急性出血坏死性肠炎患者术后多个消化道造瘘的护理

Nursing care of multiple gastrointestinal fistulas after operation in a patient with acute hemorrhagic necro-tizing enteritis

总结1例急性出血坏死性肠炎伴感染性休克患者术后多个消化道造瘘的护理体会。针对本例患者多次手术术后感染严重、营养状况差、切口和造瘘多、位置临近、造瘘排泄量大等问题,多学科共同参与评估和诊疗,针对多处不同菌株多重耐药菌感染采取经验性联合抗生素治疗、动态调整全静脉营养配方、抑制消化液分泌、心理支持等措施;运用负压封闭引流技术、分区隔断管理切口和造瘘,选用合适的造口袋有效收集造瘘排泄物,避免造瘘排泄物渗漏,促进切口愈合。患者术后30d感染控制,腹部切口愈合,造瘘功能良好;术后4个月生活自理,为后期治疗奠定了基础。

This article summarized the nursing experience of multiple gastrointestinal fistulas after operation in a patient with acute hemorrhagic necrotizing enteritis and septic shock. The patients had severe postoperative infections,poor nutritional status,multiple incisions and fistulas with close location and large excretion. Multi-disciplinary joint evaluation,diagnosis and treatment were conducted. Nursing measures included implementing empirical combined antibiotic therapy according to multiple drug-resistant bacterial infections with different strains,dynamic adjustment of total intravenous nutrition formula,inhibition of digestive juice secretion,psychological support and etc.And nurses used vacuum sealing drainage technology,separated the areas of incisions and fistulas for management,selected appropriate ostomy bags to effectively collect fistula excrement and avoid leakage,to promote the healing of the incision. The patient’s infection was controlled 30 days after the operation,the abdominal incision was healed,and the fistula functioned well. The patient can take care of himself 4 months after the operation,which laid the foundation for the later treatment.