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⚠️ 风险降低 · 第2课，共6课 · 8 min

术后1至10天：何时出现何种并发症

Post-op Days 1 Through 10: What Goes Wrong When

📆 第一天和第二天关注肺部、出血和膀胱。第三至五天关注伤口、肠道和血栓。第五至十天切口可能裂开。术后并发症有固定的时间表，考试会按这个日程来考你。

📆 Days one and two: lungs, bleeding and bladder. Days three to five: wound, bowel and clots. Days five to ten: the incision might open. Post-op complications keep a schedule, and the exam quizzes you on the calendar.

💡 核心要点

最初48小时关注肺部、出血和膀胱，然后第3至5天关注伤口、肠道和血栓，再到第5至10天关注切口裂开。内脏脱出时使用湿润的无菌纱布，取低Fowler体位并屈膝，保持NPO，并呼叫外科医生。

Lungs, bleeding and bladder in the first 48 hours, then wounds, bowel and clots at days 3 to 5, then dehiscence at days 5 to 10. Evisceration: moist sterile gauze, low Fowler's with knees up, NPO, call the surgeon.

🧠 为什么重要

最初48小时内会出现肺不张和通气不足，表现为低热、湿啰音和血氧饱和度下降；预防方法是清醒时每小时使用激励式肺量计10次，咳嗽时固定切口，并尽早下床活动。出血和低血容量表现为心动过速、低血压、皮肤凉而苍白、烦躁不安和尿量减少；要检查敷料以及患者身下。尿潴留方面应预期患者在6至8小时内排尿；若未排尿则进行膀胱扫描。第3至5天可能出现伤口感染，表现为发热、发红、温热感和脓性引流；麻痹性肠梗阻表现为腹胀、无排气和肠鸣音消失，治疗包括保持NPO状态、置入鼻胃管和下床活动；深静脉血栓形成表现为单侧小腿肿胀和温热感，预防方法包括使用加压装置、尽早下床活动和预防性抗凝剂。第5至10天可能出现切口裂开（切口分离）和内脏脱出（器官突出），常发生在肥胖、糖尿病或咳嗽的患者用力后听到砰的一声并涌出浆液血性液体之后。对于内脏脱出，要用浸有无菌生理盐水的无菌纱布覆盖器官，将患者置于低Fowler体位并屈膝以减少张力，保持NPO，不要将任何东西推回，并呼叫外科医生。恶性高热发生在麻醉期间或麻醉后不久：呼气末二氧化碳升高、肌肉强直和心动过速最先出现，随后出现危险的高体温；治疗包括使用dantrolene和降温。

FIRST 48 HOURS: ATELECTASIS and hypoventilation, shown by a low-grade fever, crackles and a falling saturation; prevent with the incentive spirometer 10 times an hour while awake, coughing with the incision splinted, and early ambulation. HEMORRHAGE and HYPOVOLEMIA: tachycardia, hypotension, cool pale skin, restlessness and low urine output; check the dressing and under the client. URINARY RETENTION: expect voiding within 6 to 8 hours; bladder scan if not. DAYS 3 TO 5: WOUND INFECTION with fever, redness, warmth and purulent drainage; PARALYTIC ILEUS with distention, no flatus and absent bowel sounds, treated with NPO status, a nasogastric tube and ambulation; DEEP VEIN THROMBOSIS with unilateral calf swelling and warmth, prevented with compression devices, early ambulation and prophylactic anticoagulants. DAYS 5 TO 10: DEHISCENCE (the incision separates) and EVISCERATION (organs protrude), often after a 'pop' with a gush of serosanguineous fluid in obese, diabetic or coughing clients. For evisceration: cover the organs with sterile gauze soaked in sterile normal saline, place the client in low Fowler's with the knees bent to reduce tension, keep NPO, do not push anything back in, and call the surgeon. MALIGNANT HYPERTHERMIA occurs during or soon after anesthesia: a rising end-tidal carbon dioxide, muscle rigidity and tachycardia come first, then a dangerous temperature; treat with dantrolene and cooling.

🏥 真实场景

🫢 术后第六天，一名腹部有大切口的患者用力咳嗽，说感觉有什么东西松开了，护士发现敷料上有一段肠管。将无菌生理盐水浸湿的纱布覆盖在肠管上，把床调整为低Fowler体位并屈膝，让患者保持NPO，并呼叫外科医生。将其推回或让患者坐起都会使情况更糟。

🫢 On post-op day six, a client with a large abdominal incision coughs hard, says 'something gave way', and the nurse finds a loop of bowel on the dressing. Sterile saline-moistened gauze goes over the bowel, the bed is lowered to low Fowler's with the knees flexed, the client is kept NPO, and the surgeon is called. Pushing it back or sitting the client up would have made it worse.

📌 要点总结

  • 48小时内：肺不张、出血、尿潴留48 hours: atelectasis, hemorrhage, urinary retention
  • 第3至5天：伤口感染、肠梗阻、DVTDays 3 to 5: wound infection, ileus, DVT
  • 第5至10天：切口裂开和内脏脱出；覆盖、低Fowler体位、NPO、外科医生Days 5 to 10: dehiscence and evisceration; cover, low Fowler's, NPO, surgeon

📖 本课术语

内脏脱出 (Evisceration): 器官从裂开的手术切口突出；用湿润的无菌纱布覆盖并呼叫外科医生。

裂开 (Dehiscence): 手术切口边缘分离，通常在第五至第十天左右。

麻痹性肠梗阻 (Paralytic ileus): 手术后肠道停止蠕动，伴腹胀、无排气和肠鸣音消失。

✅ 自我测试

一名患者在术后第一天体温为38.1 °C（100.6 °F），肺底呼吸音减弱，血氧饱和度为92%。最可能的原因是什么？A client on the first post-operative day has a temperature of 38.1 °C (100.6 °F), diminished breath sounds in the bases and an oxygen saturation of 92%. What is the most likely cause?
  1. 深静脉血栓形成Deep vein thrombosis
  2. 尿路感染Urinary tract infection
  3. 伤口感染Wound infection
  4. 肺不张Atelectasis

答案: D · 肺不张

术后早期发热伴肺底呼吸音减弱是肺不张的典型表现；伤口感染和DVT出现得更晚。

Early post-op fever with diminished basilar breath sounds is classic for atelectasis; wound infection and DVT occur later.

一名患者的腹部切口裂开，可见肠管。护士应首先采取哪项行动？A client's abdominal incision has opened and intestines are visible. Which action should the nurse take first?
  1. 轻轻将肠管推回内部并加压包扎Gently push the intestines back inside and apply a pressure dressing
  2. 将患者置于高Fowler体位Place the client in high Fowler's position
  3. 用湿润的无菌纱布覆盖肠管Cover the intestines with moist sterile gauze
  4. 给患者一杯水以保持水分Give the client a glass of water to stay hydrated

答案: C · 用湿润的无菌纱布覆盖肠管

湿润的无菌纱布可保护组织。患者保持NPO，取低Fowler体位并屈膝，并立即呼叫外科医生。轻轻将肠管推回内部并加压包扎是错误的做法，因为重新置入暴露的肠管可能损伤组织并引入感染。

Moist sterile gauze protects the tissue. The client is kept NPO in low Fowler's with knees flexed, and the surgeon is called immediately. Gently pushing the intestines back inside and applying a pressure dressing is wrong because reinserting exposed bowel can injure tissue and introduce infection.

术后第4天哪项发现应由护士报告为可能的麻痹性肠梗阻？Which post-operative finding on day 4 should the nurse report as a possible paralytic ileus?
  1. 排气并能耐受清流质Passing flatus and tolerating clear liquids
  2. 肠鸣音消失且无排气Absent bowel sounds and no flatus
  3. 活动时有轻度切口疼痛Mild incisional pain with movement
  4. 手术以来有两次软质成形大便Two soft formed bowel movements since surgery

答案: B · 肠鸣音消失且无排气

腹胀、肠鸣音消失和无排气提示肠梗阻；患者保持NPO，可能需要置入鼻胃管。排气并能耐受清流质表明肠道功能正在恢复，与肠梗阻相反。

Distention, absent bowel sounds and no flatus indicate ileus; the client is kept NPO and a nasogastric tube may be needed. Passing flatus and tolerating clear liquids show the bowel is working again, the opposite of an ileus.

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