Hepatitis liver cirrhosis erupts _'s prevention and health care of nursing of the bacterial peritonitis simultaneously

Hepatitis liver cirrhosis erupts _'s prevention and health care of nursing of the bacterial peritonitis simultaneously
Wang XueQin Cui HuaWei Xu LinLin 2005-12-13 13:49:38 Chinese medical research magazine Number 2 of Vol. 3 of February of 2003

The intersection of hepatitis and liver cirrhosis erupt the intersection of spontaneity and bacterial the intersection of peritonitis and common complication one of at being clinical simultaneously, the mechanism is that it has illness coming on: ( 1) Intestinal factor: Move in the hepatitis liver cirrhosis patient's intestine at the fungus group, the bacterium breeds and increases, the germ enters the chance of the abdominal cavity to increase through the enteric wall. Patient of hepatitis liver cirrhosis the intersection of door and pulse make intestinal extravasated blood edema under high pressure, the bacterium can move to the blood or abdominal cavity. Pathogen of this disease is blue with the leather negative bacillus is much. Especially when the intestine are infected, the bacterium is apt to absorb and invade the abdominal cavity from the intestine through the lymphocytic system or intestines wall. ( 2) The organism defends the function low [1] : The single nuclear macrophage system in the liver, especially kuffer cell function is low, make the intestinal fungus that actually could be removed enter systemic circulation directly, and then cause bacterial peritonitis. Patient, liver cirrhosis of hepatitis, leucocyte hasten, take function to be low in the body, cell immunological function led to lie between damage, the organism resists infection ability further drops. In addition, contain abundant albumen, candy and electrolyte in the ascites, it is ideal culture medium of bacterium, make the bacterium apt to grow and breed in the ascites, and cause the ascites to infect. ( 3) The opening of the collateral circulation: Hepatitis liver cirrhosis patient most door pulse blood through at liver, shunt to last systemic circulation outer door body, and bacteremia is an important link that the bacterial peritonitis of the spontaneity takes place. If this disease can't get correct treatment and nursing in time, will threaten the patient's life seriously [2] . While treating, it is to treat hepatitis liver cirrhosis and erupt the important links of spontaneity with essential bacterial peritonitis simultaneously that correct nursing cooperates.
A clinical materials
It is that hepatitis liver cirrhosis erupt the bacterial peritonitis patient of spontaneity simultaneously that this group observes 53 cases, among them, 42 men, 11 women, 30-68 years old, 9 die in 53. Among them 4 die from upper digestive tract and bleed, 3 die from liver function depletedly, 2 die of liver kidney syndrome.
2 is attended to
2.1 Attend to hepatitis liver cirrhosis and should absolutely stay in bed to erupt the bacterial peritonitis patient of spontaneity simultaneously conventionally, in order to lighten the liver burden, increase the blood circulation of the liver, reduce liver extravasated blood. Staying in bed can increase kidney sodium excreting and diuresis function, stand up on time, encourage and help patients to often change the body posture, keep the bed clean and neat, often scrub the skin with the warm water, keep the skin clean, prevent bedsore. Carry out and operate aseptically strictly in the course of infusing, keeping a close eye on has infusion to react to observe patients, once notify the doctor to deal with in time immediately.
2.2 Observe life physical sign and condition and change hepatitis liver cirrhosis and erupt the bacterial peritonitis of spontaneity simultaneously to bring out the hepatic coma tightly, should pay attention to observing body temperature, pulse, breathing, change of the blood pressure, find abnormality to report to a doctor in time.
2.3 Diet attend to according to the intersection of ascites and situation, can adopt, have salt or less salt diet. The intaking amount of the daily salt of on diet is less than 0.5g. The intaking amount of the daily salt of diet of less salt is less than 2g. In addition, liver cirrhosis ascites person also should limit the intersection of liquid and intaking amount, general daily the intersection of liquid and quantity can 500ml calculate in addition according to last day the intersection of urine and quantity, rely mainly on taking orally, forbid employing and producing gastric acid too much food and hard food, do not eat the greasy, spicy, difficult digesting, unclean food. There is an example that have relations with diet while dying from persons who bleed of digestive tract in 4, so the diet is attended to particularly important.
2.4 Employ the nursing of diuretic the patients of this group use heavier dose of spironolactone daily 160- 480mg, divide for 2- 3 times and take orally, a few patients add with the urine skin note of the speed or intravenous and give medicine. While employing diuretic to treat the liver cirrhosis ascites, need to attend to observing: ( 1) Take oral diuretic as the core, such as spironolactone, can also further strengthen the dosage; Essential the intersection of speed per hour and the intersection of urine and the intersection of skin and note or add albumin to be quiet to drip, reduce vein inject, cause leather the intersection of cell and dehydration at the renal tubule, thus reduce liver kidney syndrome. ( 2) Whether there are disorderly electrolytes. Draw blood on time and measure K +, Na +, Cl - 2 times every week, the condition is changed, check at any time, if there is low potassium that should mend potassium immediately. ( 3) Record 24h coming in and going out amount accurately, examine abdominal girth every day. ( 4) Pay attention to the renal function, check urine routine and blood urea nitrogen, skin anhydride regularly.
2.5 Erupt the bacterial peritonitis patient of spontaneity simultaneously in infecting nursing hepatitis liver cirrhosis of the serious one, the routine is treated with antibiotic, choose different antibiotic, the multi-purpose very beginning spore's three piperazine 1g intravenous injection of the patients of this group according to the condition, 2 times a day. Antibiotic of injection in the abdominal cavity if necessary. The recuring rate of condition of 3 weeks is low to generally use medicine, one week after or the ascites disappears. In addition, the indoor air should keep fresh, the indoor air sterilizes on time, keep the skin clean, the oral cavity is attended to 2 times a day.
2.6 Correct low the intersection of albumen and the intersection of blood and the intersection of disease and general the intersection of hepatitis and liver cirrhosis, erupt the intersection of spontaneity and bacterial the intersection of peritonitis and patient simultaneously, have more low the intersection of albumen and the intersection of blood and disease, so, hepatitis liver cirrhosis can erupt the spontaneous peritonitis patient simultaneously while with antibiotic the vein inputs albuminous 10- 20g every day or the next day, improve the colloid of blood plasma to permeate, press, promote the absorption of the ascites and diuresis function of increase.
2.7 The psychology is attended to Hepatitis liver cirrhosis have depressed, anxious, frightened even desperate psychology more to erupt the spontaneous peritonitis patient simultaneously [3] ,Should dispel the patient's psychological pressure at first, do a good job of psychological consultation, in order to make the patient's trust, talk with patient, care for the patient, make patients strengthen and overcome the confidence of disease. Arouse the enthusiasm of patient to the maximum extent, cooperate and treat the work effectively, make the patient recover as soon as possible.
References
A roof beam expands the extensive region. The liver disease is studied. Beijing: People's Health Publisher, 1995, 412-413.
2 Pan beautiful and sweet-smelling, Hao Ping. Liver cirrhosis erupts treatment and nursing of the bacterial peritonitis of spontaneity simultaneously. Practical to attend to the magazine, 2001, 17( 8) : 23.
3 old persons are beautiful. Clinical controlled study of the social factor of patient's psychology of chronic hepatitis. China's mental hygiene magazine, 1995, 9( 3) : 127-128.
(Accept draft date: 2002-08-23)
Author's unit: 250002 infectious hospitals of Jinan of Shandong

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