1例切口全层哆裂合并肠造口皮肤黏膜分离患儿的护理

doi:10.3761/j.issn.0254-1769.2021.05.019

摘要/Abstract

摘要：

总结1例切口全层哆裂合并重度肠造口皮肤黏膜分离营养不良脑瘫患儿的护理经验。护理要点包括：积极抗感染;切口、造口及造口周围皮肤管理,运用湿性愈合理念,科学裁剪、粘贴造口袋,及时清除伤口及造口渗液和粪水,促进创面及周围皮肤愈合;实施个性化营养方案,积极预防压力性损伤发生。经过62 d的治疗及精心护理,患儿创面恢复,效果满意。

关键词: 切口哆裂, 造瘘, 肠瘘, 儿科护理学

Abstract:

To summarize the nursing experience of a child with incision full-thickness fissure combined with enterostomy skin and mucosal separation. The main points of nursing include active anti-infection;well management of the skin around incision,orifice and the use of the concept of wet healing,the scientific cutting and sticking of the pocket,the timely removing of the wound and orifice exudate and fecal water,the promotion of the wound and surrounding skin healing;implementing individualized nutrition programs to actively prevent the occurrence of pressure sores. After 62 d of treatment and careful nursing,the recovery effect of the wound was satisfactory.

Key words: Incision Fissure, Fistulation, Intestinal Leakage, Pediatric Nursing

施倩倩,王新,侍玲,梁培荣,李萍. 1例切口全层哆裂合并肠造口皮肤黏膜分离患儿的护理[J]. 中华护理杂志, 2021, 56(5): 751-754.

SHI Qianqian,WANG Xin,SHI Ling,LIANG Peirong,LI Ping. Nursing care of a child with incision full-thickness fissure combined with enterostomy skin and mucosal separation[J]. Chinese Journal of Nursing, 2021, 56(5): 751-754.

图/表 2

参考文献 16

[1]	武丽丽. 湿性敷料换药及护理在术后切口裂开中的应用[J]. 护理实践与研究, 2015,12(12):52-53.
	Wu LL. Application of wet dressing changing and nursing in postoperative incision dehiscence[J]. Nurs Pract Res, 2015,12(12):52-53.
[2]	胡艳红, 胡盼, 臧家涛, 等. 腹部外科术后切口愈合不良风险因素与防治分析[J]. 局解手术学杂志, 2019,28(10):837-842.
	Hu YH, Hu P, Zang JT, et al. Analysis on risk factors and prevention of poor wound healing after abdominal surgery[J]. J Reg Anat Oper Surg, 2019,28(10):837-842.
[3]	罗娟, 马云丽. 肠瘘病儿肠内营养支持方案的实施与护理[J]. 肠外与肠内营养, 2020,27(2):109-111,116.
	Luo J, Ma YL. Implementation and nursing of enteral nutrition support for children with intestinal fistula[J]. Parenter Enter Nutr, 2020,27(2):109-111,116.
[4]	张颐, 蒋朱明. 营养筛查、评定与干预是成人营养诊疗的关键步骤:美国肠外肠内营养学会(ASPEN)2011年临床指南[J]. 中华临床营养杂志, 2012,20(5):261-268.
	Zhang Y, Jiang ZM. Nutrition screening,assessment and intervention are key steps in adult nutrition diagnosis and treatment:American Society of Parenteral and Enteral Nutrition(ASPEN)2011 Clinical Guidelines[J]. Chin J Clin Nutr, 2012,20(5):261-268.
[5]	甘红霞, 刘晓文, 郑静, 等. 1例回肠造口术后切口裂开合并重度皮肤黏膜分离患儿的护理[J]. 中华护理杂志, 2015,50(9):1137-1139.
	Gan HX, Liu XW, Zheng J, et al. Nursing care of one child suffering from incision dehiscence after ileostomy complicated with severe skin and mucous membrane separation[J]. Chin J Nurs, 2015,50(9):1137-1139.
[6]	罗娟, 马云丽, 赵允召, 等. 回肠造口术后切口裂开合并肠空气瘘患儿的护理[J]. 中华护理杂志, 2019,54(5):727-729.
	Luo J, Ma YL, Zhao YZ, et al. Nursing care of an infant complicated with disruption of wound and enteroatmospheric fistula after terminal ileum double-barrelled enterostomy[J]. Chin J Nurs, 2019,54(5):727-729.
[7]	樊丽丽. 一例回肠双腔造口术后切口裂开患者的护理[J]. 天津护理, 2019,27(2):235-236.
	Fan LL. Nursing care of a patient with incisional dehiscence after ileum double-cavity[J]. Tianjin J Nurs, 2019,27(2):235-236.
[8]	王伦英, 连方方, 毕妍娜, 等. 腹壁切口全层裂开伴肠瘘1例临床护理[J]. 齐鲁护理杂志, 2015,21(8):92-93.
	Wang LY, Lian FF, Bi YN, et al. Clinical nursing of abdominal wall incision full-layer rupture with intestinal fistula[J]. J Qilu Nurs, 2015,21(8):92-93.
[9]	卜丽文, 曾明秀. 肠癌患者术后造口旁切口裂开的处理[J]. 上海护理, 2018,18(11):61-63.
	Bu LW, Zeng MX. Treatment of postoperative parastoma incision dehiscence in patients with bowel cancer[J]. Shanghai Nurs, 2018,18(11):61-63.
[10]	谢敏仪, 黄樱, 陈莉桦, 等. 伤口三角评估在临时性肠造口患者皮肤黏膜分离中的应用及护理[J]. 中国实用护理杂志, 2016,32(28):2186-2189.
	Xie MY, Huang Y, Chen LH, et al. Application of wound triangular tools assessment and nursing care for the patients with mucocutaneous separation of temporary enterostomy[J]. Chin J Pract Nurs, 2016,32(28):2186-2189.
[11]	胡宏鸯, 魏惠燕, 叶志弘. 造口皮肤黏膜分离伴造口肠瘘患者的护理[J]. 中华护理杂志, 2013,48(4):361-362.
	Hu HY, Wei HY, Ye ZH. Nursing care of a patient with colostomy skin and mucosa membrane separation and intestinal fistula[J]. Chin J Nurs, 2013,48(4):361-362.
[12]	孟伟伟. 肠造口患儿造口周围皮肤损伤危险因素调查与预防[J]. 护理实践与研究, 2020,17(9):15-17.
	Meng WW. Investigation and prevention of risk factors of skin damage around ostomy in children with enterostomy[J]. Nurs Pract Res, 2020,17(9):15-17.
[13]	朱秀秀. 1例回肠造口患儿切口感染裂开的护理[J]. 当代护士(中旬刊), 2019(2):159-160.
	Zhu XX. Nursing care of incisional infection and dehiscence in children with ileostomy[J]. Today Nurse, 2019(2):159-160.
[14]	Lopes PAC, Amancio OMS, Araújo RFC, et al. Food pattern and nutritional status of children with cerebral palsy[J]. Rev Paul Pediatr, 2013,31(3):344-349. DOI URL
[15]	王景刚, 贠国俊, 刘青, 等. 脑瘫儿童的营养评估和干预[J]. 中国康复, 2020,35(4):204-207.
	Wang JG, Yun GJ, Liu Q, et al. Nutrition assessment and intervention in children with cerebral palsy[J]. Chin J Rehabi-litation, 2020,35(4):204-207.
[16]	裴菊红, 马英萍, 王兴蕾, 等. 脑瘫患儿慢性疼痛评估工具的研究进展[J]. 中国护理管理, 2020,20(2):308-312.
	Pei JH, Ma YP, Wang XL, et al. A review of chronic pain assessment tools for children with cerebral palsy[J]. Chin Nurs Manag, 2020,20(2):308-312.