多学科协作手术治疗妊娠晚期合并颅内巨大动静脉畸形伴破裂出血的围手术期护理  

Perioperative nursing of patients with giant ruptired brain arteriovenous malformations in late pregnancy undergoing surgery assisted by multidisciplinary cooperation

作　　者：张美芳[1] 薛晴 张新元 ZHANG Mei-fang;XUE Qing;ZHANG Xin-yuan(Department of Neurosurgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院东院神经外科,武汉430060

出　　处：《中国临床神经外科杂志》2024年第3期169-171,共3页Chinese Journal of Clinical Neurosurgery

基　　金：湖北省重点实验室开放项目(2021KFH002);武汉大学临床护理专项科研培育基金项目(LCHL202308)。

摘　　要：目的总结多学科协作手术治疗妊娠晚期合并颅内巨大动静脉畸形(AVM)伴破裂出血的围手术期的护理经验。方法回顾性分析1例妊娠30+3周合并颅内巨大AVM伴破裂出血的临床资料,结合文献总结护理经验。结果30岁女性,因突发头痛伴意识不清、抽搐8 h余入院。头颈部CTA及CT平扫示右侧枕叶AVM,大小约4.8 cm×3.7 cm×5.0 cm,双侧侧脑室、第三脑室及第四脑室铸型。为保障母婴安全,积极采用多学科联合会诊共同手术治疗。先在产科与麻醉科医生配合下实施剖宫产手术,娩出一男婴,阿氏评分7分;胎儿娩出后,将病人更换体位后实施神经外科手术,利用神经内镜切除颅内血管畸形团,同时清除颅内血肿。围手术期积极采用多学科护理模式控制血压,营养支持、心理干预、延续性护理等方面进行有效干预,住院37 d后康复出院,并与婴儿建立良好的母子关系。结论妊娠晚期合并颅内巨大动静脉畸形伴破裂出血病人,建议积极采用多学科联合会诊共同手术治疗。围手术期注意监测病人血压,加强营养支持和心理干预,并积极预防手术并发症。Objective To summarize the perioperative nursing experience of patients with giant ruptired brain arteriovenous malformations(AVM)in late pregnancy undergoing surgery assisted by multidisciplinary cooperation.Methods The clinical data of a 30+3 weeks pregnant woman with a giant ruptured brain AVM were retrospectively analyzed,and the nursing experience was summarized.Results A 30-year-old woman was admitted to our hospital due to sudden headache with unconsciousness and convulsion for more than 8 hours.The head and neck CTA and CT scanning showed a right occipital lobe AVM,with a size of about 4.8 cm×3.7 cm×5.0 cm,and casts in the bilateral lateral ventricle,the third ventricle and the fourth ventricle.In order to ensure the safety of the patient and her infant,multidisciplinary consultation was actively adopted for surgical treatment.Cesarean section was performed under the cooperation of obstetrics and anesthesiology doctors,and a boy was born with an Apgar score of 7 points.After the delivery of the fetus,the patient was changed into a different position and underwent neurosurgery,using neuroendoscopy to remove the brain AVM and intracranial hematoma.Multidisciplinary nursing mode was actively adopted during the perioperative period to control blood pressure,nutritional support,psychological intervention,and continuous nursing.After 37 days of hospitalization,the patient was discharged and established a good mother-child relationship.Conclusions It is suggested to actively adopt multidisciplinary consultation for surgical treatment of patients with giant ruptured brain AVM in late pregnancy.During the perioperative period,attention should be paid to monitoring the patient's blood pressure,strengthening nutritional support and psychological intervention,and actively preventing surgical complications.

关 键 词：颅内动静脉畸形 脑出血 妊娠晚期 多学科协作 手术治疗 围手术期 护理 

分 类 号：R743[医药卫生—神经病学与精神病学] R473.6[医药卫生—临床医学]