纤毛不动综合征继发胸腔积液及咯血患儿的护理

doi:10.3761/j.issn.2096-7446.2023.05.010

摘要/Abstract

摘要： 总结1例纤毛不动综合征继发胸腔积液及咯血患儿的护理体会。针对患儿气道廓清障碍、呼吸道分泌物难以清除,并继发胸腔积液及咯血等问题,实施分阶段气道廓清技术,配合医生行胸腔穿刺术,密切观察病情变化,预防大咯血引起窒息,并采取多形式心理护理,帮助患儿改善焦虑情绪。经过12 d的精心治疗和护理,患儿病情稳定出院。出院后随访1年,患儿状态良好。

关键词: 纤毛不动综合征, 胸腔积液, 咯血, 气道管理, 危重病护理

Abstract: To summarize the nursing experience of a child with primary ciliary dyskinesia and secondary pleural effusion and hemoptysis. For the child with problems such as obstructed airway clearance,difficulty to effectively remove respiratory secretions and secondary pleural effusion and hemoptysis,we adopted using the phased airway clearance technique,cooperating with the doctor to perform the thoracentesis,paying close attention to the changes of the child's conditions,preventing asphyxia caused by massive hemoptysis,and taking various forms of psychological care to help the child ameliorate anxiety. After 12 days of careful treatment and nursing,the child was discharged from hospital in a stable condition. Follow-up of one year after discharge showed that the child was in good condition.

Key words: Primary Ciliary Dyskinesia, Pleural Effusion, Hemoptysis, Airway Management, Critical Care Nursing

吴婷婷, 阮娟娟, 韦晴宇, 邵菡清. 纤毛不动综合征继发胸腔积液及咯血患儿的护理[J]. 中华急危重症护理杂志, 2023, 4(5): 436-440.

WU Tingting, RUAN Juanjuan, WEI Qingyu, SHAO Hanqing. Nursing of a child with primary ciliary dyskinesia and secondary pleural effusion and hemoptysis[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023, 4(5): 436-440.

参考文献

[1] Lucas JS,Davis SD,Omran H,et al.Primary ciliary dyskinesia in the genomics age[J]. Lancet Respir Med,2020,8(2):202-216.
[2] Guo ZY,Chen WC,Wang LB,et al.Clinical and genetic spectrum of children with primary ciliary dyskinesia in China[J]. J Pediatr,2020,225:157-165.
[3] Lucas JS,Burgess A,Mitchison HM,et al.Diagnosis and management of primary ciliary dyskinesia[J]. Arch Dis Child,2014,99(9):850-856.
[4] 吴喜蓉,刘秀云,刘军,等. 北京儿童医院住院儿童胸腔积液病因分析[J]. 中华实用儿科临床杂志,2021,36(4):258-261.
Wu XR,Liu XY,Liu J,et al.Etiological analysis of pleural effusion in children in Beijing Children's Hospital[J]. Chin J Appl Clin Pediatr,2021,36(4):258-261.
[5] 高丽,庞敏. 支气管扩张症表型的研究进展[J]. 临床肺科杂志,2021,26(3):453-456.
Gao L,Pang M.Research progress of bronchiectasis phenotype[J]. J Clin Pulm Med,2021,26(3):453-456.
[6] 夏姗姗,丁亚平,周红琴,等. 机械通气患儿呼吸道管理的研究进展[J]. 中华急危重症护理杂志,2021,2(6):553-556.
Xia SS,Ding YP,Zhou HQ,et al.Research progress of respiratory tract management in children with mechanical ventilation[J]. Chin J Emerg Crit Care Nurs,2021,2(6):553-556.
[7] Horani A,Ferkol TW. Understanding primary ciliary dyskinesia and other ciliopathies[J]. J Pediatr,2021,230:15-22.e1.
[8] 杨仕容,陈兰,汪江,等. 非人工气道患者痰培养标本规范化采集管理的效果研究[J]. 护士进修杂志,2022,37(18):1685-1688.
Yang SR,Chen L,Wang J,et al.Effect of standardized collection management of sputum culture specimen in patients with non-artificial airway[J]. J Nurses Train,2022,37(18):1685-1688.
[9] 吕钦. 主动呼吸循环技术对支气管扩张病人排痰效果及临床症状改善的影响[J]. 全科护理,2021,19(35):5010-5013.
Lü Q.Effect of active respiratory circulation technology on expectoration effect and improvement of clinical symptoms in patients with bronchiectasis[J]. Chin Gen Pract Nurs,2021,19(35):5010-5013.
[10] Bingol I,Gokdemir Y,Yilmaz-Yegit C,et al.Comparison of con-ventional chest physiotherapy and oscillatory positive expiratory pressure therapy in primary ciliary dyskinesia[J]. Pediatr Pulmonol,2020,55(12):3414-3420.
[11] 姜源,王颖硕,唐兰芳,等. 儿童气道廓清技术的应用[J]. 中华儿科杂志,2020,58(8):690-693.
Jiang Y,Wang YS,Tang LF,et al.Applications of airway clearance techniques in children[J]. Chin J Pediatr,2020,58(8):690-693.
[12] 张新娜,李倩倩,王红钰,等. 振动呼气正压装置与诱发性肺量计在肺癌术后患者康复训练中的应用研究[J]. 中华护理杂志,2021,56(3):330-335.
Zhang XN,Li QQ,Wang HY,et al.The research of the rehabilitation effects of oscillatory positive expiratory pressure device combined with incentive spirometer for patients with lung cancer after surgery[J]. Chin J Nurs,2021,56(3):330-335.
[13] 北京医师协会呼吸内科专科医师分会咯血诊治专家共识编写组. 咯血诊治专家共识[J]. 中国呼吸与危重监护杂志,2020,19(1):1-11.
Expert Consensus Writing Group on Diagnosis and Treatment of Hemoptysis,Respiratory Branch of Beijing Doctor Association. Expert consensus on hemoptysis diagnosis and treatment[J]. Chin J Respir Crit Care Med,2020,19(1):1-11.
[14] 祝利红,林娟,陈上仲. 以音乐治疗为核心的系统化护理在重症肺炎患者中的应用及临床价值[J]. 中华全科医学,2018,16(6):1029-1031.
Zhu LH,Lin J,Chen SZ.Application and clinical value of systematic nursing based on music therapy in patients with severe pneumonia[J]. Chin J Gen Pract,2018,16(6):1029-1031.
[15] 杨慧,李红梅,何芸,等. 亲子阅读法对学龄期哮喘儿童症状管理和自我管理行为的影响[J]. 中国实用护理杂志,2021,37(24):1880-1885.
Yang H,Li HM,He Y,et al.Effect of parent-child bibliotherapy on symptom management and self-management behaviors in school-age children with asthma[J]. Chin J Pract Nurs,2021,37(24):1880-1885.
[16] 陈海燕,江文婷. 个性化随访对室间隔缺损术后患儿生活质量与身体意象的影响[J]. 护理实践与研究,2019,16(2):123-125.
Chen HY,Jiang WT.Effect of personalized follow-up on quality of life and body image in postoperative children with ventricular septal defect[J]. Nurs Pract Res,2019,16(2):123-125.