5例小儿膀胱外翻修复I期手术的护理体会.docVIP

精品论文 参考文献 5例小儿膀胱外翻修复I期手术的护理体会 章洁1 万嫣敏1 顾莺2* （通信作者） (1复旦大学附属儿科医院泌尿外科 201102; 2复旦大学附属儿科医院护理部 201102） 【中图分类号】R473.72 【文献标识码】B【文章编号】1672-5085（2013）17-0237-02 【摘要】 目的 通过分析膀胱外翻患儿I期手术的围手术期护理情况，总结护理经验，为提高膀胱外翻的临床护理提供指导。方法　回顾分析2009年7月至2011年11月我院收治的5例膀胱外翻患儿，分析术前护理症状、手术方式及术后护理、护理并发症。结果　所有均分期手术并顺利完成I期手术，术前护理注意检查皮肤的完整性，保护外露的膀胱粘膜，减少湿疹的发生。术后注意导管及外固定支架的护理，其中有1例患儿出现外固定针孔感染1处，经换药后愈合。结论　小儿膀胱外翻围术期护理的重点包括术前皮肤护理，术后导管、外固定支架的护理, 以及预防压疮的护理等,使患儿平稳渡过围手术期，促进术后康复。作为少见疾病，膀胱外翻的护理尚需进一步总结经验，提高护理质量。 【关键词】膀胱外翻 围手术期护理 Nursing experience of 5 bladder exstrophy cases Zhang jie, Wan yanmin，Gu ying Childrenrsquo;s Hospital of Fudan University ,Shanghai，China，201102 【Abstracts】 Objective: To analyze the clinical data of bladder exstrophy ,and give a summary of perioperative nursing. Methods: A retrospective analysis performed on 5 patients received reconstructive operation of bladder exstrophy in our Hospital. Age, operation style, complications and nursing management were compared. Results: All 5 patients received first stage operation and recovered well. Preoperative nursing was focused on checking the integrity of skin, protecting the exposed bladder mucous, reducing the occurrence of eczema. Some complications occurred during postoperative care including one case with needle way infection infection. Conclusion: The key points of perioperative care of the child with bladder exstrophy includes preoperative skin care, postoperative catheter amp; external fixator care, as well as the prevention of bedsore. The aim is to promote recovery of the patients. AS one of the rare diseases, further attention should be paid on the study of bladder exstrophy, thus to improve the nursing quality. 【Key words】 bladder exstrophy perioperative nursing 膀胱外翻是少见而棘手的泌尿系统先天性畸形。膀胱外翻表现为耻骨联合分离，腹壁发育不良，膀胱粘膜暴露于腹壁外，常合并尿道上裂，呈完全性尿失禁。其发病率缺乏完整的统计，据报道约为0.2～1/万，男性多于女性[1,2]。膀胱外翻患儿多存在局部粘膜外露引起的刺激不适，而较大年龄儿童因长期的膀胱外露，膀胱上皮鳞状化生及增厚，以及长期尿失禁引起膀胱粘膜和局部皮肤的溃疡和刺激性疼痛。延迟修复的膀胱外露带来外观的异常还常引起较大年龄患儿的心理问题。膀胱外翻的临床修复过程复杂，目前规范的治疗为分期手术，进行功能性膀