1, cough, expectoration
After chest surgery, patients should actively carry out respiratory rehabilitation exercises to restore respiratory function and prevent atelectasis and respiratory system infection. However, the patient was afraid of pain after operation and dared not cough, which led to the accumulation of secretions in the trachea. If the patient has a long-term smoking habit before operation, the secretion in the bronchus will increase, which is more likely to cause atelectasis and lung infection. Therefore, we encourage and help patients to cough and expectorate after operation.
Within 24 ~ 48 hours after operation, the patient should cough and take a deep breath for 5 ~ 10 times every12 hours. Within 3 days after operation, nurses or their families should help patients cough and expectorate 4 ~ 6 times a day. The specific way is: when coughing and expectoration, it is best to take a semi-lying position, or the patient's preferred lying position: instruct the patient or accompany relatives and friends to hold the wound with their hands, so as to limit the expansion of the lungs and relieve the pain. Companions hold the patient with their hands, put their fingers together, pat the patient on the back, and repeat from bottom to top, so that the patient can cough and expectorate effectively. If the sputum is too thick to cough, you can tell the medical staff to do atomization inhalation first, dilute the sputum, pat the back to help cough and help discharge.
2, postoperative diet
Postoperative diet is one of the key factors to improve the therapeutic effect. Generally speaking, except for esophageal surgery, normal diet gradually returned to normal on the first day after thoracic surgery. Patients with esophageal cancer can't take food orally in the early postoperative period (about 7 days), but they can be nourished by intravenous or drip nutrient solution through duodenal feeding tube or jejunostomy tube.
Generally, we should start with clean food, which should be light, soft and easy to digest and absorb. Because surgical trauma will cause dysfunction of the digestive system, so when choosing and supplementing food, don't rush for success. Starting from the simplest, if there is no adverse reaction in the gastrointestinal tract, then transition to semi-liquid food and general food. Eat more fresh vegetables and fruits, such as green vegetables, yellow vegetables, red vegetables, mushrooms, black fungus, asparagus, lemons and red dates. Before and after the operation, because fruits and vegetables are rich in vitamin C, vitamin C is an anticancer substance, which can block the formation of cancer cells. Do not eat or eat less irritating food, including fried food. You can often eat garlic, which contains anticancer substances. No smoking, no drinking.
3. Closed thoracic drainage
That is, the chest tube is placed in the chest to drain pleural effusion. Patients with upper lobe resection will have two thoracic tubes on the same side, the upper tube is mainly for venting and the lower tube is mainly for drainage. Clamp the chest tube during pneumonectomy to prevent the mediastinum from shifting to the healthy side and affecting the respiratory ability.
4. Prevent postoperative infection complications.
Pulmonary infection and wound infection are common complications after thoracotomy, which not only increase the pain of patients' postoperative recovery, increase economic expenditure, but even threaten their lives. Therefore, we attach great importance to preventing postoperative infection.
(1) Ensure air circulation in the ward, and open the window for ventilation at least twice a day for at least 30 minutes each time.
(2) Prevent cross-infection and reduce the number of accompanying and visiting personnel.
(3) Ensure that the bed unit is clean and tidy, the accompanying personnel do not occupy the bed, and the clothes are changed in time when they are contaminated by oozing blood.
(4) Effective cough and expectoration are also important means to prevent lung infection.
5. Moderate activities
From the first day after operation, if the vital signs (blood pressure, respiration and pulse) are stable, patients can be encouraged to stay in bed by fixing the thoracic drainage tube. Due to closed thoracic drainage, infusion, ECG monitoring and other reasons, patients will be restricted from getting out of bed. When resting in bed, patients should actively exercise the flexion and extension of lower limbs to promote blood circulation of lower limbs. After the drainage tube is removed, the patient can be helped out of bed every 4 hours in the early stage and walked indoors for 3 ~ 5 minutes. In the future, patients can get out of bed by themselves to prevent deep vein thrombosis of lower limbs.
6, postoperative functional exercise
Taking a semi-supine position after waking up is beneficial to drainage of pleural effusion, relieving wound pain, lowering diaphragm and improving respiratory and circulatory function.
After thoracotomy, due to the long incision and many muscle cuts, the ribs are broken during the operation, which is easy to cause muscle adhesion and stiffness. Therefore, the recovery of shoulder joint and chest and back muscle function is also an important part of rehabilitation nursing. However, patients are often afraid to operate the surgical arm because of pain, which limits the range of motion of the shoulder joint. When resting in bed, the patient should take the initiative or with the assistance of accompanying family members, rotate the shoulder joint back and forth, and gradually lift the arm on the surgical side. You can climb the wall after getting up. The method is: spread your arms outward, stand with one arm away from the wall, climb your fingers along the wall, keep your arms straight, climb up at the same time, move your feet to the wall, continue to climb over your head, climb down slowly in the opposite direction against the wall and return to your original position.
7. Minimally invasive chest surgery can recover faster.
Minimally invasive surgery is the inevitable trend of surgical development. Minimally invasive thoracic surgery has been widely carried out in the world and accepted by patients and their families. One of the important medical features of Professor Liao Yongde's team is to treat thoracic diseases, including lung cancer, esophageal cancer, mediastinal tumor, pneumothorax, funnel chest, palmar hyperhidrosis and so on. Just punch 3-4 small holes with a diameter of about 2-3 cm on the chest wall, and the same operation as the conventional operation with a diameter of 25-30 cm can be completed. The surgical effect is the same as that of conventional surgery, and its incomparable advantages are: small and beautiful incision, little injury and quick recovery; Without cutting large chest muscles, cutting or stretching ribs, pulling scapula, and not damaging the muscles and bones of the motor system, the shoulder joint activity function is slightly affected, and the recovery is fast, and the postoperative pain is obviously reduced compared with the traditional incision. Thoracoscopic surgery has little damage to lung function, can maintain and improve the quality of life of patients, and is of great significance to the elderly and patients with poor lung function who are difficult to accept traditional thoracic surgery.
8, the principle of postoperative diet
1, eat enough protein and starch. Protein mainly comes from lean meat, chicken, fish, eggs and beans. Starch substances such as noodles, rice and potatoes. A bowl of noodles, a piece of cheese and a sandwich will be very effective as long as you ensure that you have the above two foods for every meal.
2. Fresh fruits and vegetables. Fresh fruits and vegetables are rich in plant fiber, which is good for preventing postoperative constipation. Vitamin C and β -carotene are also beneficial to wound repair.
3, a small amount of meals. You can eat five meals a day if you have a bad appetite. Eat fruit between meals, such as half an apple and a small amount of vegetables. Have soup in the afternoon, such as mixed vegetable soup, mushroom and corn soup, etc. Have some chocolate and nuts during the break.
4. Supplement trace elements and vitamins. Supplement 1-3 times a day, with 200-220mg zinc sulfate or zinc gluconate each time. At the same time, it is suggested to supplement 10 microgram of vitamin D.
Finally, avoid eating lard, animal offal, eels and turtles, and eat less marine fish with high fat and cholesterol. Also avoid cigarettes, wine, strong tea, ginseng, royal jelly and ganoderma lucidum. Don't make up too much after operation. According to the patient's physical condition and food characteristics, choose foods with light taste, reasonable nutrition and appropriate quality.