优质护理在新生儿先天性十二指肠闭锁的围术期的应用

优质护理在新生儿先天性十二指肠闭锁的围术期的应用

目的探讨新生儿先天性十二指肠闭锁的围术期护理效果。方法选择2013年1月～2016年1月我院收治的先天性十二指肠闭锁新生儿共80例，随机分为观察组和对照组，每组各40例。对照组患儿给予常规先天性十二指肠闭锁手术围术期护理干预，观察组同时给予优质护理。观察两组患儿术后并发症发生情况，评定治疗效果，调查两组患儿家属护理满意度。结果观察组术后并发症为7.5%，对照组术后并发症为25.0%，观察组术后并发症低于对照组，差异有统计学意义（P＜0.05）。观察组治疗有效率为97.5%，对照组治疗有效率为80.0%，观察组治疗有效率高于对照组，差异有统计学意义（P＜0.05）。观察组患儿家属的護理满意度为95.0%，对照组患儿家属的护理满意度为77.5%，观察组患儿家属的护理满意高于对照组，差异有统计学意义（P＜0.05）。结论围术期优质护理干预有助于降低新生儿先天性十二指肠闭锁术后并发症，改善患儿预后，护理效果显著。

[Abstract]Objective To investigate the effect of high quality nursing in perioperative period of congenital duodenal atresia in infants.Methods 80 infants with congenital duodenal atresia were selected in our hospital from January 2013 to January 2016，and they were randomly divided into observation group and control group，with 40 cases in each group，the control group were given routine perioperative nursing intervention of congenital duodenal atresia，the observation group was given high quality nursing care.The postoperative complications of two groups were observed，the curative effect was evaluated，and the nursing satisfaction of the two groups was investigated.Results The incidence of postoperative complications was 7.5% in the observation group and 25.0% in the control group.The postoperative complications in the observation group was lower than those in the control group，the difference was statistically significant （P＜0.05）.The effective rate was 97.5% in the observation group and 80.0% in the control group.The effective rate of the observation group was higher than that of the control group，the difference was statistically significant （P＜0.05）.The nursing satisfaction of family members of children in the observation group was 95.0%，and the satisfaction degree of family members of children in the control group was 77.5%.The nursing satisfaction of the family members in the observation group was higher than that in the control group，and the difference was statistically significant （P＜0.05）.Conclusion The high quality nursing intervention is helpful to reduce the postoperative complications and improve the prognosis of neonates with congenital duodenal atresia，and the nursing effect is remarkable.

[Key words]Newborn；Congenital duodenal atresia；Perioperative period；Nursing；Quality care

在新生儿消化道畸形疾病中，新生儿先天性十二指肠闭锁较为常见，是胚胎时期肠管空泡化不全而引起，同时可伴其他畸形。此类患儿在出生后即可发生呕

吐，且呕吐次数较多，量多[1]。手术治疗是新生儿先天性十二指肠闭锁的治疗手段。而此类患儿围术期护理干预是十分重要的。特别是此类患儿术后并发症严重影响到患儿的预后[2-3]。本研究选择我院收治的先天性十二指肠闭锁新生儿，观察围术期优质护理干预对此类患儿术后并发症的影响。现报道如下。1资料与方法

1.1一般资料

选择2013年1月～2016年1月我院收治的先天性十二指肠闭锁新生儿共80例，患儿出生后即出现呕吐等症状，经临床体格检查、影像学检查等确诊。所选患儿家属同意参与本实验研究，本实验经我院医学伦理委员会同意并在其指导下进行。同时排除不在我院接受手术治疗及护理干预、不能顺利完成本实验的患儿。将入选患儿随机分为观察组和对照组，每组40例。两组患儿一般情况比较，差异无统计学意义（P>0.05）（表1），具有可比性。

1.2方法

对照组患儿给予常规先天性十二指肠闭锁手术围术期护理干预：观察患儿病情、记录患儿呕吐情况、嘱咐患儿家属为患儿做好术前准备、术后病情观察等。观察组患儿在常规护理基础上实施优质护理干预：①病情监测优质护理。术前严格观察患儿呕吐、腹胀等临床症状，监测患儿脉搏、呼吸、体温、血压等生命体征改变情况，一旦发现病情改变及时通知医生做出处理。术后患儿的心率、血压、呼吸、血氧饱和度等指标监测对患儿术后至关重要，详细记录患儿呕吐物的量和颜色等，如果患儿呕吐物为胆汁样，患儿体温升高以及肺部听诊有湿啰音等，这可能是术后并发症，要及时通知医生并及时作出正确处理。②做好术后呼吸道优质护理。此类患儿呕吐物容易导致误吸，引起吸入性肺炎发生；麻醉时气管插管可导致患儿喉头水肿而导致气道口径变小，导致吸气性呼吸困难，要及时发现并告知医师作出处理；术后做好呼吸道分泌物清理，及时控制肺部感染；通过叩背、吸痰等方式清理呼吸痰液。保持病房内湿度和温度适中。每天对病房消毒，并通风换气。③体温优质护理。新生儿中枢神经系统未发育完全对体温调节功能有限；再者，新生儿皮下脂肪和成人有差别，饱和脂肪酸所占比例较多，外界温度对其影响大，容易使患儿发生硬肿症，所以对患儿要做好保温。把要做的护理集中在一起，避免患儿身体长时间暴露而影响体温。定时测量患儿体温，预防此类患儿发生硬肿症。④胃肠减压优质护理。当患儿出现吻合口瘘等术后并发症时，要对此类患儿做好胃肠减压，胃肠减压过程中，记录引流的量和颜色，同时告诫患儿家属做好胃管方面的保护。

1.3观察指标

①观察并记录两组患儿术后并发症（吻合口狭窄、吻合口瘘、硬肿症、肺部感染、肠粘连致梗阻等）发生情况。②评定两组患治疗效果比较：患儿经过手术治疗后呕吐等临床症状消失，术后并发症相关症状和体征消失，患儿术后痊愈顺利出院，为治愈；患儿术后呕吐等临床症状消失，术后并发症相关症状和体征显著改善，为好转；患儿呕吐临床症状没有改善，术后并发症并没有改善，甚至患