What are the nursing measures after subtotal gastrectomy? How to observe and deal with common postoperative complications

The patient's psychological endurance is affected by the surgical blow. Mental stress leads to the disorder of gastric movement rhythm, which in turn leads to vagus nerve inhibition [4], while gastroparesis leads to the expansion of remnant stomach and the swelling of gastric mucosal cells, which can aggravate gastric dysfunction and further aggravate gastric emptying dysfunction. Therefore, it is necessary to do a good job in psychological nursing, observe patients' psychological state, actively communicate with patients, relieve their nervousness, eliminate their fears and explain the characteristics of the disease, so as to establish patients' confidence in overcoming the disease and recover as soon as possible.

3.2 Maintain effective gastrointestinal decompression

Once diagnosed, patients with gastroparesis should continue gastrointestinal decompression, keep the gastric tube in the stomach, observe the amount, nature and color of drainage fluid, inform the patients of the importance of keeping the gastric tube, do basic nursing to prevent the gastric tube from twisting, blocking or slipping, and wash the gastric tube with warm physiological saline regularly to keep it unobstructed. Regularly detect biochemical indicators to observe whether there is anhydrous electrolyte and acid-base balance disorder.

3.3 Observe the therapeutic effect of traditional Chinese medicine.

According to the theory of traditional Chinese medicine, the trauma of anesthesia and abdominal surgery will lead to qi stagnation and blood stasis in abdominal organs and dysfunction of transportation and transformation of intestines and fu organs. Compound Dachengqi Decoction has the effects of dredging the bowels, purging diarrhea, dredging the fu organs, resolving stagnation, promoting qi circulation and resolving hard mass. Modern domestic research data [5, 6] confirmed that Dachengqi decoction can enhance the contractile function of gastrointestinal smooth muscle, increase the pressure in stomach, increase the contraction amount per unit time, promote the peristalsis and propulsion of gastrointestinal smooth muscle, improve the blood circulation of abdominal cavity and intestinal wall, reduce delayed edema, promote the absorption of necrotic tissue and have antibacterial and anti-inflammatory effects. Poria cocos and Atractylodes macrocephala are beneficial to water absorption, promoting edema absorption and eliminating gastric mucosal edema, reducing tissue edema, improving gastric motility and promoting gastric emptying; In addition, the combined application of the above traditional Chinese medicines may also have a synergistic effect. In this group, compound Dachengqi decoction was used: Pu Chuan 15 g, Fructus Aurantii Immaturus 9 g, Fried Raphani 30 g, Peach kernel 9 g, Radix Paeoniae Rubra 15 g, Poria 12 g, Atractylodes macrocephala 12 g, Pericarpium Citri Tangerinae 10 g. Add 500 ml of water and decoct into a 150 ml ~200 ml gastric tube, inject it in three times, clamp the tube for 2 h~3 h, and then open the negative pressure suction, with 2 doses per day. Before taking the medicine, we should do a good job in publicity and education, get the cooperation of patients, and take warm soup, which should not be too fast and generally have no adverse reactions. After 5 d~ 10 d, the symptoms of this group were obviously improved, vomiting stopped, gastric drainage gradually decreased, and the patients felt uncomfortable in the upper abdomen and hungry.

3.4 Nursing of Total Parenteral Nutrition Support Therapy

Mechanism of treating gastroparesis: TPN can inhibit the secretion of digestive juice and make the gastrointestinal tract have a better rest [7]. The nutrients provided by the three-liter bag meet the physiological needs, and the uniform and slow input makes the body fully absorb and utilize the nutrients. TPN provides proper vitamins, trace elements and electrolytes, which is beneficial to maintaining internal environment stability and protecting cell function, and can also promote the functional recovery of gastric wall smooth muscle cells. Using TPN as early as possible to provide nutritional support from the beginning of gastroparesis symptoms has obvious effect on restoring gastric wall function and blocking vicious circle. Because of long-term fasting, drainage loss, severe dehydration and electrolyte acid-base balance disorder, TPN is a very effective supportive therapy for patients with gastroparesis after subtotal gastrectomy. TPN is a complicated treatment method, in which amino acids, sugar, fat, electrolytes, trace elements and vitamins are infused through peripheral or central venous cannula. It can be divided into four aspects: nursing of venous catheter, preparation and infusion of nutrient solution, monitoring of patients and prevention of complications.

3.4. 1 Nursing care of central venous catheter

Clarify the importance of catheter: medical staff should comprehensively understand and evaluate the nutritional status of patients, determine the nutritional needs and weigh the advantages and disadvantages of applying TPN to patients, and cooperate in the process of nutritional support: after intravenous catheterization, nutrient solution can be continuously infused for 24 hours, but there are certain risks, so it is necessary to explain clearly to patients, pay attention to the fixation of catheter during activities, prevent twisting and pulling, and do not adjust the dripping speed at will. In case of accidents such as disconnection of infusion pipeline, don't panic, don't shout loudly, and inform the nurse to deal with it in time. There are various types of catheters placed in vena cava, which should be checked in advance: sterilization. If there are sterilized commercial catheters, check whether the package is damaged, and prepare 2 ~3 catheters for replacement. According to different intubation methods, all materials are prepared in advance and disinfected for later use. The most common complications of catheterization are pneumothorax, hemothorax, vascular or nerve injury. Therefore, during catheterization and within 24 hours after catheterization, the patient's vital signs and local conditions should be closely observed to understand the patient's chief complaints, such as chest tightness and dyspnea. And pull it out in time and handle it in time. Complications related to catheter are: sepsis, mostly because bacteria follow the sinus between venous catheter and tissue during catheterization, and contaminated nutrient solution enters the blood through infusion pipeline to produce infection; The gas embolism can cause phlebitis due to the failure to change the infusion in time, the loosening of the infusion pipe joint and the rupture of the venous catheter; Venous embolism can be caused by catheter hypertonic fluid and infection, and the lesion can involve subclavian vein or superior vena cava. Metabolic complications mainly include disorder of glucose metabolism, abnormal liver function and electrolyte disorder. The dressing at the inlet of the catheter should be changed in time once a day or three times a week according to the possibility of pollution at the inlet of the catheter. If the temperature is high and you sweat a lot, when TPN treatment is completed or catheter infection is suspected due to catheter blockage, you should pull out the catheter in time and press the puncture site 1 min~2 min.

3. 4. 2 TPNR preparation should set up a special room. Disinfect before liquid preparation every day, clean and ventilate after operation, and thoroughly clean once a week. Read and fill in the liquid preparation form carefully before preparing the liquid, and the articles should be fully prepared to avoid going in and out of the room many times. After preparation, you should wash your hands before preparing the liquid, do not touch articles any more, strictly carry out aseptic operation, and add the liquid in groups at one time to avoid repeated puncture and increase pollution, and pay attention to the incompatibility. Shake the liquid well, check for impurities, store it in the refrigerator at 40℃, and take it out when using. The preparation solution is required to be input within 24 hours. The maximum length shall not exceed 48 h, and continuous input or cyclic input method shall be adopted according to the plan. Complete the infusion quantity evenly on time and according to the quantity. The infusion volume per hour should not be greater than or less than 10% of the planned infusion volume, in case it is too fast or too slow.

3.4.3 TPN addition to catheter local care, patients with TPN should also do the following work: observe the changes of body temperature, pulse and respiration, accurately record input and output, and measure urine sugar on time. If urine sugar exceeds (++), it should be treated. Take blood biochemical samples, analyze arterial blood gas, evaluate nutritional status, and take 24 h urine to determine nitrogen balance, creatinine and electrolyte.

3.5 Health education

3.5. 1 Do a good job in diet education.

Patients were required to fast, observe the color, quantity and nature of vomit, and observe abdominal signs and intestinal peristalsis. The patient's condition was stable, nausea and vomiting disappeared, and abdominal distension was relieved. When the amount of gastric juice is less than 200 ml within 24 hours, the gastric tube can be removed. Warm boiled water 1h/ time to 2h/ time, and a small amount of liquid diet, 40ml to 50ml/time the next day, gradually increased to 100ml/ time to 150ml/ time, less.

3.5.2 Activities

Getting out of bed early after operation is conducive to promoting the recovery of gastrointestinal activities, doing basic nursing, paying attention to the drainage tube in place to avoid falling off, and paying attention to preventing bedsores and lung infections.

Emission guide

Pay attention to rest, develop a regular life, eat less and eat more, choose nutritious food, and quit irritating food.

4 conclusion

Through the observation and nursing of this group of cases, it is recognized that TPN combined with Dachengqi decoction is effective in treating gastroparesis, and whether the patients with gastroparesis can recover smoothly is closely related to nursing work. Close observation of the disease, correct implementation of TPN treatment and nursing, application of compound Dachengqi decoction, dietary guidance, rehabilitation and health education after discharge are important links in the rehabilitation of this disease.