老年急性心肌梗死并发非闭塞性缺血性肠病患者的护理

doi:10.3761/j.issn.2096-7446.2022.03.003

摘要/Abstract

摘要： 总结1例老年急性心肌梗死并发非闭塞性缺血性肠病患者的护理体会。护理要点：腹胀期采用小角度翻身代替传统的翻身方法,预防压力性损伤的同时保证了患者血流动力学的稳定,又缓解患者腹胀症状;腹泻期准确记录大便量,为患者容量管理提供依据;出血期使用鼻饲加灌肠的方法在胃肠道内局部应用止血药物,使用吸痰管代替肛管进行灌肠;在加速康复过程中,以全身运动带动局部功能。通过给予针对性的护理措施,患者预后良好,于3个月后出院。

关键词: 老年人, 急性心肌梗塞, 缺血性肠病, 急症护理

Abstract: The nursing experience of an elderly patient with acute myocardial infarction complicated with non-occlusive ischemic bowel disease was summarized. Small angle turning over was used instead of the traditional turning method during the period of abdominal distension,which can prevent the pressure injury,relieve the symptoms of abdominal distension and ensure the hemodynamic stability of the patient. Stool volume was recorded accurately during diarrhea period to provide a basis for patient volume management. During bleeding period,nasal feeding and enema was used to apply local hemostatic drugs in the gastrointestinal tract,and the suction tube was used instead of anal canal for enema. In the process of accelerated rehabilitation,the whole-body movement drove the local function. By giving targeted care measures,the patient had a good prognosis and was discharged after 3 months.

Key words: Aged, Acute Myocardial Infarction, Ischemic Enteropathy, Emergency Nursing

杨林, 刘宁, 单晓燕, 李爽, 王筝. 老年急性心肌梗死并发非闭塞性缺血性肠病患者的护理[J]. 中华急危重症护理杂志, 2022, 3(3): 208-211.

YANG Lin, LIU Ning, SHAN Xiaoyan, LI Shuang, WANG Zheng. Nursing care of an elderly patient with acute myocardial infarction and non-occlusive ischemic bowel disease[J]. Chinese Journal of Emergency and Critical Care Nursing, 2022, 3(3): 208-211.

参考文献

[1] Leanne A,Andrea M,Wendy C.ACCCN重症护理[M]. 李庆印,左选琴,孙红,译. 北京:人民卫生出版社,2019:260.
Leanne A,Andrea M,Wendy C.ACCCN's critical care nursing[M]. Li QY,Zuo XQ,Sun H,trans. Beijing:People's Medical Pub-lishing House,2019:260.
[2] 刘大为. 实用重症医学[M]. 2版. 北京:人民卫生出版社,2017:465.
Liu DW.Practice of critical care medicine[M]. Beijing:People's Medical Publishing House,2017:465.
[3] 缺血性肠病诊治中国专家建议写作组,中华医学会老年医学分会,《中华老年医学杂志》编辑委员会. 老年人缺血性肠病诊治中国专家建议(2011)[J]. 中华老年医学杂志,2011,30(1):1-6.
Writing Group of Chinese Experts Suggestions on the Diagnosis and Treatment of Ischemic Bowel Disease,the Geriatric Committee of the Chinese Medical Society,Editorial Committee of Chinese Journal of Geriatric Medicine. Suggestions of Chinese experts on the diagnosis and treatment of ischemic bowel disease in the elderly(2011)[J]. Chin J Geriatr,2011,30(1):1-6.
[4] 陈英,张龙方,肖军,等. 老年缺血性肠病患者的临床特点[J]. 中华老年多器官疾病杂志,2021,20(10):776-778.
Chen Y,Zhang LF,Xiao J,et al.Clinical characteristics of elderly patients with ischemic bowel disease[J]. Chin J Mult Organ Dis Elder,2021,20(10):776-778.
[5] 陈洁,徐静娟,景新华,等. 不同气垫床翻身间隔时间预防重型颅脑损伤患者压疮效果比较[J]. 护理学杂志,2016,31(14):48-51.
Chen J,Xu JJ,Jing XH,et al.Protection against pressure ulcer with different air mattresses and different repositioning schedules for patients with severe traumatic brain injury[J]. J NursSci,2016,31(14):48-51.
[6] 翟海龙. 对于压疮认识的几点辨析[J]. 中华护理杂志,2011,46(4):411-412.
Zhai HL.Some analysis of the understanding of pressure ulcer[J]. Chin J Nurs,2011,46(4):411-412.
[7] 朱桂霞,牛艳霞,汪莉,等. 肠道重建手术后早期干预对肠功能恢复的影响[J]. 护士进修杂志,2011,26(22):2048-2049.
Zhu GX,Niu YX,Wang L,et al.Study of the effect in intestinal function recovery after intestinal reconstruction surgery by early intervention[J]. J Nurs Train,2011,26(22):2048-2049.
[8] 许继芹,贾秋敏,杨洪杰,等. 一次性吸痰管代替肛管灌肠的应用[J]. 中华现代护理杂志,2009,15(18):1784.
Xu JQ,Jia QM,Yang HJ,et al.Application of disposable sputum suction tube instead of anal canal enema[J]. Chin J Mod Nurs,2009,15(18):1784.
[9] 林春敏,李欣欣,蒋英姿. 影响溃疡性结肠炎患者灌肠效果的相关参数进展[J]. 中华护理教育,2013,10(3):134-135.
Lin CM,Li XX,Jiang YZ.Progress of related parameters affecting the enema effect in patients with ulcerative colitis[J]. Chin J Nurs Educ,2013,10(3):134-135.
[10] 赵诗雨,喻姣花,汪欢,等. 基于循证构建肠内营养护理质量敏感指标体系[J]. 中华护理杂志,2019,54(3):344-349.
Zhao SY,Yu JH,Wang H,et al.Construction of nursing sensitive quality indicators system of enteral nutrition on the basis of evidence-based approach[J]. Chin J Nurs,2019,54(3):344-349.
[11] 毕晓林,隋忠国. 常见疾病临床营养治疗[M]. 北京:人民卫生出版社,2020:67-70.
Bi XL,Sui ZG.Clinical nutrition treatment of common diseases[M]. Beijing:People's Medical Publishing House,2020:67-70.
[12] 范建高,沈峰. 提高缺血性肠病的临床认识[J]. 胃肠病学和肝病学杂志,2011,20(6):491-494.
Fan JG,Shen F.To strengthen the clinical recognition of ischemic bowel diseases[J]. Chin J Gastroenterol Hepatol,2011, 20(6):491-494.

[1]	羊木英, 范文琪, 胡汉. 维持性血液透析患者透析中脑出血的早期识别与急救护理[J]. 中华急危重症护理杂志, 2026, 7(6): 704-706.
[2]	丁幼芽, 王飒, 闫丹萍, 周帅帅, 武作家, 王钰炜. 甲醇中毒致顽固性低钾血症患者的护理[J]. 中华急危重症护理杂志, 2026, 7(4): 447-449.
[3]	陈兆斐, 王薇, 翟振国. 静脉血栓栓塞症一体化防治策略的实施与质量控制[J]. 中华急危重症护理杂志, 2026, 7(3): 274-278.
[4]	于雅诺, 宋雨航, 高凌婕, 李晓波. 临床决策支持系统在急诊分诊管理中应用的范围综述[J]. 中华急危重症护理杂志, 2026, 7(3): 306-311.
[5]	高彬炳, 王飒, 周帅帅, 张玉坤, 王钰炜. 肺栓塞致心搏骤停患者并发肝血管瘤破裂的急救护理[J]. 中华急危重症护理杂志, 2026, 7(3): 315-318.
[6]	李京南, 胡紫月, 孙超, 武全莹, 胡慧秀, 郭红, 樊娟, 黄竞缘. 老年重症肺炎患者肠内营养管饲体验的旅程地图研究[J]. 中华急危重症护理杂志, 2026, 7(2): 133-141.
[7]	夏致远, 何佳, 王黎醒, 石义容, 杨敏, 王荀, 黄燕梅, 李志艳, 张利. 钩吻群体中毒患者跨机构协作及急救护理[J]. 中华急危重症护理杂志, 2026, 7(1): 77-79.
[8]	杨晓华, 孙婷, 王萍, 姚梅琪. 1例高龄患者因水摄入过量致重度低钠血症的急救与警示[J]. 中华急危重症护理杂志, 2025, 6(8): 995-997.
[9]	司童, 周勇, 王爽. 从医生视角看基于案例的过度水化所致神经系统症状的临床特征与防范[J]. 中华急危重症护理杂志, 2025, 6(8): 998-1002.
[10]	谢婉婷, 朱海利, 朱冬, 傅涵, 陈必慧. ICU护士维护老年患者尊严影响因素的质性研究[J]. 中华急危重症护理杂志, 2025, 6(7): 786-791.
[11]	周惠云, 罗飞翔, 慎斐. 急性呼吸窘迫综合征早产儿体外膜肺氧合下行俯卧位通气的护理[J]. 中华急危重症护理杂志, 2025, 6(7): 826-829.
[12]	周春霞, 田萌, 吴丽贞, 李倩. 老年人跌倒防控研究热点及发展趋势的可视化分析[J]. 中华急危重症护理杂志, 2025, 6(7): 879-884.
[13]	陈鹏. 呼气末二氧化碳监测在心肺复苏患者中应用的研究进展[J]. 中华急危重症护理杂志, 2025, 6(7): 891-896.
[14]	周军, 陈阮, 诸纪华. 难治性支原体肺炎患儿并发右心室血栓与肺栓塞的护理[J]. 中华急危重症护理杂志, 2025, 6(6): 700-703.
[15]	王飒, 闫丹萍, 刘亚洁, 周帅帅, 王美玲, 林高兴, 许书荣, 周光居, 王钰炜. 急诊心搏骤停患者低灌流期间神经系统监测与护理管理实践[J]. 中华急危重症护理杂志, 2025, 6(6): 713-718.