总结1例孕中期不完全性子宫破裂患者行修补术后并发下肢深静脉血栓,最后成功妊娠至足月分娩的护理体会。针对该例子宫破裂修补术后延长妊娠至足月难度大、期间并发下肢深静脉血栓等护理问题,采取了多学科团队合作、严密监测、抑制宫缩、改良踝泵运动、早期下床活动、预防肺栓塞、延续性护理等,母婴结局良好,以期为今后该类患者的临床护理、预防并发症提供照护经验。
To summarize the nursing experience of a patient with incomplete uterine rupture complicated by deep vein thrombosis after repair surgery and successful pregnancy to full term delivery. Regarding the difficulty and complicated deep vein thrombosis in this case of extending pregnancy to full-term after uterine rupture repair surgery,we adopted a multidisciplinary team cooperation,and vigilant monitor,uterine contraction suppression,modified ankle pump exercises,early ambulation,prevention of pulmonary embolism,continuous care. Both maternal and neonatal outcomes were good. The aim is to provide nursing experience for future care and prevention of complications in such cases.
[1] 谢幸,孔北华,段涛. 妇产科学[M]. 9版. 北京:人民卫生出版社,2018.
Xie X,Kong BH,Duan T.Obstetrics and gynecology[M]. 9th ed. Beijing:People's Medical Publishing House,2018.
[2] Motomura K,Ganchimeg T,Nagata C,et al.Incidence and outcomes of uterine rupture among women with prior Caesarean section:who Multicountry Survey on Maternal and Newborn Health[J]. Sci Rep,2017,7:44093.
[3] 冯燕,刘晓贞,鲁逸樵,等. 妊娠中期瘢痕子宫不全破裂修补术后妊娠至34周分娩1例[J]. 中华妇产科杂志,2022,57(11):864-868.
Feng Y,Liu XZ,Lu YQ,et al.A case from pregnancy to delivery at 34 weeks after repair of incomplete rupture of scar uterus in the second trimester of pregnancy[J]. Chin J Obstet Gynecol,2022,57(11):864-868.
[4] 郑媛媛,丁新. 剖宫产后阴道试产中子宫破裂的早期识别[J]. 中华围产医学杂志,2016,19(9):677-680.
Zheng YY,Ding X.Early identification of uterine rupture during trial of labor after cesarean section[J]. Chin J Perinat Med,2016,19(9):677-680.
[5] Schulman S.Studies on the medical treatment of deep vein thrombosis[J]. Acta Med Scand Suppl,1985,704:1-68.
[6] 孙建华,马玉芬,郭一峰,等. 急性深静脉血栓患者早日下床活动可行性与安全性的系统评价[J]. 中华护理杂志,2017,52(5):581-585.
Sun JH,Ma YF,Guo YF,et al.Early ambulation in the treatment of acute deep venous thrombosis:a systematic review[J]. Chin J Nurs,2017,52(5):581-585.
[7] Hillegass E,Lukaszewicz K,Puthoff M. Role of physical therapists in the management of individuals at risk for or diagnosed with venous thromboembolism:evidence-based clinical practice guideline2022[J]. Phys Ther,2022,102(8):pzac057.
[8] 中华医学会妇产科学分会产科学组. 妊娠期及产褥期静脉血栓栓塞症预防和诊治专家共识[J]. 中华妇产科杂志,2021,56(4):236-243.
Obstetrics Group of Obstetrics and Gynecology Committee of Chinese Medical Association. Expert consensus on the prevention,diagnosis and treatment of venous thromboembolism in pregnancy and puerperium[J]. Chin J Obstet Gynecol,2021,56(4):236-243.
[9] Li HY,Zhang W,Lu QS,et al.Which frequency of ankle pump exercise should be chosen for the prophylaxis of deep vein thrombosis?[J]. Inquiry,2022,59:469580221105989.
[10] 严欣,叶圣龙,顾珣可,等. 改良Caprini血栓风险评估量表预测妊娠相关静脉血栓栓塞疾病的价值[J]. 国际妇产科学杂志,2022,49(1):95-100.
Yan X,Ye SL,Gu XK,et al.The value of the modified caprini risk assessment model in predicting pregnancy associated venous thromboembolism[J]. J Int Obstet Gynecol,2022,49(1):95-100.
[11] Jiménez D,García-Sanchez A,Rali P,et al.Incidence of VTE and bleeding among hospitalized patients with coronavirus disease 2019:a systematic review and meta-analysis[J]. Chest,2021,159(3):1182-1196.
