总结13例巨型脐膨出患儿行二期修补术并发腹内高压的护理经验。针对该组患儿二期修补创伤大、术后腹内高压、长期保护性机械通气、镇静镇痛难度大、下腔静脉回流受阻,需面临低氧血症、肾功能障碍等棘手问题。采取目标式镇痛镇静,优化以腹内压为导向的体位管理策略,加强呼吸系统监护与管理,严密监测肾功能、维持循环稳定,充分营养支持、积极促进康复等护理措施。经过严密监护和精心护理,该组患儿术后均顺利度过腹内高压期,预后良好,顺利出院。
To summarize the nursing experience of 13 children with giant omphalocele complicated with intra-abdominal hypertension after secondary repair. Due to the severe trauma of secondary repair,postoperative intra-abdominal hypertension,long-term protective mechanical ventilation,difficult sedation and analgesia,obstruction of inferior vena cava reflux,we had to face hypoxemia,renal dysfunction and other difficult problems. We adopted targeted analgesia and sedation,optimized posture management strategy guided by intra-abdominal pressure value,strengthened the monitoring and management of respiratory system,closely monitored renal function,maintained circulatory stability,fully supported nutrition,and active promoted the of rehabilitation. After close monitoring and careful nursing,all the children successfully survived the period of intra-abdominal hypertension with good prognosis and were discharged smoothly.
[1] 钭金法. 新生儿巨型脐膨出的治疗策略[J]. 临床小儿外科杂志,2020,19(4):292-296.
Dou JF.Treatment strategy of giant omphalocele in neonates[J]. J Clin Pediatr Surg,2020,19(4):292-296.
[2] Zalieckas J,Weldon C.Sedation and analgesia in the ICU[J]. Semin Pediatr Surg,2015,24(1):37-46.
[3] Smit M,Koopman B,Dieperink W,et al.Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU[J]. Ann Intensive Care,2020,10(1):130.
[4] 中华医学会儿科学分会急救学组,中华医学会急诊医学分会儿科学组,中国医师协会儿童重症医师分会,等. 中国儿童重症监护病房镇痛和镇静治疗专家共识(2018版)[J]. 中华儿科杂志,2019,57(5):324-330.
Emergency Medicine Subgroup of Pediatrics Branch of Chinese Medical Association,Pediatrics Subgroup of Emergency Medicine Branch of Chinese Medical Association,Pediatric Intensive Care Physician Branch of Chinese Medical Doctor Association,et al. Experts' consensus on sedation and analgesia for children in pediatric intensive care unit of China (2018)[J]. Chin J Pediatr,2019,57(5):324-330.
[5] 金芸,顾莺,陆国平,等. 目标导向程序性镇痛镇静在儿童重症监护病房中的应用效果[J]. 护理研究,2022,36(19):3503-3507.
Jin Y,Gu Y,Lu GP,et al.Application effect of goal-directed procedural analgesia and sedation for children in intensive care unit[J]. Chin Nurs Res,2022,36(19):3503-3507.
[6] 尤小贵,江方正,姚红林,等. 腹腔高压患者不同体位监测腹腔压的效果观察[J]. 中华现代护理杂志,2020,26(35):4877-4881.
You XG,Jiang FZ,Yao HL,et al.Influences of abdominal pressure monitoring in different positions among abdominal hypertension patients[J]. Chin J Mod Nurs,2020,26(35):4877-4881.
[7] 中国腹腔重症协作组. 重症患者腹内高压监测与管理专家共识(2020版)[J]. 中华消化外科杂志,2020,19(10):1030-1037.
Chinese Abdominal Critical Care Collaboration Group. Expert consensus on monitoring and management of intra-abdominal hypertension in severe patients(2020 edition)[J]. Chin J Dig Surg,2020,19(10):1030-1037.
[8] 朱海虹,凌云,俞亚楠,等. 巨型脐膨出合并肺动脉高压行保守等待疗法期间患儿的护理[J]. 护理与康复,2022,21(9):70-72.
Zhu HH,Ling Y,Yu YN,et al.Case study of children with giant omphalocele complicated with pulmonary hypertension during conservative therapy[J]. J Nurs Rehabil,2022,21(9):70-72.
[9] 盛美君,裘妃,叶飞亚,等. 咽部毛息肉患儿的围手术期护理[J]. 中华急危重症护理杂志,2022(3):253-256.
Sheng MJ,Qiu F,Ye FY,et al.Perioperative nursing of 7 infants with pharyngeal hairy polyps[J]. Chin J Emerg Crit Care Nurs,2022(3):253-256.
[10] 罗月,葛伟婷,张帅,等. ICU经鼻高流量湿化氧疗患者舒适度评估及护理研究进展[J]. 中华急危重症护理杂志,2020,1(3):273-276.
Luo Y,Ge WT,Zhang S,et al.Research progress on comfort evaluation and nursing care of patients undergoing nasal high-flow humidified oxygen therapy in ICU[J]. Chin J Emerg Crit Care Nurs,2020,1(3):273-276.
[11] 樊小燕,诸纪华,罗飞翔,等. 巨型脐膨出患儿行一期修补术的术后护理[J]. 中华急危重症护理杂志,2021,2(2):131-134.
Fan XY,Zhu JH,Luo FX,et al.Postoperative nursing care of one-stage repair for giant umbilical distention in newborns[J]. Chin J Emerg Crit Care Nurs,2021,2(2):131-134.
