1例感染性腹主动脉瘤置换术后发生食管瘘患者的护理.docVIP

精品论文 参考文献 1例感染性腹主动脉瘤置换术后发生食管瘘患者的护理 （北京军区总医院 北京 100700） 【摘 要】食管瘘是临床上少见的症状，发病原因复杂，治疗困难，死亡率高，是临床治疗的难点。食管瘘的病因不同，但临床症状基本相似，主要为胸闷、胸痛、呼吸困难、纵膈气肿、皮下气肿、液气胸以及全身性感染和中毒症状等[1]。感染性腹主动脉瘤也是一种较为常见的动脉扩张性疾病，其发病率占所有动脉瘤的第一位，是一种严重威胁生命的疾病，其发病率逐渐增加[2]。本病例患者除发热外尚无其他明显症状，易导致误诊和漏诊。本科室护理的1例感染性腹主动脉瘤置换术后发生食管瘘患者的护理报告如下： 【关键词】腹主动脉瘤；食管漏；发热 【中图分类号】R47 【文献标识码】B 【文章编号】1003-5028（2015）6-0773-02 【Abstract】Esophageal fistula is a rare clinical symptoms, the etiology is complex and difficult to treat.the mortality rate is high.it is difficult to treat. The etiology of esophageal fistula is differentbut similar clinical symptoms For example mainly for chest tightness, chest pain and dyspnea, pneumomediastinum and subcutaneous emphysema, fluid pneumothorax and systemic infection and symptoms of poisoning. [1].Infection of abdominal aortic aneurysm is a disease of artery dilatation is more common, the first incidence of all aneurysms,It is a severe life-threatening disease, surgery as soon as possible to avoid the occurrence ofrupture and death [2]. In this case, It lead to misdiagnosiseasily and missed diagnosis.in addition to fever patients with no otherobvious symptoms, Thenursing of the patients with esophageal fistula occurred in 1 cases of infectedabdominal aortic aneurysm replacement after nurse the report is as follows: 【Key words】Abdominal aortic aneurysm Esophageal fistula Fever 1 病例介绍： 患者男，51岁，体重70kg，主因间断发热1年余入院。患者因胸主动脉假性瘤一年前在当地医院行人工血管置换术，病理证实为感染性动脉瘤，术后1个月开始出现间断发热，体温波动范围38.5℃-39.5℃，曾到多家医院救治未见明显好转，以“发热原因待查”入住我院。入科查体：体温39.5℃，血压140/78mmHg；血常规及生化检查：白细胞22x109/l，中性粒细胞百分比81%，CRP58mg/l,血沉69mm/h，白蛋白35g/L，血培养结果为沙门菌及真菌感染。CT检查显示动脉人工血管周围有少量气体（图1）、右下肺叶感染及脾脓肿。在CT引导下脾穿刺引流出黄褐色粘稠脓液，留置引流管，行食管造影提示食管中下段瘘（图2）. 2 原因分析： 感染性动脉瘤的致病体以细菌多见，也可见到白色念珠菌，本例血培养中有沙门菌，其次革兰阴性菌，其对血管壁及周围组织的侵蚀性强于革兰阳性菌[3]这可能是导致患者迟发性食管瘘的原因之一；另外也应考虑食管自身组织特点：无浆膜覆盖，肌纤维呈纵向排列且比较脆弱，易发生撕裂[4]。腹主动脉瘤消化道瘘（abdominal aortoenteric fistula,AAEF）是腹主动脉瘤少见但极为严重的并发症，是消化道出血的少见病因。AAEF分原发性和继发性，前者是指腹主动脉瘤壁与邻近肠道发生侵蚀交通形成的病变，后者是指腹主动脉移