肝性脑病病生论文

3 讨论 本组肝硬化患者感染发生率，肝硬化肝功能失代偿child—pugh C级患者合并感染者明显增多。院内感染总发生例次率，住院时间超过1月者发生院人感染机会明显增加，住院期间由于诊冶需要而行各种创伤性操作也增加了医源性感染的机会。肝硬化验室患者肠道内菌群上移，而小肠段肠壁较薄，门脉压增高使肠壁淤血，淋巴流量增多，导致肠壁水肿，致使肠壁屏障被破坏〔3〕。肝硬化患者肝细胞坏死、纤维化的同时，肝脏的单核—巨噬细胞系统功能亦显著受损，使来自肠腔的细菌不能被清除，易发生肠源性感染。本资料已培养检测到的细菌以条件致病菌居多，治疗选用抗菌药物最多的是甲硝唑和头孢第三代类。本组发生感染者病死率％，明显高于无合并感染者的病死率％。提示肝硬化合并感染是造成病情加重，导致死亡的重要原因。这主要与机体免疫功能低下，高胆红素血症、白蛋白明显下降及肝功能衰竭有关。而感染又常诱发生上消化道出血，肝性脑病及肝肾综合征等严重并发症，使肝硬化进展为慢性重型肝炎、肝功能衰竭甚至多脏器功能衰竭而死亡，病死率明显增高。因此，肝硬化患者住院后应抓紧时间检诊，在诊治过程中加强消毒隔离，严格无菌操作及掌握各种侵袭性操作的适应症，尽量减少医源性感染的诱因。对肝功能child—pughC级患者采取绝对卧床休息、给予高热量、适量蛋白质(以植物蛋白为主)、丰富维生素等易消化饮食，并应细嚼慢咽，绝对戒烟酒，加强口腔及皮肤护理，病情稳定后尽早出院。发现感染征兆如不明原因的持续低热，黄疸明显升高，顽固性腹胀、腹痛、腹泻、腹水量明显增多或利尿剂无效等，应及早作细菌培养，合理应用抗菌药物，加强支持利退黄治疗，积极预防和控制感染及严重并发症的发生

Results � 2 181 cirrhotic patients with the infection rate of 101 cases of infection. infection rate was , of nosocomial infection. � infection sites were 101 cases of infection times for a total of 133 cases of infection occurred. 4 cases of which three infections, 24 cases of infection of two parts, one part of the remaining 73 cases of infection. By the frequency of infection sites were as follows : 59 cases of primary peritonitis time, 15 cases of intestinal infection. 12 cases of upper respiratory tract infection, bacteremia nine cases meeting, lung infection and pleurisy meeting of the eight cases. Biliary tract infection, urinary tract infection and oral infection five times, four cases of skin and soft tissue infections time, 3 cases of septic shock. � incidence of infection-related factors causing infection and liver function grades of Child - Section 101 cases of infection. A, B and C patients respectively 11 cases, 41 cases and 49 cases. 80 cases of non-infected group, A, B and C patients respectively 26 cases, 39 cases and 15 cases. Child-C infection in patients with cirrhosis group were significantly higher than non-infected patients. significant difference between the two groups (x2=, ) is shown in Table 1. � liver function Child-grade comparison group (X2) A B C Total infected groups of 11 (20. 6) 41 () 49 () 101 non-infected group, 26 () 39 ( ) 15 () 81 Total 37 80 64 181 Note : Theoretical data for the number of brackets (T) nosocomial infection and hospital stay time "in January. Ointment and "half of those on the incidence of nosocomial infection rates were , , . Cirrhotic patients at the hospital, "hospital occurred in January were significantly higher than the chances of infection" in January (P <) in Table 2. Nosocomial infections of the relationship between length of stay and hospital infection cases of infection "half 5 1 Ointment 3 , "January 31 nosocomial infections and 133 cases of invasive operation between infection , the number of patients with invasive operation in the first three places respectively : 25 cases of deep venous catheter infection received before the operation. 14 patients with abdominal paracentesis, four cases Thoracentesis. � add : pathogenic bacteria has been detected in the culture of Escherichia coli bacteria are : (ascites); aeruginosa (ascites); Klebsiella foul nose (blood, phlegm, bedsore pus), fungal prima Sisha (blood jugular vein cannulation), grape skin bacteria (sputum), Candida albicans (sputum, feces throat), Rumsfeld Xidixi bacteria (sputum). Staphylococcal ears (urine). � vesting who died 29 cases of infection occurred, the mortality rate for infected persons died in 2002 two cases did not occur. mortality rate of . The remaining 72 cases were infected in pathogen detection based on the rational use of antibiotics and protective, and diuretic therapy, etc., maintain a clean mouth and skin care benefit under both improved infection control discharged The average hospital stay was days for the few. No infection in the other 78 cases under treatment and care are reasonable discharged improved, the average length of stay was days. Mortality was significantly higher than non-infected patients with cirrhosis infected. (X2= ) Table 3 � infected and non-infected group compared mortality improvement in the number of death cases Total number of infected cases, 29 () 72 () 101 non-infected group 2 () 78 ( ) 80 Total 31 150 181 difference between the two groups is statistically significant

肝病是指发生在肝脏的病变。包括乙肝，甲肝，丙肝，肝硬化，脂肪化，肝癌，酒精肝等等多种肝病。下文是我为大家蒐集整理的关于的内容，欢迎大家阅读参考!

浅谈酒精性肝病患者的护理干预

研究表明，长期大量饮酒，酒精的代谢产物对肝细胞有明显的毒性作用，可导致肝细胞的变性和坏死[1]。临床上将由于长期大量饮酒而引起的肝脏损害性疾病统称为酒精性肝病ALD即酒精肝。包括：酒精性脂肪肝AFD、酒精性肝炎AH、酒精性肝硬化AC。随着我国居民生活水平的不断提高、社交圈扩大、工作压力增加等，酒精性肝病的发病率逐年上升，针对此病无特效药物治疗、病程长、易反复等特点，我院对2009年1月至2010年12月收治的109例酒精肝患者，在抗氧化、抗纤维化、保肝药物治疗的同时给予系统的护理干预，取得良好效果，现总结报道如下。

1 临床资料

一般资料:2009年1月至2010年12月我院共收治酒精肝109例，其中：男108 例，女1例，年龄29-63岁，平均年龄43±岁，酒精性脂肪肝11例，酒精性肝炎26例，酒精性肝硬化72例。均符合《酒精性肝病诊断指南》的诊断标准。①饮酒史：5-33年，平均年限±年，饮酒量：45-700g/d折合乙醇，平均日饮酒量±。②临床表现:不同程度的上腹部不适，食欲不振，乏力，发热，黄疸，严重者伴腹水，消化道出血，肝性脑病等。③ 实验室检查：肝功能异常、不同程度贫血，血清r-GT升高明显。④ 超声，CT扫描有慢性肝损害改变，肝活检有助诊断。

方法:全部病例均给予抗氧化、抗纤维化、保肝支援治疗同时给予有针对性的系统护理干预。

结果:109例酒精肝患者除2例上消化道出血、1例肝性脑病急诊入院后短时间死亡，其余106例全部戒酒，无一例复饮，病情得到不同程度控制而好转出院。

2 护理干预

认知干预:患者入院后安排一名主管医生和一名责任护士，定期向患者及家属宣教酒精性肝病的相关知识，把酒精进入体内是如何毒害肝脏的过程制作成动漫，形象、逼真地表现酒精对肝脏的毒害和损伤，宣传戒酒对疾病的转归、预后影响的重要性，提高患者的认知水平。

心理干预:酒精肝患者存在不同程度的心理精神方面的问题，现代医学研究表明，患者的心理因素对酒精性肝病的发生、发展、转归及预后有重要影响[2]。家庭矛盾、工作压力、邻里纠纷等长期精神不愉快时以酒浇愁、暴饮、狂饮，极易导致酒精性肝损害的发生。因此根据患者不同文化层次、不同心理特点，选用不同方法进行心理疏导，如理解、安慰、帮助、鼓励、支援等，积极与患者及家属进行沟通，了解其家庭、社会、工作中的背景情况，协助患者建立良好的家庭社会环境，给患者提供必要的心理支援，用亲情、温情化解患者的心理症结，使之感受到家庭社会的温暖，使其能以积极、乐观、愉快的心情配合治疗，以提高疗效，树立战胜疾病的信心和勇气。

行为干预:不良的饮酒行为习惯，导致酒精肝的发生、发展[3]，因此终生戒酒是首当其冲的关键治疗，戒酒可避免酒精继续对肝脏的毒害，清除病因、改变疾病程序、提高疗效、促进康复。轻度嗜酒者通过认知教育、心理干预能做到理性戒酒，但长期酗酒、酒依赖患者，视酒如命，一旦断酒就会出现戒断综合征，表现为;全身颤抖，烦躁，焦虑，甚至幻听、幻视，严重者可出现谵妄，意识不清等，对此应积极抢救和对症治疗，病情稳定之后，采取多种手段和方法戒酒，如药物戒酒、厌恶疗法戒酒，对个别酒依赖患者必要时通过家庭社会力量采取强制戒酒。

饮食干预:酒精性肝病患者因长期嗜酒而存在不同程度的胃肠功能紊乱，消化能力下降，故急性期合理饮食以清淡易消化为主，少食多餐，避免过食发生腹胀不适。恢复期予高蛋白、高维生素饮食，可荤素搭配增加蛋白质的利用率，热量一般控制在2000千卡左右。

生活干预:酒精性肝病急性期绝对卧床休息，以减轻肝脏负担，促进肝细胞功能恢复，随着病情好转可适当动静结合，以散步活动为宜，避免剧烈运动和强体力劳动，在肝功能恢复正常后6个月至一年可正常劳动、工作。

3 讨论

调查发现 我国酒精肝呈现发病率逐年上升、肝脏损害程度加重、受损功能器官增多等态势，已对我国人群健康造成系统性危害，已成为乙型病毒性肝炎之外的第二大杀手。应引起国家 *** 及社会居民的高度重视。从我院2009至2010年收治的109例酒精肝的诊治情况也证实了以上调查结果，109例患者中有三例因严重的并发症在入院后短时间内死亡。由于酒精肝尚无特效药物，因此预防和早期诊治十分重要，加强对过量饮酒危害性的宣传和教育，强调节制饮酒、理性饮酒，倡导文明用酒，酒文化渊源流长，要让社会居民懂得怎样用酒，什么时候能饮酒，什么情况不宜饮酒，比如：身体不适、心情烦躁、抑郁忧愁，或盛怒之时要严禁饮酒，否则就会对身体造成损害，只有充分认识才能更加自觉的把握适量饮酒或戒酒，才能更大程度地预防疾病的发生和进展，本文通过对106例酒精肝患者实施护理干预表明，系统的护理干预可提高患者对疾病的认知水平和治疗依从性，改变不良行为习惯，对降低复发率、提高治愈好转率、促进患者康复起到了至关重要的作用，收到事半功倍的良好效果。

参考文献

[1] 付小红,王维琴.慢性酒精性肝病病人心理性因素的调查分析及临床干预[J].护理研究,2007,213:264

[2] 沈雪妹,汪敏.医学心理学[M].上海交通大学出版社,2006:244

[3] 周艳馨,朱立君.酒精性肝病患者心理分析及护理干预[B].实用护理杂志,2009,06;147

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2 results infections formation rates 181 examples liver cirrhosispatient merges infects 101 examples, the infection formation , in the courtyard the infection percentage is . infections has the spot 101 examples infections altogether to haveeach kind of infection example order is 133. 4 examples are 3 spotsinfect, 24 examples are 2 spots infect Other 73 examples are a spot infect. The infection spotaccording to has the frequency height is in turn: Primary peritonitis59 examples, the intestinal tract infects 15 examples, on The respiratory tract infects 12 examples, bacteriemia 9examples, the lungs infection and pleurisy each 8 examples. Thebiliary duct infects, the urine road infection and the oral cavityinfects each 5 examples The skin soft tissue infects 4 examples, infectiousness is inshock 3 examples. has the infection correlation factor infections and liver function child - pugh graduationrelational infection group 101 examples. A, B and the C level patientpopulation respectively is 11 examples, 41 examples and 49 Example. The non- infection group 80 examples, A, B and the Clevel patient population respectively is 26 examples, 39 examples and15 examples. In liver cirrhosis merge infection group child - pugh Clevel The patient counts obviously are many to the non- infectiongroup, two groups compare the difference to be extremely remarkable(x2=, P < ) see Table 1. Two groups of liver function child - pugh graduation comparison (X2) Group other A B C grand total Infection group 11 () 41 () 49 () 101 Non- infection group 26 () 39 () 15 () 81 Amounts to 378064181 Note: In the parenthesis the data is various numbers theorynumber (T) In courtyards infects with is hospitalized the timerelations to be hospitalized the time > in January, 1/2 ~ in Januaryand < 1/2 month courtyard 内感 dyes the formation rate respectivelyis , , . The liver cirrhosis patient is hospitalizedwhen > January has the opportunity which in the courtyard infectsobviously to be higher than < January (P < ) to see Table 2. In the courtyard infects with is hospitalized the time relations Is hospitalized the time infection example number infectionpercentage < 1/2 5 1/2 ~ in January 13 > In January 31 In courtyards the infection and in the attack operationrelational 133 examples infection, accepts the attack operationpatient person sequence to the first 3 distinctions is: 25 examples Before the infection accepts the deep vein to set at the tubetechnique, 14 examples abdominal cavities puncture method, 4 exampleschest cavities puncture method. Question supplement that, etiology bacilliculture examined thebacterium includes: Large intestine Egypt hopes the fungus (ascites);假单胞菌 (ascites); Smelly nose 克雷 伯氏 fungus ( The blood, the phlegm, the bedsore pus fluid), Purey Mao theSi sand mold (blood, neck vein inserts a tube), epidermis grape fungus(phlegm), white rosary fungus (phlegm, excrement, Swallows 拭子), pulls west west the peduncle the fungus(phlegm), ear grape fungus (urine). revolutions turn over to have the infection to die of illness 29examples, the mortality rate are ; Has not had the infection todie of illness 2 examples, the mortality rate . Other 72 examplesinfection The reasonable use antibiotic and guarantees treatment and soon liver, diuresis in the etiology examination foundation, maintainsthe patient oral cavity and the whole body skin cleanly in order tohelp the control infection and so on Under nurses all good extension to leave the hospital, equallyis hospitalized the number of days is days. Under has not had theinfection other 78 examples reasonably to treat and to nurse all goodextension to leave the hospital, even Is hospitalized the number of days is days. The livercirrhosis merge infection mortality rate obviously is higher than thenon- infection. (X2= P < ) see Table 3 The infection compares with the non- infection mortality rate The group other death example number change for the betterexample number equals Infection group 29 () 72 () 101 Non- infection group 2 () 78 () 80 Amounts to 31150181 Two groups of differences have 显著性 the significance