Lawrence D M
Crit Care Nurs Clin North Am. 1993 Mar;5(1):127-40.
The incidence of gastrointestinal trauma is low in comparison with solid organ injury to the abdomen. The most commonly injured organs are the small bowel and colon. Knowledge of the mechanism of injury alerts the nurse to areas of potential injury and guides the clinical examination. Because of the delayed presentation of these injuries, the nurse must have a high degree of suspicion for the patient who presents with the following clinical findings: bruising of the abdomen, abdominal tenderness or guarding, leukocytosis and elevated amylase and lipase, absent or decreased bowel sounds, and abdominal distention. Morbidity and mortality are directly related to the failure to treat the injuries early and the number of associated injuries. Monitoring of the hemodynamic, respiratory, and metabolic status, along with fluid and electrolyte balance, are key in the management of patients. Surveillance for signs of infection is mandatory for preventing sepsis in these types of injuries. Maintenance of skin integrity is a major concern and requires vigilant nursing care and, in some instances, innovative ways to manage the drainage from wounds and drains. Continuous monitoring and surveillance of the patient with trauma to the gastrointestinal tract will alert the nurse to the injury and prevent complications. These include hemorrhage, abscess, fistula, peritonitis, pancreatitis, esophageal stricture, and wound problems.
与腹部实质性器官损伤相比，胃肠道创伤的发生率较低。最常受伤的器官是小肠和结肠。了解损伤机制可使护士警惕潜在的损伤部位，并指导临床检查。由于这些损伤的症状出现较晚，对于出现以下临床表现的患者，护士必须高度怀疑：腹部瘀伤、腹部压痛或肌紧张、白细胞增多以及淀粉酶和脂肪酶升高、肠鸣音消失或减弱、腹部膨隆。发病率和死亡率与未能早期治疗损伤以及相关损伤的数量直接相关。监测血流动力学、呼吸和代谢状况以及液体和电解质平衡，是患者管理的关键。对感染迹象进行监测对于预防这类损伤中的败血症至关重要。维持皮肤完整性是一个主要关注点，需要警惕的护理，在某些情况下，还需要创新的方法来处理伤口和引流管的引流。对胃肠道创伤患者进行持续监测和观察，将使护士发现损伤并预防并发症。这些并发症包括出血、脓肿、瘘管、腹膜炎、胰腺炎、食管狭窄和伤口问题。
