总结1例先天性双侧后鼻腔狭窄患儿在鼻内镜下行双侧鼻腔狭窄扩张术的术后护理体会。针对患儿术后扩张管留置时间长、存在营养不良风险、术后1年再狭窄发生率高等问题,强调鼻腔扩张管维护及并发症预防措施的重要性,包括安全固定、有效清除分泌物、保持皮肤完整性,并制订个体化营养支持方案,落实出院后居家护理与随访延伸服务。经过51 d的精心治疗与护理,患儿好转出院,出院后4次随访均状况良好。
To summarize the experience of postoperative nursing of a child with congenital bilateral posterior nasal stenosis who underwent nasal endoscopic bilateral nasal stenosis dilation. Aiming at the problems of prolonged indwelling time of dilation tubes,risk of malnutrition,and high incidence of restenosis within one year after surgery in the child,the importance of maintenance of nasal dilation tubes and prevention of complications were emphasized,including safe fixation,effective removal of secretions,the maintain of skin integrity. An individualized nutritional support plan was formulated and extended services for home care and follow-up after discharge were implemented. After 51 days of careful treatment and care,the child was improved and discharged. And he was in good condition during the four follow-ups after discharge.
[1] Kurosaka H.Choanal atresia and stenosis:development and di-seases of the nasal cavity[J]. Wiley Interdiscip Rev Dev Biol,2019,8(1):e336.
[2] Galluzzi F,Garavello W,Dalfino G,et al.Congenital bony nasal cavity stenosis:a review of current trends in diagnosis and treatment[J]. Int J Pediatr Otorhinolaryngol,2021,144:110670.
[3] Wolf A,Lang-Loidolt D,Koele W,et al.Are stents beneficial in endoscopic choanal atresia repair of newborns and children? Case series of 11 patients[J]. Clin Otolaryngol,2016,41(6):821-825.
[4] Karligkiotis A,Farneti P,Gallo S,et al.An Italian multicentre experience in endoscopic endonasal treatment of congenital choanal atresia:proposal for a novel classification system of surgical outcomes[J]. J Craniomaxillofac Surg,2017,45(6):1018-1025.
[5] 郑文婷. 小儿先天性后鼻孔闭锁经鼻内窥镜手术围手术期护理[J]. 医学信息,2013,26(29):354-354,355.
Zheng WT.Perioperative care for pediatric congenital posterior nostril atresia perinasal endoscopic surgery[J]. J Med Inf,2013, 26(6):354-355.
[6] 朱淑贞,张萍芳,陈晓飞,等. 新生儿后鼻孔闭锁成形术的围手术期护理[J]. 护理与康复,2018,17(11):41-44.
Zhu SZ,Zhang PF,Chen XF,et al.Perioperative nursing on choanal plasty for repairing neonatal choanal atresia[J]. J Nurs Rehabil,2018,17(11):41-44.
[7] 瞿颖华,巩树梅,任立旺. 先天性后鼻孔闭锁成形术后扩张管的观察与护理[J]. 上海护理,2015,15(6):43-45.
Qu YH,Gong SM,Ren LW.Observation and nursing of dilation tube after congenital posterior nasal atreplasty[J]. Shanghai Nurs,2015,15(6):43-45.
[8] Schneider SM,Veyres P,Pivot X,et al.Malnutrition is an independent factor associated with nosocomial infections[J]. Br J Nutr,2004,92(1):105-111.
