联体双胎合并一胎先天性心脏病行分离手术的护理  

Surgical nursing care of conjoined twins complicated with congenital heart disease of one infant undergoing separation operation

作　　者：赵杭燕[1] 钭金法[2] 施蜜 诸纪华[3] ZHAO Hangyan;TOU Jinfa;SHI Mi;ZHU Jihua

机构地区：[1]国家儿童健康与疾病临床医学研究中心/浙江大学医学院附属儿童医院手术室,杭州市310052 [2]国家儿童健康与疾病临床医学研究中心/浙江大学医学院附属儿童医院新生儿外科,杭州市310052 [3]国家儿童健康与疾病临床医学研究中心/浙江大学医学院附属儿童医院护理部,杭州市310052

出　　处：《中华急危重症护理杂志》2023年第7期604-606,共3页Chinese Journal of Emergency and Critical Care Nursing

摘　　要：报告1例胸腹联体合并一胎先天性心脏病患儿行分离手术的护理体会。护理要点:术前多学科联合模拟演练,制订个性化麻醉方案,实施精细化管理,如驼峰式体位安置支撑联体部位、多模式精准控温、分离前后手术的安全过渡、感染预防等来保障手术安全。手术总用时180 min,联体儿分离用时11 min,双胎生后阿氏评分9~10分。术后送至新生儿重症监护病房进一步治疗及护理,双胎A分离术后有呼吸费力等心功能不全表现,考虑动脉导管未闭致肺血过多,遂于分离术后第7天行床边动脉导管未闭结扎术,术后氧合逐步改善,无胸闷气促,心律齐,于分离术后40 d出院。双胎A存在肺动脉瓣狭窄,远期再行心脏病矫治手术。双胎B于分离术后第8天康复出院。This paper reported the nursing experience of thoracoabdominal conjoined twins accompanied by congenital heart disease of one infant undergoing separation operation.Nursing points:refined managements were implemented after preoperative multidisciplinary joint simulation exercise and making personalized anesthesia plan to ensure the safety,such as hump position placement to support the joint part,multi-mode accurate temperature control,safe transition of operation before and after separation,infection prevention.The total operation time was 180 minutes,and the separation time for conjoined children was 11 minutes,the Apgar score of 1~5 minute was 9~10.After operation,the twins were sent to NICU for further treatment and nursing.After separation Twin A had some cardiac insufficiency symptom such as labored breathing and so on.We considered the pulmonary hyperaemia due to patent ductus arteriosus(PDA),so PDA ligation was performed on the 7th day after separation and postoperative oxygenation was improved gradually.Twin A had regular heartbeat without chest tightness and shortness of breath,and was discharged 40 days after separation.Twin A had pulmonary valve stenosis and underwent long-term corrective heart surgery.Twin B recovered and was discharged on the 8th day afters eparation.

关 键 词：双生 联体 先天性心脏病 手术室护理 

分 类 号：R473.72[医药卫生—护理学]