What Is Abdominal Trauma?

Abdominal trauma is a more common serious trauma both in peacetime and wartime. Its incidence is about 0.4% to 1.8% of various injuries in peacetime; about 5% to 8% in wartime. 4% during the battle.

Abdominal trauma is a more common serious trauma both in peacetime and wartime. Its incidence is about 0.4% to 1.8% of various injuries in peacetime; about 5% to 8% in wartime. 4% during the battle.

Chinese name

Abdominal trauma

Foreign name

celiac trauma

Department

General Surgery

Abdominal trauma symptoms and signs

1. Nausea, vomiting, blood in the stool, hematuria.

2. Physical examination pay attention to blood pressure, pulse, breathing, whether there are signs of shock, abdominal wall skin with bleeding, ecchymosis, closed injury or open injury, check the wound for visceral prolapse or organ contents flowing out, whether abdominal type Respiratory movement restriction, abdominal distension, abdominal muscle tension, tenderness, mobile dullness, bowel sound reduction or disappearance of visceral damage and signs of intra-abdominal bleeding. Digital rectal examination for tenderness or lumps, and no blood stains on finger cuffs. All abdominal penetrating injuries (open wounds penetrating the peritoneum) should be considered as having the possibility of visceral injury. For chest, lumbosacral, hip and perineal injuries (especially firearm injuries), the abdomen must be carefully examined.

Incidence and mortality of abdominal trauma

The key problem of abdominal trauma is whether there is damage to internal organs. The only result is a simple abdominal wall trauma, which does not pose much threat to the life of the injured. What is important is the major bleeding and shock, infection and peritonitis caused by visceral injury. Failure to diagnose and treat in time will endanger the life of the wounded, and its mortality rate can reach 10-20%. Therefore, the wounded with abdominal trauma should be diagnosed and treated as soon as possible.

The mortality of abdominal trauma is closely related to the time from injury to definitive surgery. 90% of those who receive the correct treatment within two hours of injury are expected to cure. With the delay of time, the mortality rate has increased significantly. Therefore, to reduce mortality, we must first try our best to shorten the time from injury to definitive surgery. At the same time, we must improve rescue and diagnosis techniques to prevent missed diagnosis.

Classification of abdominal trauma and its characteristics

Abdominal injuries can be divided into two categories: open injuries and closed injuries:

Open abdominal wound

Most commonly seen in wartime, mainly caused by firearm injuries, can also be caused by sharp weapon injuries. In the case of penetrating injuries, there are entrances and exits, and blind tube injuries only have entrances and no exits. Open injuries can be divided into penetrating injuries and non-penetrating injuries. The former means that the peritoneum has been penetrated, and most of them are accompanied by abdominal organ damage. The latter is that the peritoneum is still intact and the abdominal cavity is not in communication with the outside, but it may also damage the abdominal cavity. Internal organs.

Abdominal trauma

It is caused by blunt violence such as squeezing, collision and knock, and can also be divided into two types: abdominal wall injury and abdominal visceral injury. Compared with open injuries, closed injuries have more important clinical significance. Because open lesions are often diagnosed, even if they involve the internal organs. Closed wounds have no wounds on the surface, and it is sometimes difficult to determine the presence of visceral damage. If it is not possible to determine early on whether the internal organs are damaged, it is likely to delay the operation and cause serious consequences.

Clinical manifestations of abdominal trauma

Symptoms and signs of simple abdominal wall injury are generally mild. Local abdominal wall swelling, pain and tenderness are common, and subcutaneous bruising is sometimes seen. Their extent and scope do not increase or expand over time. Simple abdominal wall injuries usually do not show nausea, vomiting, or shock.

With abdominal organ damage, its clinical manifestations vary depending on the nature and degree of damage to the damaged organ. Generally speaking, the main clinical manifestations of intra-abdominal rupture of the internal organs (liver, spleen, mesentery, etc.) It is internal hemorrhage, which is mainly manifested by shock. The main clinical manifestations of intra-abdominal cavity organ damage (gastrointestinal, gallbladder, bladder, etc.) rupture are peritonitis.

(I) General condition: The wounded are often in a state of excessive nervousness, pale, sweaty, and cold skin. Generally, they have no unconscious disturbance; if there is a disturbance of consciousness after the injury, it is necessary to consider whether there is a brain injury. In the early stage of abdominal injury, even if there is no visceral injury, the pulse rate may increase due to severe pain and the blood pressure temporarily rises, but it can return to normal after rest. If the internal organs are injured, as the amount of bleeding increases, the pulse speeds up, weakens, blood pressure drops, and finally shock occurs. The effect of gastrointestinal rupture on pulse and blood pressure is related to the site of injury. Stomach and duodenum rupture, the peritoneum is strongly stimulated by chemical gastrointestinal fluid, and early shock symptoms such as increased pulse rate and decreased blood pressure appear, but they can improve after a short period of time, and then again when bacterial abdominal inflammation is obvious deterioration. Ileum, colon rupture, because the contents of the intestine are less irritating, there may be no blood pressure and pulse changes in the early stage.

(B) Abdominal pain and abdominal internal organ injuries, except for a few people with severe brain trauma and shock, have symptoms of abdominal pain, and the incidence rate is 95 to 100%. After the injury, the wounded sustained unbearable severe pain, which means that there was serious injury in the abdominal cavity. The early wounded reported that the most painful part was often the part of organ damage, which was very helpful for diagnosis.

(3) Nausea and vomiting, rupture of cavity organs, and internal bleeding can stimulate the peritoneum, causing reflex nausea, vomiting, and bacterial peritonitis. Vomiting is a manifestation of intestinal paralysis, which is mostly persistent.

(IV) Abdominal distension is not obvious in the early stage, and after intestinal paralysis due to peritonitis in the later stage, abdominal distension is often obvious. Retroperitoneal hematomas can also cause intestinal paralysis, abdominal distension and low back pain due to the stimulation of the retroperitoneal visceral plexus.

(V) Peritoneal irritation signs such as abdominal tenderness, rebound pain, and muscle tension. In addition to simple spleen rupture, the peritoneal irritation is mild, and other abdominal organ injuries have more obvious peritoneal irritation signs. The most obvious place for tenderness is often where the organs are damaged.

(6) The disappearance of the liver dullness boundary is of diagnostic significance for closed injuries, which mostly indicates that the cavity organs are ruptured, and the gas enters the abdominal cavity to form subsacral gas.

(7) The occurrence of mobile dullness early after mobile dullness injury is the basis for intra-abdominal bleeding or extravasation of urine. Fixed dullness may occur in the ruptured organ parts, which is caused by the accumulation of clots near the organs.

(8) The bowel sounds are weakened or disappeared in the early stage due to the suppression of reflex bowel motility, and the bowel sounds are weakened or disappeared in the later stage due to peritonitis and intestinal paralysis.

Diagnosis of abdominal trauma

Understanding the injury process and obtaining signs are the main content of the diagnosis of abdominal injury, but sometimes because of the emergency, understanding the history of the injury and checking the signs are often performed simultaneously with some necessary treatment measures (such as hemostasis, infusion, anti-shock, maintaining airway patency, etc.) . Whether the abdominal trauma is open or closed, the presence of visceral damage should be determined first, and then the nature, location and severity of the organ damage should be analyzed. At the same time, there should be attention to the existence of multiple injuries to the life association outside the abdomen. In order to make a correct diagnosis early and treat it promptly.

Abdominal trauma

1. The presence or absence of visceral injuries. Most of the injured patients have typical clinical manifestations. It is generally not difficult to determine whether the internal organs are damaged, but many of them are not easy to diagnose. This condition is often seen in early visits and the signs of abdominal internal organ damage are not obvious. In order to solve this difficulty, it is necessary to conduct close observation for a short time. It is worth noting that some injured persons have more serious combined injuries outside the abdomen, which may cause the performance of abdominal organ damage to be masked, or may be drawn to the combined injuries due to the attention of the injured person, companion, and even medical staff. Manifestations while ignoring abdominal conditions. For example, when a brain injury is combined, the injured person may not be able to provide the conscious symptoms of abdominal injury due to a disturbance of consciousness; when a chest injury is combined, people's attention is drawn to the chest due to dramatic breathing difficulties; when a long bone fracture is combined The severe pain and dyskinesia in the fracture area make people ignore the abdominal condition. To prevent missed diagnosis, you must:

(1) Learn more about the injury history, including the time of injury, the location of the injury, the conditions of the injury, the injury, the change in the injury from the injury to the consultation, and the emergency treatment before the consultation. When the injured person has a disturbance of consciousness or cannot answer questions due to other circumstances, he should ask the witnesses or escorts on the scene.

(2) Pay attention to the observation of the whole body, including the measurement of pulse rate, respiration, temperature and blood pressure, and pay attention to the signs of shock.

(3) A comprehensive and focused physical examination, including the degree and scope of abdominal tenderness, muscle tension and rebound pain, whether there is a change in liver dullness or mobile dullness, and whether a positive digital rectal examination has a positive finding. Attention should also be paid to any injuries outside the abdomen.

(4) Perform necessary laboratory inspections. When there is substantial rupture of organs in the abdomen and bleeding, the values of red blood cells, hemoglobin, and hematocrit can be decreased, while the white blood cell count is slightly increased. When the cavity organs are ruptured, the white blood cell count can be significantly increased. Routine urine tests can help detect damage to the urinary organs. When the pancreas is injured, the value of hematuria amylase increases.

Abdominal trauma physical examination

Pay attention to blood pressure, pulse, breathing, whether there are signs of shock, whether there is bleeding or ecchymosis of the skin of the abdominal wall, closed or open wounds, check whether there is visceral prolapse or organ contents flowing out of the wound, and whether there is abdominal breathing Limitation, abdominal distension, abdominal muscle tension, tenderness, mobile dullness, weakening or disappearing of bowel sounds and signs of intra-abdominal bleeding. Digital rectal examination for tenderness or lumps, and no blood stains on finger cuffs. All abdominal penetrating injuries (open wounds penetrating the peritoneum) should be considered as having the possibility of visceral injury. For chest, lumbosacral, hip and perineal injuries (especially firearm injuries), the abdomen must be carefully examined.

Abdominal trauma test

Blood and urine routine, if there is hematuria, it indicates urinary tract damage. In severely injured patients, indwelling the catheter to observe the hourly urine output and its characteristics is more important for those with traumatic shock. When pancreatic injury is suspected, blood and urinary amylase must be checked, and the disease should be re-examined to observe the changes. Suspected internal hemorrhage, hematocrit and blood group identification and blood preparation should be made.

Abdominal trauma examination

If the injury allows, you can do X-ray examination, such as abdominal fluoroscopy or radiographs, you can observe the presence of pneumoperitoneum, diaphragm position and its range of motion, the presence of metal foreign bodies and its location, and can also show the presence of spine and pelvic fractures. Low rib fractures should be noted for liver and spleen rupture. For patients with suspected substantial organ damage and intra-abdominal hemorrhage, ultrasound, CT, or selective abdominal angiography may be used to assist diagnosis when the condition permits. Diagnostic abdominal puncture and lavage

(1) Diagnostic abdominal puncture: The bladder should be emptied before puncture. The puncture point is located in the upper quadrant, upper right, lower left, and lower right quadrants of the abdomen. Generally, the lower left or lower right quadrant is used for puncture. Take the puncture point at the junction of the middle and outer 1/3 of the umbilical cord and the anterior superior spinal cord. When puncturing the upper abdomen, select the needle insertion point along the outer edge of the rectus abdominis. The patient was supine or laterally lying on the injured side, and punctured with a 18-gauge needle with a short beveled tip (the tip of the bevel pointed outwards). When the resistance of the needle was reduced, it indicated that the abdominal cavity had been punctured, and suction could be performed. Aspiration of non-coagulant or turbid liquid is positive. If the puncture technique is correct, the intra-abdominal bleeding or cavity organ perforation can be clearly diagnosed. The puncture on the injured side should be used to prevent false positive results from penetrating the posterior peritoneal hematoma. When one puncture is negative, puncture can be performed in the other three quadrants. Patients with coma, craniocerebral injury, and chest injury who are suspected of having multiple puncture failures but still suspected of having abdominal organ damage can be diagnosed with diagnostic lavage.

(2) Diagnostic peritoneal lavage: The patient is supine, the bladder is emptied, and local anesthesia is performed on the midline of 3cm of water below the umbilicus. The abdominal cavity is punctured at a 30 ° angle with a 14 gauge needle connected to the syringe. Tube, insert a silicone tube with a side hole into the pelvic cavity (usually 20 to 25 cm) through the needle, and then remove the needle. A physiological saline bottle was connected to the outer end of the tube, and it was slowly injected into the abdominal cavity at a volume of 20 ml / kg of physiological saline. After the liquid has run out, lower the infusion bottle so that the lavage fluid in the abdominal cavity flows back into the bottle by siphoning. After the operation, the silicone tube was pulled out, and the puncture site was covered with sterile gauze. Take the effluent for microscopic examination (the cell count exceeds 0.01 × 1012 / L, and the white blood cell count exceeds 0.5 × 109 / L. When it has diagnostic significance) and amylase determination. This procedure often yields positive results, even if there is less hemorrhage or exudation in the abdominal cavity.

(3) Radiological examination: If the condition permits, the wounded of abdominal trauma should take radiograph of chest and abdomen. Fractures of the lower ribs were observed on plain chest radiographs. A flat film of the abdomen can be observed to accumulate gas under the diaphragm, changes in the size, shape and position of some organs. These are helpful for the diagnosis of abdominal internal organ damage. For example, when the spleen is ruptured, the left diaphragm is elevated, the stomach is moved to the right, the space between the stomach and the colon is widened, and the left lower rib is fractured. Selective arteriography can also be performed in certain places, which has certain diagnostic value for the site of visceral bleeding; urethral cystography can help diagnose urethral bladder damage; even CT examination is feasible. However, due to the more severe injuries of abdominal injuries, some of them are in shock. In fact, these tests are often very limited. (4) Ultrasound examination is helpful to check the shape, size and internal fluid of abdominal cavity, but there are many false positives and false negatives.

In addition, radionuclide scanning, laparoscopy, etc. can be performed under conditions, but due to the need for special equipment, the situation of the wounded is severely limited.

Abdominal trauma firearm injury

Abdominal battle injuries are mainly penetrating wounds. Because there is a wound in the abdomen, diagnosis is generally not difficult. From the wound site and the direction of the wound path, the posture at the time of the injury is combined. It can be judged whether there is an organ injury in the abdomen. If there is visceral prolapse in the wound, the content of the intestine or more blood flows out, the diagnosis can be confirmed. For open abdominal injuries, as long as the peritoneum is punctured, it should be an indication of laparotomy in the field, but the entrance to the trauma is outside the abdomen. If the abdominal signs are not obvious, it can cause a diagnostic error. Although the direction of the wound can be estimated for the internal organs of the abdomen, it is not certain because the caliber of light weapons is small and the bullet is light. After hitting the human body, it can change the direction when it encounters tissues of different densities. For wounded patients whose entrances and exits are in the lower chest, lumbosacral region, hips, thighs, or perineum, the abdomen must be examined in detail to see if there are organ damage. For example, in a group of 329 cases of abdominal firearm injuries, 135 cases were not in the abdomen, accounting for 41%. Among thoracoabdominal injuries, there are more diagnosis of abdominal injuries. For example, in a group of 75 cases of thoracoabdominal injuries, 28 cases were missed in the first-line hospital, accounting for 39.3%. Due to obvious chest wounds and dramatic respiratory symptoms, doctors often focus on chest injuries and ignore abdominal injuries during rescue. In short, the diagnosis of abdominal visceral injuries that do not involve the abdominal wall must be combined with various abdominal closure injuries. Check and analyze carefully. If suspicious abdominal internal organ injuries are difficult to rule out, a laparotomy should be performed in time.

Precautions for abdominal trauma

The diagnosis of abdominal trauma under field conditions should be compared with the following: Due to the simple equipment under field conditions, some routine examinations are difficult to perform in the battlefield. Therefore, the diagnosis of abdominal trauma mainly depends on clinical physical examination and should not be overly dependent Laboratory tests, radiological examinations and other special inspections.

Suspicious abdominal trauma due to less manpower. The wounded are highly mobile, and it is difficult to observe systematically for a long time. It is necessary to make a decisive decision as soon as possible.

In the diagnosis of abdominal injuries during wartime, as long as there are certain visceral injuries, even if one or some organ injuries cannot be determined, a laparotomy should be performed as soon as possible.

During the war, wounds in the closed abdomen or wounds in the perineum, buttocks, and pubic hair area should be carefully judged if there are signs of abdominal irritation. Do not miss or misdiagnose.

It is difficult to exclude the internal visceral wounds in clinical examination. It is feasible to perform laparotomy to explore, and it is not advisable to take the risk of evacuating the injured with visceral injuries. The indications for laparotomy during wartime should be appropriately relaxed than usual to avoid missed diagnosis and treatment.

First aid for abdominal trauma

The first aid for patients with abdominal trauma is the same as the first aid for other organ injuries. It should be checked first for immediate life-threatening conditions and should be dealt with promptly. First, pay attention to check for respiratory obstruction and respiratory dysfunction, and remove respiratory secretions. And foreign bodies to keep the airway unobstructed, if there is an immediate life-threatening situation such as open pneumothorax, obvious external bleeding, etc., it should be promptly dealt with. If there is a fracture in the extremities, it should be initially fixed before moving. Shock should be actively prevented before the shock occurs, such as keeping warm in winter, preventing heatstroke in summer, keeping the wounded quiet, analgesics (prevention of analgesics such as morphine, etc.) and supplemental fluids. When the shock occurs, rapid blood transfusion and infusion must be performed to recover as soon as possible Blood volume will make blood pressure rise. It is best to use the upper extremity for the input vein, because in abdominal injuries, there may be vascular damage to the inferior vena cava system. Transfusion of lower limbs may increase internal bleeding. When an abdominal wound is found, it should be bandaged immediately. For those with visceral prolapse, it is generally not allowed to return randomly to avoid contaminating the abdominal cavity. Cover it with a first aid kit or a large piece of dressing, and then cover the viscera with a military bowl (or a wide belt as a protective ring) to prevent compression, and then bandage it outside. If the prolapsed bowel is likely to be strangulated, the wound can be enlarged and the internal organs can be returned to the abdominal cavity. Therefore, the main contradiction is intestinal necrosis rather than infection.

If the prolapsed internal organs are ruptured, in order to prevent the contents from flowing out, you can use pliers to temporarily close the intestinal laceration and wrap the pliers in the dressing together with the wounded. If there is a large defect in the abdominal wall and more organs prolapse, the internal organs should be returned to the abdominal cavity during emergency treatment to avoid exacerbation of shock due to exposure.

At the same time of emergency treatment, the use of antibiotics such as tetanus antitoxin and other suspected visceral injuries should be fasted, if necessary, gastrointestinal decompression tubes can be placed to suck the stomach contents. The wounded who have urinary retention should be checked for catheterization, and the catheter should be left in place to observe the hourly urine output.

After the emergency treatment, under strict observation, send back as soon as possible. During the delivery, you should pad your knees with clothing to make the hips and knees semi-flexed to reduce abdominal wall tension and reduce the pain of the injured.

Abdominal trauma treatment plan

Abdominal trauma treatment principles

Symptoms and signs should be observed closely. Those who have the following conditions should immediately conduct surgical exploration:

(1) Closed abdominal injury, positive abdominal puncture or X-ray examination showed free gas under the diaphragm.

(2) Patients with open abdominal injury and signs of peritonitis.

(3) During the observation period, the general condition deteriorated, even in shock.

(4) When the patient comes to the hospital, he is in a state of shock, and should be actively anti-shock. When the systolic blood pressure exceeds 12.0kPa and can be moved, the surgeon will be sent directly to the operating room for surgery; Those who are in severe condition are not allowed to move, and can be rescued while anti-shock in the emergency operating room.

Preoperative preparation for abdominal trauma

(1) Quickly remove airway obstruction, ensure airway patency, perform cardiopulmonary resuscitation, actively resist shock, quickly control external bleeding, and deal with immediate life-threatening brain injury, open pneumothorax, tension pneumothorax, etc.

(2) Supplement blood volume and maintain multi-channel infusion and blood transfusion with thick needles.

(3) Place the urinary catheter, record the urine volume, and observe its properties.

(4) Place the gastric tube, clean the stomach contents, observe whether there is bleeding, and maintain gastrointestinal decompression.

(5) Apply antibiotics as early as possible to prevent infection.

(6) If viscera prolapses, it should be covered with sterile normal saline gauze and wrapped with sterile towels externally, and then rinsed with normal saline before surgery.

(7) Taboo enema.

Anesthesia requirements:

Intratracheal intubation is generally used for general anesthesia. Patients without shock may consider epidural anesthesia.

Points to note during abdominal trauma

(1) If the diagnosis has not been determined, a median incision can be made. If a diagnosis has been made, the incision should be close to the injury. If it is an open injury, it is usually entered into the abdominal cavity without the original mouth.

(2) After incision of the peritoneum, suck the liquid in the abdominal cavity with an aspirator; the nature and approximate location of the injury can be initially determined according to the contents of the abdominal cavity. Perform systemic inspections according to certain procedures: first look for ruptured blood vessels and explore organs and tissues that are prone to bleeding, such as the liver, spleen, and mesentery. gap. The investigation must be systematic and comprehensive to avoid missing the injury site.

(3) Treatment of visceral prolapse: Rinse the prolapsed viscera with sterile normal saline, cut the abdominal wall at the midline of the abdomen, then enlarge the original mouth, and return the prolapsed viscera to the abdominal cavity. If the exudate is an omentum, it can be removed appropriately.

(4) After the treatment of internal organ injuries in the abdominal cavity, the abdominal cavity should be flushed with normal saline, and then the fluid in the abdominal cavity should be sucked up.

(5) Abdominal drainage tube: Abdominal drainage tube should be placed in the following cases: cavity organ injury; bleeding on wound surface; long injury time, infection or poor healing may be repaired or sutured; severe liver, spleen, Pancreatic damage, large retroperitoneal hematoma, etc. Cigarette drainage or double casing drainage can be used for drainage, and it must be properly fixed.

(6) Incision suture: Generally, it can be sutured in one stage. The wound wounds were sutured only in the peritoneum. After 4-8 days, secondary sutures were performed if there was no infection. In severely injured cases, or combined with hypoproteinemia, anemia, etc., extraperitoneal reduction suture should be performed

Postoperative management of abdominal trauma

(1) Correction of decompensated shock should continue after surgery.

(2) For those with visceral rupture and abdominal cavity pollution, the treatment is the same as that of acute peritonitis.

(3) For those with visceral injury, the general treatment is the same as that after surgery.

(4) Those with stoma should properly protect the skin around the stoma.

(5) For patients with pancreatic injury, drugs such as aprotinin and somatostatin can be used to inhibit and reduce the secretion of pancreatic juice, which has a certain effect on the treatment of post-traumatic pancreatitis and the prevention of pancreatic fistula.

(6) Treatment of drainage, if there is not much exudation, drainage can be removed 48 hours after small bowel injury; gradually remove 3 to 5 days after colon injury; drainage time of retroperitoneal space should be slightly longer; packing gauze strips for hemostasis From 7 days after the operation, a section is drawn out every day, and all are taken out about 10 days. When a celiac infection or pancreatic fistula is suspected, drainage fluid can be taken for bacterial culture and drug sensitivity, or to check for amylase.

(7) According to the condition, fluid feeding is usually started 3 days after the operation, and those who cannot eat for a long time can be treated with total parenteral nutrition.

(8) Three weeks after the colostomy, two-stage closed surgery is feasible. The conditions are: the patient's general condition is restored; local inflammation control, if there is local infection, it should be postponed until infection control; the colonic suture (anastomotic) at the far side of the stoma must have healed; multiple abdominal organs Injured patients, other wounds have been healed; X-ray barium radiography confirmed that the distal patency. Prepare the intestines before closing.

Abdominal trauma care

(1) The same as the general nursing routine of surgery.

(2) Ensure that the patient rests quietly, avoids excessive movement, and closely observes changes in the condition.

(3) After the anaesthesia is awake, if the blood pressure is stable, it is preferable to take a supine position.

(4) Continue decompression of the gastrointestinal tract and keep the gastric tube unobstructed.

Discharge criteria:

The wound healed and the abdominal symptoms disappeared.

Follow-up:

Patients with severe injuries were reviewed 3 months, 6 months, and 1 year after discharge.

Abdominal Trauma Health Tips

Diet nursing after abdominal trauma

When the gastrointestinal function of the patient is restored, the gastric tube can be removed before the diet can be given. The principle is to go from less to more, from thin to thick, and eat more in small quantities. Start with a small amount of rice soup, broth, vegetable soup or egg soup, and gradually increase or change to semi-liquid. Food should be rich in protein, high calories and multivitamins.

Psychological nursing after abdominal trauma

Most of the patients with abdominal trauma were emergency patients, and they were not prepared for the sudden shock. When hospitalized, they showed panic, fear, and even irritability, and some even refused treatment. Nurses should be enthusiastic about the patients, so that patients and their families have a sense of security and dependence, reduce panic, and actively cooperate with examination and treatment. According to the condition after surgery, it is appropriate to get out of bed early to enhance physical fitness to reduce the occurrence of intestinal adhesions. You can read newspapers, watch TV and watch magazines when your condition permits.