素C(MMC)3種藥物膀胱灌注治療淺表性膀胱癌的療效和安全性。減少術后膀胱內灌注的副作用，對患者進行灌注預防并發癥的發生，提高患者生活質量的對策。
 方法：進行膀胱內藥物灌注患者采取一系列的針對性護理措施，并跟蹤調查記錄：130例經尿道膀胱腫瘤電切術后的淺表性膀胱癌患者, 分為THP（48例）、HCPT（41例）和MMC（41例）3組，采用SPSS 12.0統計學軟件包進行統計學處理，各組復發率、不良反應率的比較采用χ2檢驗，檢驗水準α=0.05。所有患者術后1～2周開始膀胱內灌注治療，灌注前先排空尿液,常規消毒后,置導尿管入膀胱,注入灌注液。
 結果 ：130例3組復發率的比較THP、HCPT、MMC組隨訪24個月后的復發率分別為16.67%，17.07%，36.59%，MMC組明顯高于THP、HCPT組（P<0.05）。MMC組術后3個月復發的6例患者,再次手術后改用HCPT灌注治療,隨訪2年未出現復發堅持完成全程化療，患者積極配合治療，保持比較樂觀的態度。隨訪2a～5a，其中8例復發，有效率達93%。23例患者隨訪24個月后復發率為22.3%，未見藥物性皮炎和化學性尿道炎發生，無膀胱攣縮現象，血常規及肝腎功能未見明顯異常。
 結論：應用適當的針對性的護理措施, 術后膀胱灌注配合必要的護理，能降低膀胱腫瘤術后膀胱內灌注的副作用,可有效延緩腫瘤復發及預防病變進展。做好心理護理及膀胱灌注的健康護理教育可防止并發癥的發生，使患者順利完成全程化療，從而有效預防膀胱腫瘤術后復發和提高術后患者的生活質量。
 關 鍵 詞：膀胱腫瘤；經尿道電切術；膀胱灌注；生活質量；護理
 論文類型：應用研究

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  錄

1  緒論 1
 1.1背景及意義 1
 1.2  研究目的及目標 2
 1.3  關鍵詞及意義 2
 1.4  文獻回顧 3
2  研究設計 8
 2.1  研究對象 8
 2.2  一般資料 8
 2.3  研究方法 8
 2.4  研究步驟 8
3  研究結果 9
 3.1  不同三組灌注的護理對比情況 9
 3.2  不良反應發生情況 9
 3.3  影響灌注的護理生活質量回歸分析 10
4  討論          11
 4.1  采用定期膀胱灌注的護理預防療效 11
 4.2  灌注后提前排藥的原因分析及對策 12
 4.3  通過心理干預提高患者的心理健康水平 13
5  推論及建議 15
 5.1   推論 15
 5.2   建議 15
致    謝 17
參考文獻 18
聲    明 20