缩短先天性巨结肠症患儿术后疗程的护理

Nursing experience in shortening course of treatment of postoperative Hirschsprung＇s disease

目的探讨更适用于新生儿期有小肠结肠炎病史长段型先天性巨结肠症（HD）患儿术前家庭通便护理，缩短HD术后疗程，提高生命质量。方法 40例新生儿期有小肠结肠炎病史长段型HD患儿术前家庭通便护理3~6个月电话通知回院行一期根治术，2010年1月至2013年2月为常规组19例，2013年3月至2016年4月为改良组21例，常规组灌肠后不扩肛，改良组为自行设计的灌肠后加扩肛治疗。术后观察首次排便时间、住院时间、扩肛所需时间、9~12 d排便情况、第1年需要灌肠干预辅助排便率及1~3年小肠结肠炎复发率。结果 患儿术后首次排便时间、住院时间及扩肛所需时间常规组分别为（39.15 ± 8.23）h、（7.89 ± 0.82）d、（5.17 ± 0.98）min，改良组分别为（23.79 ± 7.54）h、（7.10 ± 0.29）d、（3.15 ± 0.73）min，2组比较差异有统计学意义（t = 6.13、5.46、15.54，均P〈0.01）。9~12 d排便通畅与不通畅发生率常规组分别为12/19、7/19，改良组分别为100.00%（21/21）、0。2组比较差异有统计学意义（χ2=9.38，P〈0.01）。术后第1年不需要灌肠、偶尔灌肠、常常灌肠干预率常规组分别为2/19、12/19、5/19，改良组分别为76.19%（16/21）、23.81%（5/21）、0，2组比较差异有统计学意义（χ2=18.25，P〈0.01）。2组术后小肠结肠炎复发率比较差异无统计学意义（χ2= 2.33，P〉0.05）。结论 新生儿期有小肠结肠炎病史HD患儿行一期根治术前家庭灌肠后扩肛3~6个月能缩短术后HD疗程，提高生命质量。

Objective To discuss the influence of preoperative family purge care for the quality of life of patients with long type of congenital Hirschsprung′s disease （HD） who had enterocolitis history in neonatal period. Preoperative family purge care, which can shorten the HD postoperative treatment, improve the quality of life.Methods A total of 40 cases of patients with long type of congenital HD who had enterocolitis history in neonatal period received 1-stage radical preoperative by family phone call. Nineteen cases from January 2010 to February 2013 were as normal group and 21 cases from March 2013 to April 2016 were as improved group. Routine family purge nursing care 3-6 months were used in both the groups, while the combined nursing care of expanding anus were used in the improved group in addition. Evaluated the effects of postoperative observation indicates： the first defecation time, length of hospital stay, time needed for expanding anus, patency rate of defecation and not patency rate in 9-12 days, need enema intervention to assist defecate rate after postoperative 1 year, the recurrence of enterocolitis at 1-3 years after operation.Results The first defecation time, length of hospital stay, time needed for expanding anus were （39.15±8.23） h, （7.89±0.82）d, （5.17±0.98） min in normal group, （23.79±7.54） h, （7.10± 0.29） d, （3.15±0.73） min in improved group, and there were significant differences between two groups （t = 6.13, 5.46, 15.54, all P 〈 0.01）. The patency rate of defecation and not patency rate in 9-12 days were 12/19, 7/19 in normal group, 100.00%（21/21）, 0 in improved group, and there were significant differences between two groups （χ2=9.38, P〈0.01）. The intervention rate of no need for enema, occasionally enema, often enema were 2/19, 12/19, 5/19 in normal group, 76.19% （16/21）, 23.81%（5/21）, 0 in improved group, and there were significant differences between two groups （χ2=18.25, P〈0.01）. There was no significant difference in the recurrence of enterocolitis at 1, 2, 3 years after operation between two groups （χ2= 2.33, P〉0.05）.Conclusions Patient with long type of congenital HD who had enterocolitis history in neonatal period neonatal period,received family enema and expanding anus in 3-6 months before 1-stage radical preoperative can shorten the postoperative HD treatment, improve the quality of life.