Nursing methods after laryngeal cancer surgery

For patients with advanced laryngeal cancer, most of them currently use a combination of radiotherapy and surgery. However, the repair capacity of normal tissues is damaged after preoperative radiotherapy, which affects postoperative wound healing. The incidence of short-term postoperative complications such as pharyngeal fistula formation, incision and fistula infection is as high as 73%. Wound care for such patients is directly related to surgical efficacy and bed turnover rate, so it is very important.

Special care before surgery

1. Use antibiotics before surgery to prevent infection. Since the pharynx has been cut open during laryngeal surgery, bacterial contamination is inevitable. In addition, after irradiation, the patient's immunity and ability to limit bacterial invasion are reduced, and the normal flora is imbalanced. Therefore, intramuscular antibiotics are given 3 hours before surgery to ensure that the highest blood concentration of antibiotics has been formed in the tissue during infection, so as to achieve the ideal preventive effect. Penicillin, cefotaxime, erythromycin, etc. are commonly used. It is best to do 1-2 throat swab cultures 8 days before surgery and choose the best antibiotics based on drug sensitivity.

2. Before surgery, pay attention to protecting the skin of the surgical field to prevent mechanical stimulation such as friction and scratching. Also avoid using drugs with too much irritation. After the patient is admitted to the hospital, apply 75% alcohol wet compress twice a day.

3. Treat the infected lesions of the oropharynx and nose before surgery, observe the patient carefully and treat any colds or oral ulcers in time. Pay attention to oral hygiene. Rinse the mouth with 5% boric acid solution 3 days before surgery to remove bad breath and treat inflammation of the oral cavity and pharynx.

4. Give high-protein nutrients before surgery: In addition to encouraging patients to eat high-protein foods, if necessary, some amino acids, hypertonic sugar or a small amount of fresh blood can be supplemented intravenously to increase hemoglobin levels and provide the necessary protein and calories for tissue repair.

In addition, psychological care before surgery is also one of the factors that promote wound healing. Patients often develop a defective mentality, and their psychological manifestations are often despair, fear, loneliness, loss of group, resentment, temper and other bad states. At this time, it is very necessary to use some psychological knowledge to care for patients. ① Tell the patient to face the objective reality, relax the mind, stabilize the mood, and have the confidence to overcome the disease, otherwise it will affect the treatment effect. ② Teach the patient some commonly used: sign language, and prepare paper and pen for the patient, encourage the use of writing to express the meaning, and lay the foundation for postoperative treatment. ⑧ Tell the patient that even if he loses his voice, he can practice esophageal sounds fifteen days after the operation, and he can also install an artificial larynx later. ④ Frequently contact the patient, give spiritual support, and give him the greatest comfort in psychological and emotional aspects.

Special care after surgery

1. Appropriate body position: When the patient returns to the ward and wakes up from general anesthesia, the head of the bed can be appropriately raised by 30°-45° to reduce local edema, reduce flap congestion, and reduce the tension of the pharyngeal mucosa.

2. Intermittent suction with a suction device improves efficacy: The drainage tubes of neck dissection and laryngeal surgery should be connected to suction devices respectively to remove exudates and blood clots in time, eliminate dead space, and use negative pressure to make the flap and tissue close together, resulting in blood vessel regeneration and promoting healing. Suction with a suction device 2-3 times a day until the tube is removed.

3. Correct tube changing technique is extremely important to prevent wound infection. Dressings should be changed frequently and wounds should be closely observed. The dressing of the neck incision should be changed once a day. The tracheal tube of the fistula should be changed three times a day three days after surgery, and twice a day thereafter. The wound should be cleaned with 75% alcohol each time. Note: (1) Body position when changing the tube: Instruct the patient to tilt his head back appropriately to fully expose the tracheal opening and avoid scratching the posterior wall mucosa. (2) When inserting the tracheal tube, place an uncut, wrung-out V-shaped alcohol gauze and a dry gauze against the tracheal tube. This can absorb blood and secretions on the wound surface through the wet dressing, prevent the metal tracheal tube from rubbing against the wound, and prevent fiber fibers from accidentally entering the trachea.

Patients who go home with a tracheal cuff should not wear high-necked or round-necked cotton sweaters to keep their airways open. To keep the airway clean and dry, the tracheal cuff should be cleaned regularly. If the cuff is made of plastic, it cannot be soaked in hot water to avoid deformation. After total laryngectomy, the stoma is permanent. If the stoma heals well, try not to wear the cuff during the day and wear it before going to bed at night to reduce the inconvenience of wearing a cuff during the day and prevent stenosis of the tracheostomy. Lubricate the cuff with paraffin oil before wearing it to make it easier to wear.

With the development of science, families with conditions can buy electronic throats to solve the problem of being unable to pronounce after surgery. It is also possible to train esophageal pronunciation or prescribe some actions, and to express and exchange ideas through gestures or writing. In daily life, you should strengthen your diet and eat easily digestible, high-protein, and high-vitamin foods. Swimming is prohibited to prevent soap foam and dirty water from entering the tracheostomy during bathing. Check regularly and contact your doctor as soon as possible if you find any problems or notice any new symptoms.

The above is an introduction to "Care methods after laryngeal cancer surgery". People who are related to the pathogenic factors of laryngeal cancer are advised to take preventive measures against laryngeal cancer. If you have other questions about laryngeal cancer, please consult our experts online or call for consultation.

Laryngeal cancer http://www..com.cn/zhongliu/ha/