3个月龄患儿完全性肺静脉异位引流的围术期护理

Perioperative nursing of 3-month infants with total anomalous pulmonary venous drainage

目的探讨3个月龄患儿完全性肺静脉异位引流围术期的护理,提高术前术后的监护水平及护理问题的解决方法。方法本院完成了27例3个月以内的完全性肺静脉异位引流患儿在低温体外循环下矫治术,术后通过维护循环功能的稳定,预防低心排和心包填塞;采取综合措施预防肺动脉高压;积极防治呼吸机相关性肺炎以及术后体温维持、营养支持等治疗护理措施。结果本组5例患儿延迟关胸,术后21~56 h在床边顺利关胸,其中术后并发肺出血1例,经应用东莨菪碱治疗、增加呼吸机PEEP+5^+8 cmH2O,加强呼吸道管理后好转并治愈;另有4例患儿发生肺部感染,经抗感染后痊愈;无1例出现严重心律失常(可能与手术方式有关);27例患儿除1例术后21 h因低心排抢救无效死亡,其余26例经精心治疗和护理,均痊愈出院。结论 3个月以内完全性肺静脉异位引流患儿病情严重,术后护理难度大,通过精心护理可明显提高低龄患儿手术成功率和治愈率,降低术后并发症。

Objective To explore the nursing of 3-month infants with total anomalous pul- monary venous drainage（TAPVD） and to enhance the preoperative and postoperative nursing quality and to settle the nursing problems. Methods 27 infant patients under 3 months with total anomalous pulmonary venous drainage were applied orthopaedy in the condition of extracorporeal circulation in low temperature, and the postoperative circulation function was safeguarded to prevent low cardiac output syndrome and cardiac tamponade. Meanwhile, some comprehensive nursing measures were applied to avoid pulmonary hypertension. Moreover, therapeutic nursing measures were exerted to positively prevent ventilator-associated pneumonia and to maintain body temperature and nutrition. Results 5 delayed sternal closure patients were successfully closured after 21 to 56 hours of operation, among which 1 patient had postoperative complications of pneumorrhagia. With the treatment of scopolamine and addition of ventilator PEEP ＋ 5 - ＋ 8 cmH20, the patient was cured after the enhancement of respiratory tract management. In addition, 4 patients were cured after the postoperative pulmonary infection. Except for i patient died of low cardiac output syndrome after 21 hours, the rest of 26 patients were all discharged after surgical treatment and nursing. Conehtsion Although it is difficult to nurse three-month infants with total anomalous pulmonary venous drainage after operation, careful nursing could evidently improve the success of operation as well as recovery of patients and could reduce the postoperative complications.