① Improve the general situation, correct the imbalance of water and electrolyte, and prepare 200 ~ 1 200 ml blood; Conventional skin preparation.
② Rinse the bladder with metronidazole 200 ml before operation and keep it.
③ Prepare 1 20 ~ 22 F balloon catheter, 2 ureteral catheters, 1 anal canal, 1 negative pressure balloon mitomycin 6 ~ 10 mg for intraoperative use.
④ After the diagnosis of bladder cancer, patients have a heavy psychological burden, and they are worried that the original urination and living habits will change after cystectomy, which will affect their own image or be regarded as a disability, resulting in inferiority and despair. Therefore, the advantages and disadvantages of several methods of replacing bladder with intestine are explained to patients, so that patients can have more adequate choices and eliminate despair. All patients in this group chose positive (in situ) micturition neobladder surgery, that is, controlling micturition from the original urethra, which can protect renal function, improve quality of life and restore self-image.
1.2 digestive tract preparation
Adequate intestinal preparation can increase the success rate and safety of surgery. Oral neomycin 1 g 3 days before operation, 4 times a day, to inhibit intestinal bacteria and prevent postoperative infection; The absorption of vitamin K in intestinal tract is impaired when intramuscular injection of vitamin K and supplementary use of bacteriostatic agent; Give a liquid diet 2 days before operation to help clean the intestines. Total intestinal preparation began at 65438±0d days before operation; 0.2 g metronidazole was taken orally at 13, 14, 15, 18, 2 1 respectively. 15, oral administration of 10% mannitol 500 ml and intestinal tablet 0.4 g can promote the peristalsis of large intestine, eliminate intestinal feces and clean the intestine.
1.3 postoperative care
(1) Catheter care: All catheters should be kept unobstructed, and the drainage volume, color and nature should be closely observed and recorded accurately.
① Nursing care of bilateral ureteral catheter. After ileocolic neobladder surgery, indwelling bilateral ureteral catheters and draining urine from abdominal incision through neocystostomy are beneficial to the repair of neobladder and wound healing. Therefore, it is necessary to keep the catheter unblocked and avoid the upper urinary tract obstruction caused by edema and stenosis of anastomosis caused by premature shedding of catheter due to traction. In order to prevent retrograde infection, washing is generally not done. If there is blood clot blockage, it must be aspirated under aseptic operation or washed with metronidazole and normal saline. Pelvic lavage fluid should not exceed 5 ~ 10 ml at a time, and the force should not be too large to prevent backflow. If there is no abnormality, extubation should be done at 12 ~ 14 d after operation. Before extubation, retrograde angiography is needed to confirm that the ureter is unobstructed and there is no anastomotic leakage before extubation. No anastomotic leakage occurred in this group.
② Nursing care of balloon catheter. The purpose of indwelling balloon catheter is to heal the incision of new bladder. Insert the catheter from urethra into the new bladder to extract urine and intestinal fluid, and adjust the washing speed and fluid in time according to the color and characteristics of drainage fluid. Early after operation, the bladder was continuously flushed with normal saline, and 250 ml of 5% sodium bicarbonate was used every 4 ~ 5 hours to reduce mucus secretion and prevent mucus from blocking the catheter. Rinse bladder with 1∶5 000 nitrofurazone solution, 2 ~ 3 times a day. External urethral orifice care, twice a day, to reduce secretions or retrograde infection. Irrigation lotion < < 100 ml every time the catheter is blocked, so as to avoid the influence of excessive amount on the wound healing and anastomosis of the new bladder.
③ Nursing care of negative pressure ball drainage. Always keep the retropubic negative pressure drainage tube in a negative pressure state to achieve effective drainage, prevent retropubic infection and promote wound healing. The drainage tube can be removed when the drainage fluid is less than 5 ml in 24 hours. Shameless postosseous infection occurred in this group.
(2) Strengthening basic nursing: Close observation of vital signs and monitoring of blood oxygen saturation in elderly patients in the early postoperative period. Long-term bed rest after operation should prevent pulmonary infection, encourage expectoration, pat back and aerosol inhalation treatment, and no pulmonary infection occurred in this group. Strengthen the nursing of colon neobladder anal canal, and scrub around anus with 0. 1% bromogeramine solution twice a day; Metronidazole 50 ml was used to flush anal canal, 65438 0 times/d; Abdominal distension requires gastrointestinal decompression to avoid anastomotic leakage.
2 Health education
2. 1 instruct patients to practice the controllability of new bladder.
Once the catheter is removed, the bladder capacity is relatively small or the sphincter is not fully recovered, resulting in frequent urination and poor controllability. At this time, the patient is instructed to use false catheterization, and at the same time, the patient is instructed to contract abdominal muscles and hold his breath to urinate (protect groin area with both hands to avoid oblique hernia). Encourage patients to do the exercise of lifting anus to improve the function of external sphincter so as to restore the controllability of new bladder as soon as possible.
2.2 The importance of timing urination and urination posture
The reason for the poor night controllability of postoperative patients may be the decrease of urethral sphincter tension after falling asleep. At this time, if the new bladder has no inhibitory contraction, urine will overflow [3]. In order to avoid new bladder volume decompensation, reflux and acidosis, it is necessary to urinate regularly (1 time /2 ~ 3 h) and instruct patients to urinate twice at night. For a few patients with excessive residual urine, self-catheterization should be guided. The posture of urination can be squatting to urinate, so that urine can be exhausted and complications can be minimized.