1例先天性巨型脐膨出合并肠系膜旋转不良新生儿行四期腹壁修补手术的围手术期护理

doi:10.3761/j.issn.0254-1769.2026.17.018

中华护理杂志 ›› 2026, Vol. 61 ›› Issue (17): 2433-2437.DOI: 10.3761/j.issn.0254-1769.2026.17.018

1例先天性巨型脐膨出合并肠系膜旋转不良新生儿行四期腹壁修补手术的围手术期护理

饶亚琴¹(), 王芳¹, 钟麒麟¹, 许燕昕¹, 林真元¹, 乌日尼勒图², 刘贤¹^,^*()

¹ 深圳市宝安区妇幼保健院手术室深圳市 518100
² 深圳市宝安区妇幼保健院儿外科一区深圳市 518100

收稿日期:2026-01-12 出版日期:2026-09-10 发布日期:2026-09-03
*通讯作者: 刘贤，E-mail：785552148@qq.com
作者简介:饶亚琴：女，本科，主管护师，E-mail：526121322@qq.com
第一联系人：作者贡献声明
饶亚琴：选题、资料收集、文献检索、论文撰写、论文审阅和修改；王芳、钟麒麟、林真元：资料收集、文献检索；许燕昕、乌日尼勒图：文献检索、论文审阅和修改；刘贤：选题、文献检索、论文撰写、论文审阅和修改

Perioperative nursing care of a neonate with congenital giant omphalocele complicated with intestinal malrotation undergoing four-stage abdominal wall repair surgery

RAO Yaqin¹(), WANG Fang¹, ZHONG Qilin¹, XU Yanxin¹, LIN Zhenyuan¹, WU Riniletu², LIU Xian¹^,^*()

¹ Operating Room， Shenzhen Baoan Women’s and Children’s Hospital， Shenzhen 518100， China
² Pediatric Surgery Department I， Shenzhen Baoan Women’s and Children’s Hospital， Shenzhen 518100， China

Received:2026-01-12 Online:2026-09-10 Published:2026-09-03
* Corresponding author: LIU Xian，E-mail：785552148@qq.com

摘要/Abstract

摘要：

总结1例先天性巨型脐膨出合并肠系膜旋转不良新生儿行四期腹壁修补手术的围手术期护理经验。基于“阶段性目标导向”理念，将围手术期护理分为4个阶段：第1阶段（术前及Ⅰ期术后）聚焦囊膜完整性保护、个性化体位管理、主动性体温保护及内环境精准化调控；第2阶段（Ⅱ-Ⅲ期围手术期）核心为感染防控与腹腔渐进性扩容，运用Bates-Jensen伤口评估工具进行悬吊袋感染的闭环管理，基于腹腔高压四联征实现早期预警并优化体位管理；第3阶段（Ⅲ期术后恢复期）重点为多器官功能支持与并发症预防，执行肝功能保护导向的个体化营养支持、多模式镇痛及集束化护理策略；第4阶段（Ⅳ期围手术期及出院准备）为促进切口愈合并赋能患儿家庭，实施精细化切口与腹胀护理，并进行系统性家庭照护培训与线上延续性随访。经过4期手术、总计82 d的住院治疗与精心护理，患儿腹壁缺损完全闭合，痊愈出院。出院时体重3.8 kg，身长52 cm，头围35 cm。术后10个月随访，体重9.0 kg，身长74 cm，生长发育正常。

关键词: 新生儿, 先天性脐膨出, 分期手术, 围手术期护理

Abstract:

This article summarizes the perioperative nursing experience of a neonate with congenital giant omphalocele complicated by mesenteric malrotation undergoing four-stage abdominal wall repair surgery. Based on the “stage-specific goal-oriented” concept，the perioperative nursing was divided into 4 phases. Phase 1（preoperative and post-stage Ⅰ） focused on maintaining the integrity of the membrane sac，individualized positioning management，proactive thermoregulation，and precise regulation of the internal environment. Phase 2（perioperative for stages Ⅱ-Ⅲ） centered on infection prevention and gradual abdominal expansion. The Bates-Jensen wound assessment tool was used for closed loop management of infections related to the suspension bag. An early warning system for intra abdominal hypertension was achieved using a four sign clinical trial，and positioning management was optimized accordingly. Phase 3（post-stage Ⅲ recovery） emphasized multi organ function support and complication prevention，including liver protection oriented individualized nutritional support，multimodal analgesia，and bundled nursing strategies. Phase 4（perioperative for stage Ⅳ and discharge preparation） focused on promoting wound healing and empowering the family. This involved meticulous incision and abdominal distension care，systematic family caregiver training，and online follow up care. After staged repair over 82 days of hospitalization with careful nursing care，the newborn with congenital omphalocele achieved complete abdominal closure and was discharged. At discharge，weight was 3.8 kg，length was 52 cm，and head circumference was 35 cm. At the 10 month follow up，body weight reached 9.0 kg and length 74 cm，with normal growth and development.

Key words: Newborn, Congenital Omphalocele, Staged Surgery, Perioperative Nursing Care

饶亚琴, 王芳, 钟麒麟, 许燕昕, 林真元, 乌日尼勒图, 刘贤. 1例先天性巨型脐膨出合并肠系膜旋转不良新生儿行四期腹壁修补手术的围手术期护理[J]. 中华护理杂志, 2026, 61(17): 2433-2437.

RAO Yaqin, WANG Fang, ZHONG Qilin, XU Yanxin, LIN Zhenyuan, WU Riniletu, LIU Xian. Perioperative nursing care of a neonate with congenital giant omphalocele complicated with intestinal malrotation undergoing four-stage abdominal wall repair surgery[J]. Chinese Journal of Nursing, 2026, 61(17): 2433-2437.

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1例先天性巨型脐膨出合并肠系膜旋转不良新生儿行四期腹壁修补手术的围手术期护理

Perioperative nursing care of a neonate with congenital giant omphalocele complicated with intestinal malrotation undergoing four-stage abdominal wall repair surgery

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