2021年10月28日星期四

Ten people and nine hemorrhoids?! The Health Commission released the clinical path of thrombotic external hemorrhoids. It turns out that hemorrhoids are diagnosed and treated in this way

Clinical pathway of thrombotic external hemorrhoids

(2019 Edition)

1、 Clinical pathway standard hospitalization process of thrombotic external hemorrhoids

(1) Applicable object

The first diagnosis was thrombotic external hemorrhoids (ICD-10: i84.3), and thrombotic external hemorrhoidectomy was performed (icd-9-cm-3: 49.47).

(2) Diagnostic basis

According to clinical diagnosis and treatment guidelines · surgery volume (compiled by Chinese Medical Association, people's Health Publishing House, 1st edition, 2006).

1. Clinical manifestations: anal discomfort, dampness and uncleanness; In case of thrombosis, local anal pain and sudden onset.

2. Physical examination: Digital anorectal examination, rectal, sigmoid colonoscopy or fiber colonoscopy when necessary.

(3) Treatment options

According to clinical diagnosis and treatment guidelines · surgery volume (compiled by Chinese Medical Association, people's Health Publishing House, 1st edition, 2006).

1. General treatment: including increasing water intake and dietary fiber, keeping stool unobstructed, preventing constipation and diarrhea, warm hip bath, keeping perineum clean, etc.

2. Surgical treatment: thrombotic external hemorrhoids are usually accompanied by obvious pain. Emergency surgery should be performed to reduce pressure and remove thrombus.

(4) The standard hospital stay is 3 days

(5) Entry path criteria

1. The first diagnosis must comply with ICD-10: i84.3 code of thrombotic external hemorrhoids.

2. When the patient has other disease diagnoses at the same time, but does not need special treatment during hospitalization and does not affect the implementation of the clinical path process of the first diagnosis, he can enter the path.

(6) Preoperative preparation (preoperative evaluation) 1 day

1. Necessary inspection items:

(1) Blood routine and urine routine;

(2) liver and kidney function, electrolytes, coagulation function, blood type, infectious diseases screening (hepatitis B, hepatitis C, syphilis, AIDS, etc.);

(3) ECG, X-ray chest film.

2. Rectum, sigmoid colonoscopy or fibroenteroscopy should be performed when necessary.

(7) Selection and timing of prophylactic antibiotics

Prophylactic antibiotics: it shall be implemented in accordance with the guiding principles for clinical application of antibiotics (WYF [2015] No. 43), and the selection of antibiotics shall be determined in combination with the patient's condition.

(8) The operation day is the day of admission

1. Anesthesia: local anesthesia, subarachnoid anesthesia, continuous epidural anesthesia or combined epidural subarachnoid block anesthesia.

2. Thrombotic external hemorrhoidectomy was performed in emergency operation.

3. Send postoperative specimens to pathology.

(9) Postoperative hospitalization recovered for 2 days

1. Patients under local anesthesia can eat after operation and get out of bed and eat after half an hour.

2. Patients under continuous epidural anesthesia or combined spinal epidural anesthesia should go to the pillow and lie flat, fast and water for 6 hours after operation, and be rehydrated; 6 hours after operation, you can get out of bed and eat liquid diet.

3. Change dressing 1 ~ 2 times a day. When the wound is deep, place gauze for drainage and keep the drainage unobstructed.

4. Postoperative medication: local medication (suppository, plaster, lotion), oral medication, physical therapy, etc.

5. Treatment of postoperative abnormal reaction:

(1) Pain management: sedatives, analgesics, patient-controlled analgesia pump, etc. shall be selected as appropriate.

* (2) prevention and management of postoperative urinary retention: physical therapy, acupuncture, local closure, catheterization, etc.

(3) Wound bleeding treatment: dressing change, bleeding point compression, use hemostatic agent.

(4) Defecation difficulty: defecate softening drugs are taken orally, and enema is induced when necessary.

(5) Wound edema: use local or systemic anti edema drugs.

(6) Treatment of postoperative secondary massive hemorrhage.

(7) Other treatment: vomiting, fever, headache, etc., symptomatic treatment.

(10) Discharge criteria

1. The patient is generally in good condition, with normal diet, smooth defecation, no obvious anal pain during defecation, normal laboratory results and normal body temperature.

2. There is no abnormal secretion in the wound of anus, the drainage is unobstructed, and there is no obvious edema and bleeding.

(11) Variation and cause analysis

1. In case of complications such as secondary incision infection or persistent massive hemorrhage after operation, the hospital stay will be prolonged and the cost will be increased.

2. With other basic diseases, further diagnosis is needed, resulting in prolonged hospitalization and increased costs.

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