严重多发伤致肠空气瘘患者行分段式营养治疗的护理

doi:10.3761/j.issn.2096-7446.2024.02.006

摘要/Abstract

摘要： 总结1例严重多发伤肠空气瘘患者分段式营养治疗的护理体会。针对肠空气瘘局部创面大,消化系统连续性遭到破坏,营养支持难度高,采取腹腔开放处瘘口肠管保护及负压辅助关腹技术的护理,结合分段式肠内营养治疗和肠液回输护理。患者瘘口肠液引流顺利,后期腹壁缺损处愈合良好,肠内营养支持达到目标量,住院60 d后患者康复出院。

关键词: 肠空气瘘, 腹腔开放技术, 营养支持, 肠液回输, 危重病护理

Abstract: To summarize the nursing experience of segmented nutrition therapy in a patient with severe polytrauma and entero-atmospheric fistula. In view of the difficulty of wound care around entero-atmospheric fistula,the disruption of the continuity of the digestive system,and the difficulty of nutritional support,the fistula and intestinal tube protection at the open abdomen with vacuum-assisted closure technology was adopted,combined with segmented enteral nutrition therapy and nursing of intestinal fluid reinfusion treatment. The intestinal fluid from the fistula was drained smoothly,and abdominal wall defect healed well in the later period,the enteral nutrition support reached the target amount. After 60-day hospitalization,the patient finally recovered and was discharged.

Key words: Entero-atmospheric Fistula, Open Abdominal Techniques, Nutritional Support, Intestinal Fluid Reinfusion, Critical Care Nursing

殷伟, 乔丽, 刘宝晨, 吴翠丽, 叶向红, 章黎. 严重多发伤致肠空气瘘患者行分段式营养治疗的护理[J]. 中华急危重症护理杂志, 2024, 5(2): 128-130.

YIN Wei, QIAO Li, LIU Baochen, WU Cuili, YE Xianghong, ZHANG Li. Nursing care of a patient with severe polytraumatic entero-atmospheric fistula undergoing segmented nutrition therapy[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(2): 128-130.

参考文献

[1] 中华医学会外科学分会外科感染与重症医学学组,中国医师协会外科医师分会肠瘘专业委员会. 腹腔开放疗法中国专家共识(2023版)[J]. 中华胃肠外科杂志,2023,26(3):207-214.
Critical Care Group of Surgery Branch of Chinese Medical Association, Intestinal Fistula Committee of Surgeon Branch of Chinese Medical Doctor Association. Chinese consensus on open abdomen therapy(2023 edition)[J]. Chin J Gastrointest Surg,2023,26(3):207-214.
[2] Cristaudo AT,Jennings SB,Hitos K,et al.Treatments and other prognostic factors in the management of the open abdomen:a systematic review[J]. J Trauma Acute Care Surg,2017,82(2):407-418.
[3] 任建安. 腹腔开放疗法在腹部创伤的应用[J]. 创伤外科杂志,2015,17(3):193-196.
Ren JA.Open abdomen therapy in the management of abdominal trauma[J]. J Trauma Surg,2015,17(3):193-196.
[4] 黎介寿. “损伤控制” 在非创伤腹部外科患者中的应用[J]. 中华肝脏外科手术学电子杂志,2012,1(1):5-7.
Li JS.Application of “injury control” in patients undergoing non-traumatic abdominal surgery[J]. Chin J Hepatic Surg Electron Ed,2012,1(1):5-7.
[5] Ribeiro Junior MA,Barros EA,de Carvalho SM,et al. Open abdomen in gastrointestinal surgery:which technique is the best for temporary closure during damage control?[J]. World J Gastrointest Surg,2016,8(8):590-597.
[6] 中国医师协会创伤外科医师分会. 负压封闭引流技术腹部应用指南[J]. 中华创伤杂志,2019,35(4):289-302.
Trauma Surgeon Branch of Chinese Medical Doctor Association. Guideline for application of vacuum sealing drainage in abdominal surgery[J]. Chin J Trauma,2019,35(4):289-302.
[7] 孙红玲,孙艳,许彩云,等. 一例肝胆管结石术后并发严重肠瘘患者应用伤口护理技术联合处置方案的护理[J]. 中国实用护理杂志,2021,37(16):1258-1261.
Sun HL,Sun Y,Xu CY,et al.The application of wound care technologies combined with other multiple treatments in the hepatolithiasis patient who suffered from postoperative severe intestinal fistula[J]. Chin J Prac Nurs,2021,37(16):1258-1261.
[8] 吴磊,周济宏,汤雨佳,等. 负压治疗结合滴注冲洗在伤口护理中的应用进展[J]. 中华护理杂志,2019,54(6):950-954.
Wu L,Zhou JH,Tang YJ,et al.Application progress of negative pressure therapy combined with drip irrigation in wound care[J]. Chin J Nurs,2019,54(6):950-954.
[9] 蒋琪霞,朱礼霞,张媛,等. 负压伤口治疗联合湿性疗法用于交通挤压伤的研究[J]. 医学研究生学报,2014(9):955-958.
Jiang QX,Zhu LX Zhang Y,et al. Study on negative pressure wound therapy combined with moist wound therapy for traffic crush injury[J]. J Med Postgrad,27(9):955-958.
[10] 杨颖,盛玉,卞兰峥,等. 3例消化道高流量瘘患儿行消化液回输联合接力式营养支持的护理[J]. 中华护理杂志,2021,56(12):1838-1842.
Yang Y,Sheng Y,Bian LZ,et al.Application of relayed parenteral and enteral nutrition support assisted by digestive fluid reinfusion in the nursing care of 3 children with high flow fistula[J]. Chin J Nurs,2021,56(12):1838-1842.
[11] Wick EC,Grant MC,Wu CL.Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques[J]. JAMA Surg,2017,152(7):691.
[12] 鲍书欣,雍雅,丁威威. 1例肠空气瘘患者分段式肠内营养联合消化液回输的护理[J]. 东南国防医药,2018,20(2):200-203.
Bao SX,Yong Y,Ding WW.Nursing care of a case of intestinal air fistula with staged enteral nutrition combined with digestive juice reinfusion[J]. Mil Med J Southeast China,2018,20(2):200-203.
[13] McClave SA,Taylor BE,Martindale RG,et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient[J]. J Parenter Enteral Nutr,2016,40(2):159-211.
[14] 叶向红,宫雪梅,王慧君. 减少护理操作中喂养中断提高早期肠内营养达标率[J]. 肠外与肠内营养,2019,26(1):6-7.
Ye XH,Gong XM,Wang HJ.Reducing feeding interruption in nursing operation and improving the compliance rate of early enteral nutrition[J]. Parenter Enter Nutr,2019,26(1):6-7.
[15] 叶向红,江方正,郑桃花,等. 肢体功能锻炼强度对外科ICU患者康复效果的影响[J]. 中华护理杂志,2014,49(2):143-147.
Ye XH,Jiang FZ,Zheng TH,et al.Effect of early exercise on the rehabilitation of critically ill patients in the surgical intensive care unit[J]. Chin J Nurs,2014,49(2):143-147.