Nursing experience of anesthesia analgesia pump after thoracotomy

Nursing experience of anesthesia analgesia pump after thoracotomy Zhao Ling, Nie Xulan, Feng Yong (Affiliated Hospital of Taishan Medical College, Tai'an 271000, Shandong, China) Clinical application of anesthesia analgesia pump, effectively solved the patient's postoperative pain problem, 2000 From January to December, we placed a one-time continuous micro-anaesthetic analgesic pump for 60 patients with thoracotomy. All of them received satisfactory analgesia and no obvious adverse reactions. The application of the pump is now Nursing experience is described below.

1 Clinical data 1.1 General information ~ 68 years old; 44 cases of esophageal cancer, 13 cases of lung cancer, 3 cases of other lung diseases. There were 51 cases of left chest and 9 cases of right chest.

1.2 Methods Anesthesia Using thoracic epidural tracheal intubation combined with general anesthesia, after surgery preserved epidural catheter, and the injection of morphine 2mg into the load, diluted with saline 10ml. Then routinely received a one-time continuous micro-anaesthetic analgesic pump, plus morphine 20mg, haloperidol 10mg, 0.75% bupivacaine 10ml, plus normal saline to 60ml, with 0. 8m / h speed, uniform, slow injection, Continued 72h. 1. 3 Therapeutic effect The evaluation of postoperative analgesia in patients with open chest was assessed by visual analogue scale (VAS). After evaluation, 2 nursing 21 preoperative nursing 21.1 psychological nursing. Patients are afraid of postoperative pain, manifested as tension, anxiety, etc., nurses should let patients and their families understand the role and principles of postoperative anesthesia analgesia pump, the pump has good analgesic effect, and no obvious side effects, come Eliminate the patient's bad psychological reaction and make it actively cooperate with the treatment.

21.2 targeted guidance. Due to the differences in culture, age, gender, mental state, and social factors of each person, the degree of postoperative pain varies from person to person. They were inspired by women, emotionally fragile, and neurological postoperative analgesia to establish their belief in postoperative analgesia.

2.1.3 Pay attention to the influence of medical staff. Medical staff's every move, in a single sentence, can have a great impact on patients. They are often based on the criteria of caregivers. We do not pay attention to the words can cause a hint, affect postoperative analgesia Therefore, always pay attention to cultivate their confidence in dealing with patients.

2.1.4 cough exercise. In order to prevent individual patients from excessive drug sensitivity to motor nerve involvement, affecting cough and sputum discharge, the patient should be strengthened before the cough exercise. The specific method is: let the patient take a deep breath and hold his breath, chest and abdomen suddenly force, so that the chest pressure increases, the glottis open, gas or sputum quickly spit out, and repeat the practice, mastery.

2.2 postoperative care 2.2.1 catheter care. The puncture site was fixed with a band-aid, and the remaining catheters were fixed with adhesive tape and led out from under the neck to prevent prolapse, especially when helping the patient to stand up or sit up. Keep the epidural catheter naturally smooth and do not bend or deform. Check and change the dressing once a day, observe whether there is swelling, secretions and prolapse, if it is found that the local infection should be extubated in time, and regular dressing. At the same time observe the injection rate of the pump to keep the breath at 0.8ml/h. 2.22. After morphine is injected into the thoracic epidural space, it penetrates and diffuses into the cerebrospinal fluid, and acts on the fourth ventricle to produce respiratory depression. Therefore, after a stable condition at 12h after surgery, the patient should alternate between half sitting and lying. Reduce the impact on breathing. In addition, bupivacaine also affects breathing when the anterior spinal cord of the spinal cord is blocked too deeply or the plane of the block is too high to reach the neck. Therefore, it is required to observe the patient's respiration every 30 minutes within 24 hours after operation, including changes in respiratory rate, frequency, and rhythm, and to monitor whether or not Sp2 has decreased, according to the condition after 24 hours prolonged to 1/h. 2.23 Observing the pulse, blood pressure. Anesthetic analgesics can inhibit the release of norepinephrine caused by sympathetic nerve activity, reduce the plasma concentration, increase the body's pain threshold, and also reduce the pulse rate and blood pressure. Therefore, pulse and blood pressure were observed every 30 minutes during analgesia, and the pulse rate was maintained at 60 beats/min or more. The systolic blood pressure was not lower than type sensitivity. Emotional Yi Na, to do more to explain the appeasement work, and use 90mmHg. If the patient can only measure the pulse in the sleep state, to pulse strong, the frequency can not be slow. After 24 hours, the condition was stable and the observation time could be appropriately extended.

22.4 Prepare for first aid. After the routine preparation of emergency medicine and articles, such as respiratory stimulants, boosters, endotracheal intubation, etc., nurses should be proficient in endotracheal intubation and other cardiopulmonary resuscitation techniques.

22.5 Cough expectoration. It is very important to prevent bronchial complications such as atelectasis after coughing. Thoracic epidural anesthesia for analgesia, if affected by anteromotor nerves, can cause coughing and fatigue, while morphine also has a central antitussive effect. Therefore, it is required to help and encourage the patient to cough and sputum every 1~2h after the operation, and to give aerosol inhalation, every 4~6h1 times, adding a-chymotrypsin, etc., to make the sputum thinning and easy to spit out, and at the same time prepare to absorb Ware.

22.6 Care of catheters. Because of the side effects of morphine that cause urinary retention, after 24 hours after the anesthetic analgesic pump was removed from the catheter, the patient felt that he could urinate spontaneously to prevent urinary retention. Once urinary retention occurs, heat and massage can be given to promote urination.

22.7 Care for nausea and vomiting. Opioid drugs can cause vomiting in the medulla oblongata, and vomiting can lead to an increase in the anastomotic tension, which can easily induce anastomotic leakage. Therefore, if the patient is nauseous and vomiting, he or she should take a deep breath and open mouth. At the same time, the injection of metoclopramide 10mg can have a good therapeutic effect. There were 5 cases of nausea in this group of patients. The analysis was due to the stimulation of the pharynx caused by the stomach tube. None of the above cases had Zhang Hui (Taiyuan Aviation Instrument Co., Ltd. Hospital, Taiyuan 030006, Shanxi, China) vomiting.

3 to discuss the pain caused by open chest surgery, a direct impact on the patient's breathing and cough, so that reduced tidal volume, blood oxygen, respiratory secretions can not be smoothly discharged, the occurrence of lung insufflation, etc., is not conducive to patient rehabilitation. Therefore, it is necessary to choose an effective method of analgesia.

From the perspective of this group of patients, a continuous micro-anaesthetic analgesic pump after thoracotomy has good analgesic effect, but it must control the dose per unit of time to achieve ideal analgesia, No adverse reactions occurred. It is required that preoperative education be done well. The infusion rate of the drug in the pump and changes in the patient’s vital signs should be closely observed after the operation. Problems should be solved in a timely manner and, if necessary, the use of anesthesia analgesia pumps should be stopped.

In order to reduce side effects such as respiratory depression, blood pressure drop, nausea and vomiting, urinary retention, etc., compound administration should be promoted. We used a combination of opioids and bupivacaine to have a synergistic analgesic effect, and small doses can achieve good therapeutic effects, while also avoiding the occurrence of toxic side effects.

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