下肢静脉曲张病人的护理-

下肢静脉曲张病人的护理下肢静脉曲张病人的护理外科外科廖冬梅廖冬梅Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.【定义】【定义】下肢静脉曲张是指下肢浅表静下肢静脉曲张是指下肢浅表静脉因血流回流障碍而引起的以静脉脉因血流回流障碍而引起的以静脉扩张、迂曲为主要表现的一种疾病，扩张、迂曲为主要表现的一种疾病，晚期常合并小腿慢性溃疡。晚期常合并小腿慢性溃疡。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.【解剖和生理】v下肢静脉系统：1、浅静脉大隐静脉、小隐静脉2、深静脉3、交通静脉4、肌静脉Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.静脉瓣膜：使下肢静脉血流由下向上，由浅入深地单向回流。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.病因及发病机制病因及发病机制1.1.先天性发育异常：先天性发育异常：先天性静脉壁薄弱、静脉瓣膜缺陷。2.2.后天性致病因素：后天性致病因素：如长期站立、重体力劳动如长期站立、重体力劳动、妊娠、习惯性便秘等因素使腹腔内压力增高，影、妊娠、习惯性便秘等因素使腹腔内压力增高，影响下肢静脉血回流。响下肢静脉血回流。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.临床表现临床表现1.早期：感下肢酸胀、沉重、乏力，久站后足踝部肿早期：感下肢酸胀、沉重、乏力，久站后足踝部肿胀。小腿处浅静脉扩张、迂曲成团、隆起，直立时更胀。小腿处浅静脉扩张、迂曲成团、隆起，直立时更明显。明显。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.2.晚期：小腿和踝部皮肤发生营养性改变，晚期：小腿和踝部皮肤发生营养性改变，出现皮肤萎缩、脱屑、瘙痒、色素沉着。出现皮肤萎缩、脱屑、瘙痒、色素沉着。由于营养缺乏轻微损伤就形成经久不愈的由于营养缺乏轻微损伤就形成经久不愈的慢性溃疡，并可出现血栓性静脉炎，甚至慢性溃疡，并可出现血栓性静脉炎，甚至皮肤破溃时大量出血。皮肤破溃时大量出血。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd. 辅助检查辅助检查 1.浅静脉及交通支瓣膜试验浅静脉及交通支瓣膜试验1.大隐静脉瓣膜试验大隐静脉瓣膜试验Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.2.交通支瓣膜试验交通支瓣膜试验Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.2.深静脉通畅试验深静脉通畅试验Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.【护理诊断】【护理诊断】v一活动无耐力：与下肢静脉曲张致一活动无耐力：与下肢静脉曲张致血液瘀积有关血液瘀积有关 v二潜在并发症：小腿慢性溃疡、湿二潜在并发症：小腿慢性溃疡、湿疹、血栓性静脉炎、出血疹、血栓性静脉炎、出血 v三知识缺乏：缺乏下肢静脉曲张的三知识缺乏：缺乏下肢静脉曲张的预防知识预防知识 v Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.v处理原那么：v1、非手术治疗只能改善病症。适用于(1)病变较轻,病症较轻；2病症虽然明显，但不能耐受手术。v2、手术治疗适用于深静脉通畅、无手术禁忌症者，是治疗下肢静脉曲张的根本方法。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.【护理措施】【护理措施】一非手术治疗时的护理一非手术治疗时的护理1.减少静脉血液瘀积减少静脉血液瘀积由足背至大腿缚扎上弹性绷带或穿弹力袜由足背至大腿缚扎上弹性绷带或穿弹力袜Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.弹力袜的作用原理vA、具有促进静脉血液回流心脏的功能，在脚踝部建立最高支撑压力，顺着腿部向上逐渐递减，在小腿肚减到最大压力值的70%-90%，在大腿处减到最大压力值的25%-45%，压力的这种递减变化可使下肢静脉血回流而减少静脉血淤滞，能有效的缓解或改善下肢静脉和静脉瓣膜所承受压力。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.弹力袜的作用原理B、弹力袜的周径小于人腿的周径，早上起床下地前，一般患者的静脉血管是平复状态而不是凸出的，这时穿上弹力袜，坚持穿用一天，弹力袜的压力保证静脉血管始终不凸出皮肤外表，晚上睡觉的时候再脱下来，这样长期坚持穿用弹力袜，凸出的静脉血管会逐渐萎扁平复。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd. 维持良好坐姿。维持良好坐姿。防止腹内压增高：保持大便通畅，肥防止腹内压增高：保持大便通畅，肥胖者应有方案减轻体重。胖者应有方案减轻体重。患肢有水肿者，嘱其卧床，抬高患肢患肢有水肿者，嘱其卧床，抬高患肢30度度40度，有利于静脉、淋巴回流，度，有利于静脉、淋巴回流，以减轻患肢水肿。以减轻患肢水肿。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.抬抬高高患患肢肢30度度Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.2.小腿慢性溃疡和湿疹的护理：平卧时抬高患肢，保小腿慢性溃疡和湿疹的护理：平卧时抬高患肢，保持创面清洁，局部应勤换药，创面可湿敷持创面清洁，局部应勤换药，创面可湿敷Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.3.3.出血的护理：立即抬高患肢和加压包出血的护理：立即抬高患肢和加压包扎，必要时需缝扎止血。扎，必要时需缝扎止血。4.4.术前皮肤准备：为防止术后发生切口感术前皮肤准备：为防止术后发生切口感染，做好充分的皮肤准备。染，做好充分的皮肤准备。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.二手术后护理二手术后护理 1.术后用弹性绷带包扎。注意保持适宜的松紧度术后用弹性绷带包扎。注意保持适宜的松紧度,弹性绷带一般需维持弹性绷带一般需维持2周方可撤除。周方可撤除。2. 观察有无切口或皮下渗血，绷带如有松脱应重新包扎。观察有无切口或皮下渗血，绷带如有松脱应重新包扎。3.卧床时抬高低肢卧床时抬高低肢30度，以利静脉回流，同时做足背伸屈运动。度，以利静脉回流，同时做足背伸屈运动。4.早期离床活动：术后早期离床活动：术后24-48h鼓励病人下床活动，促进下肢静脉回流。鼓励病人下床活动，促进下肢静脉回流。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.v5、健康教育、健康教育v 鼓励病人穿弹力袜；鼓励病人穿弹力袜；告诉病人平时应保持良好坐告诉病人平时应保持良好坐姿，防止久站、双膝交叉过久，姿，防止久站、双膝交叉过久，休息时抬高患肢；休息时抬高患肢；v 不要用过紧腰带、穿过紧不要用过紧腰带、穿过紧衣物衣物进行适当体育锻炼进行适当体育锻炼防止肥胖等因素。防止肥胖等因素。Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.v谢谢聆听谢谢聆听Evaluation only.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Copyright 2004-2021 Aspose Pty Ltd.