早产儿先天性胃肠道疾病的围手术期护理措施及要点分析

Perioperative nursing measures and key point analysis of congenital gastrointestinal diseases in premature infants

目的探讨合并先天性胃肠道疾病早产儿的围手术期护理措施和管理要点.方法回顾性分析2014年11月至2018年6月36例行胃肠道手术治疗患儿的临床资料,根据其胎龄分为3组:25周≦胎龄?28周组(A组,9例),28周≦胎龄?30周组(B组,19例)和胎龄≧37周组(C组,8例).3组患儿均实施精细化综合护理对策,记录各组患儿术前(T0)、麻醉诱导后(T1)、麻醉后30 min(T2)、麻醉后1 h(T3)、术毕(T4)5个时点心率、SpO2、MAP及术后不良反应情况.结果36例手术患儿,其中2例术后1周内死亡,其余34例康复出院.C组患儿体重明显高于A组、B组,日龄明显小于A组、B组(P<0.05).A组患儿T0时SpO2明显低于B组、C组,差异有统计学意义(P<0.05);与T0比较,A组患儿T3、T4时SpO2明显升高,差异有统计学意义(P<0.05).A组患儿低氧血症、低体温、再次插管发生率明显高于B组、C组(P<0.05);B组患儿低氧血症、低体温、再次插管发生率明显高于C组(P<0.05).结论早产儿围手术期应该采取精细化综合护理措施,体温与呼吸管理为重中之重.安全有效的保温措施可提高患儿的围手术期安全,减少术后并发症的发生,提高手术成功率和生存率.

Objective To explore the key points of perioperative nursing measures and management of premature infants with congenital gastrointestinal diseases.Methods A retrospective analysis was conducted using clinical data from 36 children undergoing gastrointestinal surgery from November 2014 to June 2018.According to gestational ages,the patients were divided into groups A,B and C:group A(n=9),25 weeks≤gestational age<28 weeks,group B(n=19),28 weeks≤gestational age<30 weeks,and group C(n=8),gestational age≥37 weeks.The three groups of children received fined comprehensive nursing care.The heart rate,pulse oxygen saturation(SpO2),mean artery pressure(MAP)and adverse reactions were recorded before operation(T0),after anesthesia induction(T1),30 min after anesthesia(T2),one hour after anesthesia(T3),and at the end of operation(T4).Results There were two patients who died within one week,while the other 34 were recovered and discharged.Compared with groups A and B,patients in group C presented higher body weight and remarkable less ages than those in group C(P<0.05).The SpO2 of group A was remarkably increased at T3 and T4,compared with the level at T0(P<0.05).The incidence of hypoxemia,hypothermia and reintubation of group A were higher than those in groups B and C(P<0.05),where group B presented marked improvement in the incidence of hypoxemia,hypothermia and reintubation,compared with group C(P<0.05).Conclusions Comprehensive nursing care should be taken in perioperative period of premature infants,especially in the management of body temperature and respiration.Effective thermal insulation measures can improve perioperative safety,reduce the occurrence of postoperative complications and improve survival rate.