一例肢端型系统性硬皮病致四肢重度发育障碍患者截肢术的多学科处理方法  

A multidisciplinary approach to amputation in a case of severe developmental disorder of extremities caused by acroscleroderma

作　　者：侯毅芳[1] 肖明[1] Hou Yifang;Xiao Ming(Department of Operating Room,Peking University Shenzhen Hospital,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院手术室,518036

出　　处：《中国实用护理杂志》2021年第7期526-530,共5页Chinese Journal of Practical Nursing

摘　　要：目的探讨肢端型系统性硬皮病致四肢重度发育障碍患者截肢术的围手术期安全管理,选择合适的方法进行生命体征监测,预防术中获得性压疮、院内感染等相关并发症的有效处理措施。方法2019年11月北京大学深圳医院收治1例肢端型系统性硬皮病致四肢重度发育障碍患者需行截肢手术,通过组织多学科会诊商讨手术方案,反复选择合适用具,多次情景模拟演练,实现对四肢肢端缺如患者进行持续经皮血氧饱和度及无创血压监测,通过彩色超声监视下确定肢体动脉阻断压为术中止血带压力值,采取恰当措施预防术中获得性压疮、院内感染等相关并发症。结果在多学科团队配合下成功为患者实施截肢术,术中体位摆放舒适,手术过程顺利,术后残肢愈合良好,无术中获得性压疮、院内感染等相关并发症发生。结论建立多学科合作机制、强化手术室专科组建设、运用循证护理学方法及实际情景模拟演练,可确保四肢重度发育障碍患者及类似的特殊体型、极低体质量等患者的围手术期安全。Objective To explore the perioperative safety management of patients with severe limb dysplasia,to select appropriate methods to monitor vital signs,and to prevent intraoperative acquired pressure sore,nosocomial infection and other related complications.Methods A case of severe developmental disorder of extremities caused by acroscleroderma in November 2019 in Peking University Shenzhen Hospital needed to be amputated.By organizing multidisciplinary consultation to discuss the operation plan,repeatedly selecting appropriate tools,and multiple scenario simulation exercises,continuous transcutaneous oxygen saturation and noninvasive blood pressure monitoring could be realized for the patients with acromegaly deficiency of the extremities.Under the monitoring of color ultrasound,the arterial blocking pressure of the extremities was determined as the tourniquet pressure during the operation value,take appropriate measures to prevent intraoperative acquired pressure sore,nosocomial infection and other related complications.Results With the cooperation of multidisciplinary team,amputation was successfully carried out for the patients.The position was comfortable during the operation,the operation process was smooth,the residual limbs healed well after the operation,and there was no intraoperative acquired pressure sore,nosocomial infection and other related complications.Conclusions To establish a multidisciplinary cooperation mechanism,strengthen the construction of the operating room special group,and use evidence-based nursing methods and actual scenario simulation exercise can ensure the perioperative safety of patients with severe developmental disorder of extremities and similar patients with special body shape or very low weight.

关 键 词：系统性硬皮病 肢端型 发育障碍 四肢缺如 骨质疏松 

分 类 号：R473.6[医药卫生—护理学]