巨型脐膨出患儿行二期修补术并发腹内高压的护理

Nursing of children with giant omphalocele complicated with intra-abdominal hypertension after secondar repair

总结13例巨型脐膨出患儿行二期修补术并发腹内高压的护理经验。针对该组患儿二期修补创伤大、术后腹内高压、长期保护性机械通气、镇静镇痛难度大、下腔静脉回流受阻,需面临低氧血症、肾功能障碍等棘手问题。采取目标式镇痛镇静,优化以腹内压为导向的体位管理策略,加强呼吸系统监护与管理,严密监测肾功能、维持循环稳定,充分营养支持、积极促进康复等护理措施。经过严密监护和精心护理,该组患儿术后均顺利度过腹内高压期,预后良好,顺利出院。

To summarize the nursing experience of 13 children with giant omphalocele complicated with intraabdominal hypertension after secondary repair.Due to the severe trauma of secondary repair,postoperative intraabdominal hypertension,long-term protective mechanical ventilation,difficult sedation and analgesia,obstruction of inferior vena cava reflux,we had to face hypoxemia,renal dysfunction and other difficult problems.We adopted targeted analgesia and sedation,optimized posture management strategy guided by intra-abdominal pressure value,strengthened the monitoring and management of respiratory system,closely monitored renal function,maintained circulatory stability,fully supported nutrition,and active promoted the of rehabilitation.After close monitoring and careful nursing,all the children successfully survived the period of intra-abdominal hypertension with good prognosis and were discharged smoothly.