论文肝性脑病前言

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

摘要肝硬化是各种原因所致的肝脏慢性、进行性的弥漫性改变。其特点是一种病因或数种病因长期反复刺激和损伤肝细胞，导致肝细胞变性和坏死，并伴有多种脏器功能损害，晚期可并发上消化道出血、肝性脑病等严重疾病。因此，对肝硬化患者的护理和知识宣教就尤为重要。同时对我们护理工作也提出了更高的要求。我院2007年1月至2008年2月共收治了78肝硬化例患者，现具体报道如下。关键词肝硬化；护理；措施1临床资料我院2007年1月至2008年2月共收治78例肝硬化患者，发病原因为肝炎所致68例，酒精所致5例，药物所致3例，其他因素所致2例。其中男62例，女16例，平均年龄50岁。并发上消化道出血12例，肝性脑病3例。总结78例肝硬化患者的临床护理经验，对他们的临床资料进行回顾分析，治愈、好转64例(82%)，自动出院10例(13%)，死亡4例(5%)。通过对患者实施恰当而合理的护理措施，减轻了患者的痛苦，提高了患者的生活质量，延长了患者的生命。2护理措施一般护理〔1〕注意休息卧床休息可以增加肝脏的血流量，有助于肝细胞修复和再生。因此，休息是保护肝脏的重要措施之一。失代偿期肝硬化患者应绝对卧床，这样有利于增加肝脏的血流量，减轻肝脏负担，促进肝细胞的恢复，而代偿期肝硬化患者不强调卧床休息，但应适当减少活动，增加休息时间，注意劳逸结合，以不引起疲劳为原则。饮食合理的饮食是正常生命机能的基本保证，营养的合理调配和摄取，在肝硬化的治疗过程中起着非常重要的作用。它可以增加机体的免疫力，增加肝细胞的再生能力，使疾病早日痊愈。因此，要保证足够的营养供给，食物要多样化，应以高糖、高维生素、富含氨基酸的高效蛋白质、低脂肪、少渣饮食为主，对腹水或浮肿患者，一定要限制钠盐和水的摄入量，对有肝脏损害倾向的患者，应限制蛋白质摄入，每日蛋白质摄入量不超过20 g，以免诱发肝性脑病。有食管及胃底静脉曲张者禁食干硬、粗糙及刺激性食物，以防损伤食道黏膜及胃底血管而引起出血。 保持大便通畅肝硬化患者如果饮食不当，加之活动减少，胃肠蠕动减慢，易导致习惯性便秘，对该病的愈后极为不利。因此，要给患者适量进食一些富含纤维素的食物和香蕉之类的水果，既能通便又可补充钾，必要时可服用缓泻剂，例如乳果糖口服液，减少肠道氨的吸收，避免诱发肝性脑病。做好口腔皮肤护理每日口腔护理2次，指导患者用软牙刷刷牙，忌用牙签剔牙，保持床铺整洁，保持皮肤清洁，建议患者穿柔软宽松的棉质衣服，有水肿处用棉垫或气垫圈予以保护，避免造成皮肤破损，而增加感染机会。用药护理正确合理用药，减少肝脏负担。应用利尿药物时，密切观察药物的利尿效果及副作用，准确记录患者的液体出入量，注意电解质的平衡。 心理护理肝硬化是一种康复过程较长的慢性疾病，患者很容易产生焦虑、急燥和恐惧的心理。因此，对患者要给予耐心的解释、鼓励和安慰，消除患者的顾虑，树立战胜疾病的信心，保持乐观坦然的心情。同时指导家属给予心理支持，多与患者沟通，鼓励其说出自己的感受，建立良好的护患关系，使患者处在最佳心理、生理状态下主动接受治疗及护理操作。并发症的观察及护理上消化道出血是肝硬化最常见，最严重的并发症，应及时发现出血征兆并积极投入抢救。当患者出现黑便，呕血等症状时，应迅速建立静脉通道，快速输液，必要时输血，应用止血药物，必要时应用三腔双囊管压迫止血，加强护理，密切观察生命体征及病情变化；安慰患者嘱其卧床休息，保持安静，采取平卧位头偏向一侧，将下肢抬高，注意保暖、吸氧；禁食，及时清除呕吐物避免患者紧张。肝性脑病是肝功能严重损害，以意识改变和昏迷为主要表现的综合征，早期发现患者神志、行为异常，应及时通知医生，应用降血氨药物，加强休息和饮食护理，禁食蛋白质；随时保持呼吸道通畅；详细记录24 h出入量，保持大便通畅；有躁动不安者加床档，慎用镇静剂。出院指导出院前向患者和家属讲解肝硬化的有关知识，特别强调休息和饮食的重要性，按医嘱服药，定期复查肝肾功能、电解质。有呕血、黑便或便血、神志改变应及时就诊。指导患者保持心情愉快，树立战胜疾病的信心。加强自我护理和保健，提高生活质量。还要关注患者家属，对其讲解肝硬化相关知识，正确认识传播途径，减轻其担心被传染的顾滤，与患者保持温馨和谐的关系，从而有利于患者的康复。3结论精湛的医疗技术加上细致的护理，一定能达到最理想的效果，通过对肝硬化患者的精心护理，健康教育指导，使患者能充分认识到肝硬化的发病特点，提高了自我防护能力，消除了诱发因素，减少了并发症，延长了患者的生命。提高了生命质量。按参考文献

The result � Infect with 181 cirrhosises of the occurrence rate sufferer the merger infects with 101, infecting with of the occurrence rate, the infection rate inside the hospital is .� Infection occurrence the part 101 infections totally take place a time of various infection is among those exampleses infect with for 3 parts,24 the examples infect with for 2 parts, Rest 73 the examples infect with for a with the part press occurrence the 频 degree is high and low one by one in order is:At first the peritonitis 59 times of hair, the bowel way infects with 15, topBreathe the way infects with 12 times, the disease 9 times of the germ blood, an infection of lung and pleuritis 8 for each infection of 胆 , urine the road infects with to infect with 5 for each time with mouth cavity, The soft organization of skin infects with 4 times, the shock 3 times of infection.� Occurrence related factor � of the A 101 of the relation infection of the infection and the liver function child- pugh , B and the C class sufferer's numbers distinguish to 11,41 example and with 80 of set not, A, B and the C class sufferer's numbers distinguish to 26,39 examples and cirrhosis merger infects with the C class of child- pugh in setThe number of the sufferer is obvious and precious sight more to infect with the set not, two relatively differ to show the 著 ( x2=, P<) to see the table very much 1.�Two livers function child- pugh ratings compare( X2)Set do not the A B C is totalInfect with the set 11()41()49()101Infect with the set not 26()39()15()81Total 378064181Note:The data inside the brackets counts for the theories of each number( T) Hospital inside infection and hospitalization time relation hospitalization time> January,1/2-1 months and<1/ February hospital inside infection the occurrence rate is respectively, the sufferer of the cirrhosis stay in the hospital> January the opportunity of the infection inside the occurrence hospital is obvious high in< the of January sees the table 2. Hospital inside infect with and stay in the hospital the horary relationStay in the hospital the time infection number infection rate<1/ of 1/2-1 months> of Infection inside the hospital with encroach upon sex operation to relate to in 133 infections, accept to encroach upon sex to operate sufferer's number before list on 3 respectively is:25 exampleThe infection accepted the deep vein to place to take care of the 术 before,14 belly cavities wore to stab the 术 ,4 chests wore to stab the 术 .�Problem complement: The cause learns the germs that the germs development have already examine to have:Rare germ( the stomach water) of the large intestine 埃 ;False single afterbirth germ( the stomach water);Smelly nose gram thunder 伯 surname germ(Blood, phlegm, the bedsore 脓 liquid), 普 in the hair 斯 sand fungi( the blood, the neck vein puts the tube), the epidermis grape germ( phlegm), white beads germ( phlegm, muck,Swallow to wipe the son), pull the surname west germ( phlegm), the ear grape germ( urine).� The one who turn return to take place the infection dies of illness 29, the death rate is ;Don't the one who take place infection die of illness 2, death rate 72 infectionsLearn to examine the foundation in the cause up the reasonable usage antibiotics and protect the liver, the benefit urine etc. treatment, keep patient's mouth cavity and the whole body skin to sweep for the convenience of control infection descend all turn for the better the hospital discharge, the average hospitalization number is not take place the infection of other 78 example at reasonable treatment and nursing under all turn for the better the hospital discharge, evenAll stay in the hospital the day to count to merger infection death rate obvious high in not the one who infect with.( X2= Ps<) see 3 �s of tableInfect with with not infect with death rate compareThe set do not die the number amendment number to add upInfect with the set 29()72()101Infect with the set not 2()78()80Total 31150181Two differences show the 著 meaning