一例新生儿大动脉转位术后延期关胸合并急性肾损伤行腹膜透析护理  

Nursing care for one case of newborn with delayed closure of chest and acute renal injury after Switch operation and underwent Peritoneal dialysis

作　　者：尚文媛 俞群[2] 胡雅琴 李思雯 李倩[1] 陈瑜 侯雯晴 Shang Wenyuan;Yu Qun;Hu Yaqin;Li Siwen;Li Qian;Chen Yu;Hou Wenqing(Pediatric Surgery Intensive Care Unit of Pediatric Emergency and Critical Department,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Nursing Department,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院小儿急危重症医学科PSICU,200092 [2]上海交通大学医学院附属新华医院护理部儿科组,200092

出　　处：《中国实用护理杂志》2019年第3期200-204,共5页Chinese Journal of Practical Nursing

基　　金：上海交通大学医学院护理高原学科百人计划-青年后备人才支持基金项目(hlgy17097qnhb).

摘　　要：目的总结新生儿Switch术后延期关胸合并急性肾损伤行腹膜透析的护理经验,提高治疗效果。方法2017年11月收治1例室间隔完整型完全性大动脉转位的新生儿,对其全身麻醉体外循环Switch术后延期关胸合并急性肾损伤行腹膜透析进行疗效及围手术期护理经验总结。结果患儿术后延期关胸,于术后1 h出现低心排综合征、急性肾功能损伤,通过ICU期间监测血流动力学指标,及时处理低心排综合征、维持循环稳定、利尿、腹膜透析、维持水电解质及酸碱平衡、延期关胸护理等相关治疗后痊愈,术后机械通气辅助时间168 h,术后ICU住院时间12 d,术后总住院时间19 d。结论室间隔完整型完全性大动脉转位新生儿行Switch手术的患儿术后病情变化快、并发症多,严密、细致的护理对减少术后并发症,提高手术成功率起着关键的作用。Objective To summarize the nursing experience of delayed closure of chest with acute renal injury after switch operation and underwent peritoneal dialysis in neonates and to improve the therapeutic effect.Methods To summarize the curative effects and perioperative nursing experience of one case of the complete transposition of great arteries with intact interventricular septum neonate who underwent delayed closure of chest with acute renal injury and peritoneal dialysis after Switch operation under general anesthesia and extracorporeal circulation in November 2017 in our department.Results The child was postponed to close the chest after surgery. Low cardiac output syndrome and acute renal function injury occurred 1 hour after operation. Through monitoring hemodynamic indexes during ICU,the child recovered after timely treatment of low cardiac output syndrome,maintaining stabilization of circulation,diuresis,peritoneal dialysis,keeping water,electrolyte and acid-base balance,nursing care for delayed closure of chest and other related treatment. Postoperative assisted mechanical ventilation time was 168 hours,postoperative ICU hospitalization time was 12 days,and postoperative total hospitalization time was 19 days.Conclusion The infants who have complete transposition of the great arteries and the intact interventricular septum after Switch operation have many complications and rapid changes in the state of illness. Rigorous and meticulous nursing plays a key role in reducing the postoperative complications and improving the achievement ratio of the operation.

关 键 词：SWITCH术 低心排综合征 延期关胸 腹膜透析 

分 类 号：R473.72[医药卫生—护理学]