1例脊索瘤放疗后颅底骨坏死患者的护理

Nursing care of a patient with skull base osteonecrosis after radiotherapy for chordoma

总结1例脊索瘤放疗后颅底骨坏死患者全麻内镜经鼻颅底坏死骨清除术+复合组织瓣颅底重建术后先后继发吸入性肺炎、真菌血症、颅内感染、脑脊液漏、气颅的护理经验。护理要点:尽早开展吞咽评估、围手术期摄食管理,减少误吸,尽快恢复经口进食;实施俯卧位通气联合感染肺叶的振动排痰技术促进炎症引流,增加通气量;依据脑脊液漏点位置摆放体位,控制体位移动幅度,量性监测气管切开套管囊上分泌物,监测鼻腔填塞导管填充位置及做好鼻部皮肤保护。患者住院45 d,经过精心治疗和护理,病情好转出院。

This study summarises the care provided in a case undergoing general anaesthesia for endoscopic transnasal skull base necrotic bone removal+composite tissue flap skull base reconstruction with sequential secondary aspiration pneumonia,fungemia,intracranial infection,cerebrospinal fluid leak,and air cranium.Key points of care:early swallowing assessment and perioperative ingestion management,the reduction of the risk of mis-aspiration,the rapid recovery of oral feeding;prone position ventilation in combination with vibratory drainage techniques of the infected lung lobes promoted purulent drainage and enhanced ventilation.The key to the care of a massive cerebrospinal fluid leak with pneumocephalus included proper placement of the patient based on the position of the leak,control of head and body movement,and monitoring of the volume of secretions on the tracheotomy bag.The position of the nasal cannula was observed,and nasal skin care was performed to ensure the position of the cannula and the integrity of the nasal skin.The patient was discharged after 45 days of hospitalisation with meticulous treatment and care.