I. Clinical data
There are 68 patients in this group, including 39 males and 29 females. The minimum is 2 1 day and the maximum is 8 1 year, with an average of 46. 82 years. Among them, 59 cases of low fistula and 9 cases of high fistula were treated by surgery, and all were cured except 1 case of postoperative recurrence. The average hospitalization time was about 65438±05d, and there were no nursing complications.
Second, the nursing essentials
1, preoperative care
(1), understand the condition
Understand the medical history in detail and ask about the illness, such as hepatitis, tuberculosis and other infectious diseases; Whether there are medical diseases such as diabetes and hypertension; Whether there is a history of drug allergy, etc. Cooperate with doctors to do a good job of examination, make clear the diagnosis and surgical indications, and evaluate the surgical tolerance of patients, especially elderly patients. It is best to evaluate lung function and cardiac function first. For critically ill patients, preoperative discussion should be carried out, so as to plan ahead and strictly formulate treatment plans.
② Eliminate patients' anxiety in time.
Explain the necessity of surgical treatment to patients. Some patients are afraid of surgery and have doubts and nervousness about the surgical effect and postoperative complications [2]. Nurses timely capture patients' psychological changes, communicate patiently and meticulously, and make patients feel cordial and warm. Briefly introduce the related knowledge of anal fistula and the necessity and importance of surgical treatment to patients, and briefly explain the basic methods and procedures of surgery, so that patients can have a basic understanding and preparation for surgery, thus eliminating anxiety and enhancing treatment confidence.
③ Preoperative diet preparation
Tell patients not to eat spicy food, eat more fresh fruits and vegetables, drink more water, and keep their stools unobstructed. The patient took a digestible diet one day before operation, fasted 8 hours before operation and banned alcohol for 4 hours.
④ In the operation area, the perianal skin should be washed with soapy water to prepare the skin; Warm water enema twice, and then use hemorrhoid washing powder (a preparation in our hospital) to sit in the basin and clean the anus and perineum.
2 postoperative care
① Observe the patient's condition and closely observe the changes of vital signs, bleeding, pain and urination of the wound. After the thread-drawing operation of high anal fistula, it is necessary to check whether the bound rubber band (thread) is loose, whether the thread-drawing wound is adhered, whether the wound is red and swollen, and whether there is secretion.
② Rest after operation and arrange supine position, but choose whether to take off the pillow according to the type of anesthesia, so as to reduce postoperative complications, reduce pain and bleeding caused by anal stimulation and avoid vertical collapse.
(3) Pain nursing Because the anus and perianal nerves are rich and sensitive to pain, especially in complicated anal fistula surgery, the wound is large, the surgical incision is too tight, and the wound dressing is too tight, so the postoperative pain of anal fistula is more common. Therefore, we should pay attention to comfortable nursing after operation to relieve pain. Communicate with patients more to enhance their confidence in overcoming pain and distract their attention; Tell patients not to use painkillers as much as possible, so as not to inhibit micturition reflex, cause urinary retention and affect incision healing; If the pain is severe and unbearable, you can take orally or inject painkillers according to your doctor's advice.
④ Urination nursing Dysuria after anal fistula is often complicated, which is mainly caused by anal pain, bladder sphincter spasm and urethral compression during hemostasis. Therefore, we should first inform patients to drink more water after the anesthetic subsides. When the patient has dysuria, the following measures can be taken: (1) listening to the sound of running water to induce urination; (2) Properly loosen the over-tight dressing to reduce oppression; (3) Hot compress in bladder area, pressing Zusanli and other acupoints; (4) Acupuncture at bilateral Sanyinjiao, Yinlingquan and Zusanli, or moxibustion at Qihai, Guanyuan and Zhongwan; (5) If the above treatment fails, neostigmine can be injected. 5 ~ 1.0 mg intramuscular injection or oral terazosin hydrochloride tablets 2mg Zusanli point according to the doctor's advice. If you still can't urinate, you need to be guided by the bed all the time.
⑤ Patients with local diet anesthesia or lumbar acupoints can eat after operation, and patients with combined spinal anesthesia can eat 6 hours after operation, but it is best to drink a little water before eating without vomiting and other discomfort. Generally eat porridge, noodles and other semi-liquid diets on the day of surgery; After 1 d, the patients were given a normal diet and told to eat more fresh vegetables and fruits, such as bananas, apples, celery and spinach. It is necessary to ensure that the food is nutritious and contains a certain amount of cellulose to promote wound recovery and defecation. Some patients are afraid of defecation and reduce their dietary intake. It is necessary to find and communicate corrections in time.
⑥ Postoperative bleeding A few patients have postoperative bleeding, and those with a small amount can be monitored without special treatment. If there is much postoperative bleeding and the wound oozes blood, it can be bandaged with oil gauze or hemostatic gauze, or it can be applied to the wound with gauze soaked with Agkistrodon halys venom hemagglutinase. Patients with pulsatile bleeding can be sutured to stop bleeding. What we should pay attention to is that sometimes blood will flow to the intestinal cavity. If the patient has diarrhea, accompanied by dizziness, fatigue, listlessness, pallor, thirst, palpitation, sweating, weak pulse and other symptoms, it is necessary to consider whether there is the possibility of massive bleeding. Should be checked immediately, if bleeding, should be handled in time.
⑦ Prevention of constipation In order to prevent constipation, patients should be instructed to get out of bed and exercise moderately, eat according to the requirements of postoperative diet, and explain to patients the importance of defecation on time after operation, preferably defecation 1 time every day. However, patients are worried about the wound pain during defecation after operation, unwilling to get out of bed or eat less food to reduce defecation, or subjectively restrict defecation, which leads to postoperative constipation. At this time, they must take orally or enema with gentle laxatives such as Mamen soft capsule and polyethylene glycol 400 powder according to the doctor's advice to avoid incision pain and wound bleeding caused by dry stool and forced defecation.
⑧ Perianal nursing Due to the particularity of the local anatomical position after anal fistula surgery, the wound surface is easily contaminated by feces and infected by intestinal bacteria, so attention should be paid to the prevention and treatment of postoperative wound infection. Routine hemorrhoid washing and sitz bath were used to clean the wound after each defecation, and the dressing was changed after sitz bath. Early secretions can be used to wash the wound with hydrogen peroxide or normal saline for a long time, and coptis gauze is placed in the wound to keep the drainage of the abscess cavity unobstructed on the one hand and prevent false healing on the other. Strictly carry out aseptic operation when changing dressing. Pay attention to the color of the wound, whether there are secretions and the color, quality, quantity and smell of secretions, whether the wound is clean and granulation grows, and whether there are signs of infection. If the pus on the wound increases, the stitches should be removed immediately to drain the wound.
9 Discharge health guidance
Patients with anal fistula stay in hospital for a long time, and dressing change is the main way in the later period, and often the wound is discharged without healing. Therefore, we should do the following discharge instructions: (1) Change the dressing every day after discharge 1 time until the wound heals. (2) instruct patients to avoid spicy food and eat more fruits and vegetables. (3) Keep the anus clean and dry, get into the habit of defecating regularly, and don't use too much force or squat for a long time when defecating. (4) The postoperative outpatient follow-up was 65438 0 months. (5) Adjust mood, ensure a happy mood and strengthen nutrition. (6) Daily anal function exercise: The patient contracts the anus for 3 s, then relaxes for 5 s, inhales deeply when contracting the anus, and exhales deeply when relaxing the anus, three times a day, every time 100 times, so as to promote the adjustment of anal function.
refer to
[1] Cao Jixun. Hemorrhoids in China [M]. Chengdu: Sichuan Science and Technology Press, 1985. 193.
Zhao Xiangbi. Nursing points and experience of anal fistula [J]. Colorectal and Anal Surgery, 2009,15 (2):125-126.