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肝癌及经肝动脉化疗栓塞术后的护理
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肝癌及经肝动脉化疗栓塞术后的护理
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关注百度医学微信公众账号，医界大数据你比别人先知道相关热词相关学者相关期刊→ 脑栓塞引起的并发症，肺部感染，肝肾功能不
脑栓塞引起的并发症，肺部感染，肝肾功能不
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我爸二十几天前被确诊为右脑脑栓塞，经溶栓治疗后出现了一些并发症，肝肾功能不全，电解质高，钠路高，左fei有个肺脓肿，而且心脏不好，现在血糖也高，请问这种情况能治好吗？最佳治疗到什么程度？
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擅长: 脑出血,脑梗死后遗症治疗,颈椎病,腰椎键盘突出,小
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&&&&&&病情分析：&&&&&&脑栓塞是脑梗塞中较为严重的，栓塞后会有一些并发症，治疗中用的药物会影响患者的肝肾功能。&&&&&&指导意见：&&&&&&现阶段最重要的是稳定患者的病情，预防栓塞的再次发生，控制好血压血糖，改善肝肾功能，肺脓肿建议到呼吸科进行系统治疗，具体预后怎样还是要看患者的身体状况和病情轻重。
擅长: 擅长临床常见疾病的诊疗，手足癣，带状疱疹急慢性湿疹
帮助网友：20115称赞：153
&&&&&&病情分析：&&&&&&一般情况下，如果治疗合适，身体底子比较好，可以治好，最好可以正常生活。&&&&&&指导意见：&&&&&&注意休息饮食起居，少吃辛辣刺激，少吃鱼虾海鲜，少吃生冷食物。多喝温热蔬菜汤，多喝温热米粥
疾病百科| 肾功能不全
挂号科室：肾内科
温馨提示：可多食新鲜的水果和蔬菜，以保证维生素的摄入量。
肾功能不全（renal insufficiency）是由多种原因引起的，肾小球严重破坏，使身体在排泄代谢废物和调节水电解质、酸碱平衡等方面出现紊乱的临床综合症后群。分为急性肾功能不全和慢性肾功能不全。...
好发人群：原基础疾病继发
是否医保：医保疾病
常见症状：厌食、腹部不适、恶心、呕吐、腹泻、舌炎、
治疗方法：西药治疗、中药治疗、手术治疗、饮食治疗、生活调理
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由于肝脏的双重血供，肝动脉肝动脉闭塞闭塞引起的肝脏梗死少见。肝动脉闭塞可由动脉粥样硬化、，形成、或休克引起，偶尔在或口服避孕药后亦可发生肝动脉血栓形成。本病发病急骤，病情凶险，除非早期诊治，病死率高。肝动脉闭塞极其少见，本病很少能于死亡前作出诊断。其后果取决于闭塞的部位，以及可形成侧枝循环的范围。若闭塞位于胃、十二指肠动脉及胃右动脉起源的近端，则往往有足够的侧枝循环形成，因而患者能继续生存;若闭塞位于这些动脉起源的远程，则其结果随动脉的种类而异。曾有人报导因手术时不慎结扎肝动脉而致死亡的病例，但亦有能恢复者。继续生存的患者，建立了经膈动脉或肝包膜下动脉的良好侧枝循环。血栓形成缓慢的患者预后较突然阻塞者为佳。若同时发生门静脉阻塞，则往往致命。肝动脉闭塞的后果是肝脏梗塞，文献报导真正的肝脏梗塞仅123例。本病属中医腹痛、脱证等病证范畴。
肝动脉闭塞 -
(一)发病原因
肝动脉闭塞的原因可为栓塞，血栓形成，外来压迫，血管壁增厚和医源性因素等，，亚急性心内膜炎脱落的栓子;炎症，肿瘤浸润及肝动脉受损伤时血栓形成;恶性肿瘤的外来浸润和压迫;动脉硬化时的血管壁增厚，内膜破坏，增生或脱落，继发血栓形成以及外科手术时的不慎结扎等，均可导致肝动脉闭塞，近年来随着介入技术的普及，在导管造影检查或介入栓塞治疗中，导致肝动脉栓塞者有上升趋势，故严格选择适应证，严格技术操作规范，以便尽可能减少意外和不良后果。
(二)发病机制
肝动脉闭塞的后果是肝脏梗死，若同时发生门静脉阻塞，则往往致死，肝动脉阻塞发生于正常肝的病死率高于肝硬化患者，肝脏梗死大小视侧支动脉循环范畴而定，病变区的中央苍白，其四周充血出血：中央区见大量肝细胞坏死，周围虽有肝细胞坏死，但汇管区无大的改变，梗死区内的肝细胞杂乱与不规则。
肝动脉闭塞 -
肝动脉闭塞的症状:
肠麻痹&黄疸&昏迷&紧张&剧痛&脉搏细速&面色苍白&少尿中老年病例居多，发病急骤，突发右上腹剧痛，大汗淋漓，面色苍白，脉搏细速，血压下降，肝区压痛和叩击痛，肌紧张，黄疸迅速加深伴发热，肝功能损害明显，凝血酶原时间急剧延长，且非维生素K治疗所能恢复，多可伴有肠麻痹，少尿，休克和昏迷状态，并且很快死亡，若患者渡过急性期，应注意各系统内脏功能变化及所出现的相应的症状和体征，如脾脏肿大，胰腺肿胀，肠道缺血性表现，肾缺血引起少尿，无尿或尿毒症等。
肝动脉闭塞 -
肝动脉闭塞无特殊的饮食治疗措施，若突然发病，宜食蔬菜、鱼、豆制品、蛋奶、瘦肉等清淡、高蛋白饮食，若患者发生昏迷则宜给予流质、半流质食物或禁食。
肝动脉闭塞食疗方：
(1)大蒜粥：粳米100克，紫皮大蒜30克。蒜去皮后，置沸水中煮1分钟后捞出，将粳米入蒜水中煮成稀粥，再入蒜，同煮为粥。每日晚间食用。本方具有温阳活血化瘀之效，用于阳虚寒凝、瘀血阻络者，瘀热阻滞者慎用。　　
(2)楂梨膏：肥山楂、甜梨各10千克。均去核，共捣取汁，入锅煎熬，加炼蜜120克收膏。任意服之。　　
(3)赤小豆粥：赤小豆适量，浸泡半日后，同粳米100克，煮粥。每日1次。　　
(4)萝卜粥：新鲜萝卜250克，粳米100克。将萝卜切碎，同粳米同煮成粥。每日1次。　　
(5)乌杞汤：首乌、枸杞、泽漆各30克。每日煎水至300毫升，每日2次，每日1剂。　　
(6)人参银耳汤：人参5克，银耳10～15克。先将银耳用温水浸泡12小时，洗净。人参切成小片，用文火煮熬2小时，再入银耳煮熬1小时。分早晚2次服。　　
(7)桃仁粥：桃仁10克，粳米50～100克。桃仁煮熟去皮尖，取汁和粳米同煮粥食。每日服1次。本方具有活血化瘀之效，用于瘀血阻络者。
(8)双耳汤：黑木耳、白木耳各10克，红枣15枚。用温水泡发洗净后放入碗中，加水和少量冰糖，隔水蒸1小时，连汤服食，日2次。本方具有凉血活血之功，用于瘀血阻络，瘀热阻滞者。　　
(9)拔粥：薤白10～15克，葱白2茎，白面粉100～150克。混匀后调入沸水中煮沸即成。分2次服。本方具有温补肾阳之效，用于肾阳不足者。瘀热阻滞者慎用。　　
适宜食物：新鲜蔬菜、水果、瘦肉、蛋类、奶类以及各种豆制，高糖、高蛋白、高维生素的食物，如冬瓜、瓜、米仁、绿豆、黄瓜、鲤鱼等，并多食纤维素高的食物，如芹菜、菠菜、香蕉等。　　
不适宜食物：油腻、煎炸的食物，辛辣、刺激之品。滋补类食物滋补类食物。
肝动脉闭塞 -
本病暂无有效预防措施，积极治疗原发疾病，是最有效的防治措施。一旦本病发生，须积极抢救，绝对卧床休息，保证营养。
肝动脉闭塞 -
肝动脉闭塞治疗应重视饮食及生活调理，加强身体的抗病能力，延缓病情的发展。
肝动脉闭塞中西医结合治疗：国内尚未见中西医结合治疗研究本病的报道，但对本病中医药治疗，在肝科急诊中医药治疗研究是值得开拓的领域。根据本病特点，活血逐瘀同时佐以辛香温通之品如麝香、葱白等，再结合大剂量抗生素，对迅速改善症状有较好疗效。
肝动脉闭塞治疗原则：为抗休克、镇静、止痛、解痉、祛聚、供氧和抗生素应用，同时给予护肝治疗。低分子右旋糖酐可改善内脏的微循环，血浆及其代用品可缓解休克。有条件者应送ICU，充分供氧或人工辅助呼吸，由麻醉医师配合，同时给予解痉、镇痛、静脉快速补液等，以使病人渡过休克及血管痉挛期，期待侧支循环的代偿，同时进一步查明病因、病变部位，以争取针对病因、病情做进一步的处理，如取栓、溶栓等措施。
1.肝络瘀阻&主证：突发右胁或右上腹疼痛，痛势较剧，拒按，痛处不移，难以转侧。身目发黄，尿黄，烦躁或神昏，舌质青紫，脉弦涩。&治则：活血化瘀，疏肝止痛。&方药：少腹逐瘀汤加减。当归、川芎、赤芍各15g，生蒲黄、五灵脂、没药、延胡索各10g，肉桂、干姜、小茴香各6g，三棱、莪朮、红花各10g。并定时吞服三七粉。伴见神昏者可送服紫雪丹以凉肝开窍。
2.肝气闭阻，阳气衰微&主证：神志昏迷、大汗淋漓、面色苍白、鼻鼾息微，手撒肢厥，二便自遗。右胁疼痛拒按，身目黄染，舌质淡、或口唇舌青，脉微欲绝。&治则：回阳救逆。&方药：参附汤频频送服：人参10g，熟附片15g，生姜3片，大枣5枚。见汗出、面红、身热，唇舌干红，脉虚数者，此为亡阴，须用生脉散以救阴敛阳;若见阴阳两亡之证，则当以回阳为先，兼顾救阴。
本病多突发，并很快进入昏迷状态。治疗以积极抢救为主，可参照肝性脑病治疗。
主要是抗菌素的应用，本病由于肝动脉闭塞，导致肝脏梗塞，容易继发感染，所以抗菌素的大量应用尤为重要，应首选青霉素或与其它抗菌素联合运用。
肝动脉闭塞 -
肝动脉闭塞检查项目:
维生素K&白细胞数&凝血酶原时间（PT）&血管造影&肝功能检查
1.血象&白细胞数增多。
2.肝功能试验&谷丙转氨酶，谷草转氨酶明显增高。
3.凝血酶原&时间明显延长，而非维生素K所能恢复。
多普勒超声波检查可见肝动脉血流中断，可有侧支代偿，但少见，肝实质内可有液化灶，CT可见肝实质内有集中或分散的密度减低区，腹腔动脉造影对诊断最有意义，可见肝动脉呈截断或锥状征，其周边可有侧支形成。
肝动脉闭塞 -
肝动脉闭塞诊断
本病属罕见疾病，故缺乏临床描述，患者除具有原发病外，发病骤起，突然右上腹部剧痛，继之有虚脱，血压下降，右上腹部及肝脏边缘压痛，伴肌紧张，黄疸加深，发热，精神较差。
肝动脉闭塞检查
1.血象&白细胞数目增多。
2.肝功能试验&ALT、AST明显增高。&3.凝血原凝血，原时间明显延长，而非维生素K所能恢复。
肝动脉闭塞鉴别诊断
本病生前诊断困难，只有在原有疾病的基础上，有上述临床表现时，可联想到本病。常见的原发病有细胞性心内膜炎、结节性多动脉炎或曾施行艰难的上腹部手术。有鉴于此，本病突发腹痛应与下列疾病相鉴别：1.;2.;3.。
肝动脉闭塞 -
患者往往并发麻痹性肠梗阻，少尿、氮质血症、昏迷，且于短期内死亡。同时或相继发生多脏器动脉栓塞偶可见到。
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保存二维码可印刷到宣传品1. (EASL) (EORTC)EASL-EORTC (BCLC)2011
2(JSH)2010[13](HKLC)BCLCBCLC[3. 14]
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*10=(&3.0 mg/dl)Child-Pugh CTACEChild- Pugh CChild-Pugh A/B HCC
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HCC40 Gray (Gy)-(TARE)-90(90Y)90Y &64.22.5 mm11 mm90YSIR-Spheres&(Sirtex Medical Limited, Australia)TheraSphere& (Biocompatibles, UK)TheraSphere& (2500 Bq)(1.2 /3 GBq)SIR-Sphere&( 40-80 /3 GBq)& & & &&
TheraSphere&1999 FDAHCCTheraSphere&20
30 &m90Y1 GBq(27 mCi)90Y50 Gy SIR-Sphere&2002floxuridineSIR-Sphere&90Y35 &m (: 20&60 &m)15 mL3 GBq90Y 40-80 50 Bq& & & &
TACE100TARE(25-35 )TARE [49-62]Gulec90Y (SIR-Sphere&)401.2 GBq 40.1 494.8 GyTARE100Gy40Gy& & & &
TACETARE463TACE TARE TARETACE[57]TARE()TACE(49% vs. 36%P = 0.052)TARETACE (13.3 vs. 8.4
P = 0.0232)5TARETACE[58] TARETACETACE90Y [5562]99mTc (MAA)-(&20%)&30Gy50Gy-(20%)TARE&&
TAREHCCHCC TACE TACEHCC
TheraSphere&
SIR-Sphere&25 &
4966TACE3.3[63]HCC164515.618.26.813.6[1]EASL(EORTC)HCC4CTMRImRECISTTACE TARE HCC(RECIST) [64]RECISTTACETAREHCCRECISTRECIST (mRECIST) TACETAREEASL mRECISTTACE[65 66]
(AFP)AFPAFP&
TACETACE[1]
TACE3-5cmRFA189HCC&7cmc-TACE
RFARFA[67]RFA TACERFAHCC 5717RFARFA TACE[68]
(Sorafenib Nexavar& Bayer and Onyx Pharmaceuticals)HCCSPACE304HCCDEB-TACE(DEBDOX&)DEB-TACEDEB-TACE
DEB-TACETACETAREHCC (sorafenib) TACETARE II
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