As the number one cancer killer in the world, the incidence rate of lung cancer has continued to rise globally in recent years. According to statistics, the incidence rate of lung cancer in China has increased by 26.9% annually and has become the first cause of death from malignant tumors in China. Lung cancer refers to malignant tumors originating from the bronchial mucosa epithelium, also known as bronchopulmonary cancer, with the age of onset mostly above 40 years old, mostly in men. Long-term heavy smoking has a very close relationship with the occurrence of lung cancer, the probability of lung cancer in long-term heavy smokers is 10 to 20 times higher than that of non-smokers, and the younger the age of starting to smoke, the higher the chance of lung cancer.
In addition, smoking not only directly affects one’s own health, but also has a negative impact on the health of the surrounding people, resulting in a significant increase in the prevalence of lung cancer in passive smokers. In addition to routine care, the care of lung cancer patients should also focus on pre- and post-surgical care.
Pre-surgical care respiratory management is the focus of pre-surgical care.
1. Prevention and control of respiratory tract infection
(1) Quit smoking for more than two weeks.
(2) Maintain oral hygiene and treat oral diseases.
(3) Apply antibiotics as prescribed by the doctor.
Keep the respiratory tract unobstructed
(1) Instruct and assist the patient to perform abdominal breathing, effective breathing and coughing up sputum.
(2) Perform postural drainage when there is a large amount of secretion, nebulized inhalation when sputum is viscous, and fibrinoscopic lavage if necessary.
(3) For patients with respiratory dysfunction, perform mechanical ventilation if necessary.
Post-operative care
1.General care
(1) Before the patient is awake from anesthesia, take a flat position with the head to the side.
(2) After the anesthesia is awake and the blood pressure is stable, change to semi-recumbent position.
(3) After lobectomy on one side, generally take the healthy side to lie completely on the side, which is conducive to the expansion of the affected lung. However, in patients with poor respiratory function, the patient should be placed in a flat position or in the lateral position on the affected side to avoid restricting ventilation due to pressure on the healthy side of the lung.
(4) Patients with total lung resection on one side can adopt the affected side 1/4 position.
Note: Assist the patient to change position regularly to help protect the skin and prevent respiratory and circulatory system complications.
2.Observation of condition
The patient’s condition should be closely observed after surgery, and vital signs should be closely monitored, measured once every 15 minutes.
Pay attention to: whether the patient has respiratory distress, observe the patient’s consciousness, facial color, peripheral circulation, and check whether the incision dressing has hemorrhagic fluid exudation, etc.
3, respiratory care respiratory care is the focus of post-surgical care.
(1) Routine oxygen inhalation: 2~4L/min.
(2) Observe the respiratory frequency, rhythm and amplitude, and observe whether there is cyanosis, shortness of breath and other signs of hypoxia.
(3) Encourage the patient to breathe deeply, cough effectively and expel sputum. If necessary, loosen the secretions stored at the lung lobes and segments by turning and patting the back to flow into the bronchi and discharge.
(4) If the sputum is sticky, nebulized inhalation can be used to dilute the sputum, and bronchoscopic aspiration is also feasible if necessary.
4.Nutrition and fluid infusion
Postoperative patients should follow the medical prescription for intravenous infusion to maintain fluid balance, and strictly control the amount and rate of infusion.
For total lung resection: the 24-hour rehydration volume should be controlled within 2000ml, and the speed should be 20~30 drops/min.
5.Activity and exercise
Encourage and guide patients to get out of bed early to improve respiratory and circulatory functions and prevent pulmonary atelectasis; strengthen functional exercise of the arm and shoulder joint to prevent muscle adhesions of the chest wall on the operated side, shoulder joint ankylosis and disuse atrophy, etc.
6.Post-surgical complications
Some complications may occur after lung cancer surgery, which should be prevented and treated.
(1) Pulmonary atelectasis and pneumonia: emphasis on preventive measures: oxygenation, application of antibiotics, encouraging and assisting patients to cough and excrete sputum, etc.
(2) Bronchopleural impotence A few patients will have a serious complication of bronchopleural fistula after pneumonectomy, which mostly occurs one week after surgery.
Presentation: fever, shortness of breath, irritating cough with bloody sputum, and signs of pneumothorax.
Diagnosis: 1 to 2 ml of methylene blue is injected into the pleural cavity through a closed chest drainage tube, and the diagnosis of bronchopleural fistula is confirmed if the patient coughs up blue sputum.
Care measures: Continuous closed chest drainage, antibiotics, and preparation for surgical repair of the fistula if necessary.
Let the patient understand the dangers of smoking and advise him to quit smoking. Maintain good nutritional status and pay attention to rest and activity. Maintain good oral hygiene and prevent respiratory tract infections. Avoid public places or contact with people with upper respiratory tract infections, and avoid contact with smoke and chemical irritants for some time after surgery. Review regularly after discharge from the hospital. If there are symptoms such as progressive fatigue, wound pain, severe cough, hemoptysis, etc., the possibility of recurrence should be considered and return to the hospital for timely follow-up.