8例完全性大动脉转位行Switch术后延迟关胸患儿的护理

Nursing for 8 Infants with Complete Transposition of Great Arteries Undergoing Switch Operation and Delayed Sternal Closure

总结8例完全性大动脉转位行Switch术后延迟关胸患儿的护理。认为术后给予患儿充分的镇静镇痛;在持续微量泵入吗啡的基础上,为了避免吸痰对患儿的刺激,吸痰前遵医嘱再辅以吗啡、咪达唑仑等静脉注射镇静,同时护理操作时动作要轻柔,避免声光等外界刺激;加强心肺功能监测,术后持续严密监测心电图变化,并与手术前心电图对照,及时发现心肌缺血及心律失常,同时密切观察电解质平衡情况,尤其是血钾水平,以便预防心律失常;术后48h内严格控制进出液量,保持一定的负平衡状态,以减轻组织水肿和心脏负担,为关胸做好准备;由于手术操作过程中胸膜打开,因此延迟关胸的患儿在胸腔敞开期间要持续机械通气,未行关胸术前禁忌进行胸部物理治疗。术后持续动脉血压监测,根据动脉血压调整血管活性药物使用剂量,以防收缩压过高,吻合口破裂导致出血。本组6例患儿恢复,2例死亡。

The paper centers on nursing for 8 infants with complete transposition of great arteries undergoing Switch operation and delayed sternal closure. Following nursing methods were critical for these infants. Analgesia and microscale morphia were adopted after operation. To avoid the influence of aspiration of sputum, morphia and midazolam through intravenous injection were conducted with tender caring. Monitoring of cardiorespiratory function and ECG were strengthened so as to deal with potential myocardial isehemia and arrhythmia. Besides, electrolyte balance particularly serum potassium were observed intensively as well. Tight control of in-and-out fluid 48 hours after operation was for the negative balance to reduce edema. Continuous mechanical ventilation was provided and no physical therapy was allowed before sternal closure. Continuous monitoring on arterial blood pressure after operation was conducted for dose adjustment of vasoactive drugs so as to avoid excessive high systolic pressure and to avoid bleeding in stomal. 6 patients recovered while 2 died.