术后护理 (2)

术后下床走走帮助肠子恢复蠕动,术后恢复饮食之后几天不来大便的原因和使用泻药的危害

第一节 患者术后要在医嘱下下床走走,帮助肠子恢复蠕动功能,咳嗽打喷嚏时要用手捂着刀口,避免伤口在咳嗽和打喷嚏时,拉扯疼痛和甚至扯伤刀口。  

患者术后最常见的一个现象就是,手术结束患者回到病房之后家属都着急的等待着患者放屁排气了,1-2天不放屁排气家属就很慌张,肠子恢复正常蠕动放屁排气就会兴高采烈的到群里来报喜,患者也可以在医生的指导下开始喝水和吃流食了;有些患者术后身体无力怕会扯伤吻合口或者刀口,不敢在医嘱下下床走动,而导致患者2-3天都不放屁排气而惊慌失措,害怕会不会是肠梗阻了;其实术后第二天患者按医嘱下床在家属的保护下围绕着病床走动,有利于患者肠子尽快恢复蠕动,也可以避免术后肠子粘连,患者的吻合口和刀口并不会因为患者下床走动而有所损伤,患者和家属尽管按照医嘱下床走动,其实患者术后那几天咳嗽反而会扯伤伤口,患者咳嗽的时候要用手捂着伤口咳嗽。一般术后患者身上医生出于检测保护,会有输氧管、心脏和血糖的检测仪器,引流管,有些患者还会有肛门插管或插胃管,手臂挂着输液管;一般术后正常的情况下,有经验的群友会告诉新群友患者和家属,术后大概每天医生会取掉一根管子,等身上的管子都拔掉了,患者大概就可以出院回家了。

第二节 术后患者、家属甚至不专业或粗心的医生经常都会犯的一个错误

患者做肠镜或者做肠癌手术的时候,医生为了让肠子有一个可以让肠镜看清楚肠子内部情况的环境,让医生手术时有一个清洁的手术环境,医生都会用泻药把患者肠胃里的大便泻除干净,患者肠镜之后很多都小心翼翼的吃流食不敢正常吃饭,怕会弄伤肠子切除息肉或者腺瘤的伤口;患者做肠癌根治术之后更加要3-4天之后才开始恢复喝水喝汤,4-5天之后才开始吃流质食物,虽然医生术后医嘱可以开始循序渐进的正常饮食,但是患者和家属往往自己会倍加谨慎一些,恢复饮食后多数会自己加码吃流食的时间,以致于术后出院之后每天流食形成大便的物质少之又少,术后10天,恢复饮食一周不来大便的情况非常普遍;患者和家属害怕梗阻了经常着急万分,经常告诉医生术后恢复正常饮食5-7天了,患者还没有来大便,要求医生开泻药帮助患者大便,而吃完泻药之后患者一泻千里泻干净之后,患者和家属又是一个小心翼翼的流食进食过程,又是一个3-5天还不来大便的着急等待时间,等不及怕梗阻了又会自己吃泻药或者到医生要求医生开泻药,反复折腾不也乐乎;群里经常有清肠做完肠镜之后,特别是直肠癌根治术之后,“恢复饮食”之后4-7天不来大便怕梗阻而反复使用泻药,不单只没有必要而且还对脆弱的吻合口造成伤害,其实,只要患者肚子不胀,术后吃流食6天不来大便都是正常的,肠子填满了,大便自然就会达到肛门,千万不要心急吃泻药,患者术后使用泻药,腹泻时肠子的激烈蠕动会拉扯伤吻合口,导致吻合口发炎。

第三节  清肠做肠镜之后和肠癌术后患者3-7天不来大便的原因

人的消化系统很长,从胃到十二指肠到漫长的回肠,再从升结肠到横结肠,横结肠到降结肠,降结肠到乙状结肠,再到直肠和肛管、肛门,从我们吃进去食物的那一刻开始食物就“周游列肠”,食物要通过上述各种消化系统器官的营养吸收,经过结肠的提水,最终两天之后食物的残渣才会形成大便最终到达直肠存储,被肛管2-4公分的内括约肌探测到而产生便意,这个过程人体是自动运作,不需要大脑神经的指挥,最后外括约肌在接到内括约肌的信号之后,大脑才会选择方便的时间和地点,打开外括约肌的闸门将大便排出体外。而这个漫长的过程中内部结构弯弯曲曲、坑坑洼洼的肠子,都会雁过拔毛的留下一些还没消化的食物或者升结肠含水的大便,乃至横结肠和降结肠的坑坑洼洼里都会留下一些比较成型的大便,我们吃进去的食物消化系统打底就占用了我们大概3天的食物。

所以,其实清肠做完肠镜,或者清肠做完肠癌手术的患者,肠镜前和术前被清空的消化系统是有一个“克扣”和“打底”的过程的,做完肠镜的人正常吃饭2-3天不来大便非常正常;而肠癌根治手术患者术后一般3-4天之后才开始恢复喝水喝汤,4-5天之后才开始吃流质食物,虽然医生术后医嘱可以开始循序渐进的正常饮食,但是患者和家属往往自己会倍加谨慎一些,恢复饮食后多数会自己加码吃流食的时间,以致于术后出院之后每天流食形成大便的物质少之又少,术后10天消化系统还是积攒不到足够到达直肠的大便,而往往患者和家属在进食2-3天,也就是大概术后7-8天之后就期望着大便的到来,以证明肠道功能已经正常工作了,等到进食4-5天都没有便意患者和家属就开始着急万分的找医生,要求医生处理这种“异常”情况,而医生往往听信患者和家属的“恢复正常进食5-6天了,还没大便”的说词,就开出泻药给患者把患者的肠胃泻空,而泻空患者因为怕梗阻饮食更加的小心翼翼的,基本一点有渣的东西都不敢吃,结果又是4-5天不来大便,又找医生开泻药去了,周而复始折腾个不亦乐乎。

第四节  6年的肠癌群解答经历,处理了不少这类患者和家属的梗阻惊魂

我因为常年对消化系统有些研究,自己也经历数次肠镜和手术,对肠镜后和术后食物恢复摄入之后产生大便的数量和大概来大便的时间,纠正了不少这类患者和家属自我折腾的无知做法;因为是个普遍容易犯的错误,而且对患者的身体恢复影响很大,泻药刺激大肠激烈蠕动对术后脆弱的吻合口的拉扯,非常容易导致吻合口炎,起码是吻合口恢复要慢很多;所以,我专门作为一章来讨论这个问题。

有了多次的经验之后,以后遇到着急在群里询问,术后8-10天不来大便是不是梗阻?有什么方法可以处理?医生电话里建议用泻药等问题,我面对患者和家属这些问题时,我只问问恢复饮食之后这几天吃了什么?肚子账不账?见到吃流食和肚子不胀的患者,我一律叫不用管它,很多群友听到我说不用管它的话时,都很惊讶的说;“怎么可以不用管它”?我的标准答案是:“患者术后多数人都吃流食或没有纤维的容易消化食物,恢复饮食之后3-5天不来大便很正常,本来吃进去的食物就产生不了什么大便,大便还得慢慢填满整个几米长的消化系统的坑坑洼洼之后,才有大便到达直肠,只要肚子不胀,就不用管它,大便填满了消化系统的坑坑洼洼之后就自然有大便排出,千万不可以吃泻药让患者大便!!!切切”!

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