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肺癌射频消融后注意事项

时间:2020-02-27 22:53来源:未知 作者:admin 点击:
Post-ablation Care Through Discharge Post-procedural nurse and physician assessment Observation: 4 to 6 hours (outpatient) Limited or overnight admission for observation depending on clinical course and assessment Acceptable side effects -
Post-ablation Care Through Discharge

  • Post-procedural nurse and physician assessment
  • Observation: 4 to 6 hours (outpatient)
  • Limited or overnight admission for observation depending on clinical course and assessment
  • Acceptable side effects 
            - Reasonable patient discomfort as managed by conscious sedation and iv and oral analgesics
                     Ibuprofen 布洛芬
                    Acetominophen(对乙酰氨基酚 一种替代阿司匹林的解热镇痛药) + hydrocodone (Vicodin)
                    Dextromethorphan (右美沙芬)+ codeine(可待因片) + guaifenesin(愈创甘油醚)
                    ± prophylactic antibiotics and/or corticosteroid pulse
           - Reasonable outcomes related to CT-guided device placement
 

Courtesy of Kamran Ahrar, M.D., MD Anderson Cancer Center (data compiled from 2000-2006)
 
Complications* Major Minor Total
Air Leak Related 111 (10.3%) 285 (26.4%) 396 (36.6%)
Effusion 8 (0.7%) 155 (14.3%) 163 (15.1%)
Hemorrhage Related 4 (0.4%) 66 (6.1%) 70 (6.5%)
Pain 0 86 (8%) 86 (8%)
Fever 0 34 (3.1%) 34 (3.1%)
Infections 24 (2.2%) 0 24 (2.2%)
Pulmonary function 4 (0.4%) 4 (0.4%) 8 (0.7%)
CNS Related 1 (0.1%) 7 (0.6%) 8 (0.7%)
Tumor Seeding 1 (0.1%) 0 1 (0.1%)
Excessive Necrosis 1 (0.1%) 0 1 (0.1%)
Pulmonary Embolus 1 (0.1%) 0 1 (0.1%)
Death 4 (0.37%) 0 4 (0.37%)
Total 159 (14.8%) 637 (58.9%) 797 (73.7%)

*  Number of complications reported per session, total of 1081 sessions


Pneumothorax Avoidance Techniques
  • O2 administration
  • Autologous blood administration 5-10 cc’s, if lung punctured
  • Ablation site dependent(位置依赖) at least 2 hours, decubitus position(卧位)  
                  - No change in overall PTX rate  
                  - Significant decrease in PTX requiring intervention(需要干预的气胸显著减少)


  • Quiet respiration-avoid: 
                   - Coughing
                   - Shouting
                   - Valsalva related to lifting or straining
 










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