总结1例超低出生体重儿合并支气管肺发育不良因胃食管反流致频繁心搏骤停,实施经口盲置空肠管维持肠内营养的护理体会。护理要点：预防误吸风险,精细化气道管理;盲置空肠管术中要点;妥善固定导管,加强观察和处理;改良喂养和维护方式,保障导管通畅。经过精心的空肠管置入围手术期护理,患儿生命体征趋于平稳,并逐渐改为经口进食,体重增长良好,无不良反应,于住院131 d后好转出院。
To summarize the nursing experience of an extremely low birth weight preterm infant combined with bronchopulmonary dysplasia who suffered from repeated cardiac arrest due to gastroesophageal reflux and received transoral blind placement of jejunal tube to maintain enteral nutrition. Nursing points included prevention of aspiration risk and refined airway management,nursing during blind jejunal tube placement,proper fixation of the catheter and strengthening observation and treatment,improving the feeding and maintenance methods to ensure the smoothness of the catheter. After careful perioperative care of jejunal tube placement,the child‘s vital signs gradually stabilized,and gradually changed to oral feeding,with good weight gain and no adverse reactions,and he was discharged after 131 d of hospitalization.
[1] 邵肖梅. 实用新生儿学[M]. 5版. 北京:人民卫生出版社,2019:57,633-634,855-858.
Shao XM. Practical Neonatology[M]. Fifth version. BeiJing:People‘s Medical Publishig House,2019:57,633-634,855-858.
[2] 李金洋,石秦川,胡晓山,等. 胎龄≤32周早产儿中重度支气管肺发育不良与早期母乳喂养的相关性分析[J]. 实用临床医药杂志,2024,28(06):79-82+93.
Li JY,Shi QC,Hu XS,et al. Correlation between moderate to severe bronchopulmonary dysplasia and early breastfeeding in preterm infants with a gestational age of ≤32weeks[J]. J Clin Med Pract,2024,28(06):79-82+93.
[3] 杨勇晖,贺晓日,张雪菲,等. 极早早产儿支气管肺发育不良的临床特征[J]. 中南大学学报(医学版),2023,48(10):1592-1601.
Yang YH,He XR,Zhuang XF,et al.Clinical characteristics of bronchopulmonary dysplasia in very preterm infants[J]. J Cent South Univ(Med Sci),2023,48(10):1592-1601.
[4] Wemhöner A,Ortner D,Tschirch E,et al. Nutrition of preterm infants in relation to bronchopulmonary dysplasia[J]. BMC Pulm Med.2011,3;11:7.
[5] Giannì ML,Roggero P,Colnaghi MR,et al. The role of nutrition in promoting growth in pre-term infants with bronchopulmonary dysplasia:a prospective non-randomised interventional cohort study[J]. BMC Pediatr,2014,22;14:235.
[6] Wang B,Sun J,Sun Y,et al.A clinical analysis of very and extremely low birth weight preterm infants[J]. Am J Transl Res, 2021,13(8):9395-9403.
[7] 李佳涛,王欣,高玉先,等. 体位角度对极低出生体重儿胃食管反流及胃排空的影响[J]. 护理研究,2023,37(9):1649-1652.
Li JT,Wang X,Gao YX,et al.Effect of postural angle on gastroesophageal reflux and gastric emptying in very low birth weight infants[J]. Chin Nurs Res,2023,37(9):1649-1652.
[8] Wallenstein MB,Stevenson DK.Need for reassessment of early transpyloric feeding in preterm infants[J]. JAMA Pediatr,2018, 172(11):1004-1005.
[9] Wallenstein MB,Brooks C,Kline TA,et al.Early transpyloric vs gastric feeding in preterm infants:a retrospective cohort study[J]. J Perinatol. 2019;39(6):837-841.
[10] 封云,邱洁,陈俊,等. 不同喂养方式对极低出生体质量儿胃肠功能影响的比较[J]. 肠外与肠内营养,2017,24(4):213-215,220.
Feng Y,Qiu J,Chen J,et al.Comparison of the gastrointestinal function in very lowbirth weight infants among different modes of feeding[J]. Parenter Enteral Nutr,2017,24(4):213-215,220.
[11] Farhath S,He ZP,Nakhla T,et al.Pepsin,a marker of gastric contents,is increased in tracheal aspirates from preterm infants who develop bronchopulmonary dysplasia[J]. Pediatrics,2008,121(2):e253-e259.
