尿道下裂患儿围手术期留置导尿管的精细化护理

Meticulous nursing of indwelling urinary catheter between the children with hypospadias during ;perioperative

目的：总结尿道下裂患儿围手术期留置导尿管的精细化护理经验。方法对317例仅在尿道内留置硅胶Foley导尿管，而不做其他形式尿流改道的尿道下裂患儿进行回顾性分析，总结其精细化护理要点，包括术前对患儿进行全面风险评估、规范术前备皮方式、术后实施有效的保护性约束、妥善固定导尿管、保持尿液引流通畅、严密观察尿液引流性状、保持集尿系统的密闭性、保持会阴局部清洁、改良拔管护理方法、并做好拔管后的护理等。结果317例尿道下裂患儿手术治愈266例患儿，治愈率为83.9%（266/317）；术后发生尿瘘42例占13.2%（42/317），尿道狭窄7例占2.2%（7/317），尿道憩室2例占0.6%（2/317），无一例患儿出现意外拔管。结论精细化护理在尿道下裂患儿围手术期中具有较佳的应用效果，可以降低术后并发症的发生率，缩短患儿的住院时间，减轻患儿痛苦，提高了护理服务质量，值得在临床中推广。

Objective To summarize the meticulous nursing experience of indwelling urinary catheter between the children with hypospadias during perioperative. Methods 317 cases of indwelling urethral only in the silicone Foley tube, and without other urinary diversion with hypospadias were retrospectively analyzed, summarized the fine points of nursing, including preoperative children with comprehensive risk assessment, standardized preoperative skin preparation and postoperative protective constraint, effective properly fixed catheter keep the urine drainage unobstructed, close observation of urine drainage characteristics, maintain urine collection system tightness, maintain perineal skin clean and improved extubation nursing method, and do a good job after extubation nursing. Results 266 cases were cured with a cure rate of 83.9%(266/317);the incidence of urine leakage in 42 cases, the incidence rate was 13.2%(42/317); 7 cases of urethral stenosis, the incidence rate was 2.2%(7/317); 2 cases of urethral closing, the incidence was 0.6% (2/317), none of the patients had accidental extubation. Conclusions The meticulous nursing has a better effect in hypospadias patients during the perioperative period and it can reduce the incidence of postoperative complications;shorten the time of hospitalization and alleviate the suffering of children;improve the quality of nursing service, which is worthy of clinical application.