总结1例软骨发育不全性侏儒症伴巨块型肝癌患者自发性破裂出血合并结肠穿孔的护理体会。针对患者特殊生理结构及病情危重等问题,采取肝癌破裂出血预见性护理;实施目标导向护理策略,进行序贯性个体化护理;采用水胶体敷料第二平面法做好造口维护;实施谵妄综合管理,促进患者加速康复;实施个体化心理护理及出院延续性指导。经过18 d精心诊疗和护理,患者康复出院。随访2个月,患者恢复良好。
To summarize the nursing experience of a patient with achondroplasia Dwarfism accompanied by massive liver cancer with spontaneous rupture and bleeding and colon perforation. Targeting the special physiological structure and critical condition of patients,predictive care for liver cancer rupture and bleeding was taken,and emergency plans for major bleeding was formulated. We implemented goal-oriented nursing strategies and carried out sequential individualized nursing,established a second plane method for hydrocolloid dressings to maintain the stoma,implemented comprehensive management of delirium and promoted accelerated recovery,implemented individualized psychological care and discharge continuity guidance. After 18 days of meticulous treatment and nursing care,the patient recovered and was discharged from the hospital. After a 2-month follow-up,his recovery was good.
[1] 中国医师协会医学遗传医师分会,中华医学会儿科学分会内分泌遗传代谢学组,中华医学会儿科学分会罕见病学组,等. 软骨发育不全诊断及治疗专家共识[J]. 中华儿科杂志,2021,59(7):545-550.
Medical Genetics Committee of Chinese Medical Doctor Asso-ciation,Endocrinologic Hereditary and Metabolic Diseases Subspecialty Group of Pediatrics Branch of Chinese Medical Association,Rare Diseases Subspecialty Group of Pediatrics Branch of Chinese Medical Association,et al. Experts consen-sus on diagnosis and treatment of achondroplasia[J]. Chin J Pediatr,2021,59(7):545-550.
[2] 戴朝六,周天伊,鞠明光. 巨块型肝癌的外科治疗[J]. 肝胆外科杂志,2020,28(3):161-166
Dai CL,Zhou TY,Ju MG.Surgical treatment of massive hepato-cellular carcinoma[J]. J Hepatobiliary Surg,2020,28(3):161-166.
[3] 王兴宇,张剑林,陈卫东. 18例肝癌自发性破裂出血治疗体会[J]. 肝胆外科杂志,2016,24(2):95-98.
Wang XY,Zhang JL,Chen WD.The analysis of treatment of 18 cases of spontaneous rupture of hepatocellular carcinoma[J]. J Hepatobiliary Surg,2016,24(2):95-98.
[4] 吴飞,郑瑞强,陈齐红. 脓毒性休克初始液体复苏:该如何选择?[J]. 中华危重症医学杂志(电子版),2021,14(3):244-247.
Wu F,Zheng RQ,Chen QH.Initial fluid resuscitation for septic shock:How to choose?[J]. Chin J Crit Care Med(Electron Edi),2021,14(3):244-247.
[5] de Backer D,Bakker J,Cecconi M,et al. Alternatives to the swan-ganz catheter[J]. Intensive Care Med,2018,44(6):730-741.
[6] 陈丽花,盛青青,黄瑶,等. 重症患者腹内高压预防与管理的最佳证据总结[J]. 中华护理杂志,2022,57(17):2164-2170.
Chen LH,Sheng QQ,Huang Y,et al.Summary of best evidence on preventing and management of intra-abdominal hypertension in critically ill patients[J]. Chin J Nurs,2022,57(17):2164-2170.
[7] 中国急诊危重症患者肠内营养治疗专家共识组. 中国急诊危重症患者肠内营养治疗专家共识[J]. 中华急诊医学杂志,2022, 31(3):281-290.
Expert Consensus Group on Enteral Nutrition Therapy for Emergency Critically Ill Patients in China. Expert consensus on enteral nutrition therapy for emergency and critical patients in China[J]. Chin J Emerg Med,2022,31(3):281-290.
[8] 中国康复医学会骨质疏松预防与康复专业委员会. 骨质疏松性骨折二级预防中国专家共识[J]. 中华医学杂志,2022,102(45):3581-3591.
Osteoporosis Prevention and Rehabilitation Committee of Chinese Rehabilitation Society. China expert consensus on secondary prevention of osteoporotic fracture[J]. Natl Med J China,2022,102(45):3581-3591.
[9] 周茹珍,钱火红,邱群,等. 水胶体敷料建立第二平面法在近手术切口的肠造口护理中的应用[J]. 解放军护理杂志,2020,37(12):89-92.
Zhou RZ,Qian HH,Qiu Q,et al.Application of the second plane method created by hydrocolloid in the nursing of intestinal stoma near surgical incision[J]. Nurs J Chin PLA,2020,37(12):89-92.
[10] Savarirayan R,Ireland P,Irving M,et al.International consensus statement on the diagnosis,multidisciplinary management and lifelong care of individuals with achondroplasia[J]. Nat Rev Endocrinol,2022,18(3):173-189.
