颌骨放射性骨坏死并发胃食管返流误吸的护理干预

Nursing intervention of gastroesophageal reflux and aspiration in osteoradionecrosis of jaw patients

目的探讨颌骨放射性骨坏死(ORN)并发胃食管返流误吸的相关因素及护理对策。方法对112例ORN患者临床资料进行回顾分析。结果 1例术前予胃管鼻饲饮食患者发生胃食管返流误吸导致呼吸困难等呼吸道梗阻症状;1例患者术后第1天插胃管时因呕吐诱发胃食管返流误吸导致吸入性肺炎;2例患者术后第1天鼻饲时出现胃食管返流导致吸入性肺炎。经及时抢救,对症处理和相应的护理措施,4例患者均抢救成功,其中2例因吸入性肺不张转至ICU进一步治疗。结论 ORN患者因为口咽部放射性损伤,易并发胃食管返流,尤其是全麻加气管切开术后3天内鼻饲饮食诱发胃食管返流误吸的风险性最大,且后果最严重。加强围手术期的护理,采取相应的护理干预可有效减少并发症的发生,提高治愈率。

Objective To investigate the associate factors and nursing strategy for gastroesophageal reflux and aspiration in jaw osteoradionecrosis patients. Method Clinical data of 112 cases of jaw osteoradionecrosis in department of oral and maxillofacial surgery, Hospital of stomatology, Sun Yat-sen University between October 2005 and September 2009 were analyzed retrospectively. Results Among the 112 jaw osteoradionecrosis cases, one patient with preoperative nasogastric tube feeding had difficult breathing for gastroesophageal reflux and aspiration; one patient who got gastric entubatton in the first day after operation had aspiration pneumonia because of gastroesophageal reflux and aspiration induced by vomit; while aspiration pneumonia occurred in two postoperative patients when nasogastric feeding. All patiens recovered satisfactorily with early rescue, symptomatic treatment and relevant nursing care. Conclusions Because of the radiation injury in mouth and pharyngeal, gastroesophageal reflux occurs more often in jaw osteoradionecrosis patients, especially those who get general anesthesia and tracheotomy. The study find that the risk for gastroesophageal reflux and aspiration is the higheest for those nasal feeding patients within the first three days after operation. Strengthening perioperation nursing is of great significance in reducing the adverse effect and complications and raising the success rate of operation.