自闭症儿童经结肠TET管行洗涤粪菌移植的护理

Nursing Care of Children with Autism Who Underwent Washed Fecal Microbial Transplantation Via Colonic TET Tube

目的:探讨自闭症儿童通过结肠TET管途径行洗涤粪菌移植的护理要点。方法:随机选取2020年8月至2021年8月南京医科大学第二附属医院和新疆伊犁州友谊医院进行首次洗涤粪菌移植治疗的15例自闭症儿童,移植前统计患儿CARS评分,将其分为特殊护理组(11例)和一般护理组(4例),一般护理组予以常规护理,特殊护理组做好入院宣教、移植中做好管道护理配合以及不良反应观察、移植后做好生活饮食及管道护理等相关指导、移植全程均做好患儿及其家长的心理护理。洗涤粪菌移植治疗后8周随访患儿疗效,评估其CARS评分。结果:洗涤粪菌移植前患儿CARS评分(40.39±3.44),移植后患儿CARS评分(33.93±1.74),两者相比差异具有统计学意义(P<0.001);一般护理组治疗前和治疗后的CARS评分(37.63±2.87)及(33.63±2.36),特殊护理组治疗前和治疗后的CARS评分(41.50±3.10)和(34.05±1.57),两者相比差异具有统计学意义(P=0.005);一般护理组发生1例自行拔管导致黑便外,其余无发热、出血、腹痛等严重不良反应。结论:自闭症儿童行洗涤粪菌移植治疗的同时给予有效的护理可提高洗涤粪菌移植的疗效,值得推广和进一步研究。

Objective:To investigate the key points of care for washing fecal transplantation via the colonic TET tube route in children with autism.Methods:Fifteen children with autism who underwent their first washout fecal transplantation treatment at the Second Affiliated Hospital of Nanjing Medical University and Xinjiang Yili Prefecture Friendship Hospital from August 2020 to August 2021 were randomly selected.The children's CARS scores were counted before transplantation,and the children's behavioral changes before and after transplantation were observed.The group was divided into special care group(11 cases)and general care group(4 cases),and the general care group was given routine care,while the special care group was given good admission education,good cooperation with pipeline care during transplantation and observation of adverse reactions,good guidance on diet and pipeline care after transplantation,and good psychological care for the children and their parents throughout the transplantation.The efficacy of the children was followed up 8 weeks after the washout fecal transplantation treatment,and their CARS scores were evaluated.Results:The CARS scores of children with washed fecal bacteria were 40.39±3.44 before transplantation and 33.93±1.74 after transplantation,with statistically significant differences compared to each other(P<0.001).The CARS scores before and after treatment were 37.63±2.87 and 33.63±2.36 in the general care group and 41.50±3.10 and 34.05±1.57 in the special care group,with statistically significant differences compared to each other(P=0.005).In the general care group,there was a self-extracted tube resulting in black stool,and the rest have no serious adverse effects such as fever,bleeding,abdominal pain,etc.Conclusion:Effective care for children with autism treated with detergent fecal transplantation can improve the efficacy of detergent fecal transplantation and is worth promoting and further studying.