总结1例对称性腹部联体双胎早产儿,其中一胎儿伴有复杂先天性心脏病行分离术的术前护理体会。护理要点:做好床单位规划,选择床单位空间区域大的培养箱,维持双胎体温稳定;做好标识,确保正确身份识别;合理利用道具进行体位管理,降低斜头畸形发生率;根据操作检查需求,合理安排非操作患儿体位;完善预防措施,避免联体所致相关感染;评估联体双方生理状态,提供个体化护理;精准测量联体双胎体重,为营养及用药策略提供依据。该例于入院后第41天成功完成分离术,A婴于术后第8天出院,B婴于术后第41天出院。
This case involved the care of premature symmetrical abdominal conjoined twins,and preoperative nursing for one newborn with complex congenital heart disease. The nursing points included planning the bed unit well and selecting a cultivation box with a large spatial area to maintain the stable body temperature of the twins,ensuring proper identification through careful labeling,using appropriate props for position management to reduce the incidence of head deformities,arranging the position of the non-operative twin according to examination requirements,implementing prevention measures to avoid infection related to the conjoined anatomy,evaluating the physiological status of the twins and providing individualized care,accurately measuring the weight of the conjoined twins to provide a basis for nutritional and medication strategies. The separation surgery was successfully performed on day 41 of hospitalization,and newborn A was discharged smoothly on the 8th day after surgery,and newborn B was discharged from the hospital on the 41st day after surgery.
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