新生儿先天性膈疝的外科治疗与围手术期护理

Surgical treatment and perioperative nursing of neonatal congenital diaphragmatic hernia

目的:探讨新生儿先天性膈疝的外科治疗与围术期护理。方法:收治新生儿左侧膈疝患者10例,取患侧后外侧第8肋间切口入胸7例,肋缘下经腹切口3例;经胸组将腹内脏器还纳腹腔膈肌修补4例,采用涤纶补片膈疝修补3例;经腹组将肠管牵拉入腹腔,直视下修补膈肌缺损。术前禁饮食,胃肠减压,静脉补充营养,严密呼吸系统监测;术后做好呼吸道管理,保持引流管通畅,加强肺循环监测。结果:本组10例患儿均存活,5例术后胸片提示左侧气胸,左肺不张,4例予胸腔穿刺,1例重置引流管,加强肺部理疗后痊愈。术后随访无膈疝复发。结论:新生儿先天性膈疝根据膈肌缺损大小采用直接缝合或补片修补缝合,在患儿一般生命体征维持稳定的情况下进行手术,可显著提高术后生存率。而高质量的围手术期护理能为手术成功和患儿的远期生存质量提供保障。

Objective:To explore the surgical treatment and perioperative nursing of neonatal congenital diaphragmatic hernia.Methods:10 patients with neonatal congenital diaphragmatic hernia were selected.Eighth had posterior lateral intercostal incision into the chest in 7 cases,abdominal subcostal incision in 3 cases,the incisional position of 7 cases was in the posterolateral eighth intercostal of the affected side,and 3 cases were the abdominal incision under the ribbed edge.In the thoracic group,4 cases were treated with internal organs of the abdomen returned to the abdominal cavity and diaphragmatic repair,and 3 cases were treated with repair of diaphragmatic hernia by polyester patch.In the abdominal group,the intestine was pulled into the abdominal cavity and the diaphragmatic defect was repaired under direct vision.Before the operation,we used prohibition diet,gastrointestinal decompression,intravenous supplement of nutrition and strict respiratory system monitoring.After the operation,we used good respiratory tract management,keeping the drainage tube smooth and strengthening the monitoring of pulmonary circulation.Results:10 cases of children in this group were survived,5 cases of postoperative chest radiography showed left pneumothorax and left atelectasis,4 cases were given thoracic puncture,1 case was given resetting drainage tube.After strengthening the pulmonary physiotherapy,the patients were all healed.There was no recurrence of diaphragmatic hernia after operation.Conclusion:Neonatal congenital diaphragmatic hernia should be treated by direct suture or patch repair according to the size of the diaphragmatic defect.The children's general life signs were stable can significantly improve the postoperative survival rate.High quality perioperative care provided a guarantee for the success of the operation and the long term quality of life of the children.