Psychological trauma of funnel chest in adolescents and the appropriate age for minimally invasive surgery repair

Background Funnel chest has a negative effect on adolescents and it has a strong effect on adolescents＇ psychological and behavior. This study aimed to investigate the psychological characteristics and factors that affect adolescents with funnel chest and to evaluate the relationship between the patients＇ age and their physiological and psychological health. We aimed to establish an age model for maximum surgery benefits for funnel chest patients to provide an objective basis for choosing surgery. Methods The study adopted a general evaluation approach to assess the risk and benefits of minimally invasive surgery for funnel chest. The funnel chest index, the Symptom Checklist-90, and the Eysenck Personality Questionnaire were used as assessment tools to observe physiological and psychological features in funnel chest patients. A sample of 234 adolescents with funnel chest was selected from a third-grade class-A hospital in Beijing. Age groups were adopted as an independent variable, and other factors in funnel chest patients were dependent variables. Results There was a significant difference in the relapse rate for funnel chest in the different age groups （X2=11.883, P=-O.008）. There was a higher relapse rate in patients of 〈10 or 〉-19 years old than in patients of 11-18 years old. There was a significant difference in the SCL-90 total score in the different age groups （F=12.538, P=-0.0001）, the patients older than 13 years had a higher score than those younger than 13 years in the SCL-90. There was a significant difference in the standard score of E （introversion/extraversion） in the different age groups （F=10.06, P=0.0001）. There was also a significance in the funnel chest index before surgery in the different psychological scales （P〈0.01）, with a higher funnel chest index score associated with more obvious psychological trauma. Age and the number of variables, including the relapse rate, SCL-90 score, standard score of E, and standard score of N in the EPQ were significantly correlated （correlation indices were 0.402, 0.623, -0.505, and 0.473, respectively, P〈0.01）. Conclusions There are higher complication rates after surgery and relapse rates when funne{ chest patients are too young or too old. There is more obvious psychological trauma in patients with a high funnel chest index. Our results indicate that the best age for surgery for funnel chest is 14-16 years.

非胸腔镜下微创手术治疗小儿漏斗胸的护理

目的探讨非胸腔镜下改良微创Nuss手术治疗小儿漏斗胸的护理。方法 2007年3月～2009年11月收治122例患儿,均在非胸腔镜下行Nuss手术,其中男83例,女39例,年龄3～16岁,平均(6.32±3.52)岁,合并扁平胸28例,不对称漏斗胸22例,合并心脏和肺部畸形4例。119例植入1根钢板,3例植入2根钢板。术前重视患儿和家长的心理护理和健康指导,同时做好并发症的护理,术后重点做好病情观察、疼痛管理和康复护理以及出院指导,保证手术效果。结果122例均顺利完成手术,无术中并发症。平均手术时间15～40min,术后平均住院6.5d,随访1～43个月,效果满意。术后早期明显疼痛12例,胃肠道反应25例,皮下气肿及少量气胸5例,及时处理后好转。2例3月～1年术后钢板位置倾斜,再次手术。由于护理配合及时,患者恢复良好。结论非胸腔镜手术创伤小,切口美观,精心细致的护理是手术成功的重要保障。

小儿漏斗胸NUSS术治疗中临床护理路径的应用效果研究

目的探讨临床护理路径运用在小儿漏斗胸微创漏斗胸矫形术(NUSS术)治疗中的效果。方法 90例行NUSS术的漏斗胸患儿,随机分为对照组和观察组,每组45例。对照组患儿行常规护理,观察组患儿行临床护理路径。比较两组患儿治疗效果及术后并发症发生率。结果观察组治疗优良率为100.00%,与对照组的97.78%比较差异无统计学意义(P>0.05)。观察组术后并发症发生率为2.22%,低于对照组的13.33%,差异具有统计学意义(P<0.05)。结论临床上给予小儿漏斗胸NUSS术治疗时,运用临床护理路径,可以减少并发症的发生,获得较好的预后,具有一定的推广价值。

成人漏斗胸新型微创矫形法术后的护理

成人漏斗胸微创矫形法(Nuss手术)是国内外开展的一种新型整形手术。本文总结了4例接受该手术患者的术后护理,主要包括加强生命体征监测,保持呼吸道通畅,加强疼痛管理,体位和活动范围的指导,密切观察胃肠道反应、排痰困难、钢板移位和排斥反应、切口感染、肋间神经受损等并发症及注重出院指导。本组手术过程顺利,术中出血量10～30ml。术后2个月随访,主观满意度3例优,1例良。术后1例出现钢板移位,行第二次钢板固定术;3例未发生钢板移位、钢板排斥反应及肋间神经受损等并发症。

基于童趣化的认知行为干预在漏斗胸微创矫正术患儿中的应用

目的探讨基于童趣化的认知行为干预在漏斗胸微创矫正术(Nuss手术)患儿康复训练管理中的应用效果。方法选择2018年7月-2020年12月我科收治的拟行Nuss手术患儿107例为研究对象,采用随机数字表法分为试验组54例和对照组53例。对照组给予常规护理干预及康复训练指导,试验组应用基于童趣化的认知行为干预。干预6个月,比较两组心理状态、康复训练自我效能、生活质量。结果试验组干预后焦虑障碍自评量表(SCARED)、抑郁障碍自评量表(DSRSC)评分低于对照组(P<0.05),康复训练自我效能评分高于对照组(P<0.05),生活质量评分高于对照组(P<0.05)。结论基于童趣化的认知行为干预有助于缓解Nuss手术患儿焦虑、抑郁情绪,促进康复训练自我效能感的养成,改善患儿生活质量。

漏斗胸微创矫正术对漏斗胸的治疗及护理

目的探讨漏斗胸微创矫正术在漏斗胸矫治过程中的临床效果及护理。方法选取2013年5月至2014年6月我院收治的先天性漏斗胸患者24例,对其进行漏斗胸微创矫正术治疗及护理,观察记录患者的临床就诊情况。结果患者手术时间为38-56 min,平均（45.0±2.1）min;出血量在5-11 ml,术后住院时间为4-7 d,平均（5.0±1.2）d。2个月随访调查结果显示患者均无钢板移位现象发生,矫正效果较佳。结论漏斗胸微创矫正术在漏斗胸矫治过程中配合相应的护理措施,具有创伤小、出血量少,且患者术后恢复快等优点。