小儿体外循环心脏手术个体化胃肠功能维护效果分析

目的:探讨个体化胃肠功能护理在小儿体外循环心脏手术中的应用效果。方法:随机将体外循环心脏手术患儿922例分成对照组(473例)与试验组(449例),对照组实施围术期的常规护理,试验组在对照组护理前提下给予个体化胃肠护理方案,即术前给予胃肠道访视;术中采取排酸引流措施;术后采取四步监测法对胃肠功能做出评估等。结果:试验组患儿术后胃肠功能障碍发生率明显低于对照组(P<0.05)。结论:实施个体化胃肠功能护理,有利于体外循环心脏手术患儿术后胃肠功能的快速恢复,降低术后并发症发生,确保手术成功,建议临床推广应用。     

个体化胃肠功能维护在体外循环手术患儿中的应用

目的:探讨个体化胃肠功能护理在体外循环心脏手术患儿中的应用效果。方法:将体外循环心脏手术患儿942例随机分为观察组483例与对照组459例,对照组给予围术期的常规护理;观察组在对照组护理基础上采取个体化胃肠护理方案,术前早期实施胃肠道访视,术中采取排酸引流措施,术后采取"四步监测法"对胃肠功能进行评估等。结果:观察组患儿术后胃肠功能障碍发生率低于对照组(P<0.05)。结论:采取个体化胃肠功能护理能够加快体外循环心脏手术患儿术后胃肠功能的恢复进程,降低并发症发生率,提高手术成功率,提倡临床推广应用。     

中医护理干预促进婴幼儿体外循环术后胃肠功能恢复的探讨

[目的]探讨中医护理干预促进婴幼儿体外循环术后胃肠功能恢复的效果。[方法]将拟行体外循环的先天性心脏病手术患儿120例随机分为两组。对照组60例按常规围术期护理,干预组60例在此基础上实施中医护理方案,术前早期开展胃肠道访视,手术前后进行中医调理,运用中西医结合的评估法评估患儿术后胃肠功能情况,加以推拿、贴敷疗法。[结果]干预组患儿术后胃肠功能障碍发生率低于对照组(P<0.05)。[结论]中医护理干预可促进体外循环术后患儿胃肠功能的恢复,减少并发症发生。     

体外循环心脏手术后胃肠道功能紊乱的个体化护 理

目的 分析体外循环心脏手术后胃肠道功能紊乱的发病率,总结体外循环心脏手术术后患者胃肠道功能紊乱的护理治疗经验.方法 按护理方法的不同将500例体外循环心脏手术患者分为2组：普通胃肠护理组（普通组,250例）进行普通胃肠护理;个体化胃肠护理组（个体化组,250例）,进行术前胃肠道清理、术后早期进食、术后早期留置胃管、术后口腔护理等个体化胃肠护理.比较2组术后胃肠道功能紊乱的发病情况.结果 个体化组术后胃肠道功能紊乱发生率显著低于普通组（P＜0.05）,成人较儿童胃肠道功能紊乱症状有所减少（P＜0.05）.结论 个体化胃肠护理可促进体外循环心脏手术患者术后胃肠功能恢复,减少其术后并发症的发生,最终提高手术治疗效果.     

按摩联合非营养性吸吮治疗新生儿胃肠功能障碍25例

目的观察按摩联合非营养性吸吮治疗新生儿胃肠功能障碍的临床疗效。方法将50例胃肠功能障碍患儿按不同的治疗方法分为2组：观察组和对照组,每组25例。2组患儿均采用常规治疗。在此基础上,观察组给予按摩联合非营养性吸吮治疗。观察2组患儿治疗后胃残留量和腹胀消失时间、体质量增长至正常时间、喂养耐受时间、停用静脉营养时间及临床疗效等情况。结果观察组总有效率明显高于对照组（P〈0.05）。观察组患儿治疗后胃残留量及腹胀消失时间、体质量增长至正常时间、喂养耐受时间、停用静脉营养时间与对照组比较差异均有统计学意义（P〈0.05或P〈0.01）。结论采用按摩联合非营养性吸吮治疗胃肠功能障碍患儿有较好的疗效,并能促进其胃肠功能障碍的恢复。     

新生儿胃肠功能障碍临床分析

目的对患有胃肠功能障碍的新生儿症状表现和治疗的临床效果进行研究分析。方法抽取76例患有胃肠功能障碍的新生儿病例,将其分为A、B两组,每组38例。分别采用红霉素和红霉素与金双歧联合的方法进行治疗。结果 B组患儿的临床治疗效果明显优于A组患儿,相关症状消失时间明显短于A组,B组治疗后出现复发例数明显少于A组。两组患儿在治疗过程中均未出现严重的并发症和不良反应。结论采用红霉素与金双歧联合的方法对患有胃肠功能障碍的新生儿进行治疗的临床效果非常理想。     

鼻塞气道正压通气治疗小儿心脏术后急性呼吸衰竭的护理

[目的]总结鼻塞气道正压通气治疗小儿心脏术后急性呼吸衰竭的护理措施。[方法]回顾性分析56例心脏术后并发急性呼吸衰竭患儿行鼻塞气道正压通气治疗的临床资料。[结果]本组病人治愈51例,5例因病情加重,改用气管插管机械通气,均成功治愈出院。[结论]加强心脏术后并发急性呼吸衰竭患儿行鼻塞气道正压通气治疗的护理是治疗成功的保证。     

新生儿胃肠功能障碍68例临床分析

新生儿胃肠功能障碍是高危儿常见的并发症 ,一旦出现提示病情较重。如何促进胃肠功能恢复是提高危重患儿抢救成功率的关键。我科 (作者原工作在台州市立医院儿科 ) 1996年6月～ 2 0 0 3年 6月收治新生儿胃肠功能障碍 68例 ,现将临床资料分析如下。1　资料与方法1 1　一般资料 :男 46例 ,女 2 2例 ;足月儿 5 3例 ,早产儿、低出生体重儿 15例 (孕周 3 2～ 3 6周 )。原发病为新生儿窒息2 8例 ,缺氧缺血性脑病 12例 ,颅内出血 3例 ,新生儿呼吸窘迫综合征 (NRDS) 2例 ,早产儿、低出生体重儿 15例 ,肺炎 2例 ,败血症 2例 ,感染性休克 1例 ,硬肿…     

行气通腑贴对急腹症术后患儿肠功能恢复的影响

目的探讨行气通腑贴对急腹症术后患儿肠功能恢复的影响。方法采用抽签法将146例急腹症患儿分为治疗组71例和对照组75例,对照组术后给予常规治疗和护理,治疗组在对照组基础上给予行气通腑贴穴位贴敷,观察两组患儿术后肠鸣音恢复、首次排气和排便时间及胃肠功能恢复情况。结果治疗组患儿术后肠鸣音恢复时间、首次排气时间及排便时间均短于对照组;胃肠功能评分低于对照组,两组比较,差异均有统计学意义(P﹤0.05)。结论行气通腑贴穴位贴敷可有效促进急腹症术后患儿胃肠功能的恢复。贴敷操作简单,值得临床推广应用。     

新生儿窒息后胃肠功能障碍的临床分析

目的 了解新生儿窒息并发胃肠功能障碍的临床特点,提高该病诊断与治疗水平.方法 对168例新生儿窒息引起胃肠功能障碍的43例患儿进行回顾性分析.结果 新生儿窒息引起胃肠功能障碍的发生率为26.0%,仅次于脑、肾损害的发生率(68.5%、41.1%).其中轻度胃肠功能障碍占72.1%,重度胃肠功能障碍占27.9%.早期临床表现以食欲差、拒奶、频繁呕吐、轻度腹胀及肠鸣音减弱等为主,晚期临床表现为肠鸣音消失、高度腹胀.胃肠功能障碍治疗有效率为83.7%.结论 对窒息新生儿应警惕胃肠功能障碍,应早诊断、早治疗,预防多器官功能衰竭综合征发生,降低病死率.     

新生儿消化道出血临床相关因素分析(附102例报告)

目的:探讨新生儿消化道出血的临床相关原因及预防。方法:对102 例新生儿消化道出血临床资料进行回顾性分析。结果:早产儿消化道出血发生率明显高于足月儿(P<0.05),低出生体重儿明显高于正常出生体重儿(P<0.05),有围生期窒息史者明显高于无窒息史者(P<0.05)。大部分新生儿消化道出血在生后3 d内发病,它的主要病因为新生儿缺氧缺血性脑病、肺透明膜病及重症肺炎。结论:应激性溃疡是新生儿消化道出血的最常见原因。做好围产期保健、降低早产儿的出生率、减少围产期窒息、积极治疗原发病可明显减少新生儿消化道出血的发生率。     

重度新生儿窒息24 h内常规洗胃后微量喂养对胃肠功能的影响

目的探讨重度新生儿窒息后24 h内常规洗胃对胃肠功能的影响.方法通过分析对比1995-1999年我院165例重度新生儿窒息后非常规洗胃组在出生24 h内未给予常规插胃管洗胃而经口人乳喂养并辅助常规静脉营养,与2000-2005年常规洗胃组在出生24 h内给予常规插胃管洗胃后常规静脉营养并禁食24 h后经胃管早期微量喂养的疗效,对减少胃肠功能紊乱事件发生的影响.结果减少喂养不耐受的发生率.对比24 h内及24 h后对减少胃肠功能紊乱发生率差异均有显著性.结论常规洗胃组在出生24 h内给予常规插胃管洗胃后常规静脉营养并禁食24 h后经胃管早期微量喂养疗效显著,有助于加速胃肠功能的康复和成熟,帮助缩短患儿的治疗时间.     

重度新生儿窒息24h内常规洗胃后微量喂养对胃肠功能的影响

目的 探讨重度新生儿窒息后24h内常规洗胃对胃肠功能的影响。方法 通过分析对比1995～1999年我院165例重度新生儿窒息后非常规洗胃组在出生24h内未给予常规插胃管洗胃而经口人乳喂养并辅助常规静脉营养，与2000～2005年常规洗胃组在出生24h内给予常规插胃管洗胃后常规静脉营养并禁食24h后经胃管早期微量喂养的疗效，对减少胃肠功能紊乱事件发生的影响。结果 减少喂养不耐受的发生率。对比24h内及24h后对减少胃肠功能紊乱发生率差异均有显著性。结论 常规洗胃组在出生24h内给予常规插胃管洗胃后常规静脉营养并禁食24h后经胃管早期微量喂养疗效显著，有助于加速胃肠功能的康复和成熟，帮助缩短患儿的治疗时间。     

Stress-induced gastric findings in critically ill newborn infants: frequency and risk factors

Objective: To evaluate whether infants treated in neonatal intensive care units have stress-induced bleeding from gastrointestinal tract or gastric lesions and to define risk factors for these findings. Design: Part one: retrospective; part two: prospective. Setting: Tampere University Hospital, neonatal intensive care unit. Patients and interventions: In part one, 100 consecutive newborn infants treated in intensive care were retrospectively evaluated for gastrointestinal tract bleeding and risk factors, and in part two 89 gastroscopied and mechanically ventilated infants were prospectively evaluated for further risk factors for gastric mucosal lesions. The statistical evaluation of risk factors was made by multivariate analysis using logistic regression modeling. Main results: Of infants treated in the neonatal intensive care unit 20 % had signs of gastrointestinal bleeding. Mechanical ventilation was the only risk factor (OR = 4.06, 95 % confidence interval 1.21–12.3). In part two, when mechanically ventilated infants were prospectively evaluated, 53 % had remarkable gastric mucosal lesions. The analysis showed three other risk factors: abnormal and delayed delivery and hypotension after birth. Conclusions: Newborn infants treated in the intensive care unit had a high frequency of stress-induced gastric hemorrhage with gastric lesions similar to adults and children treated in intensive care. Mechanical ventilation is the main risk factor. Also mode of delivery and hypotension after birth increase the risk of stress-induced gastric lesions. These infants should be the target for prophylactic gastroprotective treatment. Received: 21 October 1999/Final revision received: 22 April 2000/Accepted: 2 May 2000     

非合并症早产儿喂养困难的护理研究

目的 寻求有效训练非合并症早产儿吸吮能力,促进胃肠蠕动和胃肠消化液分泌的护理方法.方法 随机选取80例不同胎龄、体质量出生2 d内喂养困难的非合并症早产儿,依据早产儿生理特点,采用一套有效规范、实用、连贯性定人的改良喂养方法.结果 与喂养方法改良前相比,改良后,早产儿喂养困难发生率显著降低,吸吮能力和胃肠功能显著改善.结论 改良法可促进非合并症早产儿早日恢复正常吸吮及胃肠功能,有显著的临床实用意义.     

非合并症早产儿喂养困难的护理研究

目的寻求有效训练非合并症早产儿吸吮能力，促进胃肠蠕动和胃肠消化液分泌的护理方法。方法随机选取80例不同胎龄、体质量出生2d内喂养困难的非合并症早产儿，依据早产儿生理特点，采用一套有效规范、实用、连贯性定人的改良喂养方法。结果与喂养方法改良前相比，改良后，早产儿喂养困难发生率显著降低，吸吮能力和胃肠功能显著改善。结论改良法可促进非合并症早产儿早日恢复正常吸吮及胃肠功能，有显著的临床实用意义。     

窒息新生儿多器官血流动力学和心脏功能的研究

目的 研究新生儿多脏器损伤的机理,提供早期诊断方法。方法 应用Ｕｌｔｒａｍａｒｋ－９（ＨＤＩ）采用超声诊断仪等研究同一窒息儿脑、肾、胃肠血流动力学和心脏功能的变化。结果：（１）新生儿窒息后各脏器血流灌流量均减少,但程度不一致,以肠道最先受累且程度重恢复最慢;（２）心功能障碍是窒息的常见并发症,其特点是舒张功能首先受累,收缩功能障碍则右室重于左室;（３）低氧血症是新生儿窒息的病理生理基础,且与各脏器     

Effects of zero-balanced ultrafiltration on procalcitonin and respiratory function after cardiopulmonary bypass

The abnormal conditions to which blood is subjected during cardiopulmonary bypass (CPB) trigger an activation of the inflammatory response and cause pulmonary dysfunction. It has been suggested that high-volume, zero-balanced ultrafiltration (ZBUF) facilitates clearance of inflammatory mediators and improves post-operative pulmonary function. Procalcitonin, a newly discovered inflammatory mediator, has been found to be increased after CPB and has been proven to be an appropriate parameter for predicting pulmonary dysfunction secondary to CPB. The aim of this study was to investigate the effects of zero-balanced ultrafiltration (ZBUF) on procalcitonin (PCT) and respiratory function of infants with Tetralogy of Fallot (TOF) after CPB. Twenty infants with TOF undergoing open-heart total surgical correction were randomly assigned to two groups. The trial group was given ZBUF (50 ml/kg) and conventional ultrafiltration (CUF), while the control group was given CUF only. Plasma PCT and pulmonary function were monitored and compared between the two groups before the operation (T1), before rewarming (T2), at the end of the operation (T3), and at 12 h, 24 h and 48 h after the operation (T4-T6). PCT was decreased in the trial group between 12 h and 48 h post-operatively, but the differences did not reach statistical significance. The trial group's pulmonary compliance was higher at 12 h post-operatively (p < 0.05). Oxygenation index was increased in the trial group at the end of the operation and 12 h post-operatively (p > 0.05). Intubation time was shorter in the trial group (P < 0.01). A positive correlation was found between peak PCT concentration and intubation time. ZBUF appeared to improve ventilation and shorten intubation time. The improved respiratory function may be due to the lower plasma PCT.     

Perfusion technique for nonhaemic cardiopulmonary bypass prime in neonates and infants under 6 kg body weight

BACKGROUND: Cardiopulmonary bypass (CPB) in neonates and infants is associated with significant haemodilution when priming of the CPB circuit is accomplished without transfusion of homologous blood components. The degree of haemodilution and, thus, the requirements for blood transfusion may be reduced when the CPB circuit is miniaturized without compromising patient safety. METHOD: Between January 2002 and October 2003, selected neonates and small infants were operated on using a nonhaemic prime extracorporeal circuit. CPB priming volume could be reduced from 300 mL to 190 mL by using a dedicated neonatal CPB console with mast-mounted roller pump heads. Reduction of priming volume resulted from shortening of all CPB lines to the minimum, downsizing of all CPB lines, exclusion of unused CPB components, use of vacuum-assisted venous drainage and from close co-operation between the perfusionist, cardiac surgeon and anaesthesiologist. The reduction in priming volume was achieved without eliminating the arterial line filter as safety device. RESULTS: A total of nine patients weighing between 3.2 and 5.9 kg (mean 4.7 kg) and with a body surface area of 0.22-0.35 m2 (mean 0.29 m2) were operated on with the use of the modified neonatal CPB circuit and a nonhaemic prime. Bypass time varied from 38 to 167 min (mean 96 min). The mean haematocrit on CPB was 22.5% with a range of 17-29%. The postoperative course of all patients was uneventful. CONCLUSION: A significant reduction in CPB priming volume makes nonhaemic prime CPB in neonates and small infants undergoing complex repair of congenital heart defects possible.     

新生儿游泳＋抚触疗法对新生儿胆红素的影响

目的：探讨新生儿游泳＋抚触疗法对新生儿胆红素的影响。方法：对200例生理产出生的足月正常新生儿随机分为两组，对照组100例给予单纯沐浴护理，研究组100例给予游泳＋抚触疗法。观察两组新生儿胆红素的动态变化及24h后母乳喂养次数、新生儿体重、睡眠时问。结果：研究组新生儿胆红素指数明显低于对照组，研究组有2例出现高胆红素血症，对照组13例出现高胆红素血症；研究组新生儿母乳喂养次数、新生儿体重、睡眠时问明显优于对照组。结论：新生儿游泳＋抚触疗法可减少“肠一肝”循环，降低高胆红素血症的发生率，促进新生儿生长发育。