联体婴儿分离手术前后应注意的护理问题(文摘)

Nursing of two cases of conjoined twins with exclusion operation

我院于 1996年 11月和 2 0 0 0年 8月分别为一对脐剑联体和胸腹联体的婴儿成功的进行了分离手术。两例联体婴儿均为早产男婴 ,面面相对 ,两例均为肝脏相连 ,胸腹联体儿共享一心包。两例联体婴儿出生体重分别为 4 12 5 g和 5 70 0g。分离手术的时间分别为日龄 2 8天和 96天 ,体重分别为 5 30 0g和 935 0 g。手术前应加强对联体儿的基础护理。耐心喂养 ,为手术创造条件。术前护理另一重点即采用手指捏压法和侧卧牵拉法来松驰腹壁扩大腹腔以确保手术的一期全层关腹。因联体儿分离手术所涉及的脏器较多 ,为保证术后的护理质量 ,必须在术前即成立特护小组 ,并对护理人员进行培训。分离手术后两患儿应监护心率、心律、呼吸、体温、血氧饱和度 ,饶 (足背 )动脉和股静脉插管以观察血压、血气和中心静脉压的变化 ,液体通过输液泵的控制均匀输入。保持呼吸道通畅 ,雾化稀释痰液后进行吸痰。术后心率变慢时应予右侧卧位以减清对迷走神经的刺激。准确统计出入量。手术后应重点观察伤口感染、裂开 ,肺部纵隔、腹腔感染 ,分离断面坏死脱离 ,断面出血 ,胆管断端吻合包埋不好 。

We succeeded in operating on two cases of conjoined premature twins on November 1996 and on August 2000 respectively,one case was throacodelpus,and the other was thoracico-abdomina.The birth weights were 4125g and 3700g respectively.The base nursing for the babies was reinforced.We took the methods by nipping and tractiving abdominal wall to relax muscles and enlarge a bdominal cavity to assure closing the whole abdominal wall successfully. After operation,we supervised the T.P.R.Bp,CVP,SaO2 and rhythm of heart in real time.We paid more attentions to prevent the wound,the lung and Enterocelia from infection in order to decrease the incidence rate of complications,especially the peritonitis causing by the cross section bleeding and bilis fistula.