全程无缝隙护理在新生儿先天性十二指肠梗阻腹腔镜手术围手术期的应用

Perioperative whole-course seamless nursing model of laparoscopic surgery in neonates with congenital duodenal obstruction

目的总结新生儿十二指肠梗阻的腹腔镜手术围手术期护理经验,探讨优质全程无缝隙护理模式在提高新生儿围手术期护理质量中的价值。方法回顾性分析本院2018年1月至2019年12月收治的85例确诊为先天性十二指肠梗阻并接受腹腔镜下十二指肠吻合术的新生儿病例资料,总结术前、术中、术后采取的全程无缝隙护理措施,评估其护理和治疗效果。结果85例确诊为先天性十二指肠梗阻的新生儿,行十二指肠菱形吻合术64例,十二指肠隔膜切除十二指肠吻合术21例。麻醉清醒时间(52.3±10.6)min(35~128 min),初次经口进食时间(5.9±3.4)d(1~23 d),术后足量进食时间(9.1±3.5)d(6~26 d),静脉营养时间(8.9±2.19)d(5~25 d),住院天数(10.7±7.4)d(7~28 d)。无伤口感染、吻合口瘘、吻合口梗阻等术后并发症,无肺炎、褥疮、留置针感染等护理相关并发症。总体护理满意度达99%。术后随访,上消化道造影检查十二指肠无梗阻,喂养良好,无呕吐,伤口美观。结论新生儿十二指肠梗阻腹腔镜围手术期优质全程无缝隙护理措施可行,可减少手术并发症,加快术后康复,改善护理和治疗效果,提高患方满意度,值得临床推广。

Objective To summarize the perioperative nursing experience of laparoscopic surgery for neonates with congenital duodenal obstruction,and to explore the value of high quality whole-course seamless nursing model in improving neonatal perioperative nursing quality.Methods The clinical data of 85 newborns with congenital duodenal obstruction who received laparoscopic duodenal anastomosis in our hospital from January 2018 to December 2019 were retrospectively analyzed,all cases were performed preoperativeintraoperative-postoperative whole-course seamless nursing measures,the nursing and treatment effects were evaluated.Results Among 85 newborns who were diagnosed as congenital duodenal obstruction,64 cases underwent duodenal diamond-shaped anastomosis,and 21 cases underwent duodenal septum resection and duodenal anastomosis.The postoperative anesthetic awareness time was(52.3±10.6)min(35~128 min),the first oral feeding time was(5.9±3.4)d(1~23 d),the postoperative full feeding time was(9.1±3.5)d(6~26 d),the total parenteral nutrition time was(8.9±2.19)d(5~25 d),and the length of hospital stay was(10.7±7.4)d(7~28 d).There were no postoperative complications such as wound infections,anastomotic fistula or anastomotic obstruction,there were no nursing related complications such as pneumonia,pressure sore or indwelling needle infection.The nursing satisfaction was 99%.Postoperative follow-up showed no duodenal obstruction by upper gastrointestinal radiography,good feeding,without vomiting after surgery,wound healing well.Conclusions For neonatal duodenal obstruction,it is feasible to take high-quality whole-course seamless nursing measures during the perioperative period of laparoscopic surgery,which can reduce surgical complications,speed up postoperative rehabilitation,improve nursing and treatment effects,and increase satisfaction degree,worthy of clinical application.